Environment and Synthetic Narcotic Drugs

Title: Drug Prevalence in Homeless Adults

Final Project

Submitted to: Dr. Sadia Saif

Submitted by: Aqsa Waseem & Menal Sarfraz

Major: BBA

Section: A

Submission Date: 2nd July 2020

Kinnaird College for Women, Lahore

2017-2021
 Table of Contents
Executive Summary.........................................................................................................................3
Drug Addiction and Drug Prevalence..............................................................................................4
What is Homelessness?................................................................................................................4
Causes of Homelessness..............................................................................................................5
Connection between Homelessness and Addiction.........................................................................7
Does Substance Abuse Cause Homelessness?.............................................................................8
What Forms of Mental Illness Affect the Homeless?......................................................................9
Women, Homelessness and Addiction..........................................................................................10
Young Adults, Homelessness and Addiction................................................................................11
Men, Homelessness and Addiction................................................................................................11
Factors associated with substance use among homeless young adults..........................................12
According to the National Institute of health................................................................................14
Statistics Drug Prevalence in Pakistan.......................................................................................16
Solutions of Drug Prevalence among Homeless Adults................................................................18
Barriers to Treatment.....................................................................................................................20
 Executive Summary
This report is an extensive study of Drug Prevalence among Homeless Adults Worldwide and in
Pakistan. The initial section of the report emphasis on the drug addiction along with the
prevalence among homeless adults. It explains the causes of homelessness and its connection
with addiction. Following section of the report highlights the problem of mental illness and how
it affects homeless people. Along with it, a connection of homelessness and addiction is
explained in relation to women, men and young adults. The third section includes the factors
associated with substance use among homeless young adults. Different articles are reviewed that
provide extensive details related to substance abuse among homeless adults. The last section
highlights the solutions that can be implemented to support homeless adults.
 Drug Addiction and Drug Prevalence

Drug addiction is a state of periodic or constant intoxication produced by the repeated

consumption of a drug. Its characteristics include uncontrollable desire to continue taking the
drugs, a tendency to increase the dose after interval of time, a psychological and physical
dependence on drugs, effects of drugs on individual and society. Some researchers reported that
the prevalence of drug or substance abuse increase when the society will unaware from the risk
factors such as lack of education, unemployment, peer pressure, role of company and exposure
about use of drugs as the child grow up in the family. Sometime children experience or exposure,
when child will observe to the drugs through sensory observation and child feels course. This
curiosity lead to check its taste and significance, or some of child save the potential
unconsciously in their mind and it will motivate the adolescences to take or exposure drugs when
they pass through stressors. Due to which it is observed that the frequency of use of soft drugs in
adolescences will be high as high in the society because children learn or experience through
family or society.

What is Homelessness?

Homelessness is the situation of an individual, family, or community without stable, safe,

permanent, appropriate housing, or the immediate prospect means and ability of acquiring it. For
example, Sally has lost her job for the third time in as many years. She can no longer afford the
apartment she lives in with her young son, Johnny. She has been widowed for five years, and her
only income was from her job. Slowly, Sally packs up her and Johnny's clothes. She has sold
nearly every item of value to keep them in their apartment as long as she could. Tonight, Sally
and Johnny will be staying at the Good Samaritan Shelter. As of 3pm, Sally and Johnny will be
considered homeless.

Substance abuse is often a cause of homelessness. Substance use is higher among homeless
youth than among the general population. Although substance use has been well studied, little is
known about the risk factors associated with specific substances used by homeless youth. Nearly
one quarter adults in Pakistan are identified as lesbian, gay, or bisexual. Over a third of youth
uses alcohol (38%) or marijuana (36%), and 36% uses synthetic marijuana. Analyses show that
substance use is significantly associated with race/ethnicity, age, gender identity, sexual
orientation, shelter status, stress, and trauma scores. Substance use prevention interventions for
homeless youth should be trauma informed and include housing navigation and stress
management strategies. The most at-risk subgroups include street-dwelling and lesbian, gay,
bisexual, or questioning youth.

Causes of Homelessness

There are several situations that can lead to an individual or a family becoming homeless. Let's
take a look at some of the most common causes.

A frequent cause of homelessness is when a family or individual experiences loss of income.

When there is a decrease in income in the home, the individual or family may not be able to
afford their housing costs any longer. The loss of income in the home can also lead to living in
poverty. While the definition of poverty varies from country to country, in Pakistan, an
individual is considered to be living in poverty if he or she has an income below the poverty
threshold, which is often between Rs. 1.5 lac and Rs. 2.5 lac for a single individual. Remember,
that's only the number for a single person supporting themselves. Families and couples have
higher poverty thresholds, which reflect the need to support more people on that income. Poverty
and homelessness have a direct link. People who live in poverty are unable to pay for the
everyday items they need to survive, such as food, housing, childcare, education, or health care.

However, homelessness may be a concern even for families that do not fall below the poverty
line, if they can't find affordable housing. Affordable housing is limited in cities across Pakistan,
especially in major urban areas where rent is higher and property is less available for sale.

Homelessness also has a direct connection to violence in the home. Men, women, children, and
the elderly can be subjected to different types of abuse. This can include sexual, psychological,
or physical abuse. In the case of children or the elderly, it can also include neglect. When a
person is the victim of any type of violence, they are often faced with the choice of staying in an
abusive environment or leaving the home. When the victim leaves the home, they often have
nowhere to go and become homeless.
Other causes include:

 Lack of Trustworthy Relationships – This is one of the most common causes of

homelessness we see. We all want to be close to family, have someone to call a friend or
a mentor, someone that we can go to when times get tough, or when we simply need a
little guidance to put us back on the right path. But a lack of that relationship in our lives
causes a big hole. Forming healthy, trustworthy relationships could make the difference
between having somewhere to temporarily stay with while getting back on your feet and
finding yourself left facing homelessness.
 Illness and Disability – Illnesses and disabilities do not occur by choice, and the
repercussions of enduring such traumatic circumstances too often cause homelessness.
Chronic illness and disability prevent someone from holding a job, and without a job, you
have no means of steady income. Without a steady income, how are you able to afford
somewhere to call home? How are you able to afford something to eat? Then there’s
those medical bills you have accrued. You never know when you are going to fall ill or
get into a life-changing accident, and the consequences of something you never asked for
are enough to drastically change your life.
 Abuse – More than 90% of women experiencing homelessness attest to some form of
physical or sexual abuse during their lifetime. The rate of domestic abuse survivors, both
men and women, left experiencing homelessness happens far too often. This leaves the
survivors with nowhere to turn when they escape their abusers, forcing them to call the
streets their home.
 Working, but in Poverty – Some people experiencing homelessness may have a job, but
it might be low paying, leaving them unable to afford things they need like housing and
food. Evictions and foreclosures can happen in an instant, and even with steady job,
many are left without a home and nowhere to go. This is more common than you may
think.
 Unemployment – With layoffs and workplace discrimination still actively existing in
today’s society, not everyone is lucky enough to find a secure place in the workforce. The
contingent nature of any job is enough to speak for itself. Putting yourself in the shoes of
others can be difficult, but the truth is that anyone can be faced with unforeseen
 workplace misfortunes. This sudden loss of income can force someone to stop paying
their rent, which can then turn into eviction and homelessness.
 Lack of Affordable Housing – There’s a clear connection between the lack of affordable
places to live, and the number of people living on the streets. More specifically, in cities
and metropolitan areas. While Atlanta is a beautiful place to live, it’s a growing city, and
with growth comes an increase in housing prices. The average one bedroom apartment in
the city is about $1,000 per month. Now imagine trying to find a place to live when
minimum wage is only $7.25 an hour. No one should be left without a home.
 Personal Hardship – Many times homelessness is the result of tragedy or personal
hardship – again, circumstances that are out of your control. Living through a big life-
changing event, whether it be natural disaster, toxic relationship, or divorce, requires
additional support and guidance. Their financial status could change without having a
partner to help split expenses, or their insurance may not cover the damage caused by a
hurricane. The circumstances these people face could easily be yours, your families, or
close friends in the blink of an eye.

Connection between Homelessness and Addiction

The median age of single adults experiencing homelessness is rising. Among homeless adults not
living in families, approximately 50% are aged 50 and above. This trend is projected to continue:
adults born in the second half of the “baby boom” (1954–1965) have an elevated risk of
homelessness throughout their lives. In the homeless population, adults 50 and older have
prevalence’s of geriatric conditions higher than those of housed adults 15–20 years older. As a
result, experts consider homeless adults to be “older adults” at age 50.

Homeless adults have a higher prevalence of substance use than housed individuals. In 1996, a
nationally representative study of homeless adults, the National Study of Homeless Assistance
Providers and Clients, found a higher prevalence of substance use disorders than those in the
general population. In the general population, the National Survey of Drug Use and Health has
shown that the prevalence of illicit substance use in adults 50 and older has doubled since 2002.
With the aging of the homeless population and the changes in substance use in older adults, little
is known about the prevalence of substance use disorders in older homeless adults.

Older adults who are homeless and use substances face additional health risks compared with
younger adults. Substance-using older adults are more susceptible to interactions between illicit
drugs and alcohol and their medications for chronic health conditions. They are at elevated risk
of harm from substance use, due to higher risk of substance-induced delirium, cardiovascular
events, and worsening of chronic pulmonary diseases.

Does Substance Abuse Cause Homelessness?

Negative cultural stereotypes portray the homeless as “losers,” “drunks,” or “bums” who can’t
hold down a job or maintain a stable home because of their lack of willpower or self-control. In
fact, there are many people who keep their jobs and avoid eviction or foreclosure in spite of
serious drug or alcohol problems. By the same token, there are many homeless individuals who
do not have a problem with drugs or alcohol.

However, statistics show that in general, substance abuse is more common among homeless
Pakistanis than in the general population, and many homeless people with substance use
disorders also have one or more co-occurring mental health disorders. A study published
indicates that drug overdose is becoming the most common cause of death among homeless
people, surpassing HIV/AIDS. Over 80 percent of the overdose deaths in the study involved
opioids, such as heroin and prescription painkillers. In fact, these incidents have become so
common in urban areas that the authors go so far as to propose that opioid overdose is becoming
an “epidemic” among homeless individuals.

Substance abuse can play a significant role in homelessness by causing occupational impairment,
or the inability to perform well at a job. Job loss and chronic unemployment make it difficult to
pay for housing, which can lead to eviction or foreclosure and eventually to homelessness. On
the other hand, the despair, fear, and deprivation caused by homelessness can encourage
substance abuse, leading the individual to use drugs or alcohol as a way to cope with the stress of
living on the streets or moving from one shelter to another. The National Coalition for the
Homeless emphasizes that substance abuse can be both the cause and the result of homelessness,
and that many people begin abusing alcohol or drugs after losing their homes. Unless substance
abuse is treated, homeless persons are unlikely to regain the security or financial stability that
can lead them out of poverty.

“Substance abuse can play a significant role in homelessness by causing occupational

impairment, or the inability to perform well at a job. Job loss and chronic unemployment
make it difficult to pay for housing, which can lead to eviction or foreclosure and
eventually to homelessness.”

When considering the problem of homelessness and substance abuse, it is important to remember
that addiction is a chronic disease of the brain, not a sign of personal failure or a weak character.
Overcoming substance abuse requires a great deal of support, as well as intensive treatment and
follow-up care. Many homeless people lack a strong family support system, have no health
insurance coverage to pay for treatment, and do not have reliable transportation. All of these
problems must be addressed in order to ensure adequate treatment for people living in poverty or
homelessness.

Homelessness and Drug Addiction

The symptoms of severe mental illness, such as paranoia, lack of focus, low levels of energy,
delusional thinking, and hallucinations, can make it difficult or impossible to perform the
activities that most of us take for granted, such as working, developing relationships, or
maintaining a home. Substance abuse among the homeless can worsen the symptoms of mental
illness, driving the individual even deeper into a cycle of poverty, homelessness, and despair.
Substance abuse and mental illness often co-exist, a condition known as a dual diagnosis or co-
occurring disorders.

The Substance Abuse and Mental Health Services Administration estimates that at least 50
percent of homeless individuals have co-occurring substance abuse and mental health disorders.
A dual diagnosis can make treatment more complicated, because the symptoms of drug addiction
or alcoholism can mask the symptoms of mental illness or make those symptoms much worse.
Clinicians working with the homeless must screen for both mental illness and substance abuse in
their clients, and services for both conditions should be offered at the same time within the same
treatment program in order to encourage retention and prevent a relapse.

Women, Homelessness and Addiction

Homeless women (mostly adults) suffer unique gender-based trauma, contributing to the higher
amounts of drug use with homeless women than men. While 30% of homeless people overall
suffer mental illness, the rate is significantly higher in female populations. 50% to 60% of
homeless women suffer mental and emotional disturbances, often pre-dating their homelessness.

Many homeless women become homeless in response to escaping pasts laden with domestic
violence or sexual trauma; some are victims who fled the hard grip of sex trafficking. These
factors, along with co-occurring disorders from homelessness, have contributed to the fact that
approximately one-third of homeless women have abused heroin and crack cocaine.

Young Adults, Homelessness and Addiction

Many homeless youths and young adults are victims of substance abuse. Youths aged 12 to 17
are at greater risk of homelessness than adults, and many homeless youths have been the victims
of severe abuse. 71% of missing, runaway, throwaway, or abducted children reported a substance
abuse disorder. Factors contributing to such youth homelessness substance abuse:

 Growing up in a homeless family

 Genetics of substance abuse
 Family abuse
 Maladaptive coping mechanics to stress
 Co-occurring disorders
 Early use of substance abuse (using at a very young age)
 Physical, sexual, and emotional abuse
 Running away from home
Homeless youths with substance abuse issues are much more vulnerable to long-term substance
abuse and untreated co-occurring disorders which follow them into adulthood.

Men, Homelessness and Addiction

Homeless men may be at particular risk for the negative health effects of substance use.
Homeless men are at significantly higher risk for substance dependence, with rates of drug and
alcohol abuse two to eight times higher than in the general population. Drug and alcohol use is
associated with multiple deleterious health consequences, and vulnerability factors associated
with living on the street may create riskier patterns of substance use and exacerbate the homeless
men’s already high rates of health problems and hospitalization. Men are more likely than
women to be homeless, to experience longer episodes of homelessness and when homeless, more
likely to be drug and alcohol dependent.

Factors associated with substance use among homeless young adults

Drug use for homeless young people is higher in comparison to their housed counterparts.
Previous research has estimated that 39% to 70% of homeless youth abuse drugs or alcohol.
Substance use in this population has been reported as two to three times higher than that found
among non-homeless young adults. In nationally representative samples, marijuana has been
identified as the drug of choice for homeless youth. Rates of cocaine use are four to five times
higher and amphetamine use is three to four times higher among homeless youth compared to
their housed counterparts.

Homeless young people report using drugs and alcohol as a coping strategy and often have more
favorable attitudes toward drug use than their non-homeless peers. Drug use is a common
approach to numbing the daily experiences of life on the street and alleviating the stress of street
life and the negative emotional effects of traumatic experiences. The stress resulting from
sleeping outdoors and in public places may be alleviated or eased by using drugs and alcohol to
keep warm and suppress hunger. Some drugs are used to help these young people stay awake for
extended periods, especially at night when the chances of victimization increase. Drugs also
provide a means of escape from the physical and emotional pain associated with surviving on the
street

Homeless young adults are remarkably resilient as they are able to identify survival processes
that help them manage a variety of stressors, including the lack of housing and food, loss of
family or friends, victimization, physical discomfort and disease. Although the stress of
homelessness can increase the risk of substance abuse and dependence, some homeless young
people overcome this vulnerability. Therefore, identifying factors that influence the severity of
substance use among homeless young adults may assist service providers in tailoring treatment
and services that maximize the strengths and resources of these young people. There are three
factors that may influence their level of substance use: social support, economic resources, and
future expectations.

Social/Peer Networks

Due to the disruption of family relationships and separation from social institutions (such as
schools), homeless peers often become the primary social support network for homeless young
adults. Homeless young adults draw upon peer relationships to fulfill multiple needs including
love, companionship and safety .These peer relationships often provide an educational function
to newly homeless youth regarding street survival. The relationships between homeless young
adults may provide a supportive function by protecting the individual, especially newly-homeless
young adults, from the adversity of the street lifestyle. Researchers have suggested separating
homeless young adults from peers engaged in street culture because substance use patterns are
highly influenced by this peer group. Bender and colleagues (2007) describe peer groups from a
strengths perspective where relationships with peers who choose not to abuse substances are
encouraged. It is clear that social networks are important for homeless young adults, but peer
groups may negatively influence increased substance use among these young people.

Economic Resources

Limited research has focused on the relationship between economic resources and the level of
substance use behavior of homeless populations. However, Valois and colleagues (1999) found
evidence that employment increased the risk of substance use for high school youth who worked
more than 15 hours a week. For homeless young adults, it remains unclear how financial
resources influence substance use. Studies have shown that homeless youth face barriers to
employment, such as lack of education and skills, instable housing, stigma in the workplace,
mental health problems, substance use problems and incarceration. Although the majority of
these young people voice their interest in finding paid employment, they often must turn to the
street economy. Panhandling is the most common source of income for homeless adolescents;
however, they also earn income through prostitution, drug distribution, and stealing, trading sex
for money and from parents/other family members or friends. The need for economic resources
is clear, but the level of access to these resources may influence the severity of substance use
among homeless young adults.

Future Expectations

Expectations concerning the future have been described as the extent to which the future is
perceived as predictable, structured, and controllable. An individual's perspective on the future
reflects both long-term and immediate experiences, thoughts and feelings. It includes the
tendencies to link present experiences with future events, determine how manageable the future
seems and understand how far into the future one can envision their lives. Previous research has
shown that individual's expectations for the future predict substance use behavior, such that those
with more positive expectations are less likely to abuse or be dependent on substances as
compared to those with less positive expectations of the future. Positive health practices,
including reduced substance use, have been shown associated with adolescents' beliefs and
expectations of a positive and bright future. Evidence suggests that when adolescents perceive a
high level of social support, their ability to understand that current actions have an impact on the
future increases. This motivates them to engage in positive health practices.

According to the National Institute of health

There are distinct differences in the factors that influence alcohol use, abuse and dependency
among homeless young adults. It suggests that social networks and particularly peer networks
influence the level of alcohol use among homeless young adults. Those young people who had
street friends who abstained from alcohol use also drank less frequently, whereas those whose
peers abused or were dependent on drugs were more also likely to be substance dependent. In
addition, young adults who were alcohol dependent were more likely to live on the streets or in
shelters than those with less severe levels of use.

In comparing homeless young adults who used, abused or were dependent on drugs, basic
demographics are similar; however, peer influences appear to play a major role in youth's
immersion in the street environment which is highly associated with use of illegal drugs. Some
findings indicated that associating with peers who were using drugs regularly increased the
severity of drug use among homeless young adults. These young people often seek out similarly
situated peers who provide opportunities and reinforcement for drug using attitudes and
behavior, even drawing upon one another for money and other material support. Involvement in
the culture of the streets provides opportunities to experiment with various substances, especially
as young adults travel from one region of the country to the other and become increasingly
isolated from conventional society.

Few studies have evaluated economic factors for homeless young adults or the relationship
between economic factors and drug use. In this study, it was found that the source of income was
a significant predictor of the level of drug use. For example, young adults who sold self-made
items were more likely to use drugs infrequently, while those who reported dealing drugs as their
primary source of income were more likely to be drug dependent. As a drug dependent lifestyle
requires a constant infusion of money, heavy involvement in property crime and drug
distribution is common.
Article Analysis: Division of General Internal Medicine, University of California, San
Francisco, San Francisco General Hospital, San Francisco, California, USA (Substance
abuse 2017)

63.1% had used an illicit substance in the last 6 months, and 64.6% had moderate or greater
severity symptoms for at least one illicit drug, with 14.5% reporting severe symptoms. Almost
half, 49.2% had used alcohol in the last 6 months, while 25.8% had moderate or greater severity
alcohol use, with 14.6% reporting severe symptoms. Approximately a tenth (10.3%) of HOPE
HOME participants reported binge drinking and 60% drank at least three times a week to get
drunk at some point in their life. For illicit drugs, the drugs most commonly used in the last 6
months included cannabis with 48.0%, cocaine with 37.7%, opioids with 7.4%, and
amphetamines with 7.1%. The three most commonly reported drugs with moderate or greater
severity symptoms were cocaine (43.1%), cannabis (39.1%), and opioids (12.9%). 
For participants with ASSIST-defined moderate or higher severity illicit drug symptoms, 91.6%
had used an illicit substance in the last six months. For cannabis, 92.7% of participants with
moderate or higher severity symptoms had used that specific substance in the last 6 months:
79.5% for cocaine, 67.8% for opioids, and 67.9% for amphetamines. All participants with high
severity illicit drug use, and all participants with moderate or greater severity alcohol use had
used in the last 6 months. A smaller proportion (5.4%) reported injecting drugs in the last 6
months. Almost a third (31.7%) reported moderate or greater severity symptoms for more than
one illicit substance; 21.4% reported moderate or greater severity symptoms for both cannabis
and cocaine. Less than a tenth of the sample (9.1%) used illicit non-cannabis drugs regularly,
three times a week or more, prior to age 18, while 36.6% used cannabis regularly and 15.1%
used alcohol regularly before age 18.

Article analysis: Self-Reported Changes in Drug and Alcohol Use After Becoming
Homeless. (Thomas P. O'Toole, MD, Jeanette L. Gibbon, MPH, Barbara H. Hanusa,
PhD, Paul J. Freyder, MSW, Alicia M. Conde, MD, MPH, and Michael J. Fine, MD, MSc)

This article identifies substance use patterns and factors associated with increased substance use
after users become homeless. Inclusion criteria were being 18 years of age or older and homeless
(defined as being unsheltered or living in an emergency shelter, transitional housing unit, or
“doubled-up” with friends or family) for most of the previous 3 months. To provide a more
inclusive assessment of need within this population, the unit of analysis in this study included
both individuals with current substance abuse and individuals with substance dependence.

Results

The majority of respondents with current substance abuse or dependence (69.5%) reported using
less or the same amount of drugs and alcohol after becoming homeless compared with their use
before becoming homeless.  Individuals who reported more drug and alcohol use were
significantly more likely to be nonveterans, to be without health insurance, to have been
homeless longer than 12 months, and to have been arrested in the previous 12 months. They were
also significantly more likely to report no money, no job, no entitlement assistance, and drugs
and alcohol as major reasons for their homelessness. They were more likely to use alcohol or
heroin and to report panhandling, stealing, or selling plasma to support their addiction.

Statistics Drug Prevalence in Pakistan

An estimated 100 million people are homeless throughout the world, the majority of them
women and dependent children whereas at least 600 million people live in shelters that are life
threatening in the cities of developing countries. A 2007 survey of 23 cities conducted by the US
Conference of Mayors revealed 30% of the homeless population has mental illness.6 Senator
Kirby of mental Health Commission of Canada stated that "an estimated 25- 50% of homeless
people have a mental illness and up to 70% of those with a severe mental illness also abuse
substances. One in seven users of emergency shelters across Canada is children and almost a

third of Canada's homeless are youths aged 16-24.

The above chart explains the prevalence of Opiate Use in Pakistan by Province. According to the
2006 National Assessment Report, the majority of opiate users (77 percent) were using heroin
while the remainder were using opium and other opiates. Most of the opiate users were multiple
users, i.e., they were using more than one substance at any given time or during a day.
In a study of a cohort of 201 homeless persons, it was found that 21% had mental illness.
Seventy two percent had a diagnosis of drug abuse or dependence and 51% had alcohol abuse or
dependence. Another review suggests alcohol abuse affects 30-40% and drug abuse 10-15% of
homeless persons. One study10 showed that homeless adolescents demonstrated greater
resilience than younger and older adults. Adolescents reported the shortest duration of
homelessness, lowest number of life stressors, fewest physical symptoms, largest social
networks, and fewest clinically significant mental health problems.

In terms of Pakistan, exact figures on homelessness is not available, then what to talk about its
association with mental illness. Pakistan as the world's 7th most populous, second largest
Muslim nation with population of 167 million (2008), annual national growth rate of 1.8% and
urban of 3%. The most populated city is Karachi with 12.4 million and slum to urban population
of 48%.Press reports referring UN office for Coordination of Human Affairs indicate that 500,
000 people are homeless in Lahore, 5000 persons under the age 18 live on streets, 500, 000
homeless in Karachi, and over 2 million people are internally displaced because of conflict in the
regions and earthquakes. Anecdotal reports mention the prevalence of substance abuse among
homeless people. Existence of a variety of mental and physical ailments cannot be ruled out as
homelessness is a very serious factor that would make an individual vulnerable. No official
statistics are available on the magnitude of mental illness among homeless people in Pakistan.
 According to the 2006 National Assessment Report on Problem Drug Use in Pakistan, Cannabis
is the most commonly used substance and the ‘drug of choice’ given its low price and easy
availability. The report makes no estimate of its prevalence. The prevalence of opiate use in
Pakistan is estimated at around 0.7 percent of the adult population or 628,000 opiate users. The
prevalence of Injecting Drug Users (IDUs) is estimated to be around 0.14 percent of the adult
population with a corresponding estimate of around 125,000 injecting drug users in the country.

Solutions of Drug Prevalence among Homeless Adults

There are many volunteer groups, charitable organizations, churches, and government agencies
working to improve the quality of life of homeless people with mental illness and/or substance
use disorders. Effective outreach programs help to connect homeless individuals with services
that can help them lead more secure, satisfying lives:

 Affordable therapy and counseling:

Affordable, confidential mental health services for the homeless are often lacking. Publicly
sponsored programs, like Care for the Homeless in New York City, offer emergency
intervention, counseling, case management, and other services to help this population recover
from mental illness.

 Medication management:

Psychiatric medication can be highly effective at treating the symptoms of schizophrenia,

depression, bipolar disorder, and other serious forms of mental illness. Case managers,
therapists, nurses, and physicians are needed to help the homeless find the structure and
motivation they need to comply with a medical treatment program.
 Substance abuse treatment:

Treatment for substance use disorders has traditionally been viewed as a prerequisite for mental
health treatment or housing services for the homeless. However, the National Health Care for the
Homeless Council emphasizes the importance of integrating substance abuse treatment with
mental healthcare and housing in order to provide comprehensive, effective treatment. Detox,
rehab, 12-Step meetings, counseling, and medication management are among the services that
homeless people need to recover from addiction.

 Case management:

Case managers work with public health agencies and other organizations to help homeless
individuals find consistent treatment and safe, affordable housing. Case managers follow up with
homeless clients to assess their mental status, ask about their needs, and help them find resources
in the community to meet those needs.

 Safe housing options:

People who suffer from severe forms of mental illness, such as schizophrenia, are in particular
danger of being the victims of violence, robbery, or assault. The Safe Haven
programs established by HUD provide temporary accommodations to homeless individuals with
severe mental illness, so they can have a secure living environment until their mental health
condition stabilizes.

According to the Mental Health America, supported housing services may include:

 Visits from a counselor

 Individual therapy
 Group therapy sessions
 Assistance with transportation
 Occupational counseling
Supported housing programs work simultaneously to treat substance abuse and help individuals
create more stable lives. These programs provide access to psychosocial services within the
structure of a temporary or permanent living environment. Supported housing options range from
highly structured communities to independent housing options with regular home visits by a case
manager. A stable living environment is one of the most important factors in promoting sobriety
and preventing relapse. 

In a compassionate society, all members are treated with dignity and respect, no matter what
their economic condition or health status may be. Meeting the basic needs of the homeless for
shelter, food, and healthcare provides the security they need to stay consistent with treatment for
mental illness and substance abuse.

Barriers to Treatment

Mental illness and substance abuse are themselves barriers to treatment. Many shelters,
transitional housing communities, and low-income housing units require that residents pass
sobriety tests or drug tests before they can qualify for housing. This requirement can contribute
to the problem of substance abuse by excluding homeless individuals from housing
opportunities. Instead of finding supportive treatment for a substance use disorder, many of them
remain on the streets, sleeping in public places, jails, detox centers, or temporary homeless
shelters. Other barriers to treatment among the homeless with mental illness include:

 Lack of health insurance or financial resources to pay for rehab

 Low motivation to seek help due to depression and hopelessness
 Fears about treatment caused by paranoid beliefs or anxiety
 Inadequate transportation to get to a treatment center
 Lack of awareness of resources for homeless people
 Lack of support from friends or family to recover and lead a sober life

When homeless people do receive mental health or substance abuse treatment, they may have
difficulty following through with a therapeutic program or complying with a medication
regimen. For people with severe mental illness who need psychiatric medication, noncompliance
can quickly lead to relapse. In a population whose members are in constant transition from one
shelter, hospital, or jail to another, consistent treatment may be difficult or impossible to find.