Addiction Is the Leading Cause of Homelessness—Here’s What We Can Do About It

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Addiction Is the Leading Cause of Homelessness—Here’s What We Can Do About It

Homelessness is one of the most significant issues facing local communities today, but policy conversations usually begin and end with housing. The number of unhoused people in the United States has increased by nearly 20% since 2023, and with millions more on the verge of homelessness, the need for lasting solutions is more urgent than ever. Finding the right solutions requires understanding the full range of underlying causes.

Dr. Roger Starner Jones Jr., MD, an addiction recovery specialist based in Tennessee, argues that untreated substance abuse is one of the primary—and most overlooked—causes of homelessness. Lack of access to quality recovery services can both lead to and perpetuate homelessness within communities.

Dr. Jones is a board-certified emergency and addiction medicine physician, as well as the founder of Nashville Addiction Recovery, Belle Meade AMP, and Recovery Now. He is a graduate of the Emergency Medicine Residency at the University of Mississippi Medical Center and the Addiction Medicine Fellowship in the Department of Psychiatry at Vanderbilt University Medical Center. Over the course of his career, he has treated more than 80,000 patients and helped detox over 1,000 people.

“Addiction isn’t just a symptom. For many, it’s the cause of homelessness,” says Dr. Roger Starner Jones Jr., MD of Tennessee.

Photo Credit:  Christina Morillo | Pexels

A Crisis of Disconnection

Substance use often begins as a coping mechanism—an escape from trauma, mental illness, or poverty—but quickly becomes a barrier to stability. “It hijacks your brain’s priorities,” Dr. Jones explains. “You lose your job. You lose your family. You lose your home. And eventually, you lose yourself.”

Studies differ on exact numbers, but they agree on the pattern: over a third of unhoused people struggle with alcohol or drugs, and as many as two-thirds have a lifetime history of substance use disorder. Substance use can be both a cause and an effect of homelessness. Historically, few programs have been designed to serve individuals who are not yet ready for treatment.

Furthermore, about two-thirds of people experiencing homelessness have a mental health disorder, according to a review of 85 studies involving more than 48,000 participants from the U.S., Canada, and Germany.

Roger Starner Jones, MD: How We Got Here

Dr. Jones traces the current crisis back to the Community Mental Health Act of 1963, a well-intentioned law that deinstitutionalized mental health care in favor of outpatient clinics. “The goal was noble,” he says. “But what actually happened is that people were lost to follow-up. They didn’t take their meds. They didn’t show up to clinics. And they ended up homeless.”

More than six decades later, the U.S. has no comprehensive system in place to care for people experiencing addiction and mental illness who cannot care for themselves. “We dismantled the old system without building a better one,” says Jones. “And the consequences are playing out on our sidewalks every day as a cause of homelessness.”

What’s Not Working—and What Might

While many municipalities focus on housing-first policies, Dr. Jones argues that these initiatives will fall short without addressing addiction as well. “We’re not saying housing doesn’t matter—it absolutely does. But for many people, if you don’t treat the addiction first, the housing won’t last.”

In his view, the solution must include reinstitutionalization—not as a permanent sentence, but as a structured and compassionate path to recovery.

“We need inpatient treatment options for people who can’t care for themselves. And yes, some of that should be mandatory,” Jones says. “If you have the ability to make someone better—through medication, therapy, or detox — it’s our duty to try.”

Jones believes the path forward starts with rebuilding the systems that once helped people get back on their feet. That means creating modern inpatient psychiatric and detox centers, offering structured six-month treatment plans with regular check-ins, and enforcing vagrancy and camping laws in a way that still gives people real alternatives—not just jail or the street.

He also stresses the importance of consistent medical care and access to medication for those with severe mental or behavioral health challenges.

“This isn’t about punishment,” Dr. Jones says. “It’s about giving people a real chance to get better.”

What Better Treatment Could Look Like

Through his work at Nashville Addiction Recovery and its affiliated clinics, Dr. Jones provides concierge-level addiction treatment, including in-home detox and outpatient care. But he acknowledges that what’s available to private patients isn’t available to everyone.

“Most people don’t have access to services like this,” he says. “And that’s the problem. We need more pathways to high-quality, evidence-based treatment for people on the margins.”

He points to Room In The Inn—a faith-based nonprofit in Nashville—as a model that blends shelter, community, and recovery. “They’re treating the whole person. That’s what works.”

Reframing the Public Narrative

Dr. Roger Starner Jones hopes to reframe the conversation about the causes of homelessness, not just through his clinic in Tennessee, but through a more compassionate and integrated approach to treating addiction and mental illness.

“We’ve got to stop treating addiction like a character flaw,” he says. “It’s a chronic medical condition that deserves treatment. And if we treat it, we have a real shot at solving homelessness.”

Still, he’s not naïve. “Reinstitutionalization will be controversial,” he admits. “But the alternative, letting people die on the streets, is worse. If we want a more humane society, we’ve got to make tough, smart decisions.”