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People run away from home for different and complex reasons: escaping abuse, escaping poverty, having nowhere else to go, suffering from mental health or substance abuse problems, or many other difficult explanations. Homeless people who have fled or lost their homes are mostly young, with anywhere from a half-million to almost 3 million such people in the United States alone. One of the many challenges and dangers they face is the threat of drug addiction.
The National Conference on State Legislatures uses the terms homeless and runaway interchangeably to refer to people who do not have stable and adequate living situations, and who are “at a greater risk of engaging in dangerous behaviors while living on the streets.” When youth become homeless, it is usually for a range of reasons that cover familial neglect or abandonment, a stressful or disruptive home environment, or involvement in the juvenile justice or child welfare systems, to name a few. Other reasons put forward by the Drug and Alcohol Dependence journal include poverty and unfair or discriminatory housing practices.
Youths who run away from home are often inexperienced and poor, with no connections or skill to survive on their own. This makes them a ripe target for exploitation and victimization, often being pressured to engage in substance abuse, sexually promiscuous behavior (for sex and/or drug trafficking), which can lead to teenage pregnancies, sexually transmitted diseases, and mental health problems.
Approximately 80 percent of America’s homeless youths (between the ages of 12 and 21) use drugs or alcohol. Many of the people in this position are unwilling or unable to return home; some might not even have homes or family members to return to. They may turn to drugs and alcohol to cope with the stress and depression of not having a home; they may be forced to use and sell drugs and alcohol to survive on the streets, gain acceptance from gangs, or simply to barter for food and drink.
The National Runaway Safeline reports that at least 70 percent of teen runaways left home abruptly, without planning their departure or next steps. More often than not, the cause of the departure was to get away from some kind of abuse: physical, sexual, or otherwise. A study by the Journal of Drug Issues on substance abuse among homeless and runaway adolescents determined that youths who experienced higher levels of physical and sexual abuse from their caretakers (parents or guardians) were more likely to be dependent on alcohol when they were on their own. The teens who choose to flee might do so at the first possible opportunity, no matter how inconvenient or poorly thought out the moment is.
Between 2005 and 2008, there were more youths who left home because of economic reasons, likely due to the problems caused by the housing market crash and ensuing recession. If drugs are involved, runaways usually leave their home situations to get away from family members who are using or to conceal (and continue) their own habit. The National Runaway Switchboard warns that homeless youth are at a higher risk for mental health issues and substance abuse, as well as physical abuse, sexual exploitation, and death than the general population.
While the nature of homelessness and being a runaway preclude complete statistical accuracy, a 2008 survey of school districts suggests the extent of the problem:
Figures from the Department of Housing and Urban Development estimate that more than half the people who live in housing programs have a substance abuse problem, a mental health disorder, or both. Further research conducted by JAMA Internal Medicine suggests that overdosing on drugs is becoming the most common cause of death among homeless people and runaways, overtaking violence, suicide, and HIV/AIDS. A 15-year study conducted in Boston revealed that 80 percent of homeless individuals who died while still on the streets were consuming opioids, like heroin or prescription medication. Such deaths have become so common among the homeless in urban areas that the authors of the JAMA Internal Medicine study said that the problem was an “epidemic.”
Heroin and prescription opioid abuse is a huge problem across the entire country, but homeless and runaway people are an exceptionally vulnerable population; they come from backgrounds of extreme stress and pre-existing substance abuse, which makes it more likely that they will start using (or continue to use) deadly drugs, like heroin, which is sold cheaply and used intravenously with materials that are easily obtainable (a cheap syringe, a cigarette lighter, and a spoon). Sharing or using discarded needles also exposes a person to the possibility of contracting a blood-borne illness, like HIV/AIDS or hepatitis C.
But thanks to an oversaturation of powerful prescription medicines, as well as a thriving black market, homeless and runaway people are also exposed to the trafficking and use (and dangers) of drugs like oxycodone, hydrocodone, and hydromorphone. The medications are used for pain management; they are also very addictive and have rewritten the landscape of drug abuse across the country. While people in rural and suburban communities struggle with an influx of drugs and death, those who live on the streets and in shelters are not immune; the Drug and Alcohol Dependence journal writes of 22 percent of 457 homeless youths in Los Angeles abusing prescription drugs.
The study by the Journal of Drug Issues on substance abuse in runaway and homeless youth discovered that that population uses alcohol and drugs earlier, and much more often, than those who do not run away from home (even though experimenting with substances is common among that general age group). While opioids like heroin and prescription medication have gained popularity in recent years, the choice of drugs also depends on the location. In Hollywood, for example, runaway youths used mostly marijuana (93 percent), speed (66 percent), LSD (61 percent), and cocaine (50 percent). In the Midwest, on the other hand, alcohol was consumed by 81.2 percent of homeless youths, and only 69.4 percent smoked marijuana.
One of the most significant problems in helping people in this situation is that many shelters or homeless programs are not equipped to deal with the full scope of mental health and substance abuse issues that runaways tend to have. Many transitional housing communities and low-income units require that residents pass initial and ongoing drug tests. However, a policy like this turns away those who are not ready to give up their drug use, or whose mental health problems are such that they are too dependent on their drugs or alcohol; quitting their habits could be legitimately dangerous, both physically and psychologically.
As a result of this, many people who need those services are compelled to remain on the streets. For them, drug treatment is a lofty dream, one that is completely disconnected from the reality of making it from one day to the next. As Ohio State University puts it, “Homeless youth need more than treatment.”
For a special USA Today report on homelessness, a former homeless person who lived for more than two decades without a place to stay (and was eventually diagnosed with bipolar disorder, which led to treatment and an apartment) explained that runaways and transient people prioritize survival over anything else. If surviving means taking drugs and alcohol to make the reality a bit more bearable, then drugs and alcohol will take precedence over giving up what can be the only source of (perceived) escape and pleasure in that reality.
Other treatment barriers runaways face is the simple case of not being able to physically get to shelters or hospitals. Idiosyncrasies in a respective situation may mean that a transient person doesn’t qualify for public insurance (if, for example, they are an undocumented immigrant). As a result of poor hygiene and constant exposure to the elements, homeless and runaway people have an “inordinately high” rate of respiratory and cardiovascular conditions, says the American Public Health Association; with their immune systems thusly compromised, they are undernourished, and the effects of drugs and alcohol on their respective systems (especially if they have other health issues) can lead to death before the paperwork and processes of treatment can begin.
The longer a runaway person is without a stable home and social network, the harder it is for that person to receive necessary help. Rev. Jack Pfannenstiel, a Franciscan priest who founded a residential program in Washington, DC that helps rehabilitate homeless men, told The New York Times that people who live on the streets, and who are in the company of drug addicts, struggle the most to re-enter society. It takes about three years of transience, Father Pfannenstiel said, before a runaway person’s entire network consists of other runaways and the people who exploit them. After that period of time, all connections to a former life (friends and family members) are gone. Father Pfannenstiel described this as “a point of no return.” And when a runaway person’s social circle consists entirely of other runaways and drug users, engaging in drug and alcohol consumption could be the only form of bonding and acceptance in an environment like that.
The study by the Journal of Drug Issues on substance abuse among homeless and runaway youths found that the most important factors of life on the street were “association with deviant peers,” and then taking part in activities that, while illegal, were necessary for survival in that environment.
Doing so “significantly increased the likelihood” of developing a substance abuse habit; the study’s authors determined that once a runaway youth is on the street, that youth is likely to be exposed to a subculture of other runaways and the people who exploit them; and that combination usually “encourages a lifestyle that is conducive to substance abuse.”
The study’s authors wrote that the influence of other runaways and homeless people was “probably the most insidious risk factor” in whether a runaway youth would turn to drugs or alcohol. To combat this, early interventions (like immediate shelter and continuous services that provide nourishment and/or room and board) could wean a youth away from the lure of socializing and fraternizing with the so-called “deviant peer affiliations.” Additionally, interventions that focus on positive peer relationships (such as through student volunteer programs) could reduce how much negative influence other runaways and their exploiters have.
For some people who left home (or were forced out) for specific reasons, the company of the homeless might be the lesser of two evils. The Center for American Progress writes that there are as many as 400,000 lesbian, gay, bisexual, transgender, or questioning youths who are homeless after being disowned by their families when they came out. A study conducted by the Williams Institute at UCLA found that 68 percent of LGBT youths cited “family rejection” as a major factor in their homeless status (in fact, the most cited factor for LGBT runaways), a statistic that the institute called “America’s Shame.”
A coauthor of the study said that family abuse and rejection put many LGBT youth “at [a] high risk of homelessness,” which in turn drives those youths to drug and alcohol abuse, as well as a life of crime and victimization (which, in turn, contributes to substance abuse and mental health trauma).
Between the years 2002 and 2012, the percentage of providers at shelters and programs for homeless youth report that the number of LGBT people they served increased from 82 percent to 94 percent, suggesting that even as the general public moves toward a greater acceptance of LGBT rights and causes, there is still the problem of gay and transgender teens being turned out of their homes for their sexual identity and/or orientation. As an example, services and shelters that target LGBT runaways do not receive sufficient funds from the government, foundations, and the public.
How to address the issue of runaways and addiction is not an easy topic; the causes of the problems are so widespread and complex that there is no “one-size-fits-all” solution. A number of states have enacted different policies and programs that target specific aspects that lead to teens and youths running away from home and their families, and that offer services that are specific to their situations.
Some include early intervention and prevention, offering financial counseling and rent assistance to ensure that bills and rent do not preclude living in a safe and stable home. Parents and youths alike are coached in money management and job skills, helping them toward a position where the family can be self-sufficient and sustainable.
The same principle applies to reaching out to youths who are already runaway and homeless. Shelters have to offer services that are relevant and meaningful, like affordable housing and job skills development – small but incremental ways to get youths off the street and into programs that can rehabilitate them.
But in order to best tackle the challenge of helping runaways get away from addiction, long-term housing options have to be part of the picture.
The Ohio State University report on homeless youths needing more than treatment focused on the importance of creating viable work opportunities, as well as opening more doors to education and medical care. These factors, according to researchers at OSU, who worked with 180 homeless teens in New Mexico, were the most significant when it came to controlling rates of homelessness among adolescents.
Teens who had the most social stability (defined as those who were in school for the longest period of time or those who held down a job) had better chances of reducing their homelessness situation than those who dropped out of school early or never had any work experience.
Similarly, runaway adolescents who tended to engage in high-risk behaviors, like (intravenous) drug abuse and promiscuous/unprotected sex, were more likely to resist any attempt to get them off the streets and more likely to remain homeless even when presented with alternatives. Natasha Slesnick, the study author, referred to such individuals as “being entrenched in the homeless lifestyle.” It required intensive, one-on-one mental health counseling and drug treatment to rehabilitate them. Slesnick said that the biggest challenge was determining how best to engage youths who are deeply linked to the runaway and transient subculture, and then giving them “socially valued” chances and activities through education and employment. This could come through family support, as well as identification through a traditional culture, which was recognized as an encouraging indicator of whether a homeless youth could be successfully rehabilitated. For example, Latino youths in the New Mexico study were more likely to leave the runaway lifestyle than any other group, primarily because of the strong levels of attachment to family members that are prevalent in the Latino community. Hispanics tend to have large families, so a runaway youth of Latino heritage may have more connections to a stable and healthy life than adolescents and teens who come from smaller families. Those with ties to Latino culture and family had lower rates of substance abuse as well as a shorter period of time being homeless.
Male runaway youths were more likely to try and get away from the homeless life after six months due to homeless males being more vulnerable to environmental stress; therefore, they were more likely to actively try and rehabilitate themselves (or seek help). Female youths, however, are more likely to be exploited and victimized by human traffickers (for sex work) and face a deeper challenge in getting away from the deviant peer groups that dominate the runaway subculture.
At Ohio State University, Natasha Slesnick called for public policymakers and lawmakers in government to step up to prevent homelessness. The issues that lead to youths running away from their homes, or being turned away, are a social problem; and teenagers, with their inexperience, lack of education and resources, impulsivity, and need to be accepted are easy victims of that complicated and multifaceted social problem.
In writing about the overlooked and underserved young homeless population of New York City, The New York Times highlighted one of the biggest misconceptions of this social problem: that it is only the mentally ill or drug-addicted who are homeless because those people are often the most visible. The general public is woefully unaware that many of the late teens and early 20s on the streets of the most populous city in the United States are victims of abuse, victims of homophobia, or simply too old for state services. The young runaways interviewed by the Times said they were without options. One of them, a 23-year-old former foster child and runaway who became homeless at the age of 15 told reporters that “we are being forced to be adults,” doing anything to live from one day to another, while a government system weighed down by politics and bureaucracy struggles to help the most vulnerable of its citizens.