You Can't Blame Homelessness on Addiction

A dark pattern is playing out in cities across America. A new story about Phoenix helps us understand what's going on.

On any given night in America, more than half a million people are without a bed and a home to sleep in. Five percent of Americans (millions of people) will, at some point, be homeless in their lifetime.

Can I sit out here on the street with you tonight while you’re smoking methamphetamine and trying to stay awake so you don’t get assaulted?

This is one of the awkward questions that Pulitzer Prize winning journalist Eli Saslow has to implicitly ask the unhoused people he profiled in a story about homelessness in Phoenix. It’s also quite telling, because it helps us understand why people who are unhoused might use methamphetamine in the first place. So often, the reason people use drugs isn’t really investigated. And when it is, drug use and addiction are portrayed as symptomatic of some sort of trauma and that’s that. Certainly, that can be true for some people. I don’t think drug use is only about escaping one’s past. I think drug use is also functional in the present moment.

People use particular drugs at particular times for particular reasons.

For people who are living on the street, a stimulant like meth serves a purpose. Imagine all of your possessions, everything you care about, is vulnerable. Imagine you are just as vulnerable as those possessions. Anyone walking buy can steal or have their way with whatever they want. Going to sleep, then, might be a terrifying idea. It’s well documented that people who are unhoused have deep fears of losing their property or experiencing violence and/or sexual assault while they sleep. So one way to guard against that is to use meth, which ensures you do not fall asleep at an inopportune moment.

Knowing the actual conditions of life for those who are living on the street opens up a whole other terrain of questions. Like, why are people who are unhoused asleep during the day? Maybe it’s because they feel like nothing bad will happen to them during the day. Maybe that’s the only time they feel comfortable sleeping; after staying up all night to protect themselves, they crash.

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A small sandwich shop in Phoenix is at the center of Saslow’s article for the New York Times. His story shows the tangle of everyone’s daily life in this small corner of downtown Phoenix where the homeless population continues to grow. I liked this story because Saslow doesn’t pit the unhoused people against the small business being engulfed by Phoenix’s crisis. Saslow isn’t rooting against the unhoused people. He’s not cheering for small business. He’s simply showing how, in America, the best and most free rootin’ tootin’ country to ever exist on planet Earth, that when something goes wrong here, when something is broken, it’s on you to fix it. Nobody is really going to come save you. You got a problem? Figure it out.

The problem we face today? Cities are becoming unlivable for those who are stuck on the margins.

That’s the story of the sandwich shop. By complete happenstance, it’s located in a block where thousands of unhoused people live. The shop is run by a husband and wife duo named Joe and Debbie Faillace. They have owned the shop for the last four decades where they’ve served up homemade meatball subs and reubens to regulars. Now, the couple feels ready to retire. But they can’t sell their business at a reasonable price anymore. Eight years ago, they turned down a $250,000 offer for their downtown business. But they figured if they held out longer they could get a better deal.

Now, they’re lucky to get an offer anywhere near that. Their realtor told them: “If you were a half-mile in another direction, you’d be sitting on a million bucks. Instead, it’s, How can you dispose of it?”

In this square of downtown Phoenix, there’s more than one thousand people living outside.

A dark pattern is playing out in so many American cities, especially on the West Coast. For the Faillace’s, their sandwich shop butts up against the largest homeless encampment in Phoenix, with over 1,000 people sleeping outdoors, in tents or living in cars, on any given night. That is an untenable situation that creates chaos. It’s a lose-lose for everybody. And the problem just keeps getting worse.

If you’ve followed what’s happening in Los Angeles, Seattle, Portland, and San Francisco, you already know this pattern. Expensive West Coast cities have become unlivable for those who don’t have a lot of wealth. New York is a super expensive city where people are also living hard. But on the East Coast, the vast majority of homeless people are sheltered. On the West Coast, thousands live unsheltered. The difference between New York and San Fancisco,is that New York hides their homeless better than San Francisco.

Noticeably absent from this story is the idea that outreach and harm reduction services are the cause of Phoenix’s problem. In places like San Francisco, a well-funded backlash has tried to re-shape that narrative around homelessness. They say it’s not about economics or high rents; it’s about addiction and untreated mental illness. They say it’s about harm reduction enabling addiction and about “progressive prosecutors” coddling drug dealers. That story has it all wrong.

Of course, addiction and mental illness are factors. More specific, they are individual risk-factors. They are in the mix as risks to becoming unhoused and homeless. But these factors cannot fully explain what we’re seeing play out in all of these cities. Drugs and mental illness simply do not play a causal or even primary role in creating this unprecedented surge in homelessness around the country.

An incredibly useful book on this subject is by the scholar Gregg Colburn and data journalist Clayton Aldern called: “Homelessness is a Housing Problem: How Structural Factors Explain US Patterns.” Their book argues that homelessness is about housing, obviously. But more so, they do a great job dispelling myths about individual mental illness and behavioral health as being the primary causes of homelessness.

Through data and interviews across numerous cities, they show that when housing costs are high, there is very little margin of error for people who are on the edge of poverty. When the majority of one’s paycheck goes to rent, suddenly any mistake or bad luck or accident can trigger a cascade of dire consequences that result in homelessness. It is not a coincidence that expensive coastal cities have the largest populations of unhoused people.

Those who want to blame addiction and harm reduction refuse to acknowledge the most basic facts staring at us right in the face. The average cost of a single-family home in San Francisco is $1.32 million, and that’s down 11% from last year! How much does a home cost in Detroit, Michigan? $70,000. And yet, they argue, this has nothing to do with homelessness!

The story by Saslow about Phoenix places the socioeconomic context of the city at the forefront. Phoenix is not typically thought of as a super expensive coastal city. The average cost of a single-family home is $394,000. Not bad, but it’s been getting more epensive. And the city has been lately experiencing the same trends as other cities on the West Coast.

Phoenix’s population has been exploding in growth, increasing by 25,000 people per year. Then the pandemic hit and the cost of living rose. Inflation in Phoenix has risen faster than in any other city. Population growth, a low housing supply created high rents and that led to evictions and homelessness.

Saslow writes:

“The city’s average rent rose by more than 80 percent during the pandemic. A wave of evictions drove more people from their homes, until for the first time ever more than half of Phoenix’s homeless population was finding refuge not in traditional places, like shelters or temporary apartments, but in cars or tents.”

In order to understand homelessness, we have to think bigger than individuals. It’s bigger than mental illness. This is a problem beyond a person making bad decisions. It’s biger than someone’s drug use spiraling out of control, which happens everywhere in every city or small town.

Think about cities like Detroit or towns in West Virginia; there’s higher rates of poverty and drug use in those places than in Seattle or San Francisco. More people in Detroit live below the federal poverty line, and yet there’s lower rates of homelessness there than in San Francisco. Again, it’s because housing is more abundant and more affordable in Detroit. People are poorer, but they still have access to cheap and affordable housing.

At the community and population-level, individual risk factors like mental illnness and addiction fail to explain the true driver’s of homelessness. But at the individual-level, when we are just walking on the street, that’s all we see. We see public drug use and people in the throes of mental illness. And then we think, well, that explains that. But that gets to the limits of what we see with our own two eyes. The world is more complex than that. There’s so many things beyond our field of vision.

What’s interesting to me about Phoenix is that the politics swirling around the growth in unhoused people looks a lot different than in San Francisco. For example, syringe programs and harm reduction were pretty much illegal in Arizona up until May 2021. There were only a few underground programs that were privately funded. Since they were illegal they could not establish permanent locations, they couldn’t raise a lot of money, and they couldn’t operate freely out in the open. All of that limited their reach.

But after a major uptick in overdose deaths across the state, Arizona lawmakers decided they needed to do something different. The state embraced syringe programs and legalized fentanyl test strips. When signing the harm reduction bill into law, Arizona’s former Governor Doug Ducey, a Republican, said:

“We want everyone who is using drugs to seek professional treatment. But until someone is ready to get help, we need to make sure they have the tools necessary to prevent a lethal overdose.”

It’s a simple distillation of the harm reduction philosophy that even a Republican can get behind. The Phoenix situation also provides a clear illustration of the chronology of events: Overdose deaths rose, then Republican lawmakers decided to embrace harm reduction. And well before Arizona embraced harm reduction, cities like Phoenix had a growing population of unhoused people. In other words, the crisis of drug addiction and homelessness in Arizona preceded harm reduction programs. Unlike in San Francisco, there’s no vocal minority in that Arizona actively blames public health services for being the cause of the problems. The truth is that these programs were implemented to help contain those problems. And they do a good job at that. Fewer people share syringes and contract blood-borne illnesses. And when more people have access to naloxone, there’s fewer fatal overdoses. Over time, people accessing services through these programs make slow and steady changes that improve their lives. That’s harm reduction. It’s simple, and effective.

Arizona has long been a Republican stronghold. Only recently have elections there been close enough where Democrats stood a fighting chance. Overdoses and homelessness soared under Republican governance that kept harm reduction illegal for far too long. The state was so conservative that even syringes were deemed paraphernalia! Simple drug possession could result in a felony charge! Anti-harm reduction and ultra-punitive drug laws did not save Arizona from going the same way as Seattle and San Francisco.

It was only recently that state lawmakers realized they could be preventing a bigger portion of morbidity and mortality from drug use by embracing harm reduction. (If you’re interested in AZ programs, check out Shot in the Dark and Sonoran Prevention Works). To be sure, it’s not as though a robust harm reduction program is going to eliminate poverty and homelessness. Harm reduction is not a poverty reducing program. Harm reduction cannot fix an expensive housing market. Harm reduction cannot fix inequality.

I highly recommend people read the story of the sandwich shop in Phoenix. It’s an empathetic look at a crisis that doesn’t pit individuals against each other. The result is an emotionally gripping and accurate depiction of cities struggling to take care of all of its residents.