Week 5: What We See, What We Judge: Substance Use Disorder, Homelessness, and Compassion
An 8-part series on the intersection of homelessness and mental health with input from Dr. Katrina Amber-Monta, a third-year psychiatry resident at Lehigh Valley Health Network (PA). Dr. Amber-Monta completed her undergraduate degree at Bennington College (VT) in 2003 where she studied music, and in 2022, graduated from Cooper Medical School of Rowan University (NJ).
I've seen more track marks than I'd care to admit. I've poured bottles of liquor down storm drains handed to me by guests on their way to rehab. I've also lost dear friends to overdose, and it's heartbreaking when someone is finally ready for help, but can't access it due to insurance issues or restrictive Medicaid coverage.
This week, we're exploring a deeply personal and often misunderstood topic: substance use among people experiencing homelessness.
Many of us know someone struggling with substance use disorder (SUD). It's painful, complex, and deeply human. But that pain can sometimes lead to assumptions, especially about unhoused people.
A common myth is that homelessness and addiction always go hand-in-hand, but the reality is more nuanced. About one third of homeless adults have a chronic substance use disorder—meaning nearly two-thirds do not.
Still, the public often sees addiction as synonymous with homelessness. Why? Because in wealthier communities, addiction happens behind closed doors. For unhoused people, everything—including coping—happens in public.
Dr. Amber-Monta explains, "Addiction can be viewed as a symptom of pain or trauma. It's often driven by social isolation. Many of our friends on the streets lack the social safety net of friends and family. Thousands pass someone panhandling without even acknowledging their existence. Humans are wired for connection—when we lose that, we may turn to substances to numb the pain."
Nationwide, over 16% of Americans aged 12 and older meet criteria for SUD. Addiction doesn't discriminate, but our response often does. Private addiction gets concern; public addiction gets criminalized.
This disparity ignores root causes. Substance use is often a response to trauma, instability, or mental illness. While addiction doesn't always lead to homelessness, chronic homelessness can worsen addiction. Stability—especially housing—can be a turning point in recovery.
None of this excuses the harm addiction can cause. But instead of asking what's wrong with someone, we should ask what happened and how we can help.
Healing requires compassion, not punishment. That means investing in harm reduction, mental health care, low-barrier treatment, and, just as importantly, safe housing.
Dr. Amber-Monta adds, "Research on permanent safe housing and Housing First shows improved outcomes not just for homelessness, but for substance use disorders and criminal justice involvement. These benefits ripple out to families and entire communities."
Let's stop judging people for where they are and start helping them get where they want to go.
With Gratitude,
Josiah Haken
City Relief, CEO
