Clients with problematic drug and/or alcohol use
Specialist homelessness services (SHS) provide support to people experiencing or at risk of homelessness. The following summarises evidence from the Specialist Homelessness Services Collection about clients experiencing problematic drug and/or alcohol use. For more comprehensive analyses and the most recent data please use the hyperlinks on each evidence statement or the evidence sources at the end of this page.
Evidence summary
Around 9% of SHS clients experience problematic drug and/or alcohol use – the group is made up of a similar number of males and females[1].
At the start of support, more than half of SHS clients experiencing problematic drug and/or alcohol use are experiencing homelessness, higher than the percentage of all SHS clients experiencing homelessness at the start of support[1].
Around 3 in 5 SHS clients with problematic drug and/or alcohol use are living alone at the start of SHS support, with fewer clients living as one parent with child(ren) (around 1 in 9)[1].
Most (around 4 in 5) clients with problematic drug and/or alcohol use have previously been assisted by a SHS agency at some point since the collection began in July 2011, the highest rate among all client cohorts routinely studied[1].
On average, adult clients with problematic drug and/or alcohol use have more periods of support, are twice as likely to receive accommodation support and receive more than twice as many nights of accommodation compared with other adult SHS clients[3].
The most common main reasons clients with problematic drug and/or alcohol use seek help from SHS agencies is due to housing crisis, inadequate or inappropriate dwelling conditions and challenges relating to domestic and family violence[4].
Clients with problematic drug and/or alcohol use are more likely to require counselling for problem gambling and to require psychiatric, psychological or mental health services when interacting with SHS agencies, compared with clients without problematic drug or alcohol use[3].
Accidental poisoning was the most common underlying cause of death among people with a history of SHS support who died; accounting for around 1 in 9 deaths[5].
For help or support
If you have any concerns about your own or someone else’s alcohol or drug use you can discuss this with your local General Practitioner, or contact the National Alcohol and Other Drug Hotline on 1800 250 015 or a support and treatment centre.
Problematic drug and/or alcohol use and homelessness are closely related (Johnson and Chamberlain 2008; McVicar et al. 2015). The experience of homelessness may lead to or worsen problematic drug and/or alcohol use, whilst problematic drug and/or alcohol use may also contribute to homelessness (Johnson and Chamberlain 2008; McVicar et al. 2015; Flatau et al. 2021).
Problematic drug and/or alcohol use is a challenge for people experiencing homelessness in Australia (AIHW 2025b). The Journeys Home project (a longitudinal survey of Australians) found that among those who had experienced housing instability or homelessness, 57% reported risky alcohol use, 39% used illicit drugs, and 14% injected drugs in the past 6–12 months (Scutella et al. 2014). Among clients who seek both SHS support and alcohol and other drug treatment services in Australia, alcohol is the most common principal drug of concern (AIHW 2016).
Between 2010 and 2020, The National Advance to Zero survey found that among people at risk or experiencing homelessness in Australia, 65% reported a drug and/or alcohol problem, 29% reported consuming drugs and/or alcohol almost every day of the past month, and 29% had injected drugs in the past six months; almost 3 in 4 (71%) people rough sleeping reported a drug and/or alcohol problem compared with 3 in 5 (58%) people experiencing other forms of homelessness (Flatau et al. 2021).
Pathways into homelessness
People experiencing problematic drug and/or alcohol use may be especially vulnerable to experiencing housing instability or homelessness (Lalor 2020; Flatau et al. 2021). Problematic drug and/or alcohol use can negatively impact on a person’s mental and physical health, income, employment, education, and other factors that make it difficult to maintain stable housing or transition out of homelessness (Flatau et al. 2021). The traumatic experience of unstable housing such as sleeping rough and exposure to substance use among peers may also contribute to or prolong drug and/or alcohol use; reinforcing the cycle of homelessness (Lalor 2020; Scutella et al. 2014; Johnson and Chamberlain 2008).
Structural and individual factors including poverty, experiences of family and domestic violence, discrimination and mental health issues that contribute to homelessness may also underpin problematic drug and/or alcohol use (Pawson et al. 2024; Nilsson et al. 2019; Barry et al. 2024; Coombs et al. 2024). Although not all people exposed to these factors will experience homelessness or face problematic drug and/or alcohol use, among SHS clients experiencing problematic drug and/or alcohol use, around 4 in 5 also experienced family and domestic violence and/or a mental health issue (AIHW 2025b).
Impacts of problematic drug/alcohol use and pathways out of homelessness
People facing problematic drug and/or alcohol use are vulnerable to preventable injury, disease and premature death caused by accidental poisoning and suicide (AIHW 2025a; Flatau et al. 2021). For people facing both problematic drug and/or alcohol use and homelessness, accessing primary healthcare services can be particularly challenging due to barriers such as feelings of judgement or discrimination, lack of a fixed address, limited access to technology, low income or limited means of transport (Flatau et al. 2018, 2021; Vallesi et al. 2021). For many, this can increase the risk of poorer health outcomes and higher rates of preventable hospital presentations (Flatau et al. 2021).
People experiencing problematic drug and/or alcohol use may also face difficulty accessing drug and/or alcohol treatment services for similar reasons (Flatau et al. 2021; Vallesi et al. 2021). While housing is an important factor in accessing healthcare and treatment for those facing problematic drug and/or alcohol use, maintaining stable housing may also be difficult as traditional housing services often require clients to be participating in drug and alcohol rehabilitation and remain abstinent during their stay (Vallesi et al. 2021; Rizzo 2022).
Providing stable housing and addressing other structural and individual factors for people facing problematic drug and/or alcohol use may support greater rehabilitation, health outcomes and sustained pathways out of homelessness (Flatau et al. 2021).
About the Specialist Homelessness Services data – defining clients with problematic drug and/or alcohol use
The Specialist Homelessness Services (SHS) Collection (SHSC) commenced in July 2011.
The ‘Problematic drug and/or alcohol use’ derivation used for reporting focuses on SHS clients who have sought or received support for drug and or alcohol use. The language used seeks to reflect the self-reported experience of clients who seek support.
SHS clients aged 10 and over are considered to have problematic drug and/or alcohol use if, at the beginning of or during support, the client provided any of the following information:
- recorded their dwelling type as rehabilitation facility
- required drug or alcohol counselling
- were formally referred to the SHS agency from an alcohol and drug treatment service
- had been in a rehabilitation facility or institution during the past 12 months
- reported problematic drug, substance or alcohol use as a reason for seeking assistance or the main reason for seeking assistance.
The identification of clients with problematic drug and/or alcohol use may be current or recent – referring to issues at presentation, just prior to receiving support or at least once in the 12 months prior to support.
For further information, see Technical notes.
Source report | Time periods | Contents |
|---|---|---|
2011–12 onwards | Summarises the characteristics of clients receiving support from specialist homelessness services throughout financial years, including the services requested, outcomes achieved, and unmet requests for services. | |
July 2017 – end of last quarter | Monthly data on the number of clients supported each month since July 2017. | |
2015–16 | Longitudinal analyses undertaken for a group of SHS clients (aged 18 and older) with problematic drug and/or alcohol use from 2015–16. These analyses examine SHS service use patterns for this group of clients for a period of 4 years before and after 2015–16. | |
2011–12 onwards | Customisable demographic data cubes. | |
| 5. People with a history of specialist homelessness support who have died | 2012–13 to 22–23 | Feature analysis on deaths among people with a history of SHS support anytime since 2011–12 who died. |
Other reports
Alcohol, tobacco & other drugs in Australia – Priority populations, People experiencing homelessness.
AIHW (2016) Exploring drug treatment and homelessness in Australia: 1 July 2011 to 30 June 2014, AIHW, Australian Government, accessed 27 Aug 2025.
AIHW (2025a) People who received specialist Alcohol and Other Drug Treatment Services in their last year of life, AIHW, Australian Government, accessed 17 June 2025
AIHW (2025b) Specialist homelessness services annual report 2023–24, AIHW, Australian Government, accessed 14 May 2025.
Barry R, Anderson J, Tran L, Bahji A, Dimitropoulos G, Ghosh M and Seitz D (2024) Prevalence of mental health disorders among individuals experiencing homelessness: a systematic review and meta-analysis, JAMA psychiatry, 81(7), 691-699, accessed 14 May 2025.
Coombs T, Abdelkader A, Ginige T, Van Calster P, Harper M, Al-Jumeily D and Assi S (2024) Understanding drug use patterns among the homeless population: A systematic review of quantitative studies, Emerging Trends in Drugs, Addictions, and Health, accessed 14 May 2025.
Flatau P, Lester L, Seivwright A, Teal R, Dobrovic J, Vallesi S, Hartley C and Callis Z (2021) 'Ending Homelessness in Australia: an evidence and policy deep dive', Centre for Social Impact, Crawley.
Flatau P, Tyson K, Callis Z, Seivwright A, Box E, Rouhani L, Lester N, Firth D and Ng S-W (2018) ‘The State of Homelessness in Australia’s Cities: A Health and Social Cost Too High’, Centre for Social Impact, The University of Western Australia, Perth.
Johnson C and Chamberlain G (2008) ‘Homelessness and substance abuse: which comes first?’ Australian Social Work, 61(4).
Lalor E (2020) ‘Inquiry into Homelessness in Victoria: Submission to Legal and Social Issues Committee Legislative Council Parliament of Victoria’, North Melbourne, Vic: Alcohol and Drug Foundation.
McVicar D, Moschion J and van Ours JC (2015) ‘From substance use to homelessness or vice versa?’, Social Science & Medicine, 136, pp.89-98, accessed 14 May 2025.
Nilsson SF, Nordentoft M and Hjorthøj C (2019) ‘Individual level predictors for becoming homeless and exiting homelessness: A systematic review and meta-analysis’, Journal of Urban Health. vol. 96 issue 5, pp. 741-50.
Pawson H, Parsell C, Clarke A, Moore J, Hartley C, Aminpour F and Eagles K (2024) ‘Australian Homelessness Monitor 2024’, UNSW City Futures Research Centre, Sydney, accessed 14 May 2025.
Rizzo D, Mu T, Cotroneo S and Arunogiri S (2022) 'Barriers to accessing addiction treatment for women at risk of homelessness', Frontiers in Global Women's Health, 3, 795532, accessed 14 May 2025.
Scutella R, Chigavazira A, Killackey E, Herault N, Johnson G, Moshcion J and Wooden M (2014) ‘Journeys Home Research Report No. 4 Findings from Waves 1 to 4: Special Topics’. University of Melbourne.
Vallesi S, Tuson M, Davies A and Wood L (2021) ‘Multimorbidity among People Experiencing Homelessness–Insights from Primary Care Data’, International Journal of Environmental Research and Public Health, vol. 18, issue 12, p. 6498.