Alcohol, tobacco & other drugs in Australia

Key findings

View the People experiencing homelessness fact sheet >

The most recent data from the census of population and housing show that there were approximately 122,000 people experiencing homelessness in Australia on Census night 2021 (10 August). This is a rate of 48 people for every 10,000 population and includes people who were in:

• improvised dwellings, tents or sleeping out
• supported accommodation for the homeless
• temporary accommodation in other households
• boarding houses
• other temporary lodgings
• in severely crowded dwellings (those requiring 4 or more extra bedrooms to accommodate them adequately) (ABS 2023).

The Journeys Home project (a longitudinal survey of Australians), found that of those people who had experienced housing instability or homelessness, risky use of substances was also reported for alcohol (57%), illicit drug use (39%) and the injection of drugs (14%) in the previous 6 to 12 months (Scutella et al. 2014).

Research from homelessness services in Melbourne showed that 43% of the homeless population reported that they had alcohol and other drug use problems. Of these, one-third reported that they had these problems prior to becoming homeless, with the remaining two-thirds reporting that they developed problems with alcohol and other drugs following homelessness (Johnson & Chamberlain 2008). The duration of substance use problems is often prolonged in the homeless population, because their social networks may perpetuate their alcohol and other drug problems.

Specialist homelessness services

Specialist homelessness services (SHS) are delivered by non-government organisations and include specific services for those people seeking housing as well as other services that assist them to maintain housing. These include people who experience alcohol and/or other drug issues.

The Specialist homelessness services annual report 2022–23 found:

• 8.6%, or over 23,500 SHS clients aged 10 and over, reported problematic alcohol and/or drug use.
• 79% of clients with problematic alcohol and/or drug use in 2022–23 were returning clients (having previously been assisted by a SHS agency since 2011), compared with 63% of all clients (AIHW 2023).

The following Figure SUB.1 is from the Specialist homelessness services annual report 2022–23.

Figure SUB.1: Key demographics, clients with problematic drug and/or alcohol use, 2022–23

Of the 23,500 SHS clients who reported problematic alcohol and/or drug use in 2022–23:

• 3 in 4 (75%) clients were aged under 45 years (AIHW 2023, Table SUB.1).
• Of those who needed accommodation (18,900), 3 in 5 (61%) were provided accommodation while a further 14% were referred to another agency (AIHW 2023, Table SUB.2).
• Over 1 in 6 (18%) clients were sleeping rough (no shelter or improvised/inadequate dwelling) when they sought services and around 1 in 8 (12%) exited services sleeping rough (AIHW 2023, Table SUB.3).
• Around 1,100 (4.7%) clients were formally referred to a SHS agency by an alcohol and drug service (AIHW 2023, Table SUB.7).
• 43% had a current mental health issue, 8% had experienced family and domestic violence and 32% experienced both vulnerabilities (AIHW 2023, Table CLIENTS.47).

Tobacco smoking

The general health status of the people experiencing homelessness tends to be poorer than the general population.

• In the absence of national smoking rates for people experiencing homelessness, a study in Melbourne from 1995–96 found that 77% of people who were experiencing homelessness were smokers and this increased to 93% for those people experiencing homelessness who were sleeping rough (living on the streets) (Kermode et al. 1998).
• Studies have shown that people experiencing homelessness may adapt their smoking behaviours in order to save money, thus exposing themselves to greater health risks. This can include sharing cigarettes and smoking from used cigarette butts or filters (Okuyemi et al. 2006).
• The Journeys Home data showed that an average increase in consumption of one cigarette a day increased the risk of experiencing homelessness by 0.2% (Johnson et al. 2015).

Alcohol consumption

Research has found that problematic alcohol consumption is associated with homelessness.

• The Journeys Home data showed that an average increase in alcohol consumption of one drink a day, increased the risk of experiencing homelessness by 0.2% (Johnson et al. 2015).
• Around 2.9% (7,900) of SHS clients reported that they had sought assistance for problematic alcohol use in 2022–23, a similar proportion to previous years (AIHW 2023, tables SUB.2 and CLIENTS.9).
• Among those who received specialist alcohol and other drug treatment services, alcohol was the principal drug of concern (40.4%) for people who sought support from both SHS and alcohol and other drug (AOD) treatment services. This was slightly higher than those who had not sought assistance for homelessness (AIHW 2016, Table S1.1).

Illicit drugs

Regular drug use is correlated with entries into homelessness (Johnson et al. 2015). In 2022–23, around 8.6% of clients (23,500) who sought assistance from SHS reported problematic drug or substance use (AIHW 2023).

The Illicit Drug Reporting System (IDRS) is an annual survey of people across Australia who regularly inject illicit drugs (Sutherland et al. 2023). Of the 820 participants interviewed in 2023, over one-quarter (27%) reported that they were homeless (that is, current accommodation was no fixed address, shelter/refuge or boarding house/hostel). This is stable when compared to 2022 (26%). 

In 2023, Melbourne (34%), Brisbane/Gold Coast (31%) and Hobart (27%) had the highest proportion of respondents reporting homelessness, while Canberra (22%), Perth (20%), Adelaide (19%) and Sydney (16%) had the lowest. Homelessness data in the 2023 IDRS was not available for Darwin due to a small sample size (Sutherland et al. 2023, Table 1). 

IDRS data collection for 2023 took place in June and July. Changes due to the impacts of COVID-19 resulted in IDRS interviews in 2020–2023 being delivered face-to-face as well as via telephone and videoconference. All interviews prior to 2020 were delivered face-to-face, this change in methodology should be considered when comparing data from the 2020–2023 samples relative to previous years.

Health and harms

For clients with problematic alcohol and/or other drug use, additional vulnerabilities such as mental health issues, may make them more vulnerable to homelessness. In 2022–23, 43% (or 10,200) clients with problematic drug and/or alcohol use also reported a current mental health issue and 32% (almost 7,600) reported a current mental health issue and experiencing family and domestic violence (AIHW 2023, Table CLIENTS.47).

Treatment

Research has shown that there is often overlap between drug and alcohol misuse and homelessness (AIHW 2016). The Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) collects information on treatment provided to clients by publicly funded alcohol and other drug treatment services, yet it does not collect information on the client’s experience of homelessness.

To better understand the characteristics of those experiencing homelessness and alcohol and other drug issues, a recent study linked the AODTS NMDS to the SHS data collection (AIHW 2016). The key findings demonstrate that the homeless population experiences additional complexities. Specifically, clients who had sought assistance from both SHS and AODTS:

• had lower rates of unemployment (6%), compared to 13% of SHS-only clients
• comprised a higher proportion of Indigenous Australians (27%) compared to 13% of AODTS only clients
• sought treatment for multiple drugs (18%), 3 times higher than the AODTS only population
• had poor AOD treatment and housing outcomes compare to the AODTS-only and SHS-only populations.

Of those who had sought assistance for both homelessness and AOD treatment, the most common principal illicit drugs of concern (the main substance that the client sought treatment for) were cannabis (28.6%) and amphetamines (20.5%) (Figure HOME1).

Persons who sought assistance from both SHS and AODTS were twice as likely to report heroin as a principal drug of concern (11.3%) compared to 5.7% for AODTS only (AIHW 2016, Table S1.1).

Figure HOME1: Principal drug of concern, by matched AODT and SHS clients and AODT only clients (percent)

View data tables >

Policy context

The National Housing and Homelessness Agreement

From July 1 2018, the National Housing and Homelessness Agreement (NHHA) replaced the National Partnership Agreement on Homelessness and the National Affordable Housing Agreement (supported by the National Affordable Housing Specific Purpose Payment). The NHHA is a multilateral national agreement and its objective is to contribute to improving access to affordable, safe and sustainable housing across the housing spectrum, including to prevent and address homelessness, and to support social and economic participation (CFFR 2018).

The Federal Government in partnership with states and territories to outline priority homelessness cohorts and policy areas that must be addressed in homelessness strategies (CFFR 2018). The NHHA has a focus on policy areas that include achieving better outcomes for people, early intervention and prevention, and commitment to service program and design. The priority homelessness cohorts identified in the NHHA include:

• women and children affected by family and domestic violence
• children and young people
• Indigenous Australians
• people experiencing repeat homelessness
• people exiting institutions and care into homelessness
• older people.

Other priority homelessness cohorts may be identified with states in their respective bilateral schedules.

Whilst there is not a specific reference to those persons experiencing alcohol and other drug related problems and homelessness, some of the key groups will be likely to include this population.