1.1 Substance Use & Mental Health Interventions for Youth Who Are Homeless: The Community Reinforcement Approach & Motivational Enhancement Therapy

The relationship between mental health, substance use, and homelessness is complex. An estimated 48%–98% of youth who are homeless meet criteria for at least one mental health diagnosis (Hodgson, Shelton, van den Bree, & Los, 2013). Common disorders include depressive disorders, anxiety disorders, posttraumatic stress disorder, psychosis, substance use disorders, and attention-deficit/hyperactivity disorder (Hodgson et al., 2013). Between 69% and 86% meet criteria for a substance use disorder (Medlow, Klineberg, & Steinbeck, 2014). Compared with their housed peers, youth who are homeless have elevated rates of co-occurring substance use and mental health disorders (Hodgson et al., 2013; Kamieniecki, 2001). While mental health disorders and substance misuse can increase the risk of experiencing homelessness, homelessness itself can exacerbate preexisting mental health issues and trigger new psychological symptoms and maladaptive behaviours, such as substance use (Hodgson et al., 2013). Given the limited access that youth who are homeless have to healthy coping mechanisms, substance use may be one of the only ways they have learned to cope with mental health problems and the challenges of homelessness.

Sean Kidd, Natasha Slesnick, Tyler Frederick, Jeff Karabanow, Stephen Gaetz
Publication Date: 
Canadian Observatory on Homelessness Press