Homeless: The Drug Fallacy Rises (Again)

The state of Hawaii ranks sixth in the nation in homelessness per capita and dead last in drug use and addiction per capita. Ordinarily, such data would be of minor interest. Within the context of a recent widely published OP/ED by Yolo County District Attorney Jeff Reisig and several other purported authorities, however, it’s highly pertinent. Hawaii’s statistics are part of a fact pattern that presents conclusive rebuttals to Reisig’s group’s main claim that, “We can end our [California’s] homeless crisis in one year” by charging, “hard drug possession as a new class of crime called a ‘treatment mandated felony.’”

Reisig et al argue that homelessness is not the result of high housing costs and broken systems of care as many claim. Instead, they say, California leads the nation in per capita homelessness because of lax drug laws. They then cite four states — New Jersey, Maryland, Michigan and Illinois — that have, “much stronger hard drug laws than California.” Their conclusion is that, “Fentanyl, heroin, and other hard drug addictions, and the associated mental health crises that these drugs entail are the root cause of California’s homeless crisis.”

Even though its role as the cause of homelessness had been discredited time and again, drug use remains among the most popular explanations for homelessness and the facts be damned. Nonetheless, if it were true that drug use causes homelessness, we would find strong correlations between drug use and addiction per capita and homelessness. There is no such relationship.

Cheryl Littlefield and ambulance
Elderly homeless woman on streets of Modesto

Of the five states (including Washington D.C.) with the highest rates of drug use per capita, only Washington D.C. is in the top five in homelessness. Michigan, cited by Reisig et al as an example where tough drug laws have reduced homelessness is actually #10 in drug use and addiction per capita, despite its harsh drug penalties.

California, where Reisig  et al say lax drug laws lead to homelessness, ranks #39 in drug use and addiction per capita, which puts in a better position than every one of the states Reisig and company listed with “much stronger hard drug laws” (Illinois is #28, New Jersey #35, and Maryland #36). We’ve already mentioned that Hawaii, is #51 (including D.C.) in the entire nation in drug use and addiction, yet #6 in homelessness.

Reisig et al cite housing costs in an attempt to show they are less a factor in homelessness than drug use. In fact, housing costs have closer correlations to homelessness than drug use. Hawaii leads the nation in housing and rental costs and ranks sixth in homelessness (including Washington D.C.). California, second only to Washington D.C. in homelessness per capita, is second in housing costs to Hawaii and third overall in rental costs. Washington D.C. is third in housing costs and second in rental costs.

Reisig and company don’t discuss housing shortages, but in California, housing shortages are directly relevant to homelessness. California leads the United States in housing shortages at 978,000. That’s over three times the number of the next closest state, which is Texas at 322,000.

Near Modesto Gospel Mission, May, 2023
Near Yosemite Avenue, Modesto, May, 2023

Ironically, Houston, Texas, is often cited as a national model for reducing homeless numbers. Houston’s primary tactic? You guessed it — Houston’s primary tactic for managing homelessness is a “Housing First” model, not harsh drug penalties. In fact, the Houston Coalition for the Homeless argues that,

In the Houston region, 50% of homelessness is caused by an economic crisis (job loss, bills become higher than earnings), debunking common stereotypes that homelessness is overwhelmingly caused by substance use – which actually accounts for less than 10% of homelessness locally.

The plain fact is that if every homeless drug addict in California were to stop using tomorrow, we would still have a housing shortage of almost one million units. Furthermore, even those homeless people with incomes and jobs wouldn’t be able to afford California’s high rental costs, which in 2022 averaged $1586 per month, just behind Hawaii and Washington D.C. All three regions are in the top tier of homelessness per capita.

Arguments like those presented by Reisig et al aren’t just erroneous, they’re harmful. They never establish a causal relationship between drug use and homelessness because they can’t. Instead, they distract from the complex systemic issues that contribute to homelessness by offering specious theories that criminalize the elderly, destitute, disabled, ill, and working poor who make up the greatest proportion of homeless people in California.  It’s hard to say which is the worst offense of such arguments — contriving them in the first place or publishing them.

Eric Caine
Eric Caine
Eric Caine formerly taught in the Humanities Department at Merced College. He was an original Community Columnist at the Modesto Bee, and wrote for The Bee for over twelve years.
Comments should be no more than 350 words. Comments may be edited for correctness, clarity, and civility.


  1. “It’s hard to say which is the worst offense of such arguments — contriving them in the first place or publishing them.” I’d say it’s even worse because the source they used from the Atlantic 6/1/23: AMERICA’S APPROACH TO ADDICTION HAS GONE OFF THE RAILS – By Sam Quinones, is speaking to the fact that if we don’t reform out treatment programs for those folks addicted to Fentanyl they won’t be able to recover, ever!!

  2. There is more than a casual relationship between mental disorders, addiction and homelessness. Please check your facts.
    Dr Brenda Gregory, PsyD

    • Thank you Dr. Gregory. Could not agree more; however, “more than casual” is not causal. Our factual claims are supported by data available through links in the story.

      • I agree Eric. It is evident the homeless problem and the gun violence have a lot in common. They are very useful in fear mongering. Not to say they aren’t bad, but the time honored excuses fall flat in the face of data. Texas for one is a surprise. They actually seem to have a good homeless fixer. Hopefully the data is correct and not manipulated. Being Texas with the gun problem and refusal to admit anything is wrong with their gun, lack of rules, makes me dubious. It isn’t hard to believe drugs are a problem but I doubt that caused all homelessness. Just being on the street and not able to get anywhere except down would cause such anxiety that would lead to a problem of any kind. Old saying, walk in their shoes to be sure. Something like that.

    • Dr. Gregory,

      How many minutes, per office visit, do you spend with your patients, on average, prior to writing them a first prescription? And, ….prior to ordering them a refill, in the event there is a difference?

      The answer to those questions have been a grave matter of concern as to causal relationship, also. Please check that fact.

      Valley Citizens, and Dr. Gregory,

      A number of note worthy books have been the topic of whether or not most drugs, prescribed by PsyDs, are, or ever were, really, working for the so called mentally ill.

      Studies reveal less than 5 minutes spent per patient per visit. That was my observation whenever I had the pleasure of being able to accompany clients to their periodic PsyD appointments. Over and over a scant 5 minutes, in and out, a revolving door.
      While the poor trusting, or, untrusting souls, may not have even received relief from the multiple bottles of psych pills prescribed each and every time.

      The latest DSMs have had, and/or, do have, check the box off categories that are raising eyebrows, and scrutiny, ever more so. Each new category comes accompanied with a list of drugs that can be prescribed. While more and more patients cannot help but roam the streets with no homes in which to reside.

      The longer these mentally challenged human beings, often in drug induced fugues, keep showing up, homeless, the more PsyDs appear suspect. Opinion ops try to persuade otherwise: it can’t be a lack of homes they say it has to be that court enforced drugs will do the trick. After all NIMBY’S do not want these homes anywhere near them. So do not build these homes or they will come.

      Current law is turning against the mentally and emotionally ill homeless, wanting to impose more drugs on them, with little, and/or, especially, no proof any meds actually work, other than to zombie people out. Means of escape. What if someone does not want to exist in a slump?

      They want more local court jurisdiction over them, to appoint guardians with decision making powers over them. So when a PsyD prescribes meds, the mentally challenged will have them court ordered
      upon them. Some may be saying, Yes, Yes, they need that. When in actuality some mean Yes, Yes, we will be rid of them.

      Even the mentally challenged, can tell the numbing effects on them, so many do not faithfully take prescribed meds. Yet they get by. No drug cures
      yet some drugs are favs, enough so, that they have been known to trade off drugs to get the effect they prefer over others.

      Staying on topic, with this post, not one of my mentally challenged clients were homeless. They did live in squalor, which was all they could afford. Some had $15 per month to spend on food, after bills. Which is why I often volunteered to drive them to PsyD sessions and other commonly viewed as necessary places.

      Since rental costs have risen, I am certain some have been cast to the streets. Lack of affordable housing wrestles people to the streets against their wills, be they abled bodied, able minded, disabled bodied, disabled minded, on legal drugs or illegal drugs.

      The same common denominator is no place any longer to call home, that one can afford…

      I know I am weaving in and out here, please bear with me all lose ends will tie together. Whenever I stuck my 2 cents worth in, to inquire about food help, vermin help, cockroach help, as an advocate or Circle of Care friend, I was always promptly told that my client is an adult who could make up his or her own mind, so could do their own asking.

      Circle of Care turned out to be an empty notion bandied about because it sounds full of all good possibility for a client. Keep in mind my clients were mentally challenged and scant Social Workers were all that interested in teaching their clients how to ask for anything that would cost time or effort.
      Circle of Care turned out to lead to a very vicious circle.

      Clients are afraid of their Social Workers, so they prefer no waves be made on their behalf. They state they are afraid that some of their services will be cut. After experiencing the attitude I was on the receiving end of, I can imagine the fear inside clients. Some call it institutionalized, some call it marginalized, some call it penalized, some call it on the reservation, some call it being colonialized. Some call it conservatorship. Some call it entitlement, others call it hell. Some call it names I can’t print here.

      Whatever one calls it, different Agencies interact for each client, or to keep a single client in line. Word gets around. It is easy to be painted a non-team player when on the side of one’s client. No brownie points earned. Instead, wagons circle. Clients can be talked into saying and doing just about anything rather than being found at fault themselves. Surprising how quickly it can all unravel.

      Social Service Agencies and agents are in the habit of mobbing up on people each and every day. That is part of the job. Yes you can. No you can’t. It is a breeding ground for some not so good actors. Yet, the average person would stand back from a distance and think it a very charitable entity. Pray you never have to learn first hand.

      Reader beware, it can be very costly to find your self in a position to need a hand out and a hand up.

      You don’t have to take just my word. Or just the word of a homeless person. After my experience, my research led me to a book. There is a book all about Social Service, Bullying. If I recall correctly, it may be written my a Social Service Administrator.

      Folks, we can do so much better for our fellow mankind, than to stand idly by, while defenseless, mentally, emotionally, bodily challenged human lives dangle over man-made precipices toward where, we all can guess or know, the consequence leads.

      If we do not fill in the cracks they will fall through. We must know where the cracks are hidden that incessantly trip up what could be for the good.

      Demand subsidized housing for the homeless. Demand less subsidies for the rich.

      • Dr. Gregory and Valley Citizens,

        I want to apologize for my error in questioning Dr. Gregory about prescribing meds. She does not prescribe. My bad!

        You all though may very well relate to my deep concern about so many prescribed drugs being ordered for the mentally ill community, and as to whether they are indeed working.

        Again, I sincerely apologize for my error. I am glad to know Dr. Gregory currently does not prescribe or may never prescribe, as her career decisions may or may not change.

        Thank you for your good grace…

  3. The hospitals just keep mainlining that stuff in like it is merely saline water going into the veins. I was hospitalized for the 4th time in the last year. I refuse pain meds. Yet, after the 4th, most recent operation, I felt somewhat queasy, nauseous, drowsy. When I inquired, they had shot my vein up with Fentanyl, without my permission. I could still feel the effects in my system the entire next day. Awful Big Pharma money maker and killer…

    Start reforming the treatment, prior to folks needeng treatment centers. Surely there are other pain med choices doctors and hospitals can use, considering Fentanyl’s propensity to addict. I was absolutely disgusted they pushed that drug on me, then, and still absolutely disgusted, now. My disgust is rising!

    It is in my record, now, NEVER ADMINISTER, FENTANYL!!!!!!!!
    Do you think the doctors will obey my patient’s right? The Head Nurse became rude and inconsiderate when I refused a different medicine known to cause periferal neuropathy to non-diabetics. She even came back to me and accused me of having said something, I had not said, to someone else in the ICU. I did not back down and kept pressing the issue, which she eventually admitted may have been a miscommunication. That was the best she was willing to muster up.

    Why do I introduce all this drama? Specifically, because I am a resourceful person, capable of speaking up for myself
    yet this is what can, and does, happen to weakened people in doctors’ offices and hospitals on a daily basis. Each and every response back is an adamant: “All medicines have side effects. You are not going to find a single medicine that is free of side effects!” Gee, I feel better in their hands…

    Now, picture the thousands of ill people who do not know how to defend themselves or the thousands who do know, but are too sick to expend the energy it takes to penetrate what Big Pharma has brainwashed the Medical field to believe. And the thousands like me who are slipped a dose of Fentanyl.

    We are in a heap of trouble, and do not get me started on the necessary reforms needed in treatment programs. I can speak volumes there too.

    Reisig is quilty of the worst: contriving such arguments, then publishing them, unsupported. Of course, the lack of housing that the impoverished can afford, with subsidies, is the number one (numero uno) cause of homelessness. Break down the word Homelessness. Reisig was not using the term: Homemoreness in his argument!!! Stands to reason there are less homes available.

    The 2008 Crash was prompted by the lack of housing. Studies have brought that fact to the fore. Here we are years later, still refuting people like Reisig. Thank you, Eric Caine, and Frank for your rebuttals.

  4. Want a quick study into what’s happening in the treatment of Mental Health, read ,
    Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness…

    “For more than two hundred years, disturbances of the mind—the sorts of things that were once called “madness”—have been studied and treated by the medical profession. Mental illness, some insist, is a disease like any other, whose origins can be identified and from which one can be cured. But is this true?

    In this masterful account of America’s quest to understand and treat everything from anxiety to psychosis, one of the most provocative thinkers writing about psychiatry today sheds light on its tumultuous past. Desperate Remedies brings together a galaxy of mind doctors working in and out of institutional settings.

    Andrew Scull begins with the birth of the asylum in the reformist zeal of the 1830s and carries us through to the latest drug trials and genetic studies. He carefully reconstructs the rise and fall of state-run mental hospitals to explain why so many of the mentally ill are now on the street and why so many of those whose bodies were experimented on were women.

    Carefully researched, Desperate Remedies is a definitive account of America’s long battle with mental illness that challenges us to rethink our deepest assumptions about who we are and how we think and feel.”

    • Frank,

      I just sent a comment in response to Dr. Gregory. Subject matter was what authors’ books have been
      saying about the Mental Health Crisis and the drugs prescribed for the mentally challenged.
      Like minded people, think alike. I will be looking up the book you spoke about. Thanks!

  5. I was homeless in Honolulu for several years. In my first hand experience it was homelessness that led to drug use far more often than drug use leading to homelessness. This is due to boredom, despair and discouragement. The people who are trying to “solve” the homeless problem need to spend a little more time speaking TO the homeless than they do speaking FOR the homeless.

    • Tx for post Robert. Just to be clear, I can only speak for myself. Since I retired many years ago I’ve not only spent hundreds of hours speaking to homeless folks, helped them in many ways, and advocate frequently for them to the decision makers. The trouble is with the monied folks who make policy via the electeds to influence them to NOT spent their tax dollars on social services. Pretty simple formula actually and also airtight in regards to advocate influences!! An even simpler formula, if you wish, is the reason folks are homeless in the US: they or someone who wants to, can NOT pay the $$ needed to provide a human habitual shelter, then they are considered homeless. One should use HUDs definition of of a homeless person to make this perfectly clear. Or, it’s all about the money to make it real simple….

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