Behavioral health challenges both contribute to and are exacerbated by homelessness. To better understand behavioral health and homelessness, we examined data from the California Statewide Study of People Experiencing Homelessness. Our latest report examines the relationship between homelessness, substance use, and mental health, providing critical insights for policymakers, program leaders, Continuum of Care leaders, and healthcare systems.
Key Findings
- Nearly half (48%) of people experiencing homelessness in California have complex behavioral health needs—regular drug use, heavy drinking, hallucinations, or recent psychiatric hospitalization.
- About one-third (35%) report regular drug use; 42% reported that they began to use regularly after the first time they experienced homelessness.
- Methamphetamine (32%) is the most common drug used, followed by opioids (11%) and cocaine (3%).
- More than one in four (28%) people with regular drug use or heavy alcohol use sought treatment during their current episode of homelessness but couldn’t access it.
We thank the California Health Care Foundation (CHCF) for supporting this work.

Resources
Related Resources
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Press Release
New UCSF BHHI Report Examines the Relationship Between Homelessness and Drug Use
March 19, 2025
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Press Release
New UCSF BHHI Report Examines the Relationship Between Homelessness and Drug Use
March 19, 2025
The University of California, San Francisco Benioff Homelessness and Housing Initiative (BHHI) today released a report that examines the issues of homelessness and behavioral health (substance use and mental health) and makes recommendations for policymakers and practitioners.
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Videos
Webinar: Behavioral Health & Homelessness: Findings from CASPEH
March 20, 2025
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Homelessness and behavioral health issues (mental health and substance use) are intertwined. The UCSF Benioff Homelessness & Housing Initiative held a webinar about this complex bidirectional relationship, along with solutions to this crisis. Margot Kushel, MD, Claudine Sipili, Darrell Steinberg, JD, and Stephanie Welch, MSW, discussed findings from the California Statewide Study of People Experiencing Homelessness (CASPEH), highlighted key policy recommendations, and answered audience questions. Marc Dones moderated the webinar.
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Our Research
Illicit Substance Use and Treatment Access Among Adults Experiencing Homelessness
JAMA
February 19, 2025
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Our Research
Illicit Substance Use and Treatment Access Among Adults Experiencing Homelessness
JAMA
February 19, 2025
Most people experiencing homelessness in California are not regular drug users — and for some, substance use begins or worsens after losing housing. Some use drugs to stay awake and safe, coping with the trauma and danger of life without shelter.
At the same time, many who want treatment can’t get it.
This paper uses data from the California Statewide Study of People Experiencing Homelessness to show a comprehensive, representative look at substance use, overdose risk, and unmet treatment needs among people experiencing homelessness in California.
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