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.

A landmark study by UCSF Benioff Homelessness and Housing Initiative (BHHI) paints a different picture on people experiencing homelessness in California. Researchers at BHHI sought to capture the experiences of all people aged 18 years and older who experience some form of homelessness in California. "It took a lot of time and was a lot of work, but we wanted to be able to show policymakers what this issue looks like instead of just giving them more numbers to look at," said Margot Kushel, MD, the study’s principal investigator and director of UCSF’s Benioff Homelessness and Housing Initiative.

Hosted by the California Partnership to End Domestic Violence (the Partnership), lead researcher Anita Hargrave, MD, UCSF BHHI Policy Director Tiana Moore, PhD, and CPEDV staff dove deeper into policy recommendations and solutions that arose from the California Statewide Study of People Experiencing Homelessness (CASPEH) findings on the intersection of intimate partner violence and homelessness. The webinar featured an in-depth discussion of local and state opportunities, as well as funding and programmatic policy recommendations for advocates, policymakers, and other decision-makers.

A special report on the relationship between intimate partner violence and homelessness in California by the UCSF Benioff Homelessness and Housing Initiative, found that 1 in 5 women who become homeless in California flee their homes to escape violence. Participants described the need to plan their exit in advance and to accumulate resource; however, of those who experienced intimate partner violence in the 6 months prior to homelessness, only 12% sought help from a domestic violence organization. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Some people honestly had no idea what is a domestic violence shelter. Other people told us when they had to run, they had to run. They didn’t have time to figure out where to find a shelter."

Domestic violence is a major but often overlooked driver of homelessness in Los Angeles, with 44% of unhoused women citing it as the primary cause, according to a 2023 Urban Institute survey. Yet, LA’s survivor support system is severely underfunded—only 10% of those seeking shelter secure a bed. A UCSF BHHI study found that 60% of survivors who fled abuse end up sleeping in cars, tents, or the streets, where they remain vulnerable to further violence. Experts and advocates warn that without integrating domestic violence services into homeless support systems—and vice versa—thousands will continue to face impossible choices and unsafe conditions.

With modern home prices out of reach for many California residents on fixed incomes, older adults have become the fastest-growing segment of the unhoused population across the state, according to new research from UCSF. California makes up 30% of the nation’s unhoused population and is home to half of all the country’s unsheltered population, according to the landmark study, which looks at how people in the Golden State become unhoused, experience homelessness, and exit homelessness. Nearly half of all unhoused adults in the study were age 50 or older, and Black and Native American residents were “dramatically overrepresented,” the study shows. “The results of the study confirm that far too many Californians experience homelessness because they cannot afford housing,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative and principal investigator of the landmark study.

A new UCSF BHHI study challenges misconceptions about drug use among people experiencing homelessness in California. While only 37% of homeless individuals regularly use illicit drugs, lifetime use is high, and 27% began using after losing housing. The study highlights the difficulty of accessing treatment, with only 7% receiving care and 1 in 5 actively seeking help but unable to get it. Margot Kushel, MD, emphasized the complex relationship between drug use and homelessness, stating, “People are telling us that it helps them survive,” she said. “It keeps them awake and alert. They are using it either because they are traumatized, they have been assaulted, they are afraid or depressed, using it as coping to make it all go away.”

The California Statewide Study on People Experiencing Homelessness is the largest representative study on homelessness since the 1990s. The research highlighted crucial aspects of homelessness and debunked several myths. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative and principal investigator of the landmark study emphasized the urgent need for a national effort to combat homelessness, building upon the insights gained from the California study.

Loneliness is often more common in older adults and those who face structural vulnerabilities, including those who experience homelessness. In the United States, 48% of single homeless adults are 50 and older. There is a limited information about loneliness among older adults who have experienced homelessness. This study used qualitative data collected as part of a longitudinal mixed-methods study, Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME). The study aimed to examine the intersection between social isolation, functional and cognitive impairment, and use of supportive services among a cohort of older adults experiencing homelessness in Oakland, California. Researchers found that homeless-experienced older adults with cognitive or functional impairments exhibited diverse loneliness experiences.

Everyday 171,000 people experience homelessness in California; in rural areas, in urban areas, throughout California. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative and lead investigator spoke with the host of the California Sun podcast, Jeff Schechtman, about the recent study released by the UCSF Benioff Homelessness and Housing Initiative. When speaking about root causes, Dr. Kushel said, "The root cause comes back to just housing. It is right there in the name, to be homeless is to not have a home". 

The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. This study aimed to describe the access to and use of mobile phones, computers, and the Internet among a cohort of 350 homeless adults over the age of 50 years. Researchers found that participants with phones used them for social support and communication with healthcare providers; however, few had annual phone contracts.

A guest column by Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and Kevin Prindiville, JD, looks at the rise in homelessness among people older than 50: “With rising housing costs, fewer pensions, and a fraying safety net, many older adults are one crisis away from losing the roof over their head.”

Among people experiencing homelessness in California, the group rising the fastest by proportion is older adults. A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness highlights their experiences during homelessness, and what impacted their return to permanent housing. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The dramatic rise in homelessness among older adults has severe consequences for the health and safety of those who experience it and for our society at large. Now is the time for investments in real solutions to prevent and end homelessness among this vulnerable population."

Among people experiencing homelessness in California, nearly half of the population is now over the age of 50. By 50, a homeless person’s health more closely resembles that of someone in their 70s, with a higher chance of chronic disease, mobility issues, and cognitive decline, according to a recent special report released by the UCSF Benioff Homelessness and Housing Initiative on older adult homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We could meaningfully reduce the number of people experiencing homelessness if we focused on this group."

The homeless population in the United States is aging, however, there is limited studies on the neurologic etiologies of cognitive impairment in this population. Researchers observed a wide range of focal neurological deficits in the study participants, most notably deficits in cranial nerve function, motor function, coordination, and peripheral sensory functions. This study lays the foundation for the development of a longitudinal study of neurocognitive health among unhoused older adults in San Francisco.

A landmark study by UCSF Benioff Homelessness and Housing Initiative (BHHI) paints a different picture on people experiencing homelessness in California. The report released in June 2023, examines the demographics of people experiencing homelessness in California, how people enter and experience homelessness, factors that block or enable a person’s return to housing, and policy recommendations.

Homeless people in California are already a vulnerable group, often struggling with poor health, trauma and deep poverty before they lose their housing, according to a new study on adult homelessness. The study attempts to capture a comprehensive picture of how people become homeless in California, and what impeded their efforts at finding permanent housing. Researchers at the UCSF Benioff Homelessness and Housing Initiative hope that the study will strengthen public support for policies that focus on offering housing and emergency rental assistance—rather than policies emphasizing punishment or stigma. “People are homeless because their rent is too high. And their options are too few. And they have no cushion,” said Margot Kushel, MD, UCSF's BHHI director and lead investigator. “And it really makes you wonder how different things would look if we could solve that underlying problem.”

People experiencing homelessness in California are already a vulnerable group, often struggling with poor health, trauma, and deep poverty before losing their housing. Margot Kushel, MD, the study's principal investigator and director of UCSF’s Benioff Homelessness and Housing Initiative spoke with KTVU news about the key findings and recommendations. Dr. Kushel said, "These are not folks coming into California once they are homeless. They are our neighbors, our friends, our community members."

Homeless people in California are already a vulnerable group, often struggling with poor health, trauma and deep poverty before they lose their housing. Lead investigator of the new study, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, spoke with KTLA's the reports findings. Dr. Kushel said, "the main drivers of homelessness are deep poverty."

The University of California, San Francisco Benioff Homelessness and Housing Initiative (BHHI) today released a report that examines Latine Californians' experiences of homelessness and makes recommendations for policymakers and practitioners.

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.

Existing literature on people experiencing homelessness (PEH) draws on non-representative samples from service providers, populations with comorbidities, or areas with disproportionately high sheltered homelessness, leading to bias. Nearly a third of PEH in the US and over half of unsheltered PEH live in California. Researchers from the UCSF Benioff Homelessness and Housing Initiative designed a rigorous state-representative survey of PEH to investigate the antecedents of homelessness, understand health, and inform policy solutions. This is the first large representative study of PEH, beyond a single county, to draw inference on a large population that did not depend on service utilization.

The prevalence of tobacco use among populations experiencing homelessness is between 60% and 80%. In this qualitative study, researchers examined attitudes toward tobacco control policies among older African American homeless-experienced smokers. Researchers identified seven major themes from their in-depth semistructured interviews. They found that older African American homeless-experienced smokers face significant barriers to smoking cessation.

People experiencing homelessness have inadequate resources for regular dental hygiene and a higher prevalence of risk for tooth loss, including smoking and substance use. This study aimed to describe the prevalence of and factors associated with oral health measures in a sample of older homeless adults in Oakland, CA. Researchers conducted a cross-sectional analysis of data from a population-based study of 350 homeless adults aged ≥50. They found that tooth loss and oral pain are highly prevalent in older homeless adults.

Little is known about pathways to homelessness among older adults. In this study, researchers interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling. Participants reported current health and functional status, including recent mental health and substance use problems. Researchers found that the life course experiences and current health and functional status of individuals with first homelessness before age 50 differed in key ways from those whose first homelessness occurred later.