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HISTORY

By the 1840s, it was common for Americans to link homelessness with habitual drunkenness. In the popular view, habitual drunkards, usually men, drank up their wages and impoverished their families; they lost their jobs and their houses, and drove off their wives and children by cruel treatment. They became outcasts and drifters and their wives entered poorhouses while their children became inmates of orphanages. By the 1890s, the same logic served to explain the downward, isolated spiral of opiate and cocaine "friends" (as they were called) and the unhappy circumstances of their families.

Until the early years of the Great Depression (which began in 1929), habitual drunkenness, in particular, often was cited as a principal cause of homelessness. Even so, after the financial collapse of 1893 and an ensuing five-year depression of unprecedented severity, most thoughtful observers did not understand heavy drinking or habitual drug use to cause homelessness in any direct manner. Although scholarly studies during the first decades of the 1900s were crude by today's technical standards, their explanations of homelessness were not simple-minded. In fact, they foreshadow today's explanations.

Perhaps most important, pre-Depression students of homelessness noted that the ranks of the dispossessed grew and diminished in close relation to economic conditions. They understood that the profound depressions that haunted the economy long before 1929 caused large numbers of people to lose their grip on security. They noted as well that certain occupations were especially affected by seasonal fluctuations in the demand for labor and by technological change—by the 1920s, agricultural workers, cigar makers, printers, and others had high rates of "structural" unemployment. That is, their jobs had been lost permanently to changes in methods of production and distribution.

These scholars also understood the importance of decisions that employers made about hiring and firing. Workers without families to support and those regarded as the least productive were let go first when the economy soured. Usually, these were single young women assumed able to return to their natal families, married women presumed to be working for "pin money" (people who are today known as secondary wage earners), older men, and in particular, single men known to drink heavily. Minority racial and ethnic status also marked people for layoff. Conversely, in times of high demand for labor, employers relaxed their standards for hiring and job performance. In boom times all but the most seriously disabled, and the most erratic and disruptive heavy drinkers and drug users, could find some kind of work. The ranks of the homeless thus thinned considerably.

Pre-Depression observers also emphasized the impact of working conditions, disability, and the absence of income supports on the creation of homelessness. In an era of dangerous work and widespread chronic disease (especially tuberculosis), large numbers of men, in particular, became substantially disabled, often at a young age. In an era before significant public disability benefits or much in the way of welfare or effective medical treatment, they rapidly became abjectly poor, reduced to begging, soup kitchens, and bedding down in mission shelters or the cheapest, most verminous lodging houses ("flophouses," as they came to be called).

Some of these men were heavy drinkers, and some were habitual drug users, but it was commonly observed that such problems often developed in the context of POVERTY and rootlessness. The miseries and long stretches of boredom endemic to poverty were understood to promote frequent intoxication—even during the Prohibition years (1920-1933), when illicit ALCOHOL could be had by arrangement, as could illicit drugs. Certain "hobo" occupations that virtually demanded rootlessness, and which brought together large groups of men without families, were regarded as especially corrupting and debilitating. Railroad gangers, cowboys, farmworkers, lumberjacks, and sailors, among others, pursued risky occupations and lived in ways that provided both motive and opportunity for dissipation. During the Depression it was widely feared that tens of thousands of homeless young people in the United States would be maimed hopping freights and would learn bad habits on the road that would transform them into lifelong tramps.

Finally, and related to their understanding of homelessness as an insalubrious and demoralizing experience, early observers paid a great deal of attention to the milieu of homelessness, which is to say, the urban areas where homeless people congregated and the constellation of institutions with which they were involved. Commonly called "hobohemias" before the Depression and "skid rows" thereafter, such areas were characterized by a particular way of life and a peculiar set of economic and social resources. They were honeycombed with cheap restaurants, residential hotels and lodginghouses, private and eventually public welfare agencies, and formal and informal labor exchanges that offered casual ("day") work. Skid row (and the segregated satellites that developed in minority communities) was also a world dominated by single men. Such areas were saturated with saloons (later bars) and sex workers. Some were the sites of a vigorous drug trade.

By the 1940s, winnowed by wartime labor demand, skid row was both repository and refuge, mainly for impoverished single men disabled by age, injury, and/or chronic illness. They survived on private charity, meager public welfare allowances, modest pensions, and undemanding work. Note, however, that they were housed. In the most literal sense, skid-row denizens were not homeless, and from the 1940s through the 1970s they were more often described as "unattached" or "disaffiliated." They were homeless in the broader, social sense discussed above. Further, and contrary to the enduring stereotype, the residents of skid row were not usually heavy drinkers or habitual drug users. Although perhaps one-third could be so described, and while public intoxication was common and visible, heavy drinking or drug taking was, as today, the exception not the rule.

With the sustained prosperity of the period between 1941 and 1973, and the simultaneous elaboration of the American welfare stale, many observers believed that skid row would wither away. The older men would die off, or—helped by federal Old Age Security, and later by Medicare, state and federal disability benefits, and subsidized housing—would move to better neighborhoods. Or they would remain on a skid row that would be uplifted and transformed by urban renewal projects and effective rehabilitation programs for heavy drinkers and drug users.

In a limited sense, these optimists were correct. The expansion of the welfare state dramatically improved the economic circumstances of the elderly, and they are greatly underrepresented among today's homeless. Aided by federal funds, some cities bulldozed their skid-row areas, thus causing their bricks and mortar, at least, to disappear. But homelessness did not disappear; instead, it underwent an astonishing and tragic transformation. If literal houselessness is used as the definition and measure of the problem, only the Depression produced the prodigious dispossession we see today.

As opposed to the domiciled isolation of skid row, something like today's houseless poverty was beginning to be reported in news magazines and the occasional scholarly publication as early as 1973. But it was not until the early 1980s that a new generation of younger homeless people achieved widespread notice. At first, most observers were struck by the apparently very high rates of mental illness, heavy drinking, and drug use among those new homeless people. Explanations of the problem tended to point toward nationwide changes in policies that governed commitment to and retention in mental hospitals and incarceration for public drunkenness and minor drug offenses. During the 1960s and 1970s many states "deinstitutionalized" both mentally ill people and "alcoholics" and "addicts." That is, state hospital patients were discharged in wholesale fashion, and new commitment laws made initial involuntary commitments difficult; they severely limited the duration of involuntary treatment. Many states also "decriminalized" public drunkenness, referring public inebriates to places where they could sober up rather than housing them in jail for thirty days to six months. Similarly, many minor drug offenders were diverted from jails. During the early 1980s many observers, notably those within the Reagan administration, characterized the resurgence of homelessness as a problem related to mental disorder, excessive drinking, habitual drug use, and the new policies that kept people with such problems from their customary lodgings in state hospitals and county jails. Homelessness was described mainly as a problem in the rehabilitation and control of troubled and troublesome people who were not only houseless but barred from their traditional institutional shelters and estranged from family and friends who might take them in.

CURRENT VIEWS

Although not discounting this view entirely, most scholars now find it too simple and not supported by the evidence. Although some popular treatments of the subject continue to claim that perhaps 85 percent of homeless people are substance abusers and/or mentally ill, such huge figures are drawn from old studies and that were seriously flawed by two related methodological problems. The first requires little explanation: These studies for their estimates relied on lifetime rather than current measures of problems. In any group not in treatment or recently discharged, a lifetime measure (a determination of whetehr a person has ever had a sever mental illness or substance-use disorder) will always produce much higher prevalence rates than a measure of current disorder (customarily defined as present within the previous six months or one year).

The second problem is a matter of how homeless respondents were sampled for these studies and concerns the distinction epidemiologists make between "point prevalence" and period prevalence." The first term refers to counts of some condition conducted at a single moment in time (a snapshot), whereas the latter refers to counts taken over some expanse of time (a motion picture). Longitudinal ("period") counts of homeless people will produce much higher numbers than cross-sectional ("point-in-time") enumerations, for many more people are homeless during a year than on a given night. To the extent that people without problems of substance abuse and mental illness move out of homelessness more rapidly than those who suffer from then, they will be overrepresented in snapshot studies because they are more likely to be counted. Recent longitudinal studies demonstrate conclusively that a fairly small group of people with very high rates of disorder (usually single men under forty years old) account for a very large percentage of "shelter nights" in most cities. Since most studies of homeless populations conducted in the 1980s sampled from shelters on a cross-sectional basis, their estimates of substance abuse and mental illness were correspondingly inflated.

With these caveats in mind, it is probably fair to say that among all adults homeless during the previous year, something like half had a substance-use disorder or a major mental illness, alone or in combination. These rates are substantially higher among single men and significantly lower among adults who are homeless in family groups, most often single women.

Even so, sound prevalence estimates do not explain the casual relationship between homelessness and substance abuse and mental illness. Clearly, most people with such problems never become homeless. To explain why some do, current scholarship has returned—often unwittingly—to themes first sounded a century ago: the relationship of homelessness to changes in the economy and the nature and supply of housing; to the availability (or "coverage") and sufficiency of income supports and medical care; and to the tolerance and support capacity of kin. Heavy drinking, habitual drug use, and mental illness are considered in this larger context. Such problems are understood to be among many "risk factors" which make it more likely that some people will become homeless repeatedly or remain so for a long time. Moreover, current scholars are concerned increasingly with how such experience wears people down, introduces or rekindles bad habits or poor health, and makes "exits" from homelessness less likely or short-lived.

Briefly and simply, current scholarship suggests the following relationship between homelessness and heavy drinking and habitual drug use.

The problem of poverty has worsened considerably since the mid-1970s. Changes in the economy have added high-skill, well-paid technical jobs and low-skill, poorly paid service positions, but these changes have simultaneously produced job losses among semiskilled but highly paid workers, primarily in manufacturing. This process of "deindustrialization"—the historic passage from a manufacturing to a service economy—has been especially hard on those younger members of the huge baby-boom birth cohort (boomers are those born between 1946 and 1964), especially Hispanics and African Americans, who have entered a glutted labor market without the advantage of prolonged higher education or advanced technical training.

At the same time, the 1980s brought startling inflation in rental housing costs and a steep decline in the inflation-adjusted value of federal and state welfare benefits and unemployment insurance. In consequence, poor people had an increasingly difficult time forming independent households and poor families became increasingly hard put to support dependent adult members. On top of this and simultaneously, the stock of America's most rudimentary housing, the old hotels and lodginghouses of skid row and similar areas, was decimated by urban renewal.

The baby boom's maturation was crucial in another way. Although there is no good evidence that the combined rate of persistent and severe mental disorder, heavy drinking, or habitual drug use is significantly higher among boomers, neither is there any evidence that it is substantially lower than in previous birth cohorts. However, if a roughly constant rate (similar percentage) is applied to a much larger population, the resulting prevalence of a problem is of much greater magnitude—the numbers are much larger. Therefore, as huge numbers of boomers reached the age of greatest risk for the development of enduring mental-health, alcohol, and drug problems (roughly eighteen to twenty-five years old), the cohort generated an unprecedented number of such casualties. This situation developed just as conditions of material scarcity were becoming acute and the old policies of institutional containment were being dismantled.

Ironically, the unprecedented, sustained economic growth of the 1990s aggravated the problem of homelessness. As the decade wore on, shelter counts rose all over the country. In some part, this was because the general prosperity of the 1990s had little effect in the lowest reaches of the income distribution from which homeless people come, and cutbacks in federal, state, and local welfare eligibility compounded the problem. Further, rapid ecomonic expansion tends to have a significant inflationary effect on rents. Indeed, for the poorest 20 percent of American households, rents increased faster than incomes between 1995 and 1997. Moreover, the number of units renting renting for $300 per month (in inflation-adjusted dollars) decreased by 13 percent from 1996 to 1998, resulting in the loss of almost one million such units nationwide. At the same time, the number of households assisted by subsidies from the Department of Housing and Urban Development dropped by 65,000 between 1994 and 1998. In sum, the crisis in affordable housing became worse during the great boom.

CONCLUSION

Poor people have been badly squeezed since the early 1970s. As a consequence, perhaps 3 percent of all American adults, about 5.5 million people, experienced at least one spell of homelessness between the beginning of 1985 and the end of 1990. Some, however, experience frequent and prolonged episodes of homelessness, and it is among these people that rates of heavy drinking and habitual drug use are very high. It is not simply the case, however, that their drinking and drugging have caused their homelessness. The health problems and troublesome behavior often associated with such habits may have played an important role in job loss, familial estrangement, or displacement from housing—but this is not a new phenomenon, as we have seen.

Now, though, the absorptive mechanisms of earlier generations have gone awry. Deinstitutionalization has been a factor in this breakdown, mainly because its presumed consequence of community care never has been equal to the unprecedented generational need. Nonetheless, more important factors in the creation of widespread houseless poverty among heavy drinkers and habitual drug users have been the disappearance of casual labor, the erosion of public benefits and the capacities of kinship, and the virtual destruction of the tough but viable refuge of skid-row housing. In 1970, impoverished heavy drinkers and habitual drug users could almost always find some port in the storm, often by moving from one decrepit hotel to another, frequently pooling resources to rent a room by the week. Since the 1980s, they can no longer. Thus they have become a large and highly visible proportion of those who inhabit our public places and persist in our shelters month after month.

(SEE ALSO: ; Alcohol- and Drug-Free Housing; Halfway Houses; Treatment: History of in the U.S.)

JIM BAUMOHL