Effectiveness of Substance Use Interventions for Individuals Experiencing Homelessness

Introduction: Substance use is a significant public health concern that is particularly prevalent among individuals experiencing homelessness. This literature review examines the effectiveness of various substance use interventions targeting this population. Methods: A comprehensive search of academic databases was conducted to identify U.S.-based studies, published between 2020 and 2025, that examined substance use interventions among individuals experiencing homelessness. After applying inclusion and exclusion criteria, studies were screened for relevance and quality. The final selection encompassed a range of study designs (e.g., randomized controlled trials, cohort studies, and qualitative research) and diverse intervention strategies (e.g., supportive housing models, harm reduction approaches, and pharmacological treatments). Results: To address the variability of outcomes measured, coding was used to identify commonalities. Three outcome themes were identified: (1) frequency and amount of alcohol and drug use, (2) treatment retention and program adherence, and (3) self-efficacy and participant perceptions. The results demonstrated short-term reductions in substance use and improvements in participant engagement and psychological well-being. However, long-term outcomes were less consistent with reports of high relapse rates, poor treatment retention, and limited program adherence. Conclusions: Given the mixed and inconsistent findings across studies, there is a critical need to explore alternative approaches to treat substance use among homeless individuals. Occupational therapy (OT) is a promising yet underutilized profession in addressing substance use through holistic, meaningful, occupation-based interventions. To develop effective interventions that support sustained recovery, future research should prioritize longitudinal studies that incorporate objective and subjective measures to fully capture the lived experiences of homeless individuals who use substances.