In a classic example of too little, too late, the U.S. Department of Housing and Urban Development (HUD) just released its Annual Homelessness Assessment Report (AHAR), reporting a shocking 18% increase in homelessness — in 2023. The report is based on a physical count of homeless persons in shelters and on the streets in January 2024. Why it takes until January 2025 to get the top-line number is a mystery.

The problem with reporting on 2023 homelessness in 2025 is that it gives those responsible for assisting the homeless wiggle room to say, that was years ago. No doubt they have improved dramatically since those surveys were conducted. The 2025 survey is being conducted right now. Wouldn’t it be great if I could report the top-line number to you next week, instead of a year from now?

The other mystery is the lack of discussion of substance use disorders or mental health disorders in the AHAR report. The only time they are mentioned is in the definition of “disability,” which includes:

A physical, mental, or emotional impairment, including an impairment caused by alcohol or drug abuse, post-traumatic stress disorder, or brain injury…

In the 117-page “Report to Congress,” that is the only time the words “alcohol” or “drug” appear in the document. The omission so outraged conservative talk show host, Jason Rantz, that he cut loose an opinion piece referring to AHAR as “a complete joke,” adding,

Somehow, […] the HUD report completely missed addiction — whether to alcohol, opioids, methamphetamine, or another substance — as a major driver of homelessness. Mental health crises often compound the issue. Yet HUD couldn’t be bothered to offer even a passing reference to these issues…

It would be one thing if AHAR just limited itself to counting the sheltered and unsheltered homeless, and providing as much demographic information as they can gather such as age, gender, race, citizenship, veteran status, etc. The report, however, speculates on the causes of the increase in homelessness, blaming housing costs and immigration and completely ignoring the opioid epidemic.

Much has already changed since this survey was conducted. The year 2023 was the peak year for overdose deaths and hospitalizations in the U.S.; they have declined every month since. Interest rates also peaked in 2023 — a major factor in housing costs. In blaming housing costs and immigration, HUD chooses to ignore that more than half of those experiencing homelessness suffer from substance use disorders and/or mental health disorders that make it nearly impossible for them to stay employed.

Rantz criticizes the HUD policy of focusing on “housing first,” and failing to insist on addiction treatment as a condition for housing. However, addicts without housing find it nearly impossible to sustain a substance use treatment program. The numbers show that “homelessness becomes much more rare starting at age 65, as individuals become eligible for more income support…”

The very best way to treat severe drug addiction is to house addicts and pay them for clean pee tests and to attend counseling sessions. That program is called “contingency management,” and it probably drives conservatives like Jason Rantz nuts because it involves paying addicts to get better. Yet it works and it’s less expensive than incarcerating the homeless or burying them when they die. 

Seattle is engaged in a pilot test of contingency management now. Wisconsin’s Medicaid program in February will start offering “help with housing for members with substance use or other mental health conditions.” Hopefully, we won’t have to wait years to get the data on how well these programs are performing.

Written by Steve O’Keefe. First published January 7, 2025.

Sources:

“The 2024 Annual Homelessness Assessment Report (AHAR) to Congress,” U.S. Department of Housing and Urban Development, December 2024.

“HUD homelessness report an absolute joke by ignoring drugs, mental health,” 770KTTH Conservative Talk Radio, Dec 29, 2024.

“What’s Behind the Unprecedented Rise in Homelessness, and How Can We Reverse It?,” Center on Opportunity and Social Mobility, December 30, 2024.

“Medicaid provides new housing help for people struggling with addiction, mental health,” Wisconsin Public Radio, December 30, 2024.

Image courtesy of the U.S. Department of Housing and Urban Development, used under Public Domain.