How to Talk About Homelessness & Drugs

Broken Legs and Musical Chairs

I wrote this little parable a few months ago and for some reason, I didn’t get around to publishing it. But I thought it was quite clever! So clever, in fact, that when I ran into Gregg Colburn (author of “Homelessness is a Housing Problem), I told him about it. He reminded me that he tells a nearly identical tale in his book (which I have read). So, while I still think it is clever, it turns out I think Gregg is the clever one and I’m merely an unwitting regurgitator of good ideas that he has buried into my brain.

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Mean Musical Chairs

Imagine an unusual and rather macabre game of musical chairs.

Twelve people play for ten seats. Ten of the twelve players are healthy adults. The remaining two, Billy and Bobby, each just broke both of their legs, and are wracked with debilitating pain.

In this twisted tale, when the music stops, who will have a seat, and who will be on the floor?

The answer is as obvious as it is barbaric. Billy and Bobby’s broken legs make them by far the likeliest to lose.

Why Did Billy and Bobby Lose?

Now, if someone asks us, “what caused Billy and Bobby to lose?”, we might say “their broken legs.”

This is quite right–after all, their broken legs prevented them from getting into chairs on time.

After all, once we know the rules of the game and Billy and Bobby’s condition, we can pretty confidently predict that these two will likely lose. Had they been healthy and whole, both would have had a much better shot.

Moreover, anyone whose encounters were limited to hanging out in this group would also notice that the people sitting on the floor seem to have something in common–their broken legs.

They might reasonably conclude that broken legs are the problem.

And there is something right about that. If the goal behind the question of “what caused Billy and Bobby to lose?” was simply to ask why Billy and Bobby and why not someone else, and we had tired of pondering this perverse little parable, we might just say “broken legs” and be done with it.

A Better Question: Why Did Anybody Lose?

But what if our question about the “cause” of Billy and Bobby’s loss had a different purpose behind it?

What if we wanted to know instead why anybody had lost? What if the consequences of this game were real and meant massive differences in life outcomes for the winners and losers?

In such a case, if we were to ask what “causes” people to lose, the question would imply a different desire–to prevent the bad outcome from happening to any of the players.

In that case, the fix is fairly straightforward. Add two chairs to the game, and if Billy and Bobby cannot climb into them on their own, give them a hand.

For this reason, we might say that the cause of Billy and Bobby’s chairless status, and the existence of the chairless status in general, is down to the number of chairs.

Billy and Bobby’s broken legs just stack the deck in this particular case. But the fact that there are too few places to sit is the reason that no matter what, someone will go without.

Behavioral Health and Homelessness

This twisted little tale provides a helpful way to wrap our heads around scientific research regarding homelessness and how homelessness is perceived by people who encounter it.

Specifically, it helps us understand the hot button question of how drug use or other behavioral problems interact with housing markets to cause homelessness.

Risk Factors

The peer-reviewed literature makes it clear that there are many risk factors that predict increased rates of homelessness on the part of an individual. These operate like the broken legs in my parable. They include poverty, membership in marginalized racial groups, incarceration, mental illnesses, including alcohol and drug dependence, disability, LGBTQ status, being born in the last year, and the experiences of social isolation, bad luck, or domestic violence. (This research is reviewed on pages 33-70 of In the Midst of Plenty.)

None of these guarantee a person will go unhoused. As an example, many people with serious drug issues remain housed. In fact, 80% of the overdose deaths in Seattle’s King County happen to people who have housing.

Nor does being unhoused guarantee the presence of these risk factors. Sometimes a person is just down on his luck and happens to live in an expensive housing market. The risk factors are about probability. Like the broken legs in my parable, they merely predict that an individual is more likely to lose out than someone else.

Rates of Homelessness

But one thing these risk factors do not predict is how much homelessness will be prevalent in a metro area. (Just like broken legs do not predict how many chairs are available for the game!) They give us some sense of who might become homeless.

Fortunately, we have an answer–rigorous research makes it pretty clear that it is housing market conditions that predict how much homelessness will exist in a metropolitan region. As the authors of “In the Midst of Plenty,” one of the leading books that summarizes the bulk of the scientific literature on the topic, put it:

“The preponderance of the evidence . . . indicates that places with high rents have high rates of homelessness.”

Or as Gregg Colburn and Colton Page Aldern said more succinctly in their popularizing book, “Homelessness Is A Housing Problem,”

Page and Colbern summarized their work in a post with Sightline: “Cities with higher rents and lower rental-vacancy rates (i.e., tighter housing markets) see higher per capita rates of homelessness.” They also note that poverty rates, prevalence of mental health issues, climate and the generosity of local welfare benefits, on the other hand, do not predict the rate of homelessness.

This is why metros with higher rates of addiction, like Cleveland, or higher rates of poverty, like Baltimore, still have lower rates of homelessness than Seattle or San Francisco. Alongside other cities like Charlotte or Chicago–their housing markets have adequate availability, and prices remain relatively low.

In those cities, a person with a disability, or poverty, or a mental illness is much more likely to remain housed. She might make just enough money, or the thin social safety net the US offers might be just enough to cover his rent.

But New York, Los Angeles, Seattle and San Francisco all operate a lot like my sick little story about people with broken legs being left on the floor. Too few homes, and a fairly predictable pattern of who gets left out in the cold.

It is worth noting that in the original version of my game, even if Billy and Bobby’s legs had been fine, somebody still would have been chairless. Two somebodies actually. No amount of mending legs fixes the problem, even if mended legs are desirable for different reasons. Only changing the game by making sure there are enough chairs for everyone to sit down actually fixes the problem.

Similarly, even if we eliminated all addiction, homeless rates would remain high–as it was in Seattle before the fentanyl epidemic. We should address addiction (and poverty, and exclusion), but we should not be confused about how that will impact the rate of homelessness.

In sum, the science and this little story help us understand why we should think about the “cause of homelessness” as housing related–specifically a lack of it.

A person might become homelessness for a number of reasons. But the prevalence of homelessness is, at its root, a housing problem.