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Homelessness and Substance Use Disorder Treatment: Recovery-Oriented Housing and Achieving Healthy Lifestyles

Jesse Milby Ask the Expert

Mar Homelessness and Substance Use Disorder Treatment

Ask the Expert:  Jesse B. Milby, Ph.D, ABPP, Director of Medical/Clinical Psychology Doctoral Program and Professor in Psychology, Medicine, Psychiatry, and Public Health at the University of Alabama at Birmingham.

1. You spoke about many services, programs and options for people who are homeless and have co-occurring disorders. What is available for people who are at risk of becoming homeless due to untreated substance abuse, depression, and anxiety? My family and I are at risk due to my husband’s mental health and alcohol use, I cannot support the family by myself, and we are at risk of losing our apartment.


I think the key to your question is “untreated”.  Your husband needs to get assessed and treated.  I know that is easier said than done, but he has a lot going for him.  For instance, there are a variety of formal addiction and mental health services available if you have insurance.  If you don’t, there are community-based agencies that provide services like these on a sliding fee schedule.  Moreover, many people benefit from support groups like AA which is world wide and free.  Your husband can also visit his primary care physician for help with these problems.  Ultimately, with some level of help, most people must rely on their own motivation and choices to improve the quality of their lives, and natural recovery through self-help is often effective.  Go to for excellent self-help information and a Treatment Facility Locator.  The combination of alcohol abuse, depression and anxiety is a serious and complex behavioral and psychiatric situation which is best evaluated by a professional.  Good luck.


2. According to the Centers for Disease Control and Prevention (Health & Stats February 2008), methadone-related deaths have increased more than other narcotic-related deaths. What is meant by “detoxification phobia in methadone maintenance outcome?”


Methadone detoxification fear or phobia is a phenomenon I have researched and written about.  This is the “excessive and irrational” fear of detoxifying or withdrawing from the narcotic substitution medication of methadone.  While methadone maintenance was originally conceived as a long-term treatment, and has been successfully used that way, some rehabilitated people wish to live a totally drug-free life and begin a gradual withdrawal process under medical supervision.  Some people experience excessive and irrational fears and anxiety during this process that may cause them to abort the detoxification process or even encourage a relapse to illicit opiates.  “Irrational” fears reported by this subpopulation consist of “my bones are deteriorating” which is not the case.  Such fears may be related to memories of severe physical and psychological, but not life threatening, withdrawal symptoms experienced during withdrawal from previous illicit opiate dependency.  Methadone-related deaths have many explanations, for instance, overdosing with methadone and other illicit opiates, but are not generally physiologically related to a medically assisted methadone detoxification process. I hope that information is helpful.


3. How can I help a young person who is homeless and was kicked out of his home by his parents? He is starting to use drugs and is out on the streets most of the time. He sleeps at friends or with other family but is not consistent with it. Living with me is not an option. What kinds of services are available to help him?


Go to and click on the Homeless Resource Center.  They are aware of federally funded programs nation-wide for homeless children and families.  Good luck.


4. I am an opiate addict in recovery for 7 years; for 6 years I have taken Suboxone. I currently take 8-12mg/day. I also have depression, chronic back pain, and insomnia. My question is this: after 25 years of active opiate addiction has my brain changed to the point that I will continue to need some type of opiate replacement to feel “normal” and able to function day to day? Or is just my addiction trying to regain control?


Narcotic substitution therapy (methadone) was originally based on the premise that opiate addiction is a chronic disease and that the brain has been permanently altered requiring long-term maintenance therapy.  While there is a wealth of recent evidence that drug addiction affects the brain, the extent to which your brain was altered by opiate abuse or was that way originally, will probably remain unanswered.  Your decision to remain on substitution therapy should be based on your degree of rehabilitation and risk of relapse.  Treat your addiction like you would hypertension.  Find the best combination of pharmacotherapy and non-pharmacotherapy strategies to maintain a high quality of life and low risk of negative outcome.  You have my best wishes.


5. I live in Marietta, OH and work in prevention. My 28 year old son was arrested 2 days ago for heroin possession. He was clean for 7 years and involved in a methadone treatment plan. The clinic had him on a maintenance dose of 160 mg. He weaned off of the methadone last October but the withdrawal from the methadone made him so sick that he went back to painkillers, and then to heroin. What is available for him now?


Methadone treatment!  One of the risks of methadone detoxification is relapse; especially if the “weaning” process went too fast, causing uncomfortable withdrawal symptoms.  He should go back to what worked for 7 years.  Heroin is a serious drug and its use can result in HIV transmission or death from overdose.  Methadone maintenance is a medically assisted treatment with many programs offering combined psychosocial therapies.  Reconsider detoxification later when rehabilitation, maturity and other areas of his life are stable.  I wish you the best of luck.


6. My children and I are in a family shelter. My husband has an addiction problem that rendered us homeless. He comes in and out of our lives according to his level of sobriety. How can I help my children, and him, to have healthy family relationships? What kinds of services can my children and I get to help us with this family problem?


Since you have access to a computer, so go to and click on the Homeless Resource Center.  They are aware of federally funded programs nation-wide for homeless children and families.  Take care.


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