For some, there will be a denial and minimization of the substance habit as being inconsequential, purely recreational or extremely intermittent. This response is akin to the young adult asserting that there is no problem. For other homeless youths, their drug or alcohol habit maybe viewed as a form of survival: these drugs help these teenagers bear life on the street. In that sense the substance is attributed as beneficial for the escapism necessary to survival. "Using, even abusing substances is often viewed as a 'normal' practice by those identifying with street culture. Homeless young people report using drugs and alcohol as a coping strategy and often have more favorable attitudes toward drug use than their non-homeless peers" (Gomez et al., 2010). Thus, there could be a complete difficulty in making any assessments, since many homeless youths won't see their substance abuse as a problem at all, and won't seek treatment, viewing it instead as merely an indelible feature of life on the street. For other youths, making accurate clinical assessments becomes even more difficult because of the varying reasons for why the youth is homeless. For some youths, the homelessness is a result of the fact that they had to leave a bad home situation and find life on the streets to be an improvement. As one youth described her home life: "I'm just tired of it all, and I don't want to be in my house anymore," she said, explaining why she had run away. "One month there is money, and the next month there is none. One day, she is taking it out on me and hitting me, and the next day she is ignoring me. it's more stable out here" (Urbina, 2009).

Another issue which makes assessment difficult is that some researchers have found that the drug use of homeless youths to be all over the map. Some became homeless because of their addiction problem, some became addicted as a result of living on the street, and others became addicted because of exposure to parental drug use and others because of environmental or situational factors.

Impact of Drug Use on Homeless Youths

Drugs and drug abuse don't solve problems they create new ones and for homeless youths this is particularly the case. Drug abuse with this population causes them to need to support an expensive habit, when they're already fighting to forge their own survival as it is. Drug abuse puts members of this population at risk for a range of associated conditions and maladies. "Drug use is believed to be an important factor contributing to the poor health and increased mortality risk that has been widely observed among homeless individuals [1,2]. Substance use may increase the risk of homelessness by undermining their social ties and economic stability [3]. Drug users also suffer from numerous adverse health effects, including overdoses, psychiatric conditions, and infectious diseases" (Grinman, 2010). Furthermore, the work of Grinman and associates found that drug use among homeless teens often set them up for lifetime use as was found in one study (2010). This element was exacerbated by the fact that many homeless youths failed to identify that their drug problem was an obstacle in them securing permanent housing (Grinman, 2010).

The maladies and health concerns that fester in this specific population are both related to practical issues -- not having a warm place to sleep and not getting enough to eat -- along with certain indelible factors related to a homeless lifestyle. For instance, unprotected sex or sex with multiple partners as a result of carelessness, lack of education or involvement in the sex industry, is a definitive part of homeless life for many of these youths. "Moreover, the experience of homelessness appears to have numerous adverse implications and to affect neurocognitive development and academics, as well as mental and physical health. Substance use, sexually transmitted infections, and psychiatric disorders are particularly prevalent in this population. Whereas some of these problems may be short-lived, the chronic stress and deprivation associated with homelessness may have long-term effects on development and functioning" (Edidin, 2012). Just as some of the health effects of homelessness and drug use might be short-lived or temporary for this population, many of them might lead to lasting developmental issues that could follow the individual for life.

Another finding in regards to homeless youths and drug abuse is the fact that this population has been found to have a significantly poorer mental health status (Grinman, 2010). At this time, it's not clear whether this lower level of mental health was as a result...

In fact, the study entitled, "Estrangement factors associated with addiction to alcohol and drugs among homeless youth in three U.S. cities" attempted to pinpoint the four specific arenas of social estrangement -- disaffiliation, human capital, identification with homeless culture and psychological dysfunction -- in connection with substance abuse (Thompson, 2010). "Homeless young adults were recruited from three disparate urban areas: Los Angeles, CA (n = 50), Austin, TX (n = 50) and St. Louis, MO (n = 46) using comparable research methods and measurement instruments. Findings demonstrated that variables measuring psychological dysfunction and homeless culture predicted alcohol addiction, while institutional disaffiliation and homeless culture predicted drug addiction" (Thompson, 2010). Both substances (drugs and alcohol) were found to offer distinct patterns of estrangement for youths in all major cities (Thompson, 2010). One can only guess how such patterns of estrangement can only solidify a youth's involvement in homeless culture and drug culture, making this separation from regular society even more aggravated. Thus, one can conclude that isolation and societal estrangement are not only impacts of substance abuse with homeless youth, but are factors which act as formidable obstacles from youth receiving care.
In many youths, it has been found that post-traumatic stress disorder is a health concern they suffer from. While more research needs to be conducted in to the exact factors of this issue, it truly comes as hardly a surprise at all. Severe abuse is a common reason that youths leave home, and thus it makes sense that they would suffer from PTSD. It also is fitting that if homeless youths are thus suffering from PTSD, they would be more likely to engage in drugs in a recreational or abusive fashion. In fact, the study, "Factors associated with trauma and posttraumatic stress disorder among homeless youth in three U.S. cities" by Bender and associates, examines this factor exactly (2010). This particular study "…examined correlates of trauma and PTSD among homeless youth with a focus on the impact of homeless culture, substance addiction, and mental health challenges. Homeless youth (N = 146) from Los Angeles, California, Denver, Colorado, and St. Louis, Missouri, were recruited from organizations providing services to homeless youth using comparable methods. Results indicate that 57% of respondents had experienced a traumatic event and 24% met criteria for PTSD. A multinomial logistic regression model revealed greater transience, alcohol addiction, mania, and lower self-efficacy predicted PTSD whereas trauma exposure was associated with alcohol addiction only" (Bender et al., 2010), Thus, the research reflects that with homeless youths, PTSD is another health condition which often co-occurs with the substance abuse, or which acts as the reason for why substance abuse develops in the first place.

Current Evidence-Based Treatment

Certain therapeutic Communities (TCs) have developed for this population in various formats, both in-patient and out-patient therapy. "Modified TC programs for homeless individuals, often developed in shelter settings, have tended to incorporate auxiliary services to address clients' multiple needs, such as educational, vocational, legal, and housing placement services. Other fundamental differences include a greater degree of flexibility and less intensity or confrontation than one would see in more traditional TCs" (Zerger, 2002). These therapeutic communities feature group settings and a following of a 12-step recovery format as well as other flexible modifications to meet the needs of this specific community. For instance, certain in-patient programs have found that homeless, addicted teens are in need of more guidance and assistance and support throughout their recovery process. Certain centers treat a potential or actual relapse as part of the recovery process and just another stepping stone in the path to getting better. Others view a relapse as a sign that previous therapy had been ineffective.

However, as one scholar illuminates, the literature on treating homeless, substance abusing youth is more revelatory about what is not known than about what is and much of the literature reflects that (Slesnick, 2004). Currently, the bulk of all treatment programs center around 12 step processes such as alcoholic anonymous or narcotic anonymous. Such 12 step programs can be effective; it's just that they can't be the only answer with the specific population.…