Health Psychology Research / HPR / Online First / DOI: 10.14440/hpr.0224
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REVIEW

Substance Use and Addiction among Homelessness: A Scoping Review

Giulia Schilirò1 ,  Alessia Sangiorgio2 ,  Noemi Maria Vitale1 ,  Eleonora Uccelli1 ,  Chiara Allegra1 ,  Abdulnaser Fakhrou3 ,  Jennifer DiPiazza4 ,  Pasquale Caponnetto1,5,6*
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1 Department of Educational Sciences, Faculty of Psychology, University of Catania, Catania 95123, Sicily, Italy
2 Department of Educational Sciences, Faculty of Psychology, University of Rome, Rome 00193, Lazio, Italy
3 Department of Psychological Sciences, College of Education University, Doha 2713, Qatar
4 Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield 06424, United States of America
5 Center of Excellence For The Acceleration of Harm Reduction, University of Catania, Catania 95123, Sicily, Italy
6 Psychiatric Unit, University Hospital “AOU Policlinico G. Rodolico–San Marco,” Catania 95125, Sicily, Italy
HPR, e81240064 https://doi.org/10.14440/hpr.0224
Submitted: 27 July 2025 | Revised: 10 December 2025 | Accepted: 13 January 2026 | Published: 20 February 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background

Homelessness represents a multifaceted global challenge, closely linked to high rates of substance use disorders (SUDs). This intersection exacerbates health disparities and perpetuates social exclusion; however, effective, context-sensitive interventions remain limited.

Objective

This scoping review aims to synthesize present evidence on therapeutic, psychological, and social interventions for homeless individuals with SUDs, highlighting effective strategies and identifying gaps to inform future research and clinical practice.

Methods

Following the PRISMA Extension for Scoping Reviews guidelines, we systematically searched PubMed, Scopus, and ScienceDirect between January and June 2025. Inclusion criteria were peer-reviewed studies from the past decade, published in English, and investigating psychosocial or rehabilitative interventions targeting homeless individuals aged ≥14 with SUDs. Studies exclusively medical or without intervention components were excluded. A total of 23 studies were included.

Results

Integrated, multidisciplinary interventions—including Housing First combined with assertive community treatment, group-based motivational programs (e.g., AWARE, Tobacco-focused group motivational intervention), harm reduction approaches (e.g., Harm reduction treatment for alcohol, Extended-release naltrexone), and intensive case management—were most effective in reducing substance use, improving mental health and quality of life, and enhancing housing stability. However, the literature showed methodological variability, generally short follow-up periods, and limited incorporation of participants’ perspectives.

Conclusion

This review underscores the importance of flexible, tailored, and relationship-centered interventions to address the complex needs of homeless populations with SUDs. There is an urgent need for more rigorous and long-term studies, including qualitative insights, to better capture acceptability and feasibility. Strengthening synergies between housing, health, and psychosocial services—particularly in under-researched contexts, such as Italy— could foster more sustainable pathways toward recovery, dignity, and social reintegration.

Keywords
Homelessness
Substance use disorders
Harm reduction
Housing First
Psychosocial interventions
Funding
None.
Conflict of interest
Pasquale Caponnetto is the Editor in Chief of this journal, but was not in any way involved in the editorial and peer-re¬view process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
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