Alcohol use and support receipt among people experiencing homelessness in England: a cross-sectional analysis with comparison to private household populations.
V. Buss, Sharon Cox, et al. • BMJ public health • 2026
People experiencing homelessness had approximately fourfold higher prevalence of alcohol use disorder compared with the general population, and those sleeping rough had substantially lower odds of receiving support for their drinking.
Key Findings
Results
The prevalence of any alcohol use was similar between people experiencing homelessness and the general population.
Among people experiencing homelessness (n=2652), 78.4% (95% CI 76.5% to 80.2%) consumed alcohol in the past year.
In the general population (Health Survey for England 2022), 83.4% (95% CI 82.4% to 84.4%) consumed alcohol.
The difference in any alcohol use between the two groups was relatively small despite large differences in harmful drinking patterns.
Data for people experiencing homelessness came from the Homeless Health Needs Audit (2015–2021), a cross-sectional convenience sample survey in England.
Results
People experiencing homelessness were more likely to exceed drinking guidelines than the general population.
31.1% (95% CI 29.3% to 33.3%) of people experiencing homelessness exceeded drinking guidelines (>14 units per week).
In the general population, 23.9% (95% CI 22.7% to 25.1%) exceeded drinking guidelines.
Among people sleeping rough specifically, the prevalence of exceeding drinking guidelines was 47.4% (95% CI 40.8% to 54.1%).
Exceeding drinking guidelines was the second-highest prevalence outcome measured in the homeless population.
Results
Possible alcohol use disorder was approximately four times more prevalent among people experiencing homelessness than the general population.
19.2% (95% CI 17.4% to 20.9%) of people experiencing homelessness had possible alcohol use disorder, defined as consuming >50 units per week for men or >35 units per week for women.
In the general population, only 4.8% (95% CI 4.2% to 5.5%) met the same threshold.
The authors described this as 'approximately fourfold higher prevalence of alcohol use disorder.'
Among people sleeping rough, possible alcohol use disorder prevalence was 37.8% (95% CI 31.4% to 44.2%), the highest of any subgroup.
Results
People sleeping rough had the highest prevalence of harmful alcohol use across all homelessness subtypes.
People sleeping rough had the highest prevalence of exceeding drinking guidelines at 47.4% (95% CI 40.8% to 54.1%).
People sleeping rough also had the highest prevalence of possible alcohol use disorder at 37.8% (95% CI 31.4% to 44.2%).
Outcomes were stratified by type of homelessness including sleeping rough, temporary accommodation, and own tenancy at risk of homelessness.
These figures contrasted sharply with the general population rates of 23.9% and 4.8% for the same outcomes, respectively.
Results
Approximately 28% of people experiencing homelessness self-identified as ever having had an alcohol problem, and of these, nearly three in five received support.
28.3% (95% CI 26.5% to 30.0%) of people experiencing homelessness self-identified as ever having had an alcohol problem.
Of those who self-identified as having an alcohol problem, 58.4% (95% CI 54.7% to 62.1%) received support for their drinking.
This means approximately two in five individuals who self-identified an alcohol problem did not receive support.
Self-identification of an alcohol problem was a distinct outcome from clinically defined possible alcohol use disorder.
Results
People sleeping rough had substantially lower odds of receiving support for their alcohol problem compared to those in their own tenancy at risk of homelessness.
The adjusted odds ratio for receiving support among people sleeping rough versus those in their own tenancy at risk of homelessness was 0.26 (95% CI 0.12 to 0.54).
This odds ratio was adjusted for age and gender.
This finding indicates access to alcohol support was 'unequal' across types of homelessness.
People sleeping rough, despite having the highest prevalence of harmful drinking, faced the greatest barriers to support receipt.
Methods
The study used data from two separate cross-sectional surveys to compare alcohol use between people experiencing homelessness and the general population in England.
People experiencing homelessness data came from the Homeless Health Needs Audit (HHNA), a convenience sample survey conducted between 2015 and 2021 (n=2652).
General population estimates came from the nationally representative Health Survey for England (HSE) 2022.
Outcomes examined included any alcohol use, exceeding drinking guidelines, possible alcohol use disorder, self-identified alcohol problem, and receipt of support.
The use of a convenience sample for the homeless population is a key methodological limitation noted by the study design.
What This Means
This research suggests that while people experiencing homelessness and people living in private households drink alcohol at broadly similar rates, the severity of alcohol-related harm is dramatically higher among homeless populations. Roughly one in five people experiencing homelessness showed signs of possible alcohol use disorder — about four times the rate seen in the general population. Among those sleeping rough (living on the streets), this figure rose to nearly one in three, and almost half exceeded recommended weekly drinking limits. These findings highlight that homelessness is strongly associated with more hazardous patterns of drinking, even if the basic likelihood of drinking at all is comparable to the wider population.
This research also suggests that access to help for alcohol problems is unequal within the homeless population itself. While about 58% of homeless individuals who recognized they had an alcohol problem did receive some form of support, people sleeping rough were far less likely to receive help than those in other housing situations — their odds of receiving support were about 74% lower than those in their own tenancy but at risk of homelessness. This gap is particularly concerning given that people sleeping rough had the highest levels of harmful drinking.
The findings matter because they point to a need for targeted outreach and alcohol support services specifically designed to reach people sleeping rough, who appear to face the greatest barriers to accessing help despite having the greatest need. Traditional support services may not be effectively reaching those in the most precarious housing situations, suggesting that new or adapted approaches — such as street-based outreach — could be important for reducing alcohol-related harm in this vulnerable group.
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V. Buss, Sharon Cox, Melissa Oldham, H. Tattan-Birch, Sarah E. Jackson, Debra Hertzberg, et al.. (2026). Alcohol use and support receipt among people experiencing homelessness in England: a cross-sectional analysis with comparison to private household populations.. BMJ public health. https://doi.org/10.1136/bmjph-2026-004924