Focusing on people with overlapping experiences of homelessness and substance use, this hot topic examines what social policies would look like if they prioritised saving lives and improving lives. It brings together evidence about needs, gaps in services, and ‘what works’, as well as commentary about some of the myths and misconceptions that have fostered policies which do more harm than good. 

The hot topic questions the public disorder lens through which homelessness and substance use problems tend to be viewed, and challenges the lack of public responsibility for the conditions that lead to these problems. It also brings to the fore a key debate in the field of substance use: the validity of harm reduction not just as a mechanism to engage people who use drugs with treatment, but as a legitimate goal in itself. 

This in-depth hot topic is presented under the following headings:

1. Rough sleeping is just the ‘tip of the iceberg’
2. ‘A profoundly unequal set of risks’
3. The overlap between substance use problems and homelessness
4. Antisocial ‘street lifestyles’
5. Taking it off the streets and supervising consumption
6. The problem with demanding abstinence
7. The right foundation for recovery
8. Shifting public perceptions of homelessness
9. Changing lives in the age of austerity
10. A ‘dignity first’ approach to homelessness, drugs, and alcohol