Those are typically being used to self medicate for a legitimate issue, probably a biological issue. Substitute their prescription medication for their deadly condition and see how you feel then about the idea of requiring them to give it up.

They may or may not have a proper diagnosis. I don't think that is relevant.

When we know for certain how to completely and reliably cure addiction and mental health issues and reliably identify all health issues in a speedy fashion, then I might have some sympathy for such an attitude. But we aren't there yet.

If your mental health issues have utterly ruined your life to the point where you are homeless, that fact can help make you suicidal. To the degree that mental health issues can lead to suicide, I think it is reasonable to suggest they can be deadly.

Alcohol also kills germs. I loathe alcohol. I had a nightcap pretty much daily for about a year while doctors acted like I was crazy and failed to figure out how to treat my condition. I began getting better. I stopped drinking alcohol when I found other treatments that worked better.

I'm convinced I would have died had I not consumed alcohol for a year.

I knew someone briefly with a mental health issue who lived in fear of winding up homeless. She also drank alcohol very heavily for a time and felt enormous guilt about it. But she had surgery for something at some point and when they opened her up, they discovered some badly infected organ. They removed it and marveled at the fact that she wasn't dead.

I think her heavy drinking saved her life. After that surgery, she was able to get clean and sober, in spite of her mental health diagnosis.

However, many people use alcohol to self-medicate for legitimate issues. The fewer services available to you, the more appealing alcohol and other drugs seem. Alcohol is, after all, cheap and readily available.

Sometimes it is as simple as trying to be able to withstand a cold, wet night. Sometimes folks are in pain (a variety of things can cause this, from tooth decay to sore feet to serious issues). If you cannot afford psychiatric medications, alcohol is a way out. It might not be ideal, but it is available. More available than health care in many cases. After all, you are speaking of folks that don't have actual shelter, a proper toilet, sanitary conditions, or a place to store or cook food regularly.

I'll add that simply being homeless can be a deadly condition as can a myriad of things that you might go to the doctor for. Seriously, if you simply couldn't get anything to treat your condition, what do you think your options would be? What if daily life made you absolutely miserable and you couldn't find a way out?

And that is the entire point. Not having access to the things "normal" society does makes things different.

It's disturbing when people even rhetorically-suggest breaking with common decency and dogwhistle encourage strong-man fascism.

Ok, but keep in mind that many of them probably turned to these as an escape from the reality of their condition and are now addicted. Perhaps a better thing to do would be to help rehabilitate them instead of vilifying them as addicts?

Basically the question is: what do you do with a crazy person, or someone who has relegated themselves to squalor?

The answer for both is that we continue to try to rehabilitate. That means not just throwing them in a hole. A simple example would be to take the money we spend on incarcerating them and spend it on multifaceted programs.

Prison should not be a panacea. Reminder: the US incarcerates more people than the next two biggest encarcerating countries combined, even though our population is 1/5th the size. Either our people are the scum of the earth, or we just find locking people up an acceptable solution to most problems.

That means not calling names in arguments, not using the site for ideological battle (regardless of your ideology), and not attacking your fellow users (regardless of how wrong they are or you think they are).