Problem alcohol and drug use by adult homeless persons may put them at higher risk for other health problems and impact their access to health care. The purpose of this study was to determine if those with a positive screen for problem alcohol or drug use were at increased odds for having a lower health status and less access to care than those without problem alcohol or drug use. This was a secondary analysis of health survey data from a study related to the health of homeless adults. The survey included the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test 10 (DAST‐10) for evaluating problem substance use; health related quality of life, health care utilization, and medical history were also included. The impact of problem alcohol use or drug use on the odds of reporting lower general health status, a history of physical or mental illness, use of the emergency department (ED), and problems getting health care when needed, were estimated using logistic regression. A total of 112 adult homeless participants completed the survey. Participants with problem alcohol use tended to be less likely to obtain health care when needed (OR = 2.3, p = 0.05). Those with problem alcohol or drug use were not at increased odds of reporting a lower general health status, a positive medical history, or ED use. Problem alcohol use was associated with decreased access to health care when needed. Screening for problem alcohol use among homeless adults may not only help to identify those in need of interventions related to alcohol use but also help to identify those in need of help in accessing general health care.