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'Wet' Homeless Shelters Can Save Public Money, Study Says
April 2, 2009

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Research Summary

A new study finds that homeless shelters that allow alcoholic residents to continue to drink alcohol can save taxpayers money and still facilitate declines in alcohol consumption.

Reuters reported March 31 that the study from Mary Larimer of the University of Washington and colleagues found that homeless alcoholics admitted to shelters without being forced to quit drinking or enter into treatment were more likely to stay out of jail and emergency rooms than those on shelter waiting lists.

Researchers estimated that public costs related to the 95 individuals enrolled in a Seattle program called Housing First were reduced by more than $4 million during the yearlong study period.

Before getting housing, study participants were racking up an average of $4,000 each per month in jail, detox, hospital, and other services; that figure fell to $1,492 after six months in the program and $958 after a year, the study found. Residency at Housing First costs $1,120 per person per month, including meals and housing.

"These benefits increase over time and they are possible without requiring that participants stop drinking," Larimer said. "And yet, the longer the participants stay in the housing program, the less they drink." Housing First residents' drinking decreased from a median of 15.7 drinks daily at the start of the study to 14 after six months and 10 after a year.

The research was published in the April 1, 2009 issue of the Journal of the American Medical Association.

COMMENTS ON THIS ARTICLE:

Posted by Bernie Ellis on 03 Apr 09 08:48 AM EDT
This harm-reduction model program is well worth studying and replicating. Its results parallel similar reductions in arrests, ER admits, EMS calls, IDU-related infections, etc. that have occurred in Vancouver and elsewhere which are administering safe-injection sites. By understanding that practicing alcoholics and drug addicts can be "worked with" easier, cheaper and with meaningful behavioral outcomes in settings that do not require them to be abstinent, we are on the right path toward reducing the societal consequences of homelessness and substance dependence. Bravo to JAMA for giving this study such wide coverage and to JTO for mentioning it here.

Posted by Dennis Parnell, LCSW, LCAS on 03 Apr 09 10:00 AM EDT
It is indeed a sad comment on society that it appears that we have become so jaded that we care more about money than we do about people. This is especially true since we have at our disposal at least one extremely successful model (and there may be more) that actually BOTH reduces societal costs significantly AND has a proven long-term track rate of actually returning chronic alcoholic AND drug addicts back into to productive and sober tax paying citizens. All this is accomplished at about than $25/day. (visit www.hpowc.org and www.thehealingplace.org - Federal - Models That Work Award winner). We need to be looking further to expand this proven model before wholesale adopting harm reduction as our frontal assault on homeless addiction.

Posted by Caroline Bacon CDP on 03 Apr 09 10:14 AM EDT
The headline is misleading...the Housing First program is PERMANENT housing, not a shelter. However, the residents of the first Housing First program in Seattle, 1811 Eastlake through Downtwon Emergency Service Center, were high utilizers of shelters/jails/hospitals/detoxes prior to moving into their new home. As a care provider in the local ER, I can attest to the success of this model. For the most part, once someone moves into 1811 (or one of the other Housing First residences that have opened since then) that individual's ER utilization plummets.

Posted by Floyd Frantz on 04 Apr 09 11:58 AM EDT
We run a day center for alcoholics in Cluj, Romania. It seems that the clients we work with respond more to tolerance and love than anything else. And for the most part everyone is well behaved. Also, the AA group that meets there twice daily accepts people who have been drinking so long as they do not create a problem. Maybe turning loose of some of our need to control is not such a bad thing.

Posted by Lewis Clymore on 06 Apr 09 12:41 PM EDT
AS I read this article it felt a bit, at first, like the focus was on saving money via the warehousing of a very difficult and problematic group but then I began to be intrigued by the claim of a reduction in drinking, until I saw what they meant by "reduced"... a median of 10 DRINKS PER DAY! Wow... we can help them prolong their suicide, loneliness and misery and we can save money at the same time! What's not to like?

Posted by Dave C. on 06 Apr 09 01:55 PM EDT
Let's get past our own preferred way of doing things and realize there are many, many pathways to improving people's lives. Then we can stop competing and arguing that our way is the best way, or the only way. In fact, just about all methods, programs, or models are effective in helping people when you get the right fit for the right person at the right time. The real problem is we don't have a standard way to measure results in real-time and in real settings. With no baseline or a set of reliable and valid measures for comparison then all we have are our claims of a better way than brand B. We need real-time ways to measure results and when it isn't working try something different and find what works best for this person at this time. If we can do this we will save money all over the place which isn't a bad secondary goal!

Posted by Jim Joyner on 07 Apr 09 10:55 AM EDT
Here I’ve got another joke for you. “Lawless Towns Reduce Criminal Justice costs. A recent study of 6 murderers for six months found that not prosecuting the perpetrators reduced the cost of incarceration, reduced jail population and freed up police thus saving the tax payer $150,000 per year per individual. Two of the six did not repeat a murder during the study. While living in other towns the study participants were racking thousands of dollars of cost for police investigation, victim related costs, and the cost of incarceration. Supporters of the “lawless model” say, “in time doing away with laws all together should reduce tax payer burden by 75%.” Elected officials who are be investigated for corruption support the model. In other news, Elvis is planning to run for President….

Posted by linda on 07 Apr 09 04:44 PM EDT
We have to meet people where they are not where we think they should be. Thank you Mother Teresa.

Posted by Becky K. on 08 Apr 09 04:27 PM EDT
As a treatment provider and a relative of severely affected alcoholics I want to thank Dennis,Lewis and Jim above for their comments that cut through the baloney and tell the truth.

Posted by Jeannette on 24 Apr 09 05:46 AM EDT
Please use caution when positively judging the outcomes of such "research" as is presented here with "wet" Housing First programs. To attempt to measure counseling and treatment, one must remember the measurements involved are with people, a "soft" science with many external and internal factors to measure beyond the objective products of "hard" science. Criteria such as reduced drinking and reduced economic costs are not true measurements of the effectiveness of this project considering that human lives are what are most at stake. There are numerous factors that need to be addressed here, but the most important ones are what are the intended outcomes of such research and what role does the human condition play in the outcome? How clear are the ethics of this research? Is this research above meeting the ethical standards that other research where people might be harmed is required to meet?

Posted by Pheobe on 24 Apr 09 10:02 AM EDT
Those who are afraid of research that is antithetical to their own lifeview should remember that people aren't so much "soft" as they are "pliable." Sometimes your rules just don't allow for a lot of movement.

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