Study: Housing Homeless Drunks And Letting Them Drink Saves Millions

[Are_grits_groceries]

Three years ago, an experiment known as 1811 Eastlake opened in Seattle. It's a large apartment complex just off downtown and it houses about 100 chronic inebriates, as the term goes, all of them formerly homeless. The experiment part is that for eons America has attempted to grapple with the problem of urban street drunks by either sticking them in jail (very expensive and a practice that largely stopped in the 1970s), forcing them into housing where they couldn't drink (and inevitably relapsed and got the boot) or leaving them on the streets where they cycled from street to jail to ER to sobering center to homeless shelter to the liquor store to the streets. Commonly, such people (and it's usually guys) run up a $50,000 a year or so tab on the public purse and harm reduction advocate got to think that maybe it made more sense to stick such folks in long-term publicly supported housing and let them drink their brains (and livers) out and it'd wind up being cheaper.
<snip>
The 1811 facility wasn't a mats on the floor homeless shelter, but an actual apartment building with units along the lines of a college dorm room.

A new study came out in JAMA this week detailing whether the concept of "Housing First," as it's known, had any impact (here's an AP piece on the study). The 98 street drunks whom the study tracked had cost the public $4,066 a month prior to entering 1811 and afterwards they cost $1,492 a month after six months in the facility and $958 a month after 12 months. That's a pretty big savings and, oddly enough, some of the residents began to drink less. Some even got sober. (Some also died.)

My own interviews with residents there in 2006 turned up several who drank upwards of two fifths of hooch a day and had been for 20 years. Yes, it is amazing what the human body can endure.

While this sort of program would have to replicated elsewhere to see if these savings hold, it sure is a vastly more humane way to deal with a chronic urban problem than in the past. It also has all sorts of implications for addressing homelessness among the mentally ill, chronic crackheads and junkies of every stripe. My own guess is that, for example, housing the mentally ill who are homeless instead of herding them into very stressful homeless shelters or leaving them to the streets would improve their mental health issues dramatically, with or without medications. There is something magical about having a roof over one's head, even a modest one.
http://www.furiousseasons.com/archives/2009/04/study_housing_homeless_drunks_and_letting_them_drink_saves_millions.html

Beats the streets and gives some peace.

[MADem]

1. I hope the mattresses are the flameproof kind.

The only issue is when they get shitfaced AND smoke....of course, with tobacco getting expensive, that may become less of a problem..

[annabanana]

2. This has the astonishing combination of being both demonstrably effective and

politically impossible that will, sadly, make implementation a long shot...

[Are_grits_groceries]

3. I know. The puritans would shit. nt

[givemebackmycountry]

5. Great Observation Anna -

I'm sure the Right Wing and the Religious Right would find this perfectly sound logic.
We should try it anyway just to piss them off and watch their heads explode.

(I'm a mean bastard wanting to watch people go crazy)

[suede1]

12. It is sad that the obvious and effective programs don't have a chance.

[tblue37]

30. Like needle exchange programs for drug addicts--which save

lives and help stem the spread of disease. A lot of Puritans freaked out because the programs were "condoning" drug abuse.

[frebrd]

4. K&R n/t

[Wetzelbill]

6. got some anti-Obama rhetoric on that site

Seems they don't like the cigarette tax.

[Forkboy]

13. I'd be willing to bet there aren't many smokers on either side of the aisle who do like it.

:shrug:

[Wetzelbill]

15. I imagine not

Then again, I don't really smoke. But the argument for that is disingenous, the poster was writing about how Obama lied about raising taxes on the middle class because of the cigarette tax and that he was targeting people with mental problems etc because lots of people who are bipolar and have other mental health issues smoke. It's a reach, especially since the guy smokes himself. Then in the comments the word elitist and all the other typical stuff was being thrown around. I always thought it was funny how Obama was labeled that when McCain has enough houses and cars to form his own city.

[Forkboy]

17. As a non-smoking bipolar person it sounds like stretch to me, too.

I don't smoke, don't agree with the tax, but I also don't see it as targeting the mentally ill either.

The reason I'm against this tax is that it does nothing to help smokers quit, just punishes them for an addiction. If raising the price made people quit then everyone would have stopped when they hit 2 bucks a pack. A lot of smokers swore they'd quit then. They now swear they'll quit when it hits 10-15 bucks a pack...but they wont, and can't, sadly.

One of the reasons I hear in favor of these types of taxes is that the money can be used to pay for the declining health care of the smokers, instead of everyone else picking up the tab. But this seems a mean-spirited endless loop to me unless we do more to help people quit, or not start in the first place. Without those goals, the cycle of smoking and taxing just goes on and on.

Personally, I think we should only tax toilet paper. If we're going to tax a product let's do one that everyone uses...I hope. :scared:

[robinlynne]

28. I dont like the cigaret tax. What does that have to do with being anti-Obama?

[Wetzelbill]

40. you'd have to read the whole post on the site

and the comments.

[LuvNewcastle]

7. I'm glad to see people taking

a more enlightened approach to the homeless problem. Whether they're drunks, mentally ill, or just down on their luck, we shouldn't have people living on the street.

[Triana]

8. Stanton Peele approves...

http://blogs.psychologytoday.com/blog/addiction-in-society/200904/letting-alcoholics-drink

[SoCalDem]

9. Here's another great program that works..

http://journals.democraticunderground.com/SoCalDem/5

John Rosenthal.. his shelter has 100 % "graduation"..with full time jobs

Posted by SoCalDem in General Discussion (01/01/06 through 01/22/2007)

Tue Mar 14th 2006, 11:25 PM
http://www.boomerstv.com/episodes_episode.php?epid=35

He charges them "rent" for a semi private space,"hires" them, trains them, and at the end of their year or 2 years, they "graduate"...and he gives them back their "rent" in a lump sum..

A great example of what one businessman with a conscience can accomplish

This is a fantastic series..look for it on your PBS schedule..

...............................................................


Doing Good and Doing Well

To some, John Rosenthal presents a walking oxymoron: a successful real estate developer who is also an environmentalist, a gun owner who champions gun control, an undisputed successful capitalist and deeply committed social activist.

Believing that there is no problem that business people can't solve when they put their minds to it, John Rosenthal is all about using whatever leverage his business success provides to address the social concerns closest to his heart: gun control and the homeless.

In the clips below, John recalls some events in his early life that led to his political activism and discusses the relationship between rights and responsibilities. Also, he issues a challenge to his fellow Boomers.

Then, listen as John discusses how business leaders can leverage their influence to assist those in need.

http://www.boomerstv.com/episodes_video.php?lid=315

http://www.boomerstv.com/episodes_video.php?lid=316

.........................................

More resources on the shelter

http://www.google.com/search?hl=en&q=%22friends+of+boston+homeless%22&btnG=Google+Search

[surrealAmerican]

10. If we could only drop the obsession we have (as a society) ...

... of punishing people who do the wrong thing, we would see all sorts of rational solutions to our problems.

[suede1]

11. Bingo! And thanks.

[No.23]

19. Good point.

Thanks for making it.

In a majority-rule society (purportedly), there will always be a minority that will be saddled with a price, for the majority to feel nice and comfy.

[distantearlywarning]

23. One Hundred Percent Agreed.

Unfortunately, if you read some of the responses that have already popped up downthread, you'll see that even some posters here are a bit obsessed with that notion.

[Jack_DeLeon]

35. IMO people should only be punished for violating the rights of others...

if no one other than the person committing any act is harmed, then no one should be punished.

[Jack_DeLeon]

14. Gee you mean that people who drink because thier life sucks...

start thinking thier life doesnt suck when they get some suckers to give them a free apartment?

IMO if any of yall want to enable someones own destructive behavior by making them more comfortable with your money in the hopes that they somehow change then go for it. However I definately do not want my money spent on it. I have self control and try to take care of myself and my loved ones, I shouldnt be punished for that by having to pay for someone that doesnt.

[Sen. Walter Sobchak]

16. I find this horrifying

I watched somebody drink himself to death over three years - making their total self destruction as easy and comfortable as possible was not on my priority list.

I was more than willing to bring him groceries and drive him to the doctor, but when he begged me for a ride to the liquor store I said fuck no. If it was that important to him he could walk the two miles - naturally the state of California decided this guy shouldn't be driving.

[surrealAmerican]

22. Way to miss the point there:

"I definately do not want my money spent on it". Do you understand that "your money" is already being spent to take care of these people? It turns out this solution actually spends less of "your money" than the one that keeps these people homeless.

[Jack_DeLeon]

36. My money is being spend to punish them for commiting criminal actions...

the fact they are taken care of is just a side effect.

You might be able to argue that some of those "crimes" committed harmed no one, such as merely being intoxicated in public, and I would tend to agree and wouldnt mind having the laws changed. However when someone in a drunken stupor does something like assaulting someone they should rightly be punished for violating the rights of others. They should not be rewarded for having committed many such actions by getting a nice apartment rather than a cell with bars.

[surrealAmerican]

38. Nobody's talking about letting anyone get away with assault.

Housing them actually prevents them from breaking the law (not always, but in most cases) instead of just waiting for them break the law, and then punishing them. It makes our streets safer.

[distantearlywarning]

24. Interesting viewpoint for a "progressive". n/t

[bettyellen]

25. alcoholism is a reaction to life sucking? and "self control" is all you need. ever read about...

issues before posting self righteous bs about them?

[varelse]

32. You're already paying! We all are - and we'd pay LESS, not more with this system

http://jama.ama-assn.org/cgi/content/short/301/13/1349

Context Chronically homeless individuals with severe alcohol problems often have multiple medical and psychiatric problems and use costly health and criminal justice services at high rates.

Objective To evaluate association of a "Housing First" intervention for chronically homeless individuals with severe alcohol problems with health care use and costs.

Design, Setting, and Participants Quasi-experimental design comparing 95 housed participants (with drinking permitted) with 39 wait-list control participants enrolled between November 2005 and March 2007 in Seattle, Washington.

Main Outcome Measures Use and cost of services (jail bookings, days incarcerated, shelter and sobering center use, hospital-based medical services, publicly funded alcohol and drug detoxification and treatment, emergency medical services, and Medicaid-funded services) for Housing First participants relative to wait-list controls.

Results Housing First participants had total costs of $8 175 922 in the year prior to the study, or median costs of $4066 per person per month (interquartile range , $2067-$8264). Median monthly costs decreased to $1492 (IQR, $337-$5709) and $958 (IQR, $98-$3200) after 6 and 12 months in housing, respectively. Poisson generalized estimating equation regressions using propensity score adjustments showed total cost rate reduction of 53% for housed participants relative to wait-list controls (rate ratio, 0.47; 95% confidence interval, 0.25-0.88) over the first 6 months. Total cost offsets for Housing First participants relative to controls averaged $2449 per person per month after accounting for housing program costs.

Conclusions In this population of chronically homeless individuals with high service use and costs, a Housing First program was associated with a relative decrease in costs after 6 months. These benefits increased to the extent that participants were retained in housing longer.

[creeksneakers2]

18. I don't see how giving them a home keeps them out of other

trouble. Wouldn't they still go out of the home to get money for liquor? Wouldn't they start fights with the other tennants? Pass out on the street outside?

Homes wouldn't solve more than part of the problem.

[Zuiderelle]

20. They aren't trying to solve more than part of the problem. Pretty clear that it's focused on saving

money. And as a side-effect, if it provides some of them with a better sense of self, which not living on the street would do, that leads them to improving their lives, which it sounds like it did in at least some of the cases, then what's the harm? It's not as if they would start more fights with fellow tenants, than they would have with those same fellow homeless people.

[rucky]

21. A program that respects the population they're helping.

No program will work without that.

[maryf]

26. Good start but most homeless aren't drunk, addicted, or crazy

The number one cause of homelessness is lack of affordable housing; why can't all homeless be set up in something like this? Do they have to be drunk to warrant a home? I am very glad to read that they aren't trying to "cure" the alcoholic only the homeless aspect (about 30% of homeless might fall into the alcohol/substance abuse/mentally ill categories, about 70% just can't find affordable housing).

[file83]

29. True, but these specific kinds of homeless people (drunk ones) is exactly

what this study involves. It doesn't involve those who are homeless for other reasons.

[JanMichael]

31. a pretty good percentage of the chronically homeless have substance issues.

some are alcoholics and some are self medicating diagnosed or un-diagnosed mental issues.

Housing 1st programs are aimed at the chronically homeless not the event driven (job loss, housing expence, family disputes, medical catastrophes, etcetera) and episodic homeless.

The new HUD stimulus funding for homelessness prevention is the opposite and focuesed on what's called rapid re-housing for the event driven and episodic almost or newly homeless.

[varelse]

34. Who is Homeless?

http://www.nationalhomeless.org/publications/facts/who.html

PERSONS WITH MENTAL ILLNESS
Approximately 16% of the single adult homeless population suffers from some form of severe
and persistent mental illness (U.S. Conference of Mayors, 2005). According to the Federal Task Force on Homelessness and Severe Mental Illness, only 5-7% of homeless persons with mental illness require institutionalization; most can live in the community with the appropriate supportive housing options (Federal Task Force on Homelessness and Severe Mental Illness, 1992). For more information, see our fact sheet on Mental Illness and Homelessness.

http://www.nationalhomeless.org/publications/facts/addiction.html

Addiction Disorders and Homelessness The 2007 United States Conference of Mayors “Hunger and Homelessness Survey” reports that approximately 9.6% of the homeless population in a family with children is dealing with issues of substance abuse while 37.1% of homeless individuals are dealing with these issues. Studies that report substantially higher numbers often over-represent long-term shelter users and single men, and use lifetime rather than current measures of addiction. Another important aspect to consider is that many addiction issues arise while people are experiencing homelessness, rather than causing them to become homeless.

[Withywindle]

27. I'm not surprised it saves money.

Or that it saves lives. I don't think it's surprising that some of the people in this program drank less or got sober. A lot of alcoholics, especially the ones who hit bottom and lived there, want desperately to quit. But it's really, really, really not easy. You need support. You need incentive (something to live for). You need hope. You need to be able to improve your health in other ways, physical and mental. Hard to get any of these things when you're living on the street being constantly spat upon.

It won't catch on, though. There's too much of a national obsession with punishing people for being sick and poor and kicking them when they're down.

[XemaSab]

33. I would also guess that seeing your friends hit bottom could be a motivation

towards getting sober. :shrug:

[D-Lee]

37. Exactly the reason to support SROs ("single room occupancy" units)

Lots of people, many who have become homeless, just can't deal with possessions, obtaining and preserving their "housing" ...

These people traditionally are able to deal with having a room.

I remember my grandmother's several roomers, who stayed for years and never wanted an apartment or a house. A few items of clothing and a few objects were all they wanted.

It is a mistake to thing that everyone wants the same thing in life.

We need to offer options of all sorts, which this article illustrates.

Thank you.

[marmar]

39. If we lived in a less Puritanically silly country, this might be a viable option......

n/t