On the Bottle, Off the Streets, Halfway There

Another housing first program for chronic alcoholics:

Early last year, some people, not cops, tracked Daryl down at the sobering center, where he had slept off a drunk 360 times in one calendar year. They were from a homeless outreach organization and they had some news, good for a change.

The organization had just built a 75-unit residence for homeless chronic alcoholics at 1811 Eastlake Avenue, and was offering rooms to the frailest and costliest to the system, as determined by time spent in the sobering center, the emergency room and jail. The idea: provide them first with housing and meals, gain their trust, then encourage them to partake of the available services, including treatment for chemical dependency.

No mandatory meetings or church-going. And one more thing, crucial to all: You can drink in this place.

Welcome, Daryl. A month later: Welcome, Ed.

“I damn near bawled,” Ed recalls.

The $11 million project has endured the angry complaints of some that it uses public money to enable, even reward, chronic inebriates. And Bill Hobson, the director of the Downtown Emergency Service Center, has met that anger with some of his own.

First, he says, the complaints reflect no understanding of the grip of alcoholism: Do you really think these men and women would rather live on the streets? Second, the cost to the public appears to have dropped as the number of visits to the emergency room, jail and the sobering center has plummeted.

Finally, he asks, what kind of equation of humanity is this: Since you refuse to stop drinking, since you refuse to address your disease, you must die on the streets.

“These guys have nothing going for them,” he says. “They could not be more dispossessed.”

Reasonable people can disagree on these matters, but these articles always seem to focus on what is not required of program participants, they never seem to focus on what it required or expected of service providers. Here's what I had to say earlier this year about a PBS segment on a homeless addict provided housing with no contingencies:

I had several reactions to the segment. First, had Footie ever been provided with comprehensive treatment of and adequate dosage, duration? Why no contingencies? Maybe his housing shouldn't be contingent upon abstinence, but how about participation in treatment? If the fear is that this might be a set-up, how about reviewing it at monthly or quarterly intervals so that a bad week does not put him back on the street? Why not at least make it recovery-focused? If this approach is good for Footie and raises his functioning and quality of life to his potential, who's functioning and quality of life might be reduced to something below their potential? At Dawn Farm, we see some clients who would probably benefit greatly from a recovery-focused housing program that is not contingent upon abstinence. However, how many of clients who are currently in full recovery would have settled into an apartment like Footie's and never achieved stable recovery and a full, satisfying life? Many, I think.

UPDATE: This isn't to say it shouldn't be done, but rather how to go about it in a way that doesn't lower the bar for all homeless addicts and fail to address what caused their homelessness. Maybe one way to approach it is to ask, "Absent their addiction, would this person still be likely to be homeless?" In the case of Footie, the answer is "probably so". In the case of most of our homeless clients, the answer is "unlikely".

Of course, another big question is how to prioritize services in the context of scarce resources.