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The Case for Allowing the Homeless to Drink

Alcohol consumption inside a supportive housing unit can actually make the road to recovery easier. And that means huge taxpayer savings on arrests, hospitalizations, and welfare.
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(Photo: mobilestreetlife/Flickr)

(Photo: mobilestreetlife/Flickr)

Living on the cold streets of Seattle—decades after a war left his body 70 percent disabled—John would have never thought of himself as a role model.

He wasn’t just an alcoholic. He was the type who was so committed that he’d earned a reputation around town. After drinking for 25 years on the Seattle streets, alcohol had consumed his life. He’d survived Vietnam, but it seemed that he might wind up losing his life to the bottle.

In 2005, a new kind of housing unit for homeless people opened up in downtown Seattle. John was one of the first people to move in. The building, named for its address 1811 Eastlake, specifically targets homeless individuals who are dependent on alcohol. Unlike most shelters, however, 1811 Eastlake permits residents to continue drinking, even in their rooms, if they so desire.

So John kept drinking. Why wouldn’t he? There was no rule prohibiting it. And just because he had a bed and a roof didn’t mean he craved alcohol any less. But over the next 12 months, John’s life gradually improved. He no longer had to worry about violence or finding a place to sleep. He met with a counselor who encouraged him to drink less. By his second year at 1811 Eastlake, John decided he was going to stop drinking, and he did.

“He became a role model,” says Bill Hobson, the executive director of Seattle’s Downtown Emergency Service Center, which runs 1811 Eastlake. After all, John had been drinking on the streets for decades. Most other residents knew him and had likely shared drinks with him. “He could tell people they looked like shit today, and that he didn’t want to see them that way,” Hobson says. After more than six years, John moved out and got his own apartment. 1811 Eastlake had saved his life.

MOST SHELTERS AND HOMELESS housing units would haveturned John away, though, employing the same reasoning with alcohol that conservatives use to block sexual education: abstinence-only. In 1997, when the idea for 1811 Eastlake first arose from a meeting of Seattle and King County officials, “everyone was still locked into the idea that the way you cure an addict is to demand they stop doing drugs/alcohol,” Hobson says.

Telling a homeless alcoholic he needs to clean up his life before he can enter housing is the functional equivalent of telling an obese person they have to lose weight before they can go to a gym.

There are many reasons why so many homeless housing units employ a strict ban on drinking. Drunk residents are almost always more likely to cause trouble—anything from damaging furniture to getting in fights—than sober ones. Many shelter operators have religious or moral objections to drinking. Others put abstinence policies in place under pressure from the local community, where NIMBY-style concerns about homeless shelters frequently arise.

Though everyone can agree on the ideal—addicts who are able to overcome their disease—philosophies differ on how to get there. The traditional school of thought was to demand abstinence; anything less would encourage undesirable behavior.

But alcoholism is a notoriously difficult addiction to beat, even when you have the advantages of a home, money, and a support network. Former First Lady Betty Ford, with every possible resource available to her, still struggled to overcome her dependence on alcohol. Telling a homeless alcoholic he needs to clean up his life before he can enter housing is the functional equivalent of telling an obese person they have to lose weight before they can go to a gym.

What many homeless advocates argue now, though, is that the strict-abstinence approach is actually counterproductive. Chronic homelessness can be caused by a multitude of different factors—including alcoholism. If alcoholism were easy to overcome, after all, many alcoholics never would have wound up homeless in the first place. Therefore, demanding that they first beat their alcohol addiction before being allowed to enter supportive housing is nonsensical. Instead, it is better to get chronically homeless people into housing immediately because, as Dr. Susan Collins, an associate professor of psychiatry at University of Washington, suggests, "Housing provides the foundation upon which a person can rebuild their lives." This strategy is known as “housing first.”

Hobson saw wisdom in both approaches. “Abstinence-based approaches work for a lot of people, but we shouldn’t let that blind us to the fact that there’s a subset of the population that this just does not work for,” he says. With an estimated 500 chronically alcoholic individuals in downtown Seattle on any given day—most of whom have struggled for at least 15 years with multiple failed attempts at conventional alcohol treatment—abstinence-only clearly wasn’t enough.

City officials hoped to help this group by opening 1811 Eastlake, a first-of-its-kind housing development with 75 separate units for homeless individuals who struggle with chronic alcohol addiction. In addition to housing, 1811 Eastlake also makes support staff, as well as medical help, available 24 hours a day, seven days a week. In return, residents are expected to pay 30 percent of their income, including such streams as welfare benefits and disability insurance, in rent.

Residents are allowed to continue drinking on the premises, but only in their rooms. Counselors also offer help and encouragement for any individuals who are ready to begin fighting their alcoholism. One innovative strategy is the alcohol management program, whereby residents voluntarily work out a contract to temper how much they drink and give all their booze to staff members, who then dispense it on an agreed-upon schedule.

SOME PEOPLE OBJECT TO the very notion of having to spend their hard-earned tax dollars on alcohol addicts. “Well, my friend,” Hobson says, “you’re already doing that.” Indeed, a 1986 law mandates that when a person shows up at an emergency room and can’t afford to pay, those costs are passed on to taxpayers and also result in higher insurance premiums. A recent study in Florida found that these medical expenses, along with incarceration costs, ended up setting back taxpayers $31,065 per chronically homeless person. A 2009 study in Seattle put the figure at nearly $43,000.

Alternatively, the cost to provide homeless alcoholics a bed and 24-hour-a-day supportive services at 1811 Eastlake is approximately $13,000 per person per year. Put another way, it saves taxpayers money. During the first year alone, in fact, 1811 Eastlake saved taxpayers more than $4 million, according to a 2009 Journal of the American Medical Association study. In fact, Harborview Medical Center, a hospital which had previously taken in many homeless alcohol addicts, realized these savings were so important that they loaned out a full-time advanced registered nurse practitioner to 1811 Eastlake in order to prevent medical issues before they became emergencies.

The housing-first approach hasn’t just benefited taxpayers; it has helped many alcoholic residents as well. Collins, the University of Washington professor, has studied 1811 Eastlake at length. Even though there’s a common perception that “tolerance means encouragement,” as Hobson says, Collins found that on a typical drinking day, participants went from consuming 20 drinks initially to 12 drinks over a two-year period, a 40 percent drop. In addition, the amount of alcohol consumed on the heaviest drinking days—particularly important because that’s when most alcohol-related problems like violence and accidents occur—decreased by one-third. Tempering their alcohol consumption helped individuals improve their health, their relationships, their employment prospects, and avoid alcohol-related behavioral problems, such as injuries and arrests—which plummeted by 38 percent.

Most of these gains came relatively quickly after an individual entered housing. “Once people achieve the stability housing affords them, they’re able to make positive changes and maintain them,” Collins says. This stability wasn’t just the comfort of a bed or a roof, but also an escape from the pressure of drinking all their alcohol at once, lest it be stolen or confiscated by cops.

Other cities, including New York City, Chicago, Fort Worth, and Anchorage, are now mimicking 1811 Eastlake’s model and opening similar “wet houses” of their own. In total, one colleague recently estimated to Hobson, “there’s somewhere in the neighborhood of 30-35 wet housing units across the country.”

Giving homeless alcoholics a place to live—and permitting them to drink when they're there—may not be politically correct. And plenty of people will go on about their visceral objections. But as John and many others will tell you, it is medically and statistically the right path forward.