Nonabstinence Program Decreases Alcohol Use in Homeless Individuals

Rates of alcoholism are extremely high in the homeless population. The cost to communities to shelter, feed, and medically treat these individuals is enormous. Most programs designed to provide permanent housing to homeless individuals require strict adherence to psychiatric treatment or treatment for drug and alcohol misuse. These strict guidelines are often too rigid for many homeless people to maintain. Therefore, implementing a more flexible housing program that offers lower barriers to inclusion could potentially give homeless individuals struggling with psychological problems a solid foundation on which to rebuild their lives at their own pace. Housing First is just such a program. This nonabstinence housing program offers homeless individuals the opportunity to permanently reside in a single housing community and receive health and social services through available on-site resources, if they choose.

Policymakers have suggested that Housing First, which does not insist on abstinence or treatment for its residents, would enable residents to continue their drug or alcohol use and could potentially result in increased misuse. However, findings from a recent study conducted by Susan E. Collins of the University of Washington’s Harborview Medical Center demonstrate that this low-threshold program actually decreases alcohol use. Collins followed 95 homeless individuals as they were admitted into Housing First and for 2 years after. All of the individuals had alcohol addiction problems at entrance.

Collins discovered that contrary to the theory that Housing First would enable the participants, every 3 months that the participants were in the permanent homes, they decreased their alcohol intake by 7%. Additionally, the level of delirium tremens experienced during withdrawal from alcohol was reduced by 50%. The participants also reported fewer instances of complete intoxication. Overall, the levels of alcohol-dependent symptoms dropped from an average of five symptoms at entrance into the program to an average of two symptoms 2 years later. This represented a 4% decrease for every 3 months the participants remained in the housing program. Collins believes these findings are important and should be considered in planning and designing of future housing programs for alcohol-dependent homeless individuals. Rather than force people to completely abstain and receive treatment, Collins points to prior research that supports her findings for positive outcomes with less stringent guidelines. She added, “Recent studies have suggested that the autonomy and sense of stability afforded by Housing First provide a foundation upon which residents may take their own steps toward positive behavior change, including changes in their alcohol use.”

Collins, S. E., Malone, D. K., Clifasefi, S. L., Ginzler, J. A., Garner, M. D., Burlingham, B.,  et al. Project-based housing first for chronically homeless individuals with alcohol problems: Within-subjects analyses of 2-year alcohol trajectories. American Journal of Public Health 102.3 (2012): 511-19.

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • christine p

    christine p

    April 3rd, 2012 at 3:48 PM

    I am so on the fence about this, aaaahhh! I am struggling here, because I think that sometimes the only way to get rid of a bad habit is to just nip it in the bud, quit altogether. Does it really do them any good to continue using if this is the ultimate goal? But I can also see how some people will have a really hard time going cold turkey, they need to ease off the habit instead of just simply dropping it altogether. It is such a hard decision to make how I really feel about it. I guess there are some addicts who will be successful one way and some another, the key being finding the program that is going ot be the most effective for each individual patient.

  • Tori


    April 3rd, 2012 at 5:00 PM

    A program like Housing First allows the residents a bigger sense of control over their own lives and their own decisons. This is something that many other housing and treatment programs lack. Other programs make the residents feel like they are a child and have to adhere to these strict rules that no one can possibly live up to, especially when they are facing troubling times in their lives. This is a program that sounds like they allow the residents to do things on their own terms and in their own way. What a feeling of liberation this must offer to those who participate, they are allowed to keep decisions for themselves and to make the changes that they need to make in life when they feel like they are ready, not when someone tells them that they have to.

  • Jacob


    April 4th, 2012 at 4:21 AM

    I completely agree with the author that the stability that this program offers is a big part of what more than likely helps the men and women in these kinds of programs have an easier time trying to stop drinking.
    When your whole life spiraling out of control, no place to live, no home, no support, it is not surprising that alcohol abuse becomes prevalent in these lives.
    But when you give someone shelter with no conditions, and given them the tools that they need to improve their lives one step at a time, then you are giving them a means to get control over their addictions.

  • yogaloverrr


    April 4th, 2012 at 1:07 PM

    Sorry, but this is wrong. How do you teach those who need this kind of help that drinking alcohol is more than likely the root of most of their problems if you are going to allow them to stay in this program as well as reap all of the benefits that it has to offer?

    Many of us are leading the straight and narrow life, working, paying our bills, taking care of our families. Yet most of us are not rewarded with the kinds of health and social resources that this kind of program is going to reward these people with who have abusing the system for a long time now.

    It somehow seems wrong like we are rewarding their bad behavior with good things. They should have to at least mee some level of expectations about behavioral changes to be able to take part in this. Otherwise it is again giving them something for nothing, does not do one thing that will convince them that they need to stop drinking to be a valuable and necesssary part of society.

  • Mack


    April 5th, 2012 at 10:15 AM

    Thank God I have never found myself in this kind of situation, but we all know that there are many who face a world of loneliness and hunger and homelessness and addiction all together. Can you even imagine going around with all of this on you and feeling like there was nowhere in earth that you could find that would stand by you and help to take care of you? After all, aren’t we here to look after one another? If this is what someone needs to make a change then I am all for it. Any of us who decide to change something in our lives, we all know that it is not usually a change that is going to happen overnight. It takes time and effort and sometimes we all backslide. But when you have some support and encouragement you can find it within you to get up and try again instead of letting all of that hard work go to waste. If that is what Housing First and other programs like that are all about, than I plan to be a huge supporter.

  • Seth Harrison

    Seth Harrison

    April 5th, 2012 at 12:26 PM

    Way to go I’d say! Forcing people to leave something until and unless THEY really do not want to is futile in the wrong run.

    Most of these people do not drink all the time because they love to or because they have no ob. its their life’s circumstances and difficulties that do that to them. And by providing housing you are eliminating one of their biggest problems. So a decrease in the ‘escape’ they used(alcohol) is not surprising at all.

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