Homeless curb drinking with open alcohol policy

U. WASHINGTON (US) — According to researchers, it may be counterproductive to ban alcohol from housing for chronically homeless alcoholics.

A study of a controversial housing project that allows chronically homeless people with severe alcohol problems to drink in their apartments found that during their first two years in the building residents cut their heavy drinking by 35 percent.

For every three months during the University of Washington study, participants drank an average of 8 percent fewer drinks on their heaviest drinking days.

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As published in the American Journal of Public Health, they also had fewer instances of delirium tremens, a life-threatening form of alcohol withdrawal.

Housing for chronically homeless people usually comes with many conditions, including abstinence from drugs and alcohol and compliance with psychiatric and substance abuse treatment. But such requirements can become barriers to staying in housing.

“These individuals have multiple medical, psychiatric, and substance abuse problems, and housing that requires them to give up their belongings, adhere to curfews, stop drinking, and commit to treatment all at once is setting them up to fail.

“The result is that we are relegating some of the most vulnerable people in our community to a life on the streets,” says Susan Collins, lead author and UW research assistant professor of psychiatry and behavioral sciences.

Because they are unable to cope with the rules, they often do not qualify for housing or are asked to leave. Once back on the street, they cost taxpayers money through use of emergency room visits, shelter and sobering center stays, arrests, and jail bookings.

In response, an approach called project-based Housing First has been developed by the Downtown Emergency Service Center, a Seattle-based housing agency. Project-based Housing First provides immediate, permanent, and supportive housing to chronically homeless people within a single housing project.

It is considered “low-barrier” because it removes some of the traditional barriers to housing, such as abstinence from alcohol.

The idea behind the project is that if chronically homeless people are provided with stable, permanent housing, their medical, psychiatric, and substance abuse problems will become more manageable.

Downtown Emergency Service Center’s 1811 Eastlake housing project is the first project-based Housing First model in the United States to be scientifically studied. Residents agree to spend 30 percent of their income—if they have any—on rent, and in return they are provided with permanent housing and social services.

An earlier study found that, in its first year of operation, this housing project saved Seattle taxpayers more than $4 million in costs from publicly funded services. The new study shows that drinking also decreases.

Health also improved. Residents reporting recent bouts of delirium tremens dropped by more than half over the two-year study, from 65 percent to 23 percent.

In the study:

  • The average number of drinks consumed on the heaviest drinking day of the month decreased from 40 to 26 across two years, a decrease of 35 percent.
  • The median number of drinks, a more accurate view of drinking patterns for this study’s participants, showed a change from 20 to 12 drinks per typical drinking day—a 40 percent drop.
  • By the end of one year, 80 percent of participants remained in the study. That was reduced to 79 percent after 18 months and 61 percent after two years. Severity of drinking and demographic variables were ruled out as reasons why participants left the study.

People tend to think that chronically homeless people with severe alcohol problems are unable to control themselves or monitor their drinking, Collins says, but instead this study shows that they are “human beings who are capable of change if they are given the same chance as the rest of us.”

More news from the University of Washington: http://www.washington.edu/