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Housing Drunks and Letting Them Drink Saves Millions

Classic social programs dealing with long-term alcoholics are expensive and do not have a great success rate. In 2005, a controversial experimental program in Seattle began to put homeless drunks in their own apartment building and let them drink as they pleased.
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.)


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.

The financial aspects of this experiment are not all that surprising, but is it really a good idea? Is it more ethical to spend time and money to try to save people from their own bad decisions, or to give them the dignity of living their lives the way they choose, however harmful? Does this kind of program send the wrong message? Or would it make our streets safer? -via reddit

(image credit: Flickr user dno1967)

Unfortunately human behaviour focuses too readily on a sense of fairness rather than pragmatism. Consider jail systems and education - the evidence is fairly solidly in favour of educating criminals towards a college-equivalent level to reduce the probability of them repeating offences. It makes perfect sense, in fact. Yet to fund such measures upsets people who otherwise can't afford further education, creating a bias or sense of unfairness. In other words 'who cares if I'm safer because of it - I can't get a degree, so why should a criminal?'.

Same with this situation. 'I can't get cheap housing, so why should an alcoholic bum?'.
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What's interesting here is that you fail to mention in this post is that many residents at 1811 saw a drop in their personal drink consumption, and some have eventually become sober.

Alcoholism is a disease. Alcohol is also used by many to self-medicate a mental health issue that cannot receive more acceptable treatment due to a failing mental health system. Also, if I spent every day worrying about where I was going to sleep, whether or not I would be safe, and how the rest of society would react to me, I'd drink, too.

Harm Reduction models are better than anything else out there and I hope that if we can't appeal to people's hearts, we can at least appeal to their pocket books.

Fair doesn't come into the picture. Humanity does.
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In Paris, France, it is estimated that 60% of the homeless have psychiatric disorders or addictions. Getting most of this poeple back on a "normal" life is the most difficuly task : it's against what they "want".
So you're confronted with a choice of let-them-be maybe with a little help like in this post, or freedom reduction with mandatory re-education.
Tough choice.

On a lighter mathematical point of view : I'm sure that letting some drink themselves to death had to do with lowering the average cost. So my guess : 98-98*958/4066= 75 homeless died in this experiment. Way to go! In only a year! we're getting rid of the problem! Yoohoo, go science! ;) :p
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So I can tune in, turn on, and drop out,
and be a ward of the State as long as I stick to booze?

After years of pushing the rock up the hill with little result, I am sorely tempted.

Is my customary 3 cocktail limit enough, or will I have to pour the excess into a potted plant?
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Some interesting maths there Christophe. Because the costs were reduced by about 75%, you assume 75% of the homeless died. You're not an economist are you?
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I find the dollar amounts to be highly suspect. For example, the "after" numbers cannot include the Fair market value of owning and operating the apartment complex. Additionally, there does not appear to be a control group. Did they follow the costs of another 100 drunks who did not enter the facility?
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Edward - i live about a block north of this place and in a similar, though smaller apartment complex.

$958 sounds right to me. that's about what i pay after rent and food. same area, same size apartment.

we see these guys walking past our place and to this complex all the time. like your average street alcoholic, they look dirty and unkempt. unlike your average street alcoholic they never bother anyone and never ask for money.

the dollar amounts seem bang on the nose to me. it's not a lavish lifestyle that is being provided here, just secure accommodations that keep these people from becoming desperate and doing the kinds of things that really start costing society.
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Since I happen to live in a country of overabundance of luxury and complacency, I think a little mercy towards those who are at their lowest would help everyone. Who cares how they come to be that way? what if by showing them the basic acknowledgment as human beings we actually make a difference in their lives?
Id pay my taxes towards that.
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I agree with capella, more houses for homeless people. I pay for rent, doesn't mean I can't bear to see someone less fortunate live for free. College degrees for convicts on the other hand, I don't know, something about giving a convict a degree for free where I would have to live in a financial prison for a majority of life seems a bit strange. Plus what ahppens when the only people with degrees are convicts? Or everyone starts becoming cons so they can get degrees?
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I too agree with capella, I've been homeless and addicted to substances. (Sure I couch surfed and cruised around on my bicycle the whole time, but i lived out of a backback, slept wherever, and didn't have a job for almost a year.) Anyway my point here is that most people i've met and hung out with who have been homeless for years (not fake-can-i-sleep-in-your-backyard-homeless) while addicted to substances and seem to be silently at war with themselves having realized America is filled with greedy, inhumane, selfish people. Why would you want to return to the "functioning" society after being free from all that mess for so long? Or would you? I am glad I got my sht together. Maybe they don't want to.
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Indeed this is the sort of issue I grapple with constantly. I waffle between being a "bleeding heart" liberal/socialist and a pragmatic conservative.
I think that it is worth it, for society, to help these people. By giving them a stable roof over their head, you are not only maybe reducing "costs" but you are probably also reducing local crime, especially little stuff like petty larceny, public drunkenness/exposure, etc. But there are the ethics of allowing (condoning?) self-medication with drugs/alcohol. Also at the same time I feel like giving a person something for free just because they've had it bad isn't fair.

I have battled intermittent severe depression my whole life. I have been lucky to have a very supportive family and husband who can help take care of me when things get Really Bad. But I have enough of a support system that I live a decent life that is sometimes extremely stressful and things are stretched thin. I guess I am resentful at the idea that if someone goes "all the way" to hit rock bottom, they get a handout versus other people who barely manage to keep their sh*t together must scrape by. (Similar to my annoyance that once you have a baby, you get tons of free education, etc)
BUT. I wholly believe in doing what is good for society. To be a good humanitarian and help when and where I can. So I think I can tolerate a little uncomfortableness or resentment, when it is balanced with knowing that things are getting better.

This is what ethics majors live for.
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Malcolm Gladwell wrote a lengthy new yorker piece on this three years ago, well worth the read
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