Sobriety is NOT a Precondition for Housing Success – Look at the Facts
Once people hit the age of majority, they are entitled to drink legally. Everyone can have their own opinions about their own consumption. These opinions may be based upon their personal values, religious beliefs, upbringing or whatever. BUT – making sobriety a precondition for assisting a person who is homeless for accessing a housing program is egregiously misguided.
Let us look at 8 facts…
More adults consume alcohol than adults that do not [this Gallup Poll shows 67% of Americans consume alcohol, for example]
Most adults that consume alcohol or other drugs never experience homelessness, even when their use may be considered to be problematic or substance abuse [if you look at Point in Time Count data from HUD, while almost 664,000 people are homeless on any given night, this occurs within a country of 312,000,000; and 23.2 million Americans are considered to have an addiction…so some very simple math – .002 of the population is homeless on any given day, while .07 have an addiction on any given day]
Even for those individuals that choose to access treatment for substance use, there is no universally accepted definition for what constitutes rehabilitation or treatment [and here is a great opinion piece from Time Magazine that discusses that very issue in the article]
It is not well understood why some approaches to addiction treatment work for some people and not for others [the same Time article reference for Fact #3 is relevant here too if you want a layperson’s discussion of the issue]
While many substance treatment programs tout a 30-35% “success rate”, this is a misleading statistic as it accounts only for those that have completed the program [Joseph A. Califano Jr., who founded the National Center on Addiction and Substance Abuse at Columbia claims the therapeutic community boasts a 30% success rate, but points out that 70-80% of participants in programs drop out in three to six months.]
Problematic substance use results in considerable costs amongst homeless individuals that use substances, especially in use of police, paramedic, and ambulance resources and goes down once housed [the Journal of the American Medical Association – no slouch of a journal – shows that costs of substance using homeless persons goes down considerably once housed, in this article; and it is only one of several research pieces that have demonstrated the same thing]
The “enabling hypothesis” (providing housing for individuals that use substances results in increased use) has been debunked [see this article from the Journal of Public Health]
Motivation to change behaviour, including a reduction or cessation of substance use, increases when people have stable housing [see this article from the journal Addictive Behaviors]
Substance use is also no reason to prevent a homeless person from accessing shelter. There can be reasons to prevent people from accessing shelter because of behaviour (depending on the particular shelter), but not solely because a substance was used. Imagine if you were never allowed access to your bed just because you had a drink (the case in many shelters where abstinence is required) or smoked a joint. Why do we expect something different from homeless persons?
But now back to housing programs…
If people’s reduction is likely to decrease or stop once they have housing gets better results than expectations of treatment in order to access housing programs…
AND
If costs to the taxpayer related to police, paramedics and hospital use related to substance use of homeless persons go down considerably once people are housed…
AND
If most people with an addiction to substances are not homeless and will never experience homelessness….
AND
If being housed does not enable people to drink more…
AND
If motivation to change increases once people have secure housing
THEN
Can we please stop using sobriety as a precondition to access housing and support programs? Logically doing so makes no sense, costs a whack more, decreases the likelihood of addressing the substance use and punishes people for having an addiction.
