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Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates

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Project Summary:

Background “[T]hese apartments are a bad idea. If government is going to build housing for 75 alcoholics, at least it should insist they quit drinking in order to live there.” Seattle Times editorial, March 15, 2004. Since the decriminalization of public drunkenness in the 1970s, little has been done to address the problems that chronic public inebriates (CPIs) pose to Seattle and surrounding communities. CPIs are heavy utilizers of taxpayer-funded public health and criminal justice systems. Seattle’s Downtown Emergency Service Center (DESC), with substantial support from local government and elected officials and despite intense criticism from the public and numerous media outlets, has begun construction on 1811 Eastlake, the first supportive housing project in Seattle dedicated to this population. The project will provide housing and on-site supportive services for 75 individuals without the requirement of abstinence from alcohol or participation in a treatment program, and residents will be able to drink alcohol in the building. Specific Aims Working in collaboration with the University of Washington, this study will evaluate the effectiveness of the housing project’s three major objectives: 1. To demonstrate the effectiveness of prerecovery housing on the following: CPI healthcare utilization, legal interactions and associated costs; alcohol use and associated problems; and motivation to engage in treatment 2. To examine how motivation toward treatment and public service utilization change both over time and as a function of receipt of prerecovery housing 3. To test the mediating effects of substance use and psychiatric symptoms on service utilization, and of social support on motivation to treatment Methods Study participants will consist of 125 CPIs identified by King County as being highly ranked in terms of their number of admissions to hospital emergency departments, jails, and sobering centers. Once the county’s list is received and analyzed, those individuals offered residence and services by DESC in the 1811 Eastlake supportive housing unit (n = 75) will be compared across multiple time points to a randomly selected or case matched control group (n = 50) of CPIs eligible but not housed in the initial 75 spaces. Participants will be evaluated before housing to nine months after housing begins, those in the prerecovery housing being additionally assessed at 12 and 18 months on measures of three outcomes: utilization and costs of a broad range of community services, substance use-related negative consequences, and motivation for treatment. Based on prior research and the harm reduction model, we would anticipate that housed CPIs will show improved individual outcomes—mediated by co-morbid psychopathology, substance use, and strength of social relationships—and reduced aggregate costs to community taxpayers. While social policy is value driven as well as economically motivated, the creation of this 1811 Eastlake harm reduction housing provides a natural experiment that may speak to both these forces of social policy creation. Evaluating the cost analysis of CPIs offered supportive housing compared to those who were not should illuminate the preventative and cost-effective nature of prerecovery housing. By documenting and disseminating success stories emerging from this residential community we can personalize and humanize CPIs, challenging negative, pervasive, and chronic stereotypes. The formidable organizations partnering in this project are committed to both sound science and sound social policy and will immediately begin public awareness and dissemination about this project on local and national levels.

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