The Double Stigma: Homelessness and Alcoholism

Will My Insurance Pay for Rehab?

Sponsored Legal Stuff - This is an advertisement for Service Industries, Inc., part of a network of commonly owned substance abuse treatment service providers. Responding to this ad will connect you to one of Service Industries, Inc.’s representatives to discuss your insurance benefits and options for obtaining treatment at one of its affiliated facilities only. Service Industries, Inc. Service Industries, Inc. is unable to discuss the insurance benefits or options that may be available at any unaffiliated treatment center or business. If this advertisement appears on the same web page as a review of any particular treatment center or business, the contact information (including phone number) for that particular treatment center or business may be found at the bottom of the review.

The Double Stigma: Homelessness and Alcoholism

By Brian Whitney 03/22/16

Should homeless shelters and other housing assistance programs require people to be sober in order to receive help?

Image: 
Homelessness and Alcoholism
Shutterstock

The issues surrounding homeless alcoholics are ones that most people are quite comfortable ignoring. It is rather simple for most of us to step around them while they panhandle in doorsteps, or move to the other side of the street to avoid them and go about our day.

But for cities that have large homeless populations, and for advocates that are concerned for the homeless, policies around how homeless alcoholics are treated and housed in the community have long caused controversy. Everyone wants to help these people, of course, but there are inherent difficulties involved in working effectively with people in these situations. Even if a shelter caseworker is able to get a housing voucher for the individual, which is extremely difficult on its own, they then have to find a landlord who would be willing to rent to a street alcoholic. Then, even if that is accomplished, there are very limited support services to help the client adapt and adjust to his or her new environment. So often, they are evicted, which starts the cycle of homelessness all over again.

So, what to do? How do we help these people, and—for those who think less about people and more about the bottom line—how do cities avoid spending tens, or hundreds of thousands of dollars a year through crisis services taking care of these people?

A few years ago, I worked in a shelter in a mid-sized coastal city in the Northeast. There was a homeless alcoholic who would often pass out on the ground across the street from the shelter. He would do this a few times a week. I would head over there and try and wake him up. If he didn’t move, policy dictated that we had to call the cops. And when we did, a police car, ambulance, and a fire truck would show up. The man would be taken to the emergency room, and then released a few hours later. This cycle is how most cities deal with homelessness, and it isn’t cheap. A 2014 study showed that it cost Central Florida communities over $30,000 a year to deal with each chronically homeless individual.

There are three basic schools of thought on alcoholics and homeless shelters. The one that is the most prevalent, of course, is to offer the individual some food, some shelter, a place to sleep and some kindness—with the hope that with help, he or she will find their way. The shelter where I worked was in this camp. We would not allow people to drink at the shelter, but being drunk at the shelter was more than fine. Of course this just meant they would go downtown or down to the docks to drink, as opposed to drinking at the shelter.

There are some, however, that feel that allowing a homeless person who is under the influence of alcohol a place to stay just enables the behavior and does not facilitate change. Numerous shelters do not allow anyone who is under the influence of alcohol (at all) to stay. The traditional school of thought has always been to demand abstinence; anything less just encourages bad behavior. Why would they attempt to curb their drinking if they are given food and shelter?

One such emergency shelter in Connecticut recently decided to close rather than comply with a state directive to admit homeless people who are active alcohol "users." "MACC is not (never was) a drug and alcohol facility or service provider," Beth Stafford, the executive director of the Manchester Area Conference of Churches tells me in an email interview. "Our mission is to provide emergency assistance in form of the basic needs of food, clothing, shelter and advocacy to people in our community. We do not agree it is best practice to mix the population of people trying to overcome addictions with active users."

Others think differently. Bob Fowler is the executive director of the Milestone Foundation, which has been operating out of Portland, Maine since 1967. Milestone provides a safe place to sleep, clean clothes, food, showers and counseling to people who are experiencing issues with substance use. They also offer a detoxification program that offers medical assistance to clients wishing to break their physical addiction to alcohol and other drugs.

"Milestone’s is a substance use shelter, meaning we admit people who are under the influence of drugs or alcohol," Fowler tells me. "For me, this is a basic harm reduction approach. The people we serve are dealing with drug and alcohol addiction as well as homelessness. Depriving shelter to these individuals won’t do a thing to help the addiction. Engagement and compassion, on the other hand, just might."

There is another school of thought that feels that housing needs to happen before anything else. Instead of trying to get the person sober before attempting to fix the rest of his or her life, the goal is to house the person, let them drink, and then tackle the boozing. Finding homeless people a permanent home first may provide them with the support they need to tackle other health concerns later. It provides them with a more normal existence, which may cause them to choose to drink less on their own.

One of the major proponents of this model is 1811 Eastlake, which is part of Seattle’s Downtown Emergency Service Center. This facility attempts to address the long-term issues of homeless alcoholics by giving them a room and allowing them to drink as much as they want. At 1811 Eastlake, residents can drink on the premises, but only in their rooms. There are counselors available who offer help for anyone who is ready to begin fighting their alcoholism. There is also an alcohol management program, in which residents can choose to work out a contract to lessen how much they drink and give all their booze to staff members, who then dispense it to them, usually hourly.

"Candidates for housing are selected from data supplied to DESC from King County which shows individuals who are highest utilizers of public crisis services (meaning emergency rooms, crisis calls and detoxification centers)," Greg Jensen, DESC's director of administrative services, tells me. "We outreach those individuals and offer them the housing opportunity, provided they are chronically homeless and income qualified."

When I asked him, "Why does your program work?" He said, “I'm not sure how to give you a response to your question about why our program works. Participants’ success is measured by housing longevity and most residents stay for the long-term, despite long histories of homelessness and substance abuse. The program has been extensively evaluated, as you can see on our webpage. Studies have confirmed that the program succeeds in suppressing the use of crisis services and improving residents' quality of life.”

Some disagree. And one of them is Dr. Drew, who once said, “What exactly are these places? What are their goals? Are they harm-avoidance centers or hospices? The people running these places have to be clear about they are doing. I want to know if they are actually doing more harm than good. What motivates most people to change their behavior is consequences. No consequences? No behavior modification. Some have observed that alcoholics who are allowed to drink more may actually drink less. But if wet houses are end-of-the-line outposts, why would that even matter?”

Nick Flynn is the author of the ridiculously good memoir Another Bullshit Night in Suck City. His book details the story of his time working at a shelter in Boston where he often encountered his homeless and alcoholic father. When I asked about his thoughts on wet or dry shelters, he told me, “It is hard for me to comment on wet or dry shelters, simply because I think our thinking on homelessness has gone way beyond shelters. The housing first movement has picked up speed in the last few years as the only viable solution. The housing first model falls under the rubric of a harm reduction model—in other words, meeting people where they are, providing housing, along with whatever support is needed to allow them to stay. The issue of wet or dry is beside the point, it is the wrong question.”

And while what Nick says is true, it is a question that many will continue to ask in the foreseeable future.

Please read our comment policy. - The Fix
Disqus comments
Disqus comments