Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems

Mary E. Larimer, Daniel K. Malone, Michelle D. Garner, David C. Atkins, Bonnie Burlingham, Heather S. Lonczak, Kenneth Tanzer, Joshua Ginzler, Seema L. Clifasefi, William G. Hobson, and G. Alan Marlatt

April 2009

Chronically homeless individuals with severe alcohol problems often have multiple medical and psychiatric problems and use costly health and criminal justice services at high rates.  This study examines a “Housing First” program in Seattle (1811 Eastlake) that succeeded in lowering public costs while not requiring complete sobriety; a controversial treatment method.  The primary focus of this study is the capacity of Housing First programs to lower overall public systems costs and contacts with public services.  The study secondarily examines 1811 Eastlake's success in reducing alcohol consumption. The study used a quasi-experimental design, comparing 95 housed participants (with drinking permitted) with 39 wait-list control participants enrolled between November 2005 and March 2007.  The study sample was ethnically diverse with high rates of chronic medical illness and infrequent periods of stable housing over nearly two decades. Researchers conducted interviews at baseline, three, six, nine and 12 months post-enrollment.  Total cost offsets for Housing First participants relative to controls averaged $2449 per person per month after accounting for housing program costs.  Total costs for the housed group dropped over $6,000,000.  Both the average number of daily drinks and the number of days drinking to intoxication declined for individuals in housing.  Lengthier housing stays resulted in proportional lowering of alcohol consumption.

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