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


Chronically homeless individuals with severe alcohol problems incur very high public systems and health care costs. This study examines a Housing First program in Seattle that succeeded in lowering public costs while not requiring complete sobriety; a controversial treatment method.

Located at 1811 Eastlake in Seattle is a Housing First (HF) treatment program. Residents of HF programs have no sobriety requirements during their stays. Instead, case managers engage residents about use issues and life goals. The primary focus of this article is the capacity of HF 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 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. Statistical analyses examined archival data from official databases.

Key Findings:

  • Participants in the treatment group incurred 55 percent less costs for the first six months. 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.