A monumentally important research study allowed homeless men in shelters to drink. Over a year, these alcoholic men drank less and spent far less time in detox, jail, and hospitals, which in turn reduced per capita costs significantly. This study challenges America’s AA-abstinence-only orthodoxy, including the mantra that alcoholics will end up in jail, a hospital, or dead if they don’t stop drinking.
Shelters are notoriously dry places that refuse intoxicated or drinking residents. A group of University of Washington public health researchers published in the April 1 issue of the American Medical Association’s flagship journal (JAMA) a study finding that allowing alcoholics to drink and still to enter public homeless shelters produced indisputable benefits to society and for the alcoholics themselves.
In practice, banning drinking in shelters sentences alcoholics to the streets. The study compared 95 chronically alcoholic men who were allowed to drink in shelters, on the one hand, with another group of 39 who were wait-listed. The study was thus “quasi-experimental,” comparing randomly selected groups in terms of outcomes based on a single intervening factor – being allowed to continue drinking and yet still having housing.
The results were unquestionable. Leaving drinking alcoholics on the street is a remarkably expensive proposition: due to their repeated stints in jails, hospitals, and detox, the alcoholics admitted to “wet housing” had spent $8 million in public funds the year before the study. For the year of the study, their costs were approximately two thirds less (counting housing costs), going from a median of $4,000 monthly to $1,500 relative to the control group and their own prior costs.
Most exciting of all, the costs continue to decline the longer they stay in the wet housing, down to a thousand dollars per resident at the end of the year. And, despite the permission to drink, these long-term alcoholics reduced their consumption, from an average of 16 drinks daily at the start to 14 drinks at six months to 10 drinks daily by year’s end.
For decades, American researchers have fought to provide controlled-drinking therapy, or to count reduced drinking as a beneficial outcome. This has not been a popular position to take in this country – a battle that has spilled onto the pages of Psychology Today. (Three American psychologists in this movement have been Alan Marlatt, one of the authors of the current study, William Miller, developer of motivational interviewing, and me.)
But the JAMA study did not concern therapy. Shelters often insist that the men enter AA, but this program required no treatment. Simply allowing the men the right to be housed (the project is called “Housing First”) had the impact of improving their lives and social costs at the same time. This is called harm reduction.
Of course, AA proponents can boast how quitting drinking has sanctified them. They can then claim these men’s lives would be immeasurably better if they only got sober. But this is not the reality of “street” alcoholics. Discarding the bromides of American alcoholism treatment improved these men’s lives decisively, and promises to continue the improvement going forward.