Chron op-ed: Housing First's no-barrier orthodoxy
Image by Ted McGrath
California mandates a “housing first” model that places homeless people into permanent supportive housing where drug and alcohol use is allowed. Keith Humphreys of Stanford says sober living arrangements are required to help manage homelessness crisis.
Every reasonable person agrees that addiction is a prevalent challenge among the homeless population, whether they base that judgment on scientific research or on the experience of walking the streets of California communities. But there is a sharp disagreement about how to respond to this reality, one that touches on familiar debates about drug use, human rights and the true definition of compassion.
Since 2016, California has gone all-in on one side of this debate by requiring all tax dollars used for housing to endorse a “housing first” model. This places homeless people into permanent supportive housing immediately and with no preconditions. The use of alcohol and other drugs is not a barrier to entry or to continually live in a supportive residential setting. Proponents believe that imposing conditions would not be compassionate and would violate individual rights.
In the fentanyl era, the consequences of this shortcoming for the state’s residents are stark: three people die from drug overdoses every week in supportive housing in San Francisco alone. It would be hard to cast such an appalling outcome as the consequence of a compassionate response or a triumph for human rights.
To appreciate the suffering created by the state having only one model of supportive housing, imagine you are a homeless person who has just successfully completed a residential addiction treatment program. For the first time in months or years, you have hope for a better future, and you need a place to live to secure it. But when you ask to be placed in a drug-free housing setting that will support your recovery, you learn that current law denies you that option. This leaves you the awful choice of living in a housing situation where you will probably be exposed to powerful cues to return to drug use (e.g., other people getting high, the presence of drugs) or returning to the streets and hoping for the best there.
What then would be better for such people than housing first?
There’s strong evidence for recovery-focused housing that creates community support and forbids substance use. DePaul University researchers conducted a randomized clinical trial — medicine’s gold standard for evidence — of 150 people leaving addiction treatment who were assigned to recovery housing or other aftercare arrangements. At 24-month follow-up, those in recovery-focused housing had double the rate of abstinence from alcohol and other drugs. The substance-free environment and residents’ shared commitment to recovery had other benefits to residents and taxpayers. Recovery housing residents had more than twice as much monthly income and were two-thirds less likely to have been incarcerated.
Matt Haney's bill would end the one-size-fits-all approach in which all state housing dollars go to housing first programs, which permit unlimited drug and alcohol use by residents. Haney’s bill would allow up to 25% of that funding to be directed to housing in where substance use is not allowed and recovery from addiction is supported. This, of course, still leaves 75% of dollars available for housing-first programs to serve those who benefit from this approach.
Bringing recovery housing to California communities could save many lives while also reducing our homelessness problem. Unfortunately, after passing the Assembly with unanimous support, Haney’s bill has been hit with amendments in the state Senate that reduce the amount of funding for recovery housing to only 10% and impose added bureaucratic requirements that will make it hard to realize this goal.
When the two houses reconcile the versions of the bill, Haney’s more ambitious vision should carry the day, and Gov. Gavin Newsom should sign it. Californians should not have to choose between receiving support for recovery from addiction and their housing. Nor should cities and counties that want to help homeless Californians be required to have only a single tool in their toolbox.
Keith Humphreys is a professor of psychiatry at Stanford University and served as senior drug policy adviser in the Obama White House.
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