Sunday, May 17, 2009

Homeless Chronic alcoholics do better if you house them first

An article in this month’s JAMA looked at homeless alcoholics. Traditional treatment holds out the promise of help sometimes including free housing for those who decide to get detoxed and stop drinking. Traditional thinking goes something like this - “If you show us you are serious we will help you, but we don’t want to waste our resources on people who don’t want to help themselves”. These researchers did the opposite. They housed the alcoholics first and then provided services irrespective of whether the alcoholics stopped drinking or not.

They found that, in their program, total costs went down by about 50% and the benefits kept improving the longer the alcoholics stayed in the program. This is very interesting and is the opposite of what we usually do, but it makes a lot of sense. People need hope and they need to see the benefits of their new decisions – which for these guys was initially as simple as agreeing to stay in a free house. Once there the alcoholics got the opportunity to continue to change and improve their lives. Many got detoxed and started to change their lives. Without the free housing hardly any of them made any improvements. It is hard for those of us in the field of addiction to know when to use tough love and say that “we won’t help you until you do these things”. Sometime it is best to be flexible at the start and keep our eye on the final goal.

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