Homeless addicts get help without getting clean, sober

By Jack Gruber, USA TODAY

Pathways to Housing helped Rachelle Ellison after finding her sleeping in a D.C. alley.

EnlargeCloseBy Jack Gruber, USA TODAY

Pathways to Housing helped Rachelle Ellison after finding her sleeping in a D.C. alley.

Four years ago, Ellison, now 42, says she was a crack cocaine and alcohol addict who slept on park benches. Today she has a place to live and has taken classes at Everest College, in Arlington, Va., in a medical assistants program.

Ellison received her apartment through Housing First, a controversial nationwide initiative to house chronically homeless people without first requiring them to get treatment for their addictions.

A roof over a person's head is the first step to solving a person's problem says Sam Tsemberis, a clinical-community psychologist who started the program in 1992 in New York City.

"We had spent years trying to get people rehabilitated before giving them housing, while there's a lot of people who live on the street who already have survival skills that they can take with them when they are given an apartment," he says.

Some experts and housing facilities workers disagree with the idea of providing housing for homeless people with drug and alcohol addictions without emphasizing treatment.

"Dependency ... doesn't stop just because they have a roof over their head and food on the table," says Jesse Washington, director of affordable housing for Samaritan Inns, a housing facility for the homeless in Washington that does not follow the Housing First philosophy.

Samaritan Inns follows a 28-day social detoxification program for individuals, who are then given four- to six-months temporary residence and are required to look for a job and stay sober. The individual then has a one- to three-year stay in one of its apartments.

Housing First programs — including Pathways to Housing, an offshoot of Housing First that operates in Washington, Philadelphia, New York and Burlington, Vt. — are structured more loosely.

PHOTOS: A new place, a new lifeA person is provided with an apartment right away, Tsemberis says, and residents are not required to go to treatments or rehabilitation. They are required to meet once a week with a counselor. He says that residents can and do choose to go more often.

Elizabeth Epstein, research professor at the Center of Alcohol Studies at Rutgers University in New Jersey, disputes that approach. She says alcoholism is an addiction that is not irreversible and that putting people together in a drinking environment makes it much harder for them to quit.

"Honestly, the idea doesn't make any sense to me," she says. "I think that money would be better spent by providing them treatment and not allowing them to drink in their living quarters."

Funded in part by federal grants Seattle has a Housing-First-type building, 1811 Eastlake, which opened in 2005 and houses the city's 75 most chronically homeless individuals under one roof.

Bill Hobson, executive director of Seattle's Downtown Emergency Service Center says that housing the chronically homeless with addiction problems makes sense to him. "There are people that for whatever reason can't stop drinking," he says. "For me, it was clear that the alternative treatment methods were not getting through to them."

Both the Seattle building and Pathways apartments are funded in part by federal grants and local governments. Each requires that its residents pay 30% of their income from disability or unemployment checks or a job.

Tsemberis says that most people who are homeless are eligible for either welfare or disability benefits, and if they don't have either, Pathways helps to obtain them.

Hobson co-authored a two-year study, conducted between November 2005 and March 2007, published in the Journal of the American Medical Association in 2009, that found that housing chronically homeless alcoholics decreased the amount of taxpayer money spent on trips to emergency rooms and jails for these individuals.

The study found that public spending for the 95 people housed at the time dropped from roughly $8.1 million to about $4.1 million after being housed at 1811 Eastlake, Hobson said.

Finding the chronically homeless Pathways uses three methods to find the chronically homeless: street outreach by its workers, referrals from mental health agencies and the cities' departments of human services, says Christy Respress, director of programs and development for Pathways to Housing in Washington.

Ellison was a chronically homeless person sleeping in an alley near the Pathways D.C. office when counselors told her there was housing for her. At first she says she didn't believe it, but several days later, staff members took her to look at apartments.

Ellison says that she has a team of seven to eight people assigned to her. The group includes a psychiatrist, a family planning specialist, a drug counselor, and a team leader from the organization who talks to her by phone at least twice a week. Ellison says she used to meet with them every day but has progressed and become more independent.

She has reconnected with her three children — ages 18, 23, and 24 — and has a place to call home.

Ellison says she still drinks but is down to two or three times a week and "can control it now."

"It makes you not want to mess up so much when you have so much that you didn't have before," Ellison says of the Pathways program. "But you got to be given the opportunity to have this to know what it's like to make you want to get clean."

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