Housing First supportive housing programs do not make admission contingent on sobriety or treatment attendance and target chronically homeless people who are high users of publicly funded health and criminal-justice resources. The goal of these programs is to reduce safety-net system costs while improving quality of life for chronically homeless individuals by reducing acute care visits, hospital admissions, length of stay, incarceration, and shelter use and providing housing. Researchers studied the use and cost of services before and after program admission among 95 participants in a Housing First program in Seattle, Washington, and compared them with 39 wait-listed participants. All had severe alcohol problems.

• Monthly median costs among admitted participants decreased from $4066 in the year before admission to $1492 after 6 months in housing and $958 after 12 months in housing.
• Even after accounting for housing program costs, total mean monthly spending on housed participants compared with wait-listed participants was $2449 lower at 6 months.
• Both costs and crisis-services use decreased with longer time in housing.
• The number of drinks per day among housed participants decreased from 15.7 prior to housing to 14.0 at 6 months, 12.5 at 9 months, and 10.6 at 12 months.

Comments by James Harrison, MHS, CADC
This study provides compelling evidence that supportive housing for chronically homeless individuals can substantially reduce the cost of and burden on health and criminal justice services. It is important to note that both costs and alcohol consumption further decreased the longer participants were in supportive housing. Counselors, recognizing the high mortality rate among homeless individuals who drink heavily, should not make sobriety a prerequisite for supportive housing or other services.