Study of Seattle project shows promise for 'wet housing'

Portland housing officials took note last week of a new study from Seattle appearing to show that controversial Housing First policies, such as those implemented this year at the Bud Clark Commons in Old Town, can help residents decrease their addictions.

The $47 million commons project, which opened six months ago, is the first large-scale public housing building in Portland that allows residents to drink and use drugs in their apartments. For years, most public housing nationwide was made conditional: residents had to agree to not drink or use drugs to keep their apartments.

Recently, public housing has moved toward a Housing First model that stresses getting homeless people into stable living situations - even without sobriety conditions - with the hope that they will later address substance abuse problems.

Most of the previously homeless residents of Bud Clark Commons' 130 apartments have had substance abuse problems, and all the previously homeless residents of the 1811 Eastlake public housing building in Seattle have histories of alcohol abuse. Portland housing officials have said Bud Clark Commons was mostly modeled after the Eastlake project, now open for seven years.

The Seattle study, published in the American Journal of Public Health, found that during their first two years at Eastlake, residents cut their heavy drinking by 35 percent. They also substantially reduced the frequency of their delirium tremens, or tremors from alcohol withdrawal.

At Eastlake, residents are allowed to drink in their rooms, but not in common areas of the building. In addition, housing staff will buy alcohol for residents, in the belief that they can better monitor and perhaps limit residents' drinking. That is not a policy at Portland's Bud Clark Commons.

Susan Collins, lead author and an assistant professor of psychiatry and behavioral science at the University of Washington Harborview Medical Center, says she was studying what has been called 'the enabling hypothesis.'

'A lot of people think if you allow alcohol-dependent people access to alcohol and you don't insist on abstinence, you will enable them to drink more and more and their drinking will spiral out of control,' Collins says.

That isn't what happened at Eastlake, according to the study. The average alcohol intake of residents entering Eastlake was 20 drinks a day. During the course of the study, that dropped, on average, to 12 drinks per day. The number of residents experiencing withdrawal tremors dropped from 65 to 23.

Nearly all the Seattle building's 95 residents, whose average age is 48, are men. Collins says the average resident has been through 16 substance abuse programs before entering the building.

'There are multiple paths to alcohol dependence, and there needs to be multiple paths to recovery,' Collins says. 'Traditionally, we have insisted on one path, abstinence. We need to consider paths to recovery that include non-abstinence goals.'

Cutting some costs

Daniel Malone, housing director of Seattle's Downtown Emergency Service Center, which runs Eastlake, says some residents, embracing recovery, found Eastlake a difficult place to become abstinent and were given housing at other buildings that do not allow substance use. But other residents, he says, found that the building's policies could encourage their recovery, with drinking residents serving as 'a bit of a reminder.'

Housing consultant Heather Lyons, who was instrumental in developing the Portland Bureau of Housing's 10-year plan to end homelessness, calls the Seattle study 'very significant.'

'It's further evidence that the model works for a segment of the population that is not ready for sobriety but wants to get off the streets. Reduced drinking results in improved health outcomes, and that's good for everybody,' Lyons says. 'It's further evidence that it was a good idea to use that approach in the Bud Clark Commons.'

Traci Manning, director of the Portland Housing Bureau, says she'd like to go further with a study at Bud Clark Commons.

'They measured substance use,' Manning says. 'We'd like to take a stab at measuring other kinds of health. Does people's mental health improve? Does their primary health improve? And, does it cost less for them to be healthy?'

Manning says the housing bureau is hoping to find a way to study the health care the longtime homeless residents of Bud Clark Commons received over the two years prior to entering the building, and how much they are receiving now. The hope, she says, is that their overall health is improving and the public is spending less money on their health care in the form of items such as unpaid emergency department visits.

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