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18 Lifting the Burden of Addiction: Philanthropic opportunities to address substance use disorders in the United States

High-impact opportunity 1.3

TIPSNot all housing

programs are the same:

• Housing First

programs provide

housing and case

management,

whether or not

residents are

maintaining sobriety.

They are most often

“scattered site,”

which means that

clients aren’t all

housed in a single

building but rent

apartments through

private landlords

just like any other

leaseholder.

• Sober housing

programs provide

housing only as a

reward for sobriety—

and withdraw it as

a consequence for

drinking or drug use.

Both programs can

be helpful, depending

on the population

served. While some

with SUDs see sobriety

requirements as a

barrier to entry, others

may welcome them as

a needed incentive.

TAKE ACTIONSeveral options exist for the kind of supportive housing that keeps SUD sufferers safe, keeps the door open

for recovery, and saves societal costs. The 100,000 Homes campaign lists programs across the country

at 100khomes.org. For more information about Pathways to Housing PA and the Housing First model, see

pathwaystohousingPA.org.

Pathways to Housing PAPathways to Housing PA implements the Housing First model, housing clients regardless of their

substance use. According to a 2011 evaluation, 89% of Pathways to Housing PA participants

remained stably housed five years after entering the program.103 Clients can access services like

primary care, SUD treatment, and coaching on daily activities such as shopping for groceries.

Housing is used as a foundation for stability, rather than an incentive for sobriety. Pathways to

Housing PA partners with the Philadelphia Department of Behavioral Health on a special effort

targeting chronically homeless SUD patients.

Note: Pathways to Housing was originally a national network, but local chapters now operate

independently. A Pathways chapter in New York was closed following financial and legal

difficulties, but other implementations remain highly recommended by experts in homelessness,

including the federal agency tasked with homelessness prevention (United States Interagency

Council on Homelessness).104

Combat SUD-related homelessness

The incidence of SUDs among the homeless is four to six times greater than that of the population at large.88, 89

The instability of homeless life makes recovery more difficult, and many housing programs and other support services

require sobriety as a condition of participation. As a result, homeless SUD patients who can’t maintain sobriety remain

on the streets, largely untreated, relying on costly public services like shelters and emergency rooms.90 Stable,

supportive housing can make an immediate positive impact in quality of life for a person with an SUD, while improving

access to treatment, decreasing the use of emergency services, and ultimately saving public dollars.91-95

CORE PRACTICE: Provide stable housing with supportive services—including options that don’t require sobriety.

Target Beneficiaries: People with SUDs who are chronically homeless; these are often individuals with co-

occurring mental health disorders.96

Impact: In New York City, over 80% of participants in supportive housing without sobriety requirements remained

housed after two years.97 In a similar program in Philadelphia, 90% of clients remained stably housed at the

two-year mark. In that program, clients with severe alcohol use disorders decreased their nights in jail, hospitals,

and emergency shelters by over 90%, from an average of 88 to 8 nights per year.98 Sober housing has shown

increased use of SUD treatment services (often required for residents) and improved housing stability.99

Cost-per-impact profile: In Philadelphia, Pathways to Housing PA (see below) pays about $20 per day to provide permanent

housing to a chronically homeless person. When administration and supportive services such as primary care and SUD

treatment are included, the total cost is $77 per day.100 For comparison, short-term emergency housing costs the City of

Philadelphia $34 per day, a night in prison costs about $90 per day, and SUD treatment or mental health hospitals average

nearly $600-800 per night.101 A back-of-the-envelope estimate indicates that the above-mentioned drop from 88 to 8 nights

of public service use helped the city avoid costs of about $30 per client per day, or over $10,000 per client per year.102

HOW PHILANTHROPY CAN HELP: Philanthropists can help combat homelessness among people with SUDs

by funding supportive housing programs in their community. Public dollars fund some of these programs, but

services are not available to everyone who needs them.