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Research Summary

Impact of Supportive Housing for Chronically Homeless People with High Use of Alcohol-related Crisis Services

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.


Housing First program participation is associated with decreased crisis services use and costs and decreased alcohol use after program admission among chronically homeless people compared with wait-listed controls. It is difficult to conduct controlled experiments of basic needs, such as housing, due to ethical concerns. This study provides important support for future research and development of low-threshold service programs for high users of health and criminal justice resources. Alexander Y. Walley, MD, MSc


Larimer ME, Malone DK, Garner MD, et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009; 301(13):1349–1357.