It sounds like an alcoholic’s vision of heaven: a free place to live, paid expenses (mostly), and an ample supply of booze. But the reality of “wet houses” for homeless alcoholics looks more like hell, even as these programs — which take their residents off the streets — reduce costs to taxpayers and health-care providers.
A New York Times Magazine story slated to appear in print on Sunday reports on one such program in St. Paul, Minn. St. Anthony’s Residence houses several dozen men including Dave, a formerly homeless 60-year-old man named who lives in a single-bedded “sterile 12-by-12 concrete room.” Benoit Denizet-Lewis writes:
“If I’m going to die, I don’t want it to be under a bridge,” Dave says, gazing out his room’s one window, which overlooks a parking lot in this industrial neighborhood. Like many of the 60 residents who live in the four-story building, where virtually nothing is breakable, Dave has spent most of his life in a revolving door of detoxes, treatment centers and jails. He has had brief periods of sobriety and has worked on and off in construction, but his work ethic is no match for his alcoholism. “I agreed to come here because I want to hold onto the little bit of dignity that I have left,” he says.
Research conducted on a similar program in Seattle and published in 2009 in the Journal of the American Medical Association showed remarkable savings in public spending. The year prior to the opening of the wet house, its 95 participants had cost the government nearly $8.2 million in policing, jail, detox and other medical spending, an average of $4,066 per person per month. But after moving into the wet house, costs were reduced to $1,492 per person monthly after six months, and to $958 after 12 months.
Overall, compared with the costs incurred by those on a waiting list for the program, the program itself cost 53% less.
“Harm reduction” programs like this have long been controversial, despite their dramatic reductions in death rates and costs. One program in Canada that offers addicts a safe place to shoot up cut overdose deaths by 35% in Vancouver’s Downtown East Side.
But opponents of such programs worry that by not getting tough with addicts and alcoholics, it prevents them from “hitting bottom” and starting recovery. They say that providing opportunities to use drugs in a less harmful way “enables” addiction.
There’s no research to support that theory, however. Indeed, that kind of reasoning reflects a misconception about addiction: that addicts and alcoholics are having so much fun using drugs and drinking that they will never stop, unless their supply is forcibly cut off, or they are exiled from work and family or incarcerated.
The reality is that punishment isn’t a good way of fighting addiction: if it were, addiction wouldn’t even exist, since, by definition, addiction is the compulsive use of a substance despite negative consequences. “Negative consequences” is, of course, a synonym for punishment.
Indeed, even when addicts and alcoholics have exactly what they want — perhaps especially when they have all the substances they want — addiction is far from a life of bliss. By discovering that a steady supply can’t solve all their problems, addicts may actually be spurred to start recovery, as those who run harm-reduction programs often discover.
Addicts aren’t entirely impervious to negative consequences, but they tend to associate those consequences with not having drugs and with what they have to do to get the drugs — not with the drugs themselves. Paradoxically, then, providing the drugs makes the problem clearer: if, as with maintenance on buprenorphine or methadone for opioid addictions, a steady supply removes the compulsion and doesn’t harm health, then recovery can commence that way. If, as in the case for some at wet houses, having a supply simply allows dignity and a reduction in health problems, that, too, can be better than an endlessly alternating cycle of brief abstinence and devastating binges.
Or, as one resident of St. Anthony’s who was moving out after 18 months of sobriety told Denizet-Lewis: “I can see the consequences of alcoholism so much here that I don’t want to go back to it.”