Should Homeless Programs Serve People Who Abuse Alcohol or Drugs?

written by Martena Reed
April 8, 2014

For many years there has been debate in the homeless assistance field about whether homeless assistance programs should serve homeless people who are engaging in substance abuse. Many programs in the past were predicated on the idea that, for someone to be stably housed, the person must be sober. So programs made sobriety a requirement. Many programs across the country still operate on this model.

However, in recent years, with the growing acceptance of Housing First, more and more programs are moving to a model that incorporates harm reduction, serving the client while also reducing the negative consequences of the client’s substance abuse. You’ve probably already heard one of the most popular forms of harm reduction: needle exchanges.

The idea is that someone who is experiencing homelessness is more likely to receive and respond to drug treatment when he or she is housed, than when he or she is homeless. In harm reduction housing programs, participants are not required to be sober to get housing; substance abuse doesn’t threaten housing; and individualized services specific to a person’s stage of recovery are available.

Harm reduction has benefits for both providers and people experiencing homelessness. According to a recent study, “Provider Views of Harm Reduction Versus Abstinence Policies Within Homeless Services for Dually Diagnosed Adults,” providers identified several benefits of harm reduction:

  1. Liberation—providers felt the harm reduction approach allowed them to work “freely” with their clients.
  2. R-E-S-P-E-C-T. Plain and simple, the harm reduction approach allowed providers to treat clients with respect and to acknowledge the challenges of substance abuse stigma.
  3. Honesty and service engagement—consumers were more honest about their substance use while continuing to engage in service.
  4. Less stress! Who doesn’t want a little less stress? Harm reduction program providers had more honest relationships and felt their jobs were less stressful because of it.

Although few, providers have identified some challenges with using harm reduction. It sometimes means helping people make tough decisions. Individualized services sometimes mean that harm reduction program policies may be more unclear than policies for programs that require treatment or sobriety first. Despite these challenges, providers believed harm reduction was more effective than its alternative.


Photo courtesy of Jon Lopez's Flickr photostream.