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A monumentally important research study allowed homeless men in shelters to drink. Over a year, these alcoholic men drank less and spent far less time in detox, jail, and hospitals, which in turn reduced per capita costs significantly. This study challenges America's AA-abstinence-only orthodoxy, including the mantra that alcoholics will end up in jail, a hospital, or dead if they don't stop drinking. Read More
Was there a non drinking housed control group?
Maybe I am just being dense and missed it. But is there a stopped drinking but housed control group?
This study is interesting, showing that if homeless are drinking, then it is better that they do it housed (for them and society).
But I don't see where it could make any claims about drinking in homeless shelters having better effects for society and the individual than stopping drinking in homeless shelters.
I suppose you could safely say most will continue to drink even if they are not allowed in the shelter. Is that the argument?
It all gets a little hairy when you factor in the people who would maybe quit if they weren't allowed to drink, which this study doesn't address.
That being said, it says a lot about people that they are so anti allowing alcoholics to drink without even knowing any of the evidence either way.
Nat, Not sure you get how this works
Nat, Great to hear from you again! (as per your choice comments on "Psychologist in the Headlights" - http://blogs.psychologytoday.com/blog/addiction-in-society/200903/caught...). I seem to be in your headlights!
There was no no-drinking-in-residence control group because chronic street inebriates refuse to enter shelters where they can't drink - that's why "Housing First" was created! This is reflected in this sentence in the post: "In practice, banning drinking in shelters sentences alcoholics to the streets."
Hence, the so-called quasi-experimental design where the control group were non-admitted street alcoholics - (as well as using the pre-intervention behavior of the housed drinkers for a comparison). I'm not sure if you know Alan Marlatt's name (the psychologist behind the research design in this case), but he knows how to lay out experimental squares, as in his famous 2x2 design of drinking v. non-drinking alcoholics, expecting v. non-expecting alcohol.
I wrote Alan praising him for "going to the streets" at this point in his career to create a highly policy-relevant, impactful study publishable in JAMA, where it will reach ordinary physicians with its life-saving information, despite being highly controversial in terms of America's abstinence fixation (which you seem to share), despite the need to violate ideal laboratory experimental design, which in this case was totally irrelevant.
Keep writing! - Stanton
Great Post!
What an interesting post. A lot of food for thought. It made me think of de-institutionalization. Due to inhumane treatment the mentally ill were released from institutions and put on the streets. The notion of protecting people from horrific "treatments" and allowing them the choice to refuse medication or therapy is very noble but we seem to have fully lost track of the choice part. There is no doubt that the vast majority of homeless people have both a psychiatric problem and substance problem, one precipitated by the other at times but usually comorbid. So we turn to our ill and say, "We wont force you to get help but we wont even offer basic help like housing until you help yourself." It seems to go against the whole touted disease model. If drinking is really a disease than why are we blaming it's vicitims and labeling them unworthy of a place to sleep? Very hypocritical to promote an all or nothing disease model and yet hold people in such low esteem for drinking that they are sentenced to the streets. Mental instututions were taken to task, now it's time to take our modern institution to task as well becasue it's pretty darn crazy! I am in full support of "housing first." Help before you judge. What a beautiful lost concept.
Well said
You make a point that I have felt passionate about for years... allowing the mentally-ill to "choose" to not get well. It's a multi-faceted argument. The rights of a patient vs. the rights of society ( including hopefully those who love the patient). I see both sides of it and advocate for both. At the end of the day, we benefit from having a professional intervene with reasonable unbiased judgment to hold a patient "against his will," if it is deemed necessary. The problem with this is that said "professional" has an ENORMOUS responsibility to do the "right thing" for the mentally-ill, as well as his society. If a state has the right to force me to wear a seatbelt against my will, then perhaps that same state has a right to "treat" me for mental illness against my will? Again, I feel passionately on both sides of this argument, and ideally advocate for a fulfilling life and reconnection with family and friends, rather than the despair of a "man on the street."
We are not allowed to sit on the fence
Dear Unbiased,
You have a heart that is full of compassion. But let me remind you, we cannot choose the fence, for if you do not choose, you have allowed others to choose for you. Regarding the subject at hand, do you not believe that a person's rights end at the place where those rights trample on the rights of others. Mental illness must be addressed for reasons including, but not limited to, the rights of the mentally ill. It is a difficult balancing act. The seat belt law attempts to save lives in society so that the society does not loose its precious human resources(amoung other reasons). Society is responsible for the lives of its members. In the case of mental illness (or drug addiction), the lives of the mentally ill AS WELL AS the lives of the innocent who are affected, are to be considered here. It appears that what this article/study shows is that there is evidence suggesting that when we take both society and the individual interests and rights in mind, we are capable of coming up with inventive and effective ways of humane treatment.
I applaud this study and hope more studies like this follow.
Nice article to read.There is
Nice article to read.There is no doubt that the vast majority of homeless people have both a psychiatric problem and substance problem, one precipitated by the other at times but usually co morbid. So we turn to our ill and say, "We wont force you to get help but we wont even offer basic help like housing until you help yourself."
Multi-faceted problem
I am pleased that a recent case study exists on this. I see a need to "connect the dots" that exist throughout civil services. I have seen a common thread of alcoholic homeless men to originate as the husband who abused the bottle, then abused his wife, then was escorted to county jail via deputy sheriff. Second offences sometimes lead to state prison rather than county jail. When release occurs, no one in the family will house him, so he quite literally walks out of the state facility with resentment, so he walks to a corner store and buys a bottle of $1.75 liquor in a capital city where he knows no one. A homeless man is born from an alcoholic who was born many years before. I'm a firm believer that allowing an alcoholic or mentally-ill person to sign himself out of an institution ( jail, emer. room, hospital, etc.) without a plan of where he's going, should not be allowed. We should "connect the dots" by requiring discharge administrators to have a plan of "where is this chronic alcoholic felon going when he leaves here?" If his answer is " I'll be alright," well... he will be picked up by an officer, medic, or coroner soon, and possibly harm others in an alcoholic stupor on the streets. A shelter for him to drink in moderation until detox is an option , is a link in a chain toward recovery. So many tensions exist toward helping "street addicts," similar to the tensions that exist in allowing citizenship for "illegal immigrants." In both cases, we save "tax-payer money" and better all involved, including communities, by tossing aside our disdain for "rewarding bad behavior" in lieu of common sense solutions to real problems. Anyone know of any other related case studies?
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