If you’re interested in harm reduction, homelessness, and evidence-based responses to chronic homelessness and addiction (and if you’re a reader of mine, you probably are), check out my new piece in Crosscut about 1811 Eastlake, the 15-year-old program that provides no-strings-attached housing for chronically homeless people with alcohol use disorders. Here’s a teaser:
It was the late 1990s, and Seattle leaders were trying to decide what to do about an addiction epidemic. Residents of several center-city neighborhoods, including Capitol Hill and Pioneer Square, complained about public urination, trash and the constant parade of ambulances ferrying people to Harborview Medical Center. People told stories about coming home to find homeless addicts passed out in their yards. A task force was assembled to come up with solutions.
Back then, the substance at the center of the debate wasn’t heroin — it was alcohol. But the conversation about how to deal with what were then known as “chronic public inebriates” would be familiar to anyone following the opiate epidemic in 2019. “These people would be urinating, defecating, sleeping in doorways,” says former Seattle Police Chief Jim Pugel, who was then commander of the Seattle Police Department’s West Precinct. “We were spending $1,000 just to send people a mile up the road to Harborview. That’s the most expensive detox you can deliver.”
The best solution the city could come up with — creating special alcohol impact areas, where stores would be barred from selling certain kinds of high-alcohol malt liquor that low-income and homeless drinkers favored — was unpopular with store owners, the beverage industry and residents of nearby neighborhoods, who argued that the bans would simply push the problem into their front yards. “We were stuck in the middle,” Pugel recalls.
Into this impasse stepped Bill Hobson, the head of the Downtown Emergency Service Center, offering a third option: “Wet housing,” where chronically homeless people with alcohol use disorder would be allowed to live, and drink, without judgment or expectations. Hobson’s theory was that people could move successfully from the streets to housing without first going through treatment or other interventions — a controversial position, given the prevailing view that people living on the streets would “fail” at housing unless they got sober first.
Today, the concept of “Housing First” is enshrined in city housing policies across the country, including Seattle and King County. (The authorizing legislation for the proposed new regional homelessness authority, for example, explicitly mandates “evidence-based, housing first” policies.) So it can be easy to forget how radical the idea was just 20 years ago, when most programs targeting chronically homeless people required sobriety and intensive case management as prerequisites.
“We were skeptical — hell, yeah, we were. We thought, if you want someone to stop drinking, you should just make them stop drinking,” says Pugel, currently running to represent District 7 on the Seattle City Council: “My views have evolved since then. I’m not a Cro-Magnon anymore.”
The result of Hobson’s vision, known simply as “1811 Eastlake,” now sits on the edge of the South Lake Union neighborhood and has been serving Seattle residents for the past 15 years. The unobtrusive blue-and-gray, four-story building houses 75 formerly homeless men and women with severe alcohol use disorders and provides them with meals, counseling and health care, no strings attached. The program has saved money, and lives, by using the principles of “harm reduction,” which holds that reducing the harm people cause themselves and others through their substance use is beneficial in itself, whether or not the person quits using the harmful substance.
Pugel recalls that Hobson, who died in 2016, would declare loudly, “This is housing for drunks!” to anyone who seemed to misunderstand the purpose of what DESC was doing. Although current DESC Director Daniel Malone doesn’t remember him using “those exact words,” he says Hobson was always clear that the purpose of 1811 wasn’t to get anyone sober or to turn clients into clean-cut, productive members of society; it was to provide housing for people who had “failed out” of abstinence-based treatment and housing programs multiple times, were chronically homeless and had less than a 5% chance of “achieving and maintaining sobriety.” The point wasn’t to stop alcoholics from drinking; it was to improve their quality of life and reduce the amount they cost the public, in that order.
Read the whole story, complete with excellent photos by Matt McKnight, at Crosscut.