Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis

Purpose Recently, Managed Alcohol Programs (MAPs have emerged as an alcohol harm reduction model for those living with severe alcohol use disorder (AUD) and experiencing homelessness. There is still a lack of clarity about the role of these programs in relation to Housing First (HF) discourse. The authors examine the role of MAPs within a policy environment that has become dominated by a focus on HF approaches to addressing homelessness. This examination includes a focus on Canadian policy contexts where MAPs originated and are still predominately located. The purpose of this paper is to trace the development of MAPs as a novel response to homelessness among people experiencing severe AUD and to describe the place of MAPs within a HF context. Design/methodology/approach This conceptual paper outlines the development of discourses related to persons experiencing severe AUD and homelessness, with a focus on HF and MAPs as responses to these challenges. The authors compare the key characteristics of MAPs with “core principles” and values as outlined in various definitions of HF. Findings MAPs incorporate many of the core values or principles of HF as outlined in some definitions, although not all. MAPs (and other housing/treatment models) provide critical housing and support services for populations who might not fit well with or who might not prefer HF models. Originality/value The “silver bullet” discourse surrounding HF (and harm reduction) can obscure the importance of programs (such as MAPs) that do not fully align with all HF principles and program models. This is despite the fact that MAPs (and other models) provide critical housing and support services for populations who might fall between the cracks of HF models. There is the potential for MAPs to help fill a gap in the application of harm reduction in HF programs. The authors also suggest a need to move beyond HF discourse, to embrace complexity and move toward examining what mixture of different housing and harm reduction supports are needed to provide a complete or comprehensive array of services and supports for people who use substances and are experiencing homelessness.

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Integrating the Integrated: Merging Integrated Dual Diagnosis Treatment (IDDT) with Housing First

Community Mental Health Journal ◽

10.1007/s10597-017-0107-x ◽

2017 ◽

Vol 53 (6) ◽

pp. 672-678

Author(s):

Janice Pringle ◽

Kim Grasso ◽

Lisa Lederer

Keyword(s):

Dual Diagnosis ◽

Housing First ◽

Dual Diagnosis Treatment

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“Expensive” people: Consumer citizenship and the limits of choice in neoliberal publics

Communication and the Public ◽

10.1177/2057047318794683 ◽

2018 ◽

Vol 3 (3) ◽

pp. 190-204 ◽

Cited By ~ 1

Author(s):

Whitney Gent

Keyword(s):

Consumer Choice ◽

Cost Benefit Analysis ◽

Cost Benefit ◽

The United States ◽

Housing First ◽

Benefit Analysis ◽

Chronic Homelessness ◽

Goods And Services ◽

Consumer Citizenship ◽

The Cost

In a context of neoliberalism, decisions made for a “public” good are often articulated as what makes the most financial sense, and citizenship is exercised as a matter of consumer choice. Neoliberal theory positions choice as an unmitigated good, and as universally available when markets are deregulated and goods and services are privatized. Examining rhetorics of choice, however, illuminates the often-invisible power relations that shape choice, and makes visible the ways in which choice is conditioned by inequality. This essay attends to the cost–benefit analysis used to promote the spread of Housing First, an approach to addressing chronic homelessness in the United States. It argues that a neoliberal discourse of choice reconfigures possibilities for rhetorical citizenship by constructing “good” and “bad” consumer citizen subjectivities, constraining agency for “expensive” people while concentrating responsibility for public decision-making among “taxpayers.” These discourses thus limit membership to neoliberal publics to people with access to private resources.

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How reliable is the current evidence looking at the efficacy of harm reduction and motivational interviewing interventions in the treatment of patients with a dual diagnosis?

Journal of Psychiatric and Mental Health Nursing ◽

10.1111/j.1365-2850.2007.01159.x ◽

2007 ◽

Vol 14 (8) ◽

pp. 720-726 ◽

Cited By ~ 8

Author(s):

C. J. LAKER

Keyword(s):

Motivational Interviewing ◽

Harm Reduction ◽

Dual Diagnosis ◽

Current Evidence

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Qualitative findings from a Housing First evaluation project for homeless Veterans in Canada

Journal of Military Veteran and Family Health ◽

10.3138/jmvfh-2021-0052 ◽

2021 ◽

Author(s):

Cheryl Forchuk ◽

Jan Richardson ◽

Heather Atyeo ◽

Jonathan Serratoa

Keyword(s):

Harm Reduction ◽

Peer Support ◽

Housing First ◽

New Approach ◽

Housing Stability ◽

Homeless Veterans ◽

Permanent Housing ◽

Personal Experiences ◽

Housing Services ◽

Mental Health Support

LAY SUMMARY This two-year study implemented a Housing First approach among homelessness services for Veterans in four cities across Canada (Victoria, Calgary, London, and Toronto). This approach included peer support and harm reduction resources for Veterans. To obtain a detailed evaluation of personal experiences and opinions, focus groups were held with Veterans, housing staff, and stakeholders at three time points during the study: July-September 2012, May-June 2013, and January 2014. Harm reduction and peer support were regarded as positive aspects of this new approach to housing and homelessness. It was suggested that greater mental health support, support from peers with military experience, and issues regarding roommates should be considered in future implementations of housing services for Veterans. It was also noted that to support personal stabilization, permanent housing is preferred over transitional or temporary housing. Future housing programs serving Veterans experiencing homelessness should consider the addition of harm reduction and peer support to further enhance services and help maintain housing stability.

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