Homelessness is not a new problem, and governmental policies have changed direction more than once in an effort to address it. Indeed, persons with addiction have figured in homeless-focused research since the Great Depression (*Sutherland and Locke 1971
), and such persons represent a controversial subpopulation, in part because of the tension between punitive and rehabilitative responses, both of which can be paternalistic in nature. In the 1950s, police “drunk tanks” were condemned as “revolving doors” (*Pittman and Gordon 1958
). A decade later, they were replaced with publicly funded detoxification programs, an innovation that failed to eliminate the revolving door but, arguably, “padded” it (*Fagan and Mauss 1978
). Amid the rising rate of homelessness in the 1980s, the McKinney Homeless Assistance Act of 1987 created federal funding streams for shelters, health, and housing programs. Shortly thereafter, federal funding mechanisms were reconfigured to favor communitywide integrated-funding applications (termed Continuum of Care
plans). This funding configuration anticipates that homeless persons will enter and then graduate from a sequence of programs (shelter, transitional housing, permanent housing), with progress based on recovery toward self-sufficiency (*Couzens 1997
). Despite governing federal allocations since 1996, however, no reduction in homelessness was apparent over the next decade (*U.S. Department of Housing and Urban Development 2007
With the Continuum of Care funding mechanism still in place, the last decade has seen a major change in governmental emphasis and in the media’s coverage of homelessness, with a new focus on ending
chronic homelessness (Editorial *2002
). At last count, more than 350 American communities had embarked on plans to end chronic homelessness. This new energy was spurred by important research, by advocates both inside and outside the government, and by the operational threat that communities without plans to end chronic homelessness risked a loss of federal funding.
In this context, policymakers have looked with increasing frequency to a new intervention that offers permanent housing first (i.e., “Housing First”), allowing a client’s other problems to be worked on (if the client wishes) after securing a permanent residence. In contrast to more traditional programs (termed linear
approaches), Housing First emphasizes respect for homeless individuals as consumers entitled to make choices and condemns homelessness itself as a social evil that, like slavery in the nineteenth century, should have no place in the United States today (*McGray 2004
; *Tsemberis, Gulcur, and Nakae 2004
). In short, Housing First represents an important break from traditional models that focus on “fixing” clients to make them “housing ready.”
Within this wave of coverage, the imprimatur of scientific support has offered special authority. For example, when leaders in New Orleans considered a plan to adopt a more traditional rehabilitation-focused approach, they were derided as ignoring hard science favoring Housing First. “We can now solve anyone’s homelessness,” asserted one federal official (*Reckdahl 2008
, page A1). New Orleans then reversed course.
One premise of this article is that the junction of scientific research and policy is fraught with risk. If findings are invoked incautiously or are applied beyond the limits of the original research, then “overreach” will be the result. With overreach, outcomes may not correspond to projected benefits and risk the public’s disenchantment. The extraordinary rollout of plans to end chronic homelessness, coupled with the excitement for Housing First, makes this a prudent moment to review the data supporting it, as well as the research regarding more traditional rehabilitative approaches. Both, as we will show, have limitations.
In proposing research-based solutions to homelessness, we are suggesting that policy responses should be framed not simply as “what works?” but as “what works for whom?” (*Caton, Wilkins and Anderson 2007
). We begin by defining Housing First and also the more traditional “linear” approaches for homeless individuals, focusing on those persons for whom active addiction is an issue. Next, we summarize the research on Housing First, briefly explaining the cost-related arguments typically used in its favor.
We then turn to research on linear approaches to this population, including three conceptually distinct types of intervention, and then compare the strengths and limitations of Housing First and linear research. We believe that our present knowledge is incomplete with regard to housing persons with active addiction and that there is a risk of overreach, given the popular claims made on behalf of Housing First. Our perspective may appear controversial because its view of approaches that can also document some success is skeptical. The article concludes with suggestions to strengthen future research regarding both Housing First and linear approaches for persons with active addiction.