Beating opioid addiction and other forms of substance use disorder takes time and requires various levels of support. Supportive housing can help people reach their recovery goals and live better lives.
Homelessness is a complex social problem with many causes- poverty, unaffordable rent, domestic violence, mental and physical illness et cetera. Living without stable housing can make recovery more difficult than it already is. The stress associated with housing insecurity can lead to relapse and being constantly on the move can interrupt treatment. People experiencing both addiction and homelessness are more likely to use costly emergency room services and more likely to be incarcerated.
Housing assistance that gets people off the streets can help alleviate this problem, but for many people, more is needed. Realizing this, public health and housing advocates embrace supportive housing as a solution.
Supportive housing is housing designed to help residents in all aspects of the recovery process. Residents are provided with a wide variety of services that includes treating their condition while also providing services to help them apply for disability benefits and find employment. The services provided are not mandatory but are always available. No resident has to fear eviction because they choose not to use any provided service.
While many inpatient rehabilitation programs with a housing component require people to maintain sobriety or risk eviction, supportive housing embraces a Housing First approach. In Housing First, getting people into stable housing is given the top priority. Many cities in the US and Canada have embraced Housing First in their policies aimed at addressing homelessness.
There are two types of supportive housing: tenant and project-based. In a tenant-based approach, rental assistance that help people afford housing can be used on any apartment or home while in project-based supportive housing, the rental assistance is tied to specific rental units. The project-based approach allows for many supportive housing units to be in the same place. Project-based programs allow many supportive housing units to be close together so that providers can more effectively deliver services, such as through an in-house clinic in an apartment complex. A tenant approach, on the other hand, allows residents maximum freedom to choose where they want to live. Choice is a critical component of Housing First policies as it allows people to live in their communities.
Not only are supportive housing programs good for residents, they are good for society as a whole. Supportive housing that combines affordable housing with services that help people rebuild their lives can greatly reduce healthcare spending by reducing days spent in the hospital, emergency room visits and days in nursing homes.
Housing programs were a major part of the Ryan White HIV/AIDS Program, which is credited with helping reverse the devastating effects of the AIDS pandemic in America. In fact, a study in Chicago showed that people with HIV who were previously homeless in supportive housing were 63% more likely to be alive than those without. Now that we are faced with a public health crisis of similar magnitude to HIV/AIDS, housing must again be part of the solution.
Supportive housing is funded by a combination of government programs. Providers in supportive housing can bill Medicaid for many of their services. The Housing Choice Voucher Program, which helps people afford rent, can be used to pay for both tenant and project-based supportive housing. There are also federal grants that can fund parts supportive housing but each individual grant program is usually focused on a specific set of services- i.e. substance use treatment- or populations such as veterans or young people. In project-based housing, new complexes are often funded through federal development grants or through “pay for success” partnerships. In “pay for success”, private investors provide the capital upfront for building supportive housing units and are paid back by the government after success has been demonstrated.
For community programs especially, the burden of stigma can be a challenge. Landlords and residents might not want those in recovery in their buildings. Luckily, the Fair Housing Act prevents such discrimination based on disability status. Supportive housing advocates and providers can also work to educate landlords and tenants about the reality of substance use disorders to dispel some of those myths and fears.
While supportive housing has proven benefits for people experiencing concurrent homelessness and addiction, there remains a lack of funding. Currently, 2.5 million people, including many struggling with substance use, could be eligible for Medicaid if their states chose to expand the program under the Affordable Care Act. In fact, four of the ten most populus states (Texas, Florida, North Carolina and Georgia) have rejected Medicaid expansion that could fund supportive housing services. Last year, the House of Representatives passed the THRIVE Act to create a five-year pilot program to provide 10,000 housing choice vouchers each year to people in recovery. Unfortunately, instead of creating new vouchers for this worthy program, the legislation would redirect those vouchers from other at-risk populations. The bill did not pass the Senate.
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Ali Safawi is a Workit Associate and former Intern. He is an alumni of the University of Michigan School of Public Health and is pursuing his masters degree at George Washington University in our nation's capitol. He is passionate about fighting the opioid epidemic and creating a more equitable health system for all Americans.