Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems
Open accessAbstract
CONTEXT: Chronically homeless individuals with severe alcohol problems often have multiple medical and psychiatric problems and use costly health and criminal justice services at high rates. OBJECTIVE: To evaluate association of a "Housing First" intervention for chronically homeless individuals with severe alcohol problems with health care use and costs. DESIGN, SETTING, AND PARTICIPANTS: Quasi-experimental design comparing 95 housed participants (with drinking permitted) with 39 wait-list control participants enrolled between November 2005 and March 2007 in Seattle, Washington. MAIN OUTCOME MEASURES: Use and cost of services (jail bookings, days incarcerated, shelter and sobering center use, hospital-based medical services, publicly funded alcohol and drug detoxification and treatment, emergency medical services, and Medicaid-funded services) for Housing First participants relative to wait-list controls. RESULTS: Housing First participants had total costs of $8,175,922 in the year prior to the study, or median costs of $4066 per person per month (interquartile range [IQR], $2067-$8264). Median monthly costs decreased to $1492 (IQR, $337-$5709) and $958 (IQR, $98-$3200) after 6 and 12 months in housing, respectively. Poisson generalized estimating equation regressions using propensity score adjustments showed total cost rate reduction of 53% for housed participants relative to wait-list controls (rate ratio, 0.47; 95% confidence interval, 0.25-0.88) over the first 6 months. Total cost offsets for Housing First participants relative to controls averaged $2449 per person per month after accounting for housing program costs. CONCLUSIONS: In this population of chronically homeless individuals with high service use and costs, a Housing First program was associated with a relative decrease in costs after 6 months. These benefits increased to the extent that participants were retained in housing longer.
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Findings from a single-site Housing First program for chronically homeless adults with severe alcohol use problems in Seattle found a significant decrease in alcohol-related problems and days intoxicated up to 24 months among Housing First participants.
“Findings from a single-site Housing First program for chronically homeless adults with severe alcohol use problems in Seattle found a significant decrease in alcohol-related problems and days intoxicated up to 24 months among Housing First participants (Collins et al., 2012c; Larimer et al., 2009).”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Larimer et al., 2009
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn chronically homeless individuals with severe alcohol problems who frequently use crisis services, the HF group was significantly less likely to use sobering centers at 6 months than the WL group.
“HF group was significantly less likely to use sobering centers at 6 months than WL group”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Larimer et al. (2009)
The study compares Housing First participants with wait-list controls and includes sobering-center use among its outcomes (Abstract). The section ‘Comparison of HF and Control Participants at 6 Months’ reports a significant difference in total costs, but the passages available from our copy do not establish that the Housing First group was significantly less likely to use sobering centers. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn chronically homeless individuals with severe alcohol problems who frequently use crisis services, detoxification days did not significantly differ between the HF and WL groups.
“Detoxification days did not significantly differ between the two groups”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Larimer et al. (2009)
Table 3 reports a median of 0.0 detoxification-center contacts per person per month in both the housed and wait-list groups at six months. The Comparison of HF and Control Participants at 6 Months section says Figure 2 tests treatment differences, but our copy does not preserve a readable result for detoxification days, so it does not establish whether that difference was statistically nonsignificant. The separate finding about detoxification days and length of time housed is not a between-group comparison. (LLM, conf=0.80)
Experimental — accuracy not yet measuredThis study extended the 1-year findings of Larimer and colleagues by showing that decreases in EMS utilization were maintained over a 2-year period.
“This study thereby extended the 1-year findings of Larimer and colleagues29 by demonstrating that decreases in EMS utilization were maintained over a 2-year period.”
From Housing first is associated with reduced use of emergency medical services (2014) · cites this paper as [29]
The first study focused exclusively on single-site HF found significantly reduced publicly funded service utilization, including EMS, ED visits, and inpatient hospital admissions one year after housing provision.
“The first study that focused exclusively on single-site HF showed significantly reduced publicly funded service utilization, including EMS, ED visits, and inpatient hospital admissions one year after housing provision.29”
From Housing first is associated with reduced use of emergency medical services (2014) · cites this paper as [29]
The single-site Housing First model has been used for chronically homeless people with alcohol dependence and has received empirical support.
“The single-site Housing First (HF) model has been used to address the needs of chronically homeless people with alcohol dependence and has garnered empirical support.27–31”
From Housing first is associated with reduced use of emergency medical services (2014) · cites this paper as [29]
Only a couple of studies to date have examined the effectiveness of project-based Housing First in chronically homeless individuals with alcohol problems.
“Although project-based Housing First programs are receiving increased interest in the supportive housing field,16 only a couple of studies to date have examined their effectiveness in this population.13,17”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [13]
Project-based Housing First programs are associated with increased housing stability in this population.
“These studies have shown that project-based Housing First programs are associated with increased housing stability, reduced use of publicly funded services and associated costs, and short-term reductions in typical daily alcohol use.13,17”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [13]
Project-based Housing First programs are associated with short-term reductions in typical daily alcohol use in this population.
“These studies have shown that project-based Housing First programs are associated with increased housing stability, reduced use of publicly funded services and associated costs, and short-term reductions in typical daily alcohol use.13,17”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [13]
Project-based Housing First programs are associated with reduced use of publicly funded services and associated costs in this population.
“These studies have shown that project-based Housing First programs are associated with increased housing stability, reduced use of publicly funded services and associated costs, and short-term reductions in typical daily alcohol use.13,17”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [13]
Our study extended the evidence base for project-based Housing First to a subset of the homeless population that accounts for a disproportionate amount of use of publicly funded services and related costs.
“Our study therefore extended the evidence base for project-based Housing First to a subset of the homeless population that accounts for a disproportionate amount of use of publicly funded services and related costs.2,13,51”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [13]
The observed mortality rates corresponded to those in the larger population of chronically homeless individuals with alcohol problems.
“It should also be noted that the observed mortality rates corresponded to those in the larger population of chronically homeless individuals with alcohol problems.13”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [13]
Previous studies on this approach focused primarily on housing stability, use of publicly funded services, and costs related to the use of those services.
“These results extended previous studies’ findings on this approach, which had focused primarily on housing stability, use of publicly funded services, and costs related to the use of those services.13,17”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [13]
Mortality was most often precipitated by long-term, chronic disease acquired prior to study recruitment (e.g., liver cancer, cirrhosis), which likely limited participants' physical ability to consume alcohol.
“This finding is unsurprising because mortality was most often precipitated by long-term, chronic disease acquired prior to study recruitment (e.g., liver cancer, cirrhosis),13 which likely limited participants’ physical ability to consume alcohol.”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [13]
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- Authors
- Larimer, M. E.
- Affiliations
- University of Washington (US)
- Corresponding author
- Larimer, Mary E.
- ORCID
- Larimer, Mary E.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2009-04-01
- Volume
- 301
- Issue
- 13
- Pages
- 1349
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2128336124
- Cited by
- 615
- References
- 34
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 18 · 2023: 19 · 2022: 22 · 2021: 49 · 2020: 35 · 2019: 33 · 2018: 39 · 2017: 52 · 2016: 52 · 2015: 60 · 2014: 50 · 2013: 55 · 2012: 44
- FWCI
- 62.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- University of Washington Tacoma Digital Commons (University of Washington Tacoma) (submittedVersion)
- Funders
- National Institutes of Health (5k05aa000113-20)
- National Institute on Alcohol Abuse and Alcoholism (2K05AA00113-17, T32AA007455)
- National Institute on Drug Abuse (K01DA014685)
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- Housing First, chronic homelessness, health care costs, health care utilization, incarceration, emergency medical services, Medicaid, housing retention, cost offsets
- MeSH terms
- Adult, Alcoholism, Community Health Services, Community Mental Health Services, Emergency Medical Services, Female, Health Services, Ill-Housed Persons, Humans, Male, Middle Aged, Prisons, Public Housing, Time Factors, Washington, Program Evaluation, Substance Abuse Treatment Centers, Health Care Costs
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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