There’s plenty of evidence that people living on the streets in our major cities are dealing with some combination of addiction and mental illness. That’s not true of everyone but it is true of a majority of single adults on the street, many of whom don’t want help because it would require them to get sober. Today the Seattle Times reports on a newly published study about an alternative approach called “harm reduction” which allows the addicts to decide for themselves how much drinking they want to do:

The randomized control study conducted by researchers at the University of Washington looked at 168 homeless people with chronic alcoholism who lived in or near downtown Seattle. Half of them met with a clinician and formed goals to improve their lives, which often involved drinking less or using different substances. The other half did not.

For the group that went through this harm-reduction treatment, after three months, alcohol showed up in their urine 20 percent less often…

The effects in the study are short-term, over three months; it’s not yet clear if they stick for the long term.

“Harm reduction” is an approach to substance use that doesn’t ask for sobriety and is an alternative to abstinence programs. The few studies involving abstinence-based programs for homeless people with alcoholism show that only 15 to 28 percent start treatment, and of those, fewer than a third complete it. But for homeless people, most permanent housing projects and many shelters require sobriety.

I’m not sure what to make of this, honestly. A 20% reduction is an improvement but what good is that if the people ultimately decide to remain drunk the other 80% of the time. It seems the real appeal of something like this is the idea that addicts might gradually decide they want to stop drinking entirely and get off the street. In fact, that’s how this story opens, with the success of someone named Greg Hardegger who did just that. But it seems Hardegger’s success is a bit unusual, or perhaps it takes a lot longer than three months for a story like his to play out. I’d also like to see how successful this is long term, i.e. over five years. Do the people who got out of the addiction return to it eventually?

Ultimately, I’m for anything that works to get adults to take control of their own lives and stop living on the streets to feed their addiction. But I suspect the cost of paying a clinician to meet with them won’t be cheap, so we need to have a much better idea of how expensive and how effective this is going to be before committing a bunch of public resources. As we’ve seen, putting the horse before the cart is not something homeless activists are always good at doing.