By Emily Tiry, Staff Editor
San Francisco’s new homeless czar, Bevan Dufty, is pushing for an unconventional solution to the city’s homeless alcoholics: wet houses. These facilities would serve as shelters for the chronically homeless, but unlike many current shelters, they would also allow alcoholics to continue drinking while living there. The conventional wisdom is that these types of programs would actually enable addiction. However, wet house advocates promote a “harm reduction” strategy, which argues that if people are going to engage in self-destructive behavior anyway, it is better that they do it in a supervised environment where the harmful effects can be limited.
Many of these limited harmful effects would come in the form of reduced emergency room, ambulance, and detox costs. San Francisco spent more than $20 million in emergency medical services on 477 homeless individuals from July 2009 through June 2010. In contrast, a 2009 study of a wet house program in Seattle found that the median cost reduction was $2,249 per person per month relative to a control group. Additionally, participants reported fewer drinks per day over the course of the year.
Still, the study does not provide unconditional evidence in favor of wet houses. The Seattle study was not randomized due to ethical concerns, so the researchers cannot definitively claim that the wet house program caused the reduction in costs. Also, the study may have overstated the medical costs saved because it used billing charges rather than the actual cost of service. It would be helpful to see a careful randomized study and cost-benefit analysis of wet house programs compared both to no program as well as to traditional abstinence shelters before implementing such policies in San Francisco or elsewhere across the country.