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Keane, Martin (2011) Housing people who misuse substances. Drugnet Ireland , Issue 37, Spring 2011 , pp. 10-11.

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The St Dominic’s Housing Association (SDHA) recently commissioned research to examine the applicability of the Housing First model to people with substance misuse issues, and to identify best practice in relation to supports needed to ensure tenancy sustainment for this vulnerable group. The resulting work was undertaken by independent consultant Simon Brooke and a report was published by the SDHA in January 2011.1  

The work included reviewing a selection of studies, and consultations with nine organisations and twelve service users. Chapter one of the final report details the emergence of the Housing First approach in the US, and examines the evidence base for its effectiveness in comparison to traditional approaches. The defining feature of the Housing First approach is its focus on assisting homeless people to move into permanent accommodation and providing appropriate support services to sustain them in their tenancy. In contrast to traditional approaches, the Housing First approach does not require people to be abstinent from substance use prior to securing accommodation.
 
The report cites a number of evaluations of the Housing First approach, most of which were done in the US. The evidence suggests that individuals participating in Housing First programmes spend less time homeless and in psychiatric hospitals and incur fewer costs to the health system than those availing of the traditional approach. The report cites a recent reviewwhich suggests that the evidence on Housing First for individuals with severe substance addiction is inconclusive.2 This is in part explained by the lack of studies comparing the Housing First approach with an alternative approach for individuals recruited on the basis of having a severe addiction to substances. As Brooke points out in the SDHA report, the inconclusive nature of the evidence does not suggest that the Housing First approach will not work for people who misuse substances, but that more rigorous research is required to test its effectiveness with people with severe substance addictions. Nonetheless, the report does concur with the general consensus emerging from the literature that stable accommodation is an important factor in encouraging people to engage with treatment services and in achieving stability and abstinence.
 
Practical issues to consider when housing people who misuse substances
The report outlines a number of practical issues that need to be considered when placing people with substance addictions in permanent housing. These issues were raised during consultations with stakeholders and were identified in a number of reports from the UK which address this topic.
 
Before moving in
The report outlines a number of issues that need to be considered before potential tenants move into their new home, such as choice of location, the challenge of avoiding unwanted guests, and sensitivity to perceptions of neighbours
 
The role of the landlord
There needs to be a clear understanding of the role of landlord and the visiting support team and good lines of communication between the two. This approach can ensure that any emerging issues around rent arrears or anti-social behaviour can be dealt with in a timely and professional manner.
 
Housing-related supports
According to the author, in Ireland the housing-related supports for Housing First tenants will be provided by the Support to Live Independently (SLI) scheme delivered by Dublin Simon Community.
 
Isolation and loneliness
Loneliness and isolation were identified as major problems experienced by people who misuse substances. According to Brooke,
 
these people, who are mainly young single men, may find themselves living in an unfamiliar area, perhaps living alone for the first time, and at the same time cut off by choice from previous friends.
 
The report highlights ongoing work in the UK on developing befriending and mentoring schemes as possible ways to reduce the isolation and loneliness experienced by this group when they move into stable accommodation.
 
Meaningful activity during the day
Interviews with stakeholders revealed the importance of meaningful activity during the day for service users who are housed. Participation in Community Employment programmes and pursuing educational and recreational activities were mentioned by service users as appropriate activities; they also talked about the onset of boredom and potential relapse when their day lacked meaningful activity.
 
Family and social contacts
The importance of family and social contacts were mentioned by stakeholders; equally, it was said that, in some cases, family contact would not be a realistic option in the medium or long term.
 
Who is Housing First not appropriate for?
The report contains a number of extracts from interviews with individual substance misusers. The general theme running through these accounts is that not all substance users will benefit from the Housing First approach. Interviewees spoke about the difficulties involved in managing the responsibility of paying bills and running a home while actively using drugs. They recalled both personal and anecdotal experiences of returning to the hostel or the street when the responsibility of maintaining their tenancy became compromised by substance use. A number of interviewees spoke about the problems of maintaining their tenancy while on crack cocaine. These accounts illustrate the need for effective floating support when people who misuse substances are placed in Housing First programmes. They require support with budgeting, cooking and other domestic chores and encouragement to engage with treatment.
 
Conclusion
Brooke concludes by saying,
 
Although Housing First is largely untested in Ireland, and ... the specific case of people with substance misuse problems is less well researched than other groups, there is widespread belief among stakeholders in Ireland ... that provided it is done properly, the Housing First approach can be successful for people with substance misuse problems. (p. 20)
 
Ultimately, the approach requires a supply of affordable housing to be made available to house homeless people. To this end, and as outlined in this report, the Department of the Environment, Heritage and Local Government has established the Social Housing Leasing Initiative to release the large amount of empty properties for social housing. However, according to this report, ‘regrettably ... very little social housing has been produced by this scheme, which means that the Housing First approach is currently stalled’. 
 
1. Brooke S (2011) Housing people who misuse substances: making Housing First work. Dublin: St Dominic’s Housing Association. www.drugsandalcohol.ie/14838
2. Kertesz SG, Crouch K, Milby JB, Cusimano RE and Schumacher JE (2009) Housing First for homeless persons with active addictions. Are we overreaching? The Millbank Quarterly, 87(2): 495–534.

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