Every year, communities across the country gather volunteers to count the homeless on a single night in January. People often cycle in and out of homelessness, so these counts don’t capture the full extent of the problem, but they are among the best data we have on the U.S. homeless population. In January 2013, about 600,000 people were counted — two-thirds were in shelters or temporary housing, and one-third were living on the street.

Of particular concern are the chronically homeless, which the government defines as people with mental health problems, addiction or other disabilities who have been homeless for over a year, or who have been homeless at least four times in the past three years. About one-third of the homeless living on the street fall into this category.


To get a better sense of what problems plague the homeless, organizers at the 100,000 Homes Campaign began a project to conduct detailed interviews among the unsheltered homeless, who are some of the most vulnerable. Drawing on over 40,000 individual surveys from the past six years, they found that over 60 percent of homeless men and women living on the street have dealt with some form of substance abuse in their lives.

The traditional way to help the chronically homeless starts with cleaning up their mental health or addiction problems. Treatment-first programs put the homeless in temporary housing, where they must demonstrate they have their demons under control before they can move on to living by themselves. Total abstinence from drugs and alcohol is a common requirement, so people who struggle with staying sober often wash out. Many more are hesitant to commit to treatment in the first place.

For those with the most serious problems, the Housing First approach is appealing because it gives them a roof over their heads with few strings attached. Participants get their own apartments for free or reduced rent, where they are encouraged, but not required, to take advantage of treatment for their drug abuse or mental health issues. In theory, this flexibility means that they can approach their recovery on their own terms, without worrying about getting kicked out for a relapse.

Not surprisingly, people in Housing First programs are more reluctant to participate in treatment for their problems than those in traditional programs, where treatment is mandatory. But they also don’t seem to be doing any worse.

For instance, a two-year study in Seattle showed that homeless alcoholics began to moderate their drinking after getting free housing.

The results are particularly encouraging because these men and women had been selected for being some of city’s toughest and most expensive cases, cycling in and out of hospitals, sobering centers and jails. Though many still had problems with addiction, they saved the city money by needing fewer services. Paying their rent, it turns out, was cheaper than paying for their jail and emergency-room visits.