Housing isn’t a reward; it is a basic human right, yet for those who are unhoused and experiencing a substance use disorder, this is what more traditional rehousing services can feel like. Many programs require either sobriety before securing housing through their program or significant progress in a substance use disorder treatment plan. Treatment for most substance use disorders requires stability, but how does one achieve that when safe, dependable housing is not available? In many cases, this system is set up for failure, yet we know Housing First programs typically produce better outcomes for these individuals. However, before we continue with this article, we want to state that most unhoused individuals are not chronic substance users; in fact, approximately 108,035 persons experiencing homelessness were also experiencing chronic substance misuse, representing roughly 16.5% of the total unhoused population, according to John Hopkins Bloomberg School of Public Health. With that said, today we are focusing on the subset of the population experiencing substance use disorder.
What Does Sobriety-First Mean?
It was commonly believed, and still is by some, that sobriety is required to maintain functional and stable housing; that one who is experiencing substance use disorder is not capable of remaining housed. That, because of the nature of their illness, life is simply not stable enough, and that housing should be prioritized for those who can maintain stable housing. Securing housing for unhoused individuals requires time, effort, and funds that are often in short supply. So rather than house someone who may not be “ready” to remain housed, the sobriety-first program comes into play.
Housing First takes a different approach, recognizing that most individuals need stability to heal, and that starts with a home. A home is so much more than a bed, walls, and a door; it is safety, security, and stability. Housing First houses individuals regardless of sobriety, getting them to a safe place where they can make decisions and access wraparound services. From this point, the housed individual has a stable base from which to work.
Why Requirements Often Backfire:
With a sobriety-first requirement to secure housing, those who need housing most often aren’t able to “achieve it.” This requirement becomes a filter for those least able to clear the bar, those with active substance use disorders or those experiencing untreated mental health issues. Furthermore, when sobriety is a requirement for housing, what happens when a relapse of substance use disorder occurs? This puts not just sobriety in peril, but one’s entire life, housing, stability, and this is often where we see tragic outcomes. In the best-case scenario, we see the housing/street cycle repeat. In this worst-case scenario, this situation costs lives.
Housing First removes the sobriety requirement, creating a stable housed environment that is not dependent on one’s sobriety. Healing from a substance use disorder is rarely linear, and setbacks are common. In a Housing First program, people do not lose their home because of these setbacks; they remain housed and have access to support services to continue their healing journey. This approach is not only humanizing and compassionate, but it works.
According to a 2024 article in the American Journal of Public Health by Tsemberis, Guleur, and Nake, “The Housing First program sustains an approximately 80% housing retention rate.” Put simply, Housing First’s no-precondition model kept 80% of people housed, roughly 50 points above the sobriety-first approach. Not only is the success rate higher, but the long-term success rate continues to outpace sobriety-first models. In a Johns Hopkins Bloomberg School of Public Health study that compared Housing First vs. Sobriety First, “79% remained in stable housing at the end of six months compared to 27% in the control group. The study went on to say, “Housing First programs were more successful in reducing homelessness than programs where housing and services were contingent on sobriety and treatment progress.”
Housing is the Foundation for Recovery
Housing isn’t a reward for sobriety; it is what makes sobriety possible. For those who are unhoused, life is more than scary; it is dangerous. According to a JAMA article about Unhoused individuals and violence, the statistics are sobering,” Adults experiencing homelessness experience exceptionally high rates of violent victimization, with studies showing that between 38% and 49% of unhoused adults are victims of physical or sexual violence during their time without housing. This rate of violent victimization is more than 10 to 20 times higher.” How is society realistically possible with the imminent threat of daily violence? This is where Housing First sets those experiencing substance use disorder up for success.
Housing becomes the platform for recovery. A safe place to sleep, eat, and live resets the nervous system from a constant state of alertness and fear, allowing people to relax and feel safe. From this space of safety, you can choose to truly welcome support services. We know that successful sobriety is a choice by those experiencing substance use disorder, so sobriety cannot be forced. Housing First’s voluntary support services allow choice, and where there is choice in sobriety, we see better, more sustainable outcomes. With the Housing First approach, housing is a pillar of recovery. The VA sums this concept up plainly: “it is much easier to manage one’s health, sobriety, and employment when you don’t have to worry about where you’ll sleep each night.”
Housing is Where Healing Happens
Housing is a basic human right, not something to be earned. While sobriety-first requirements have the best intentions, they’re a barrier to housing. Every precondition is a place to lose people; by removing these barriers, we house more individuals and create opportunities for sustained recovery. It is often said that the simplest answer is usually the correct answer; Housing First is the answer. Housing First is not simple; people are complex, and the issues that cause homelessness are, too. The Housing First approach removes barriers to housing and treatment for those experiencing a substance use disorder, and recognizes housing as the platform from which healing begins.
Continue Reading this Series:
It’s Not Addiction, It’s Rent: The Real Cause of Homelessness
What The Research Actually Shows About Housing First
Housing First, Explained: The Simple Idea That Stability Starts With a Home
Sources:
U.S. Department of Housing and Urban Development, “Housing First: A Review of the Evidence,” Evidence Matters (2023). huduser.gov
Tsemberis, S., Gulcur, L., & Nakae, M., “Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis,” American Journal of Public Health, 2004;94(4):651–656. ajph.aphapublications.org
Johns Hopkins Bloomberg School of Public Health, “How Stable Housing Supports Recovery from Substance Use Disorders.” opioidprinciples.jhsph.edu
U.S. Department of Veterans Affairs, “What Is HUD-VASH, and How Does It Help Homeless Veterans?” va.gov
University of California, San Francisco, “How Common Is Illegal Drug Use Among People Who Are Homeless?” (California Statewide Study; JAMA, 2025). ucsf.edu
UCLA Fielding School of Public Health, “People Think Drug Use Causes Homelessness. It’s Usually the Other Way Around.” ph.ucla.edu
National Alliance to End Homelessness, “The Truth About Housing First.” endhomelessness.org
WFYI Public Media, “Homelessness Initiative Finds Housing for 200 People in Indianapolis” (2026). wfyi.org
Kushel, M., et al., “Experience of Violence During Homelessness,” JAMA Internal Medicine (2024). jamanetwork.com
National Coalition for the Homeless, “Violence & Victimization.” nationalhomeless.org
