Housing First vs. Treatment First: Finding a Third Way

The Housing First Model

Housing First emerged in the 1990s as a response to traditional shelter systems that required sobriety, treatment compliance, and other prerequisites before providing permanent housing. The core principle is simple: housing is a basic human right, and people are better able to address other issues once they have stable shelter.

Housing First programs provide permanent housing immediately, with voluntary supportive services. There are no requirements for sobriety or treatment participation. The philosophy is that forcing people to "earn" housing through compliance creates barriers that keep the most vulnerable on the streets.

Evidence for Housing First

Research shows Housing First is effective for many populations, particularly chronically homeless individuals. Studies demonstrate:

• • 80 to 90% housing retention rates
• • Reduced emergency room visits
• • Decreased hospitalizations
• • Lower incarceration rates
• • Cost savings for public systems

The approach has become federal policy and is required for many HUD-funded programs.

Criticisms of Housing First

Critics argue Housing First does not adequately address substance abuse or mental health issues, leading to poor outcomes for some individuals. Housing retention does not equal recovery or life improvement. Some people continue using substances, remain unemployed, and experience ongoing crises even with housing.

Neighbors and landlords sometimes face problems with Housing First placements. The model also requires ongoing subsidies indefinitely, which may not be sustainable at scale.

The Treatment First Model

Treatment First, sometimes called "staircase" or "continuum of care" models, requires individuals to progress through stages of treatment and demonstrate readiness before receiving permanent housing. This might include completing detox, maintaining sobriety, participating in mental health treatment, and following shelter rules.

The goal is to ensure people are prepared for independent living before placement. Many faith-based programs and recovery communities use this model.

Evidence for Treatment First

Treatment First programs can achieve excellent outcomes for motivated individuals. People who complete intensive programs often maintain long-term sobriety and housing stability. The structured environment provides accountability and support during the difficult early stages of recovery. Graduates often report that the requirements, while difficult, were essential to their transformation.

Criticisms of Treatment First

Critics note that Treatment First excludes people who are not ready or able to comply with requirements, leaving the most vulnerable on the streets. Some people cycle through programs multiple times without success. The approach can feel punitive and may not align with how addiction and mental health recovery actually work. Drop-out rates can be high, especially in early stages.

A Third Way: Comprehensive Restoration

At The Steady Ground, we believe the debate presents a false choice. Our model provides:

• • Immediate shelter and safety (like Housing First)
• • Structured therapeutic community with expectations (like Treatment First)
• • No ejection for relapse, but intervention when it happens
• • 12 to 18 months of comprehensive support
• • Ongoing alumni support after graduation

We do not put people on the street for relapse, but we also do not accept ongoing substance use without intervention. The key difference is that we provide enough time for real transformation to occur.