This is a case study of the development of a rural continuum of care (CoC) program funded by the US Department of Housing and Urban Development (HUD) to create a coherent system of services and planning processes to end homelessness. It concerns how the founding local coalition of agencies managed internal conflicts about HUD’s changing programmatic and administrative requirements from 1994 to 2015. It addresses the coalition’s relationship with HUD, intracoalition conflict between secular and faith-based agencies over federal requirements, and the workarounds developed to keep local divisions over service modalities from harming the larger project. Through this lens, we analyze the pressures for conformity intrinsic to the relationship between federal agencies and nonprofit grantees. We conclude that HUD and its CoC grantees have interdependent aims that limit the exercise of federal authority. Federal project grants may neither necessarily nor typically transform nonprofits in the image of the state.

David T. Courtwright's The Age of Addiction explains how societies worldwide became sites of obsessions born of pleasure seeking. Fundamental here is “limbic capitalism,” joined as an “evil twin” to market economies when science and technology made possible “addictive engineering” (p. 211). Especially in the last century, savvy industries promoted global excess, “turning [the world's] sorrows into profit” in concert with “complicit governments and criminal organizations” (pp. 25, 6). Courtwright understands addiction as obsession and organic tyranny—perhaps a brain disease—resulting not only from licit and illicit drug use but also from compulsive eating, sex, gambling, and absorption in devices. These activities and others often are engaged ensemble and their brain rewards are largely transposable. This framing permits a sweeping account of limbic capitalism as a ramified, self-sustaining international system that produces huge profits from a diverse set of pleasure-inducing commodities while, over time, normalizing much previously disreputable behavior. This is John C. Burnham's “minor vice-industrial complex” writ large and globalized. Burnham's Bad Habits (1993) was a novel complement to accounts of reform. Courtwright similarly chronicles vice advocates as he explains why reformers have had so little durable success. Everywhere, markets commodify voraciously. States love the revenue from regulation, but attempts to prohibit or tax heavily offend liberty and create illicit markets that corrupt governments and capitalize criminals. A complex web of externalities and associated interests complicates and paralyzes the politics of reform: a massive recovery industry now sprawls across health and social service institutions of research, education, and intervention; corporations thrive on the “technological arms race” involved in vice and its control (p. 245). Drugs, Courtwright observed in Forces of Habit (2001), provide “steady work for everyone from peasants to lawyers to drug historians” (p. 110).

American EthnologistVolume 35, Issue 2 p. 2045-2048 Where Have All the Homeless Gone? The Making and Unmaking of a Crisis by Anthony Marcus JIM BAUMOHL, JIM BAUMOHL Bryn Mawr CollegeSearch for more papers by this author JIM BAUMOHL, JIM BAUMOHL Bryn Mawr CollegeSearch for more papers by this author First published: 09 June 2008 https://doi.org/10.1111/j.1548-1425.2008.00060.xAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume35, Issue2May 2008Pages 2045-2048 RelatedInformation

Previous articleNext article No AccessBook ReviewThe Poorhouse: America’s Forgotten Institution. By David Wagner. Lanham, MD: Rowman & Littlefield Publishers, 2005. Pp. 200. $60.00 (cloth); $22.95 (paper).Jim BaumohlJim BaumohlBryn Mawr College Search for more articles by this author Bryn Mawr CollegePDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Social Service Review Volume 80, Number 1March 2006 Article DOIhttps://doi.org/10.1086/501481 Views: 11Total views on this site Permission to reprint a book review printed in this section may be obtained only from the author.PDF download Crossref reports no articles citing this article.

The General Accounting Office's 1990 conclusion about the prevention of homelessness still holds: It remains "too early to tell" what works best. Eviction prevention programs show some promise but have not been rigorously evaluated and tend to exclude people at highest risk of homelessness. Several studies suggest that individuals with severe mental illness can be supported in the community, but the mixture of housing and supportive services necessary remains unclear. There is even less evidence for the usefulness of planning discharges from institutions or of programs to ameliorate domestic conflicts. However, even if expanded to reach 100 percent of their target populations and even if 100 percent successful, all of these programs together would reach only a minority of the people who become homeless each year, and targeting efforts would yield many false alarms for each future case of homelessness correctly identified. Based on evidence that subsidized housing, with or without supportive services, is sufficient to end homelessness for most families, and given the important role of subsidized housing (everywhere it has been examined) in ending homelessness among people with serious mental illnesses, we propose a shift to selected strategies of prevention, such as providing housing subsidies to those with worst—case housing needs, supporting employment and transitional assistance to poor, young people setting up households for the first time, and focusing efforts on communities from which large proportions of homeless people originate. Lessons for Practitioners, Policy Makers, and Researchers Practitioners and policy makers should keep their goals clearly in mind. More specifically, they should remember that preventing homelessness is not identical with ending poverty, curing mental illness, promoting economic self-sufficiency, or making needy people healthy, wealthy, and wise. These are worthy goals, to be sure, but we believe that when attached to the objective of preventing homelessness or rehousing homeless people, these diffuse goals take on lives of their own and raise troubling questions of equity in the distribution of resources available to poor people. Every study that has looked has found that affordable, usually subsidized housing, prevents homelessness more effectively than anything else. This is true for all groups of poor people, including those with persistent and severe mental illness and/or substance abuse. Serious mental illness, while problematic in its own right, need not compromise an individual's ability to maintain housing; evidence regarding substance abuse is more mixed. Although social services are valuable for other reasons, it is not clear how much they contribute to preventing homelessness once access to subsidized housing is controlled. Studies of services that do not examine housing subsidies suggest that services are useful; studies that control for housing subsidies suggest that the intensity of services is unrelated to housing stability. Income supports are also related to housing stability, probably because the affordability of housing is a joint function of income and housing costs. Advocacy for entitlement income may be a key ingredient in case management. Some eviction prevention programs seem promising, but none have been studied rigorously. We need more research with long-term follow-up. Consumer choice in housing is associated with residential stability for people with mental illness and/or substance abuse problems. This suggests that a range of living options is valuable, with different degrees of social control and expectations for behavior. There is no evidence linking brief discharge planning efforts with reduced homelessness, although they may be useful as part of broader, more enduring services, including the provision of housing. Because homeless people in some cities come mainly from a few areas of highly concentrated poverty, it makes sense to test strategies of community development that combine housing development and subsidy, market-based economic development, supported work, public employment, and social services. http://aspe.hhs.gov/progsys/homeless/symposium/13-Preven.HTM The 1998 National Symposium on Homelessness Research 2 of 28 Because there is little research with long-term follow-up, it is impossible to know whether short-term interventions are sufficient to prevent homelessness. In contrast to the prevailing philosophy of time-limited benefits, in our view, it is likely that the shortcomings of the housing and labor markets require indefinite and expanded intervention by the state in both individual cases and in the aggregate. Tax expenditures on home mortgages, which benefit the well-to-do disproportionately, represent a long-term public investment in home ownership that dwarfs housing subsidies for the poor.

This article reviews the results of a multisite cohort study on effects of terminating Supplemental Security Income benefits for drug addiction and alcoholism. Within 2 years of the program’s termination, 35–43 percent of participants requalified for disability benefits for another impairment. Regardless of requalification status, substance abuse treatment participation declined sharply and illegal drug use was prevalent. Although many of those who did not requalify lost income, medical benefits, and housing, these losses lessened over time and were not associated with increased psychological or medical problems or with declines in other aspects of participants’ lives.

Aims This study attempted to determine: if US federal cash disability payments increase the use of cocaine or opiates among those requalifying for supplemental security income (SSI) disability benefits compared with those who lost benefits; if drug use peaks at the beginning of the month after the receipt of the disability cash disbursement; and if money management by representative payees of requalifying SSI recipients suppresses drug use.Design A multi-site, prospective, 2 year longitudinal design was used with follow-up interviews conducted every 6 months. Urine samples were collected at the final three follow-up interviews.Setting Data were collected in Chicago, IL, Los Angeles, CA, and Seattle, WA, USA.Participants This study used a randomly selected sample of 740 former recipients of SSI who had received disability benefits for drug addiction and alcoholism (DA&A) in 1996, were between the ages of 21 and 59 years, had not received concurrent social security disability insurance and provided testable urine samples and complete self-report data for at least one follow-up interview.Measurements Independent variables included demographics, SSI status at follow-up, representative payee status, drug treatment participation and income. Time of drug testing was operationalized as the first 10 days of the month versus the last 20-21 days based on when the urine sample was collected. The dependent variables were cocaine and opiate use, determined by urinalysis results.Findings Participants were 28% more likely to test positive for cocaine use in the first 10 days of the month than later in the month. This effect was general across all subjects and was not restricted to those receiving SSI benefits. No such effect was found for opiate use. Receiving SSI benefits did not increase cocaine or opiate use generally, nor did having a representative payee suppress use.Conclusions The findings do not support the contentions that federal cash benefits appreciably increase drug use or that representative payees discourage use, at least when use is defined dichotomously. The 'check effect' for cocaine use appears to be general and not confined to those receiving federal cash benefits. The lack of a 'check effect' for opiate use is probably the result of the difference between a relatively steady state of opiate use associated with addiction and a binge pattern of cocaine use triggered by suddenly flush resources.

Recipients of Supplemental Security Income (SSI) Drug Addiction and Alcoholism (DA&A) benefits had the opportunity to appeal their termination during the six months prior to the end of the DA&A program in January 1997. In this study, we examined factors that affected transition from the DA&A program to continuing SSI benefits based on other qualifying impairments. We treated requalification for SSI as the outcome of two processes: a beneficiary's submission of a request for reconsideration and the Social Security Administration's (SSA) Disability Determination Senvices’ efforts to document a qualifying impairment, culminating in a decision to approve or to deny the appeal. We developed two multivariate statistical models. The first specified factors that predict beneficiaries’ submission of appeals and the second articulated factors affecting the SSA's disposition. We tested the models using data from nine metropolitan areas in the states of Washington, Oregon, California, Illinois and Michigan. We found that the likelihood of appeal submission increased with the severity of physical and mental health problems, social support, institutional integration and employment status. The SSA's disposition was predicted by a beneficiary's frequency of alcohol consumption, economic status, level of institutional integration, functional capacity for daily living, and the metropolitan area in which he or she resided.

As part of the larger SSI Study, we conducted detailed semistructured interviews with 156 respondents in four sites. They spoke at length about matters of legislative concern during the reform and subsequent abolition of the drug addiction and alcoholism (DA&A) program. Respondents were quite aware of the problems considered by Congress. Some acknowledged using SSI payments to buy alcohol and other drugs, and a few claimed to have squandered large retroactive payments. Most insisted that they spent their checks wisely, however, and discussed how they did so. With a remarkable degree of consensus, respondents favored the DA&A program's paternalistic features of representative payment and mandatory treatment, and while less in agreement about time limits, they approved in theory of benchmarks to measure progress. A substantial majority believed the DA&A program had been an unalloyed good, and only 12 judged it to have been wholly harmful.

This paper reviews the history of the drug addiction and alcoholism (DA&A) program within Supplemental Security Income (SSI) and the controversies that dogged the years before its termination in 1996. The DA&A program began in 1972, and for reasons understood early on, it was susceptible to rapid growth and discrediting scandal. Through the mid-1980s, the program remained very small, mainly because of a conservative judicial climate that limited the grounds for claiming substance abuse as a disabling impairment. Once the legal barriers were breached, SSI became an attractive welfare alternative for impoverished substance abusers and for local governments seeking to shift welfare and medical assistance costs to the federal government. By the early 1990s, program growth was extraordinary, and oversight bodies deemed the program “out of control.” This was compounded by highly publicized misuse of funds by beneficiaries. Seen as an instance of state-induced harm, the program became an early target of the conservative welfare reformers who took control of Congress after the 1994 elections.

This study examined drug treatment participation and retention rates for a multisite sample of 1,586 former recipients of Supplemental Security Income (SSI) for drug addiction and alcoholism (DA&A). Fewer than half of the sample were complying with the DA&A program treatment mandate at the time the program was terminated by federal legislation in January 1997. For all forms of treatment, both participation and retention rates declined steadily thereafter until fewer than 10% of the total sample reported being in a formal treatment two years after termination of the mandate. Survival analyses comparing treatment retention rates for DA&A beneficiaries with non-DA&A SSI beneficiaries revealed that most of the decline in treatment retention could be attributed to ending the mandate. The findings suggest that although the mandate was often not well enforced, it did bring into drug treatment many individuals who would not otherwise have participated.

This paper describes the quantitative and qualitative methodologies used in a nine-site, two-year study of the effects of terminating Supplemental Security Income (SSI) for drug addiction and alcoholism (DA&A). The quantitative component of the study involved a longitudinal survey that collected data on 1,744 former DA&A recipients, representing about one-fourth of the national population, and achieved an aggregate follow-up rate of 82%. Despite limitations in questionnaire design and implementation, the survey provided reasonably valid data in the following areas: demographics, employment/income, medical/psychiatric status, drug and alcohol use, legal involvement, family/social functioning, food and hunger, housing, and victimization. The qualitative component examined the lives of a subsample to help clarify important issues that could not be addressed within the more structured protocol and format of the longitudinal survey. The paper also presents details on the survey instrument design, the results of validation studies of selected survey items, and data collection protocols across study sites.

The Supplemental Security Income (SSI) program for drug addicts and alcoholics (DA&A beneficiaries) ended in January 1997 without any special effort to create employment for those who lost benefits. Relying on data from a nine-site, two-year panel study of 1,764 former DA&A recipients and detailed semi structured interviews with subsamples in four sites, this paper examines employment outcomes and barriers to employment among 611 respondents who lost SSI and did not replace it with another form of publicly funded income assistance. Despite the tight labor market of the late 1990s, this group was plagued by widespread unemployment and sub-employment. At the two-year follow-up, only 25% earned $500 per month or more, and only 12% typically earned this much throughout the study. Given their age, health problems and limited human capital, it is likely that many former DA&A beneficiaries will remain indigent, returning to the SSI rolls when they requalify upon turning 65.

Drawing on findings from the SSI Study and other research, this paper takes up various policy questions fundamental to any welfare program for substance abusers. The paper considers the place of disability benefits in the U.S. system of categorical aid and the problems raised by substance abuse for the disability category. It discusses the desirable objectives of a welfare program for substance abusers and the various mechanisms by which they might be achieved. And finally, it considers how any new program might be positioned in the context of categorical aid and American federalism.

In Forces of Habit, David T. Courtwright harvests the multidisciplinary literature of the drug field and distills it with wit and historical acumen to produce the best single book we have on the history of psychoactive substances, their use and regulation. It is not the only book to read on the subject, but Forces of Habit provides the neophyte with a sophisticated place to begin and the teacher with a coherent overview from which to digress. Few books in any crowded and controversial field provide such sure-handed and wide-ranging synthesis. The book's uccess derives from its neatly crafted integration of neurobiological realities and political-economic matters. Courtwright takes his biology straight but avoids pharmacological determinism. Forces of Habit owes a great deal to Andrew Weil's insistence that we have an innate curiosity about altered states of consciousness. (In his 1972 book, The Natural Mind: A New Way of Looking at Drugs and the Higher Consciousness, Weil elevates it to the status of a “drive.”) He draws as well on the late Norman Zinberg's elaboration of the interaction of “drug, set, and setting” as a framework for understanding drug effects in view of pharmacology, the expectations of the user, and the social context of use (see Drug, Set, and Setting: The Basis for Controlled Intoxicant Use, 1984) and on Wolfgang Schivelbusch's consideration of Genussmittel (“articles of pleasure”) in the development of international commerce (see his 1980 volume, Tastes of Par -adise: A Social History of Spices, Stimulants, and Intoxicants, translated by David Jacobson in 1992). On this foundation, Courtwright builds an international story of consumption, the commodification cycle (including its environmental impacts), and fitful and flawed regulation. He begins with alcohol, tobacco, and caffeine, then takes up opium, cannabis, and coca. In the process, he attends to provincially popular drugs that have not achieved worldwide appeal: qat, for example, and many New World hallucinogens.

Conceptual and methodological problems plague efforts to prevent homelessness. Attempts to identify individuals at risk are inefficient, targeting many people who will not become homeless for each person who will. Such interventions may do useful things for needy people, but evidence that they prevent homelessness is scant. Subsidized housing, with or without supportive services, has ended homelessness for families and played a key role in ending it for people with serious mental illnesses. Other risk factors may be less important once housing is secured. But programs that allocate scarce housing may simply reallocate homelessness, determining who goes to the head of the line for housing, not shortening the line itself. We recommend reorienting homelessness prevention from work with identified at‐risk persons to efforts to increase the supply of affordable housing and sustainable sources of livelihood nationwide or in targeted communities.

Conceptual and methodological problems plague efforts to prevent homelessness. Attempts to identify individuals at risk are inefficient, targeting many people who will not become homeless for each person who will. Such interventions may do useful things for needy people, but evidence that they prevent homelessness is scant. Subsidized housing, with or without supportive services, has ended homelessness for families and played a key role in ending it for people with serious mental illnesses. Other risk factors may be less important once housing is secured. But programs that allocate scarce housing may simply reallocate homelessness, determining who goes to the head of the line for housing, not shortening the line itself. We recommend reorienting homelessness prevention from work with identified at-risk persons to efforts to increase the supply of affordable housing and sustainable sources of livelihood nationwide or in targeted communities.