Director of the Health Integration Project
May 22, 2018: This post has been updated to clarify Rep. Andy Barr’s introduction of legislation that would address the post-treatment needs of people with substance use disorders by adding funding to the Department of Housing and Urban Development.
The Trump Administration and Congress have committed to dedicating billions in new funding to help states and communities address the opioid epidemic. They should use some of these resources to meet the housing needs of people with substance use disorders (SUDs), as Senate Majority Leader Mitch McConnell has proposed in the Senate and Rep. Andy Barr has proposed in the House – rather than divert existing, oversubscribed housing resources for this purpose, as a proposal that the House Financial Services Committee is considering today would do.
The bill under consideration, also sponsored by Rep. Barr, would take funding away from existing Housing Choice Vouchers (HCVs) to pay for transitional recovery housing for people with SUDs. This approach would reduce the number of households receiving housing assistance despite significant unmet need. In contrast, the bill from Senator McConnell and Rep. Barr would address the post-treatment needs of people with SUDs by adding funding to the Department of Housing and Urban Development (HUD). That’s the approach that Congress should build on.
Housing needs among people with SUDs mainly take two forms – transitional housing (often called recovery housing) and post-treatment rental assistance, both of which are vital to recovery and should be part of the SUD continuum of care. Recovery housing is typically set in sober living communities — in which everyone living in the house or building has sobriety as their goal — that help people access both outpatient and onsite services and counseling. Some people find this structure and support helpful in their recovery process.
Post-treatment rental assistance can give people the financial support they need to live independently and maintain their recovery. An inability to pay rent and the threat of losing housing can keep people living in recovery housing longer than necessary, or in some cases, lead to stress that triggers substance misuse and relapse.
While additional resources are needed for both forms of housing assistance for people with SUDs, the bill the House Financial Services Committee is considering is the wrong approach. It would reduce voucher assistance and wouldn’t help people with SUDs transition from treatment and live independently. Specifically, the legislation would:
These provisions aren’t an appropriate use of the HCV program. Public housing agencies, not substance use treatment providers, have the expertise to administer vouchers with proper oversight. And the HUD Secretary can’t be expected to know the appropriate criteria for determining which treatment providers deliver high-quality services; that’s more appropriately a role for the Department of Health and Human Services (HHS).
And using HCV funds this way would violate core principles of the program that make it effective: that individuals choose where to live and can receive assistance as long as they need it to have a stable home. Yet to compete with other providers for funds and ensure that clients don’t continue to receive federal assistance after treatment, programs would avoid serving people with higher needs and lower incomes who likely need ongoing support.
Given limited funding for both recovery housing and housing vouchers, a better approach would be to add resources to federal grant programs that help people access housing to meet their needs, or to take advantage of the resources Congress has already designated for programs that are addressing the opioid epidemic. The President and Congress can allocate grant funding in both HUD, through programs such as the Community Development Block Grant (CDBG) and the HOME program, and HHS, primarily through programs in the Substance Abuse and Mental Health Services Administration.
The proposal from Senator McConnell and Rep. Barr is an example of a better funding approach. It would add $25 million to CDBG for housing assistance as people transition out of substance use treatment. Independent of CDBG formula grants, these funds would go to states or communities facing the highest drug-related death rates, with a preference for those with high rates of opioid misuse. The housing assistance would be available for up to 24 months or until federal rental assistance is available, and the HUD Secretary could raise the 24-month limit. Adding resources rather than shifting them from the voucher program, flexible time limits, and helping people live independently after treatment make this proposal a step in the right direction.