Home Hope vs. Homelessness Local PhD Psychologist Believes Housing First is Not Effective

Local PhD Psychologist Believes Housing First is Not Effective

by Michael Gallo, Psy.D

I am a Doctor of Psychology (Clinical) with over 25 years of experience, often treating individuals with substance abuse problems and housing challenges. In 1995 I specifically worked at the Tampa, Florida, VA hospital in a program designed to help such individuals attain rehabilitation in terms of social life behaviors, health maintenance skills (physical and mental), and daily living/housing challenges. In the latter part of my career, I worked for the U.S. Department of the Army with active-duty soldiers, many of whom were experiencing struggles with drugs and alcohol, and PTSD.

My clinical experiences have led me to conclude that a “Housing First” strategy toward helping unhoused drug and alcohol abusers is unsuccessful most of the time. Essentially, an individual who is provided housing, while still being permitted to use drugs/alcohol actively, will ultimately not be able to sustain their housing situation in an appropriate manner. In short, they will soon become evicted from the particular housing situation due to problems resulting from drug use and become homeless again. Substance abuse rules a person’s life and precludes them from behaving in a socially congruent manner. Similarly, we can not treat someone’s mental illness while they continue to abuse mind-altering substances, as the intoxicating chemicals dominate a person’s mind. Treatment with psychiatric medicines/psychotherapy will not work because drugs/alcohol precludes healing.

It is unrealistic to think that good housing alone will result in the individual beginning to live in a healthy manner. Before anything else, the person must become abstinent from drugs and alcohol.

In a recent Burien City Council meeting, I witnessed an individual who worked for the City in an official capacity, state (paraphrased) “that a drug abuser/addict may need ‘years,’ along with ‘relationships’ (not defined operationally by this official) before they come to the point where they will accept treatment and rehabilitation.” This hypothesis has not been supported by any existing credible research that I know of. Moreover, most drug addicts do not have years. With the advent of fentanyl, a single tablet can kill. Official tolerance for continued drug addiction, while we wait until someone is ‘ready to quit,’ exposes the individual to multiple other threats (e.g., health decline, medical emergencies, overdose, criminals, etc.).

An alternative exists which combines compassion with a “tough” form of caring. Individuals should be compelled to accept treatment/rehabilitation closely coupled with good shelter, meals, medical care, and other life necessities. This should initially be involuntary commitment, but transitioned to a less restrictive situation as soon as possible, as is warranted individually. People who enter the criminal justice system via the new Washington State Drug Enforcement Law should not be put in jail, but rather in secure treatment/rehabilitation facilities, where they can receive all the services I mentioned above.

The above outlined approach would be especially effective in helping persons living unhoused in public places ( i.e., campers.) We must honestly acknowledge that no mentally healthy person would choose to live in this type of situation. Cold, heat, snow, rain, great discomfort, disease, fire danger, and, most importantly, criminal attacks are omnipresent. Moreover, drug dealers have an easily accessible, centralized location to push the poisons they sell.

City ordinances should be designed to firmly motivate unhoused individuals to vacate encampments and avail themselves of public and private shelters and treatment services. These would be acts of charity, not cruelty. We should not allow our fellow citizens, who are unable or unmotivated to help themselves (because of mental illness and/or drug/alcohol addiction), to wither in misery and decline towards illness and death. We are obligated to help them firmly but compassionately start on the road to a healthy, happy life.


Michael Gallo, Psy.D

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  1. Clearly the author has not read or know of Agnew and Brezina’s (2018) amalgamation of evidence against antiquated control theories against drug crimes that clearly summarize the need for community and support. Clearly the author has not read or knows of numerous studies since the 1970’s demonstrating the importance of environment. Clearly the author has not stayed up to date about the need for significance (Kruglanski et al., 2022). If a Vail model PsyD (cited as a Boulder model PhD incorrectly) is citing cross-sectional convenience sampled anecdotal evidence, in matters of policy, then this misses the random sampled longitudinal studies that can and have been done in the last decades.

    Just because one Vail Model PsyD hasn’t heard of a study, just because one politician hasn’t heard of a study to the contrary of their positions, and just because I as a citizen and person hasn’t heard of something, doesn’t give me the authority to say “it doesn’t work because there is no evidence”. There is. Go to your local university, and go pay your neighbors more so they have enough time to go look up and do reading on these topics to be more informed.

    Besides, Alexander et al.’s (1981) study that improved on earlier “rat park” experiments used to justify incarceration of those suffering substance abuse disorders evidenced that environment (i.e., home) first matters. If it didn’t work, then why did the United States invest in improving homes for children in the past several decades?

    Also, go read a plethora of sociological and psychological monographs and studies on the efforts that have repeatedly demonstrated that mass incarceration is ineffective for the most part.

    You wrote that, “no mentally healthy person would choose to live in this type of situation,” but did not define what “healthy” is. First off, as a PsyD, you know the difference between health and well-being, and omitted well-being. Perfectly healthy people suffering low well-being are oft diagnosed with mental health disorders which later affect health. So doing the “look at health” when mental health associates with “well-being” is not only misleading, it’s not meeting the criteria of a PsyD representing the field. Someone can be perfectly healthy and suffer major depressive disorder (MDD) and dip into drugs. Someone perfectly healthy and suffer post-traumatic stress disorder (PTSD) may dip into drugs. Someone suffering from persistent devaluation of labor production due to prevailing socio-economic inequalities due to continued devaluation of labor for… blah blah blah might be experiencing some other disorders and stereotype threat as a result of… you know exactly where this is going.

    So no, take your anecdotal evidence and offer a retraction. This article, while clearly opinion should be completely divested from what a PsyD represents, along with a Vail Model that relies on evidence of a Boulder Model in its practice.

    This opinion piece is misleading, unreliable, invalid, and quite possibly politically motivated and seems to be more evidentiary of outdated, uninformed, and a persistently maintained perspective as a result of… the same thing that keeps those suffering homelessness and drug abuse in their position…

    I think everyone is just too busy helping others to have time to help themselves to updated information.

    Housing first. Relations first… and yes I support the kind of housing you mention… not incarceration, but group housing with social support. Why? Kruglanski et al.’s (2022) evidence of significance quest theory (SQT) evidences the inversion of Maslow’s hierarchy which subordinates “lower” needs to self-actualization. This “express-bus” to self-actualization most likely is occurring because of why you demonstrate in this article…

    Treating individuals like “others” (i.e., othering) and not giving them a sense of significance in the first place.

    Please reconsider why you became a PsyD in the first place.


    Agnew, R., & Brezina, T. (2018). Juvenile delinquency: Causes and control. Oxford University Press.

    Alexander, B. K., Beyerstein, B. L., Hadaway, P. F., & Coambs, R. B. (1981). Effect of early and later colony housing on oral ingestion of morphine in rats. Pharmacology, biochemistry, and behavior, 15(4), 571–576. https://doi.org/10.1016/0091-3057(81)90211-2

    Kruglanski, A. W., Molinario, E., Jasko, K., Webber, D., Leander, N. P., & Pierro, A. (2022). Significance-Quest Theory. Perspectives on Psychological Science, 17(4), 1050–1071. https://doi.org/10.1177/17456916211034825

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