| Course | PAC 411 Social Work as a Profession |
|---|---|
| Module | Module 7 |
| Paper type | Population at risk paper |
| Length | About 1,055 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Psychology and Addiction Studies |
| Updated | October 2026 |
Free sample paper for PAC 411 Module 7
Housing Before Sobriety: Chronic Homelessness, Alcohol and the Evidence for Housing First
Student Name
Psychology and Addiction Studies Program, Aspen University
PAC 411: Social Work as a Profession
Instructor Name
Month Day, Year
Housing Before Sobriety: Chronic Homelessness, Alcohol and the Evidence for Housing First
Earl is fifty-four, an Army veteran who served eight years and left after a back injury. Six years ago, after his marriage ended and he lost his job driving a delivery truck, he lost his apartment. Since then he has slept in a downtown encampment, under a highway overpass and occasionally in shelters. He drinks most of a fifth of vodka daily. He has been turned away from two shelters for arriving intoxicated and from a transitional housing program that required ninety days of sobriety before admission. In the past year, he has been to the emergency department eleven times and jailed four times for public intoxication. An outreach social worker from Westgate's outreach team, part of the fictional agency in these papers, has known him for three months. This paper examines the population Earl belongs to and the evidence on what helps. Earl is a composite, and so is the agency, while the housing trials are real.
How Common Are Substance and Mental Disorders?
Fazel et al. (2008) pooled surveys of homeless populations across Western countries to estimate how often they had mental and substance use disorders. Rates of alcohol and drug dependence were high, with alcohol dependence ranging widely across studies but consistently far above the general population, and drug dependence also common. Psychotic illnesses and major depression were also more prevalent than in the general population. The authors noted wide variation across studies, reflecting differences in samples and methods, and emphasized that services for homeless people needed to address mental health and substance use.
The findings show that Earl's situation is common, not exceptional. Many people experiencing chronic homelessness have substance use disorders, and services that exclude people who use substances exclude many of those most in need.
Treatment First and Housing First
For decades, services for homeless people with substance use disorders followed a treatment first model, sometimes called a continuum of care. People were expected to progress through stages, from shelters to treatment to transitional housing, earning permanent housing by achieving sobriety and stability. The assumption was that people were not ready for housing until their addiction was treated.
Housing First reverses the order. It offers permanent housing directly, without requiring sobriety or treatment, along with voluntary support services. The assumption is that housing is a basic need and a foundation from which people can address other problems.
The Evidence on Housing
Tsemberis et al. (2004) tested the two models in New York City. Homeless adults with psychiatric disabilities, most of whom also had substance use disorders, were randomly assigned to a Housing First program, which provided apartments and support without requiring treatment, or to the existing continuum of care. Over two years, people in Housing First spent much more time stably housed and less time homeless. They reported greater choice in their lives. There were no significant differences between the groups in substance use or psychiatric symptoms, meaning that providing housing without requiring sobriety did not worsen these problems.
Larimer et al. (2009) studied a Housing First program in Seattle for chronically homeless people with severe alcohol problems, the population often considered hardest to house. After participants moved into housing, their use of costly public services, including emergency departments, jails, sobering centers and hospitals, fell substantially, and total public costs declined by more than half within six months even after the cost of housing was included. Participants' drinking also decreased over time, though the program did not require abstinence.
Earl's Risks and Service Gaps
| Area | Risk | Gap in services |
|---|---|---|
| Housing | Six years outside; exposure to weather and violence | Transitional program requires ninety days sober |
| Alcohol | Daily heavy drinking; risk of withdrawal | Shelters turn him away when intoxicated |
| Health | Back injury; eleven emergency visits in a year | No primary care; untreated pain |
| Legal | Four jail stays for public intoxication | Arrest substitutes for treatment |
| Benefits | Possibly eligible for veterans' services and disability benefits | Never applied; no address |
A Housing First Plan
The outreach worker will refer Earl to the region's Housing First program, which accepts people who are drinking and offers apartments scattered across the city with case management. The case manager will help him apply for veterans' health care and disability benefits, now possible with an address. A primary care clinic will address his back pain. Alcohol treatment will be offered, not required: Earl will be told about medically supervised withdrawal, medications such as naltrexone and counseling, and his case manager will use motivational interviewing to explore his own goals. Because many housing first programs serve tenants who continue to drink, staff will also talk with him about safer drinking and the risks of withdrawal if he stops suddenly.
Answering the Objections
Some of Westgate's partners are skeptical. A shelter director worries that housing people who are still drinking rewards drinking. A city council member asks who will pay. The research speaks to both. Tsemberis and colleagues found that tenants in Housing First did not drink or use more than those required to get sober first, and Larimer and colleagues found that drinking declined after people were housed. On cost, Larimer and colleagues found that the public was already paying heavily for Earl's homelessness, through emergency visits, jail stays and sobering centers, and that housing reduced those costs by more than it cost. The question is not whether to spend money on Earl but whether to spend it on crisis services or on a home.
Dignity and Choice
Housing First rests on a view of people like Earl as entitled to housing and capable of making choices, consistent with social work's values. Earl's strengths include his military service, his loyalty to friends in the encampment and his skill at keeping himself fed and warm in difficult conditions. He has said he wants a door that locks and a place to keep his dog.
Conclusion
People experiencing chronic homelessness have high rates of substance use disorders, as Fazel and colleagues show, and treatment first rules have excluded many of them. Tsemberis, Gulcur and Nakae show that Housing First keeps people housed without worsening substance use, and Larimer and colleagues show that housing people with severe alcohol problems reduces costs and drinking. For Earl, housing first, with benefits, health care and voluntary treatment, offers what years of conditions did not.
References
Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in Western countries: Systematic review and meta-regression analysis. PLOS Medicine, 5(12), e225. https://doi.org/10.1371/journal.pmed.0050225
Larimer, M. E., Malone, D. K., Garner, M. D., Atkins, D. C., Burlingham, B., Lonczak, H. S., Tanzer, K., Ginzler, J., Clifasefi, S. L., Hobson, W. G., & Marlatt, G. A. (2009). Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA, 301(13), 1349-1357. https://doi.org/10.1001/jama.2009.414
Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651-656. https://doi.org/10.2105/AJPH.94.4.651
PAC 411 Module 7 instructions, in plain terms
Populations at risk are the seventh module of PAC 411, and assignments typically ask you to describe a vulnerable group, the evidence on its needs and the services that work, often through a case. Treat the Module 7 page in your Aspen course as your guide; Earl is invented. Describe the population with prevalence data from good sources. Explain competing service models and their assumptions. Present trial and cost evidence. Map the risks and service gaps a member of the group faces. Plan services that follow from the evidence. Address the dignity and choices of the people involved, with APA 7 references for every study. Name the program rules that exclude people and what replaces them. List the benefits the client may be entitled to.
How this PAC 411 Module 7 example is built
Earl, a veteran with a back injury and an alcohol use disorder, has been turned away from two shelters for intoxication and from a transitional program that required ninety days of sobriety. Fazel and colleagues' PLOS Medicine review supplies prevalence of substance and mental disorders among homeless people. Tsemberis, Gulcur and Nakae's American Journal of Public Health trial compares Housing First with treatment first. Larimer and colleagues' JAMA study reports falling costs and drinking after housing. A five-row table maps Earl's risks and gaps. The plan places him in a housing first apartment with case management, offers alcohol treatment and medication without requiring it and connects him with veterans' benefits and primary care for his back.
Where the marks sit in the PAC 411 Module 7 rubric
Population papers earn credit for accurate prevalence data, fair presentation of service models and a plan that follows from evidence. This example reports Fazel and colleagues' wide prevalence ranges honestly rather than citing a single number. It explains the assumptions behind treatment first and housing first and lets the trials adjudicate. Larimer and colleagues' cost and drinking findings address common objections. The table reveals how service rules exclude the people who need them most. The plan respects Earl's choices while offering treatment, which reflects both the evidence and the profession's values, and it names the veterans' benefits that can fund it. Earl's own wish for a locking door and a place for his dog shapes the plan.
PAC 411 Module 7 help from the desk
Papers on populations at risk often describe the group in stereotypes or as a list of problems. Use prevalence data from systematic reviews and describe ranges honestly. Explain the assumptions behind different service models. Present evidence on outcomes and costs, since policymakers ask about both. Show how program rules, such as sobriety requirements, can exclude people. Respect clients' choices while offering help. Include strengths, such as Earl's military service and his friendships on the street. Plan concrete services, including benefits people may be entitled to. Describe people by their situation rather than as a category, for example people experiencing homelessness rather than the homeless. Keep the client's own goals, such as a door that locks, in the plan.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More PAC 411 and Psychology and Addiction Studies sample papers
- PAC 411 Module 1: The Social Work Profession and Its History
- PAC 411 Module 2: Generalist Practice and Fields of Practice
- PAC 411 Module 3: Values and Ethics
- PAC 411 Module 4: The Strengths and Empowerment Perspective
- PAC 411 Module 5: Diversity, Social Justice and Human Rights
- PAC 411 Module 6: Human Behavior and the Social Environment
- PAC 411 Module 8: Social Policy and Services
- PAC 414 Module 2: Recognizing Signs of Abuse
- PAC 302 Module 4: Validity
- SBS 105 Module 4: Learning
- PAC 310 Module 5: Boundaries and Dual Relationships
PAC 411 Module 7 questions, answered
What does PAC 411 Module 7 usually ask for?
Aspen's PAC 411 covers populations at risk in this module, so describing a vulnerable group, the evidence on its needs and the services that work is typical. Check the Module 7 prompt.
How common are addiction and mental illness among homeless people?
Fazel and colleagues found substance use and mental disorders far more common among homeless people than in the general population, with wide variation across studies.
What is Housing First?
An approach that offers permanent housing without requiring sobriety or treatment first; Tsemberis, Gulcur and Nakae found it kept people housed far better than treatment first programs.
Where can I find a free PAC 411 Module 7 sample paper?
Read it free on this page: chronic homelessness with alcohol use disorder and the evidence for Housing First, with a plan for one veteran.
Does housing people with alcohol problems save money?
Larimer and colleagues found public costs for health care and jail fell substantially after chronically homeless people with severe alcohol problems were housed.