Greg Hardegger was getting drunk on vanilla extract, living under the Dravus Street Bridge in Interbay, when one day in 2015 he decided to change his life. He went to Harborview Addiction Clinic and started a 12-step program.

But it didn’t work for him. He kept going back to binge drinking.

Then he met Dr. Susan Collins, a clinical psychologist and renowned researcher of a different method of fighting addiction, called “harm reduction.” She didn’t tell him he needed to be sober. She treated him like he was anyone walking into a therapist’s office — working with him on his own goals, like tackling his depression and reconnecting with his kids.

Eventually, he concluded on his own that alcohol was at the root of his issues. He’s been sober a year and a half.

“I’m an alcoholic. I’m not afraid to admit it,” Hardegger said. “I don’t touch the stuff anymore.”

For alcoholic and chronically homeless people in Seattle who don’t want to go into abstinence programs, a new study suggests that Collins’ approach might work better.


The randomized control study conducted by researchers at the University of Washington looked at 168 homeless people with chronic alcoholism who lived in or near downtown Seattle. Half of them met with a clinician and formed goals to improve their lives, which often involved drinking less or using different substances. The other half did not.

For the group that went through this harm-reduction treatment, after three months, alcohol showed up in their urine 20 percent less often.

The study, conducted in partnership with downtown homeless-services agencies, will be published in May in the International Journal of Drug Policy but published online last week. The authors argue it shows there’s another viable alternative for homeless people who don’t want to get sober immediately.

“Honestly, we believe people know what’s best for them,” said Collins, a UW Medicine researcher and co-director of the Harm Reduction Research and Treatment (HaRRT) Center, who’s spoken at the White House about her work. “If you’re not ready or willing or able to stop drinking, you don’t have a lot of options to get help, and to make incremental or more realistic changes.”

The effects in the study are short-term, over three months; it’s not yet clear if they stick for the long term.

“Harm reduction” is an approach to substance use that doesn’t ask for sobriety and is an alternative to abstinence programs. The few studies involving abstinence-based programs for homeless people with alcoholism show that only 15 to 28 percent start treatment, and of those, fewer than a third complete it. But for homeless people, most permanent housing projects and many shelters require sobriety.


“For whatever reason, our sobriety-based treatment programs are not working for the vast majority of people,” Collins said, “and I think it’s unacceptable to say those people aren’t stepping up — it’s our treatment system that’s not reaching out.”

Collins previously studied Seattle’s 1811 Eastlake project. Targeted at chronically homeless people who were high users of emergency medical services, the project houses them without asking them to stop drinking. Research found that giving them housing without a requirement of sobriety decreased their alcohol use and was more cost-effective than allowing them to remain homeless.

But advocates of harm reduction seek to scale that approach up to other destructive behaviors, like opioid addiction, and that’s been controversial.

“Safe-injection sites” — rooms or facilities where people could inject heroin or other drugs with medical staff present — have met plenty of controversy when proposed by King County public-health officials. Many cities outside Seattle have pre-emptively banned such sites, while Seattle’s plans face a lack of funding. President Donald Trump’s Department of Justice opposes them; last month, the top federal prosecutor in Philadelphia filed a lawsuit to stop what would have been the first safe-injection site in the U.S. from opening.

But this approach isn’t at the policy level; it’s at the personal level. Collins believes that everyone from probation officers to social workers could use this approach on the street.

“You don’t have to do a tough-love approach,” Collins said. “You don’t have to make demands of a person who struggles … to see positive effects.”