Housing first or last resort? Managing the dilemmatic positions of people experiencing homelessness who use illicit drugs in social service’s team meetings

Abstract

The current study adopts a bottom-up perspective to analyse how Housing First is implemented by street-level social workers within municipal social services in the context of Sweden’s restrictive drug policy. The specific focus is on how social workers discuss and construct Housing First as an intervention for people who use drugs who do not want treatment for their drug use.

The study draws on discursive psychology to analyse meaning-making processes in decision-oriented team meetings. The results show how a dilemma arises for social workers when the restrictive drug policy requires them to actively counter clients’ drug use, while the rights-based philosophy of Housing First urges them to emphasise clients’ choice and control. It is shown how the decision-oriented discussions are permeated by the idea of an obligation to work toward drug abstinence if clients are perceived as changeable, while Housing First is promoted only when clients are perceived as non-changeable.

The idea of an obligation to work toward drug abstinence functions as a barrier to faithful implementation of Housing First. Consequently, Housing First is constructed as a kind of ‘dispreferred intervention’, only acceptable for clients where continued drug use is deemed something that needs to be accepted.