From Rat Park to Housing First - why Maslow still matters

By Rosie Phillips, DHI Chief Executive

Oh, the craic was good in Cricklewood
And they wouldn't leave the Crown
With glasses flying and Biddy’s crying
Sure Paddy was going to town
(McAlpines Fusiliers, The Dubliners, 1966)

In 1990, as a fresh faced graduate working for a London PR consultancy, every morning I would walk down Cricklewood Broadway, past the then infamous Crown, and the men waiting for the vans to take them to work. But the craic was not so good in Cricklewood by then. The building boom, that had offered opportunity for many disadvantaged Irish men, had collapsed, and their world unravelled at alarming speed. Living in insecure crowded rented accommodation without purpose, family or friends, most drank to overcome boredom, disappointment or pain, and soon swelled a rapidly growing homeless population in London.

So I started volunteering at Cricklewood Homeless Concern at weekends. I eventually got a paid job, initially by raising enough money to cover my own salary! I worked there for seven years. Mostly we gave out food and clothing, we tried to find housing, or repatriate people back to Ireland, but as the evidence now clearly shows, the longer a person is on the street, the more entrenched that lifestyle becomes. Having mostly arrived because of the Troubles, intolerance or lack of opportunity back home, too many then drank themselves to death when the financial crash signalled the end of industry’s need for their labour. Productive one day, expendable the next.

Eventually I became tired of the sticking plaster we offered, and of the perverse effect the segregation of services and funding led to. So when I saw the opportunity to run a project called the Drugs and Homeless Initiative in Bath, setting up a dry house that sought to bridge the gap between drug treatment and housing, I jumped at it. I was then fortunate to be given free rein to broaden its scope. And so began DHI in 1999, a charity that seeks to turn around the lives of those who face multiple disadvantage, by focusing on the clustering of serious social harms such as homelessness, substance misuse, mental ill health, violence, abuse and poverty. Not catchy, appealing or an easy ‘brand’ to sell, such is the interlocking nature of these issues, and their cumulative impact.

20 years on; and where are we? Treating drug addiction will always be an uphill battle while they remain illegal, since the law is by nature always one step behind the criminals that supply, market and sell it. Drug related deaths are sadly heading upwards, and the young, the vulnerable and the poor are those most likely to be caught up at the rough end. Yet, whatever your view of drug policy or current funding, treatment is in a much better place than it was: better understood, better funded and more joined up. Having shifted the paradigm from viewing addiction as a moral failing, to the disease model of the 70s, this too was challenged, largely thanks to the insights of psychologist Bruce Alexander and an experiment called ‘Rat Park’.

When the disease model was first gaining ground, evidence was thought to come from the fact that rats, given unlimited access to cocaine, would take it relentlessly, sometimes foregoing food and water even to the point of death. What explanation could there be for an animal neglecting basic needs? The answer seemed to be that drugs were so powerful they could override evolutionary instinct. But rats are highly social animals like us. Wondering why no one thought it noteworthy that the disease model was based on experiments with rats that had been removed from their family groups and kept isolated for the course of the experiment in small cages, with nothing but cocaine, Alexander constructed his own experiment: Rat Park.

Alexander took morphine dependent rats out of their isolated cages and put them in rat park, a naturalistic setting where rats were able to cohabit and reproduce. His overwhelming finding, since corroborated, was that if given a choice between drugs and either sugar, saccharine or same sex snuggling, the rats addicted to drugs chose the sugar, saccharine or snuggling over the morphine. Rats in the isolated cages took cocaine until they died, because without it, there was nothing but suffering in that environment. In rat park, the morphine dependent rats stopped taking the morphine as there were other alternatives available.

Of course, people are not rats, but the basic lessons still apply. Fortunately, treatment services no longer view those struggling as morally bankrupt or helpless addicts, or ignore the wider determinants of a person’s drink or drug use. For the men on Cricklewood Broadway, lacking opportunity to prove their self-worth through work, and without family or love, the alcohol served to anesthetise the pain.

To really understand and treat addiction, we need to understand what drugs do for people in general, and in particular when they are suffering, where the alternatives are of limited help. Don’t just blame the drugs – look at how people feel, what opportunities they have and what’s wrong in our world. People need self-worth and a sense of purpose in order to want to change, to seek to achieve their potential, and this requires a basic level of material and financial security. Talk to any of DHI’s staff today, and you’ll hear that housing is the single biggest barrier our clients face in attempts to turn their lives around. For the majority, this is not the street homelessness of the headlines (no, that is the canary in the mine; and worryingly on the rise), it is the daily grind of living insecurely, be that on a friend’s sofa, in a hostel or just through the weekly struggle to make ends meet to pay the rent.

In light of this, the relentless physical and mental battle of living in poverty must be tackled if we are to address social exclusion. Universal credit may be well intentioned – with its aims to simplify a complex system and make work pay - but the process is stressful, starts and ends with the presumption that everyone is work ready, IT literate, robust and capable, and doesn’t take account of people’s vulnerabilities. Moreover, it pushes people into debt. Meanwhile, the biggest single cost pressure for the vast majority of us – housing - is simply not affordable for far too many people.

But this isn’t about houses – it’s about people. For a home is not just a physical space: it provides roots, identity, security, a sense of belonging and a place of emotional wellbeing. Lack of affordable housing, including housing to rent at benefit levels, creates inequality, stress and ill health. It impoverishes, excludes and increases the pressure on our precious public services when we can ill afford to do so.

Housing First has recently been put forward as a model of good practice in the UK in helping rough sleepers fully move away from a street lifestyle by providing stable housing as a platform from which to begin recovery. It holds to the principle that housing is a basic human right. But there is nothing new in this. Way back in 1943, Abraham Maslow offered a way of looking at human needs: Maslow’s Hierarchy of Needs. At its heart Maslow’s hierarchy is both simple and profound. It states that all people must have their basic needs for food, warmth and shelter met in order to be able to address other higher needs effectively. Only then can they achieve their potential. Poor physical and mental health, substance misuse, domestic abuse, lack of educational attainment and poor employment prospects – these are all closely associated with poverty, and housing sits at the heart of this. To end social exclusion in 20 years’ time, we must make sure everyone can afford a decent place to live and be able to put down the foundations for achieving their potential.

Secure affordable housing may not be the end game, but it is most certainly the entry ticket!