When Wealth and Poverty Have the Same Price

Dr. Julian Somers

Date: September 7th 11 am to3:30 pm

Community Focus  – Studio 413


Many people receive addiction treatment only when their lives have become complicated by other challenges, including involvement with the law, loss of housing and employment, or mental illness. This talk examines research on the life trajectories of people who experience complex addictions. It also reviews evidence concerning interventions, and considers how the concept of recovery capital can explain why some interventions are more effective than others.

Over the past 10 years a series of studies in British Columbia have involved people experiencing complex addictions. This research has used a variety of methods: economic analyses; cohort studies; randomized controlled trials; qualitative interviews; and comparative outcome studies. Many of these studies have focused on integrated multi-agency interventions.

Taken together, the results show that people develop complex challenges over time and frequently seek help for their health and social problems. The results also show that mainstream resources in most communities have limited effectiveness for people with complex addictions, leading to greater problems in other domains and relocation to new places.

A variety of specialized programs have been developed for people with complex addictions including Drug Treatment Court, Housing First, Assertive Community Treatment, and Intensive Case Management. Evidence confirms that these programs can deliver better outcomes than the status quo on a wider range of outcomes: housing stability; crime reduction; community integration; improved health; etc. But the results also show that it’s possible to spend equivalent amounts of money of programs that yield significantly different results.

Differences between similarly-funded interventions can be explained by considering their effects on recovery capital: court outcomes are better when they provide health and social services; housing outcomes are better when people live in diverse neighbourhoods versus exclusively with others who were homeless; health outcomes are better when people have the authority to make decisions. There is an urgent need to replace ineffective services with effective ones, and to move the point of interventions upstream. This talk concludes with a focus on opportunities to achieve both objectives.

Learning Objectives:

  • Increasing knowledge regarding the relationship between addiction and additional serious life challenges including conflict with the law, employment loss, and homelessness;
  • Updating knowledge about the interventions that are most effective for promoting recovery among people with complex addictions;
  • Promoting the use of “recovery capital” as a concept to differentiate effective and less effective interventions, even when they cost the same amount of money.


Rezansoff SN, Moniruzzaman A, Fazel, S, Skeem J, McCandless L, Somers JM (2017). Housing First improves adherence to antipsychotic medication among formerly homeless adults with severe mental illness: results of a randomized controlled trial. Schizophrenia Bulletin. 43(4): 852-861. doi:10.1093/schbul/sbw136

Somers JM, Moniruzzaman A, Palepu A. (2015). Changes in substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or Usual Care. Addiction. DOI: 10.1111/add.13011.

Somers JM, Moniruzzaman A, Rezansoff SN, Brink J, Russolillo A. (2015). The prevalence and distribution of complex co-occurring disorders: a population study. Epidemiology and Psychiatric Sciences. DOI: 10.1017/S2045796015000347.


Dr. Julian Somers completed his clinical training at the University of Washington, Seattle’s Harbourview Hospital, and British Columbia’s Children’s Hospital. He was Director of the UBC Psychology Clinic and President of the BC Psychological Association.

Dr. Somers has led Provincial and multi-jurisdictional programs addressing public health crises involving addiction, physical and mental health, social welfare, public safety, and housing. He began his academic career in the UBC Faculty of Medicine, and is currently Full Professor in the Faculty of Health Sciences at Simon Fraser University.

The Somers Research Group is internationally recognized for public health initiatives with governmental, private, and not-for-profit collaborators. Dr. Somers has led large-scale applied randomized trials, multi-site interventions, and population-level studies described in over 100 publications. He has also created advanced information systems for public health surveillance and to evaluate the effectiveness of policies and services.

Members of the Somers Research Group have garnered numerous awards and distinctions for research in the public interest. Dr. Somers serves as an advisor to senior officials in government and corporate roles and is a frequent media contributor.

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