King County once operated Cedar Hills, a large residential addiction-treatment campus. Today, we spend vastly more managing the consequences of addiction without rebuilding a comparable path to recovery.
During the crack-cocaine epidemic, King County operated something we conspicuously lack today: a substantial residential addiction-treatment campus.
The Cedar Hills Addiction Treatment Facility near Maple Valley occupied ten wooded acres. It had dormitories, a cafeteria, medical care, classrooms, recreation and programs of varying duration. Residents could remain for months before transitioning into halfway houses. Some entered voluntarily; others arrived through probation or as an alternative to jail.
Cedar Hills had room for 208 residents and was licensed for 150 beds in 2001. It offered people something that outreach workers, emergency shelters and naloxone kits cannot provide: prolonged separation from the environment in which they were buying and using drugs.
Then King County decided Cedar Hills was too expensive.
At the time, the facility cost approximately $86 to $93 per resident per day. Washington State, which was responsible for treating low-income patients, reimbursed King County only $38 to $65 per day. King County had to make up the difference.
Cedar Hills also employed county workers, paid public-sector wages and benefits, and maintained an onsite medical clinic. Private treatment providers claimed they could operate beds more cheaply. Faced with state budget cuts and continuing operating deficits, government moved away from directly operating a large treatment institution and toward contracting with a decentralized network of private providers.
But was Cedar Hills really too expensive—or were its costs simply too visible?
From treating addiction to managing its consequences
In 2001, operating 150 Cedar Hills beds at the reported daily cost would have amounted to roughly $5 million annually. Adjusted for inflation and higher contemporary medical costs, recreating the campus today would certainly cost more. But compare that expense with the approximately $203 million 2026 budget of the King County Regional Homelessness Authority.
KCRHA is not an addiction-treatment agency, and it would be unfair to pretend that its entire budget is being wasted. Its contracts pay for shelters, permanent supportive housing, rapid rehousing, day centers, hygiene services, outreach and other programs used by thousands of people.
But that is precisely the point.
We closed an institution that directly treated addiction, then constructed an extraordinarily expensive system for managing homelessness—much of which is inseparable from untreated addiction and mental illness.
The public now pays for the consequences through dozens of different budgets:
- Homeless shelters and outreach teams
- Permanent supportive housing
- Emergency rooms and overdose response
- Police, courts and jail
- Fire and ambulance calls
- Encampment removals and sanitation
- Transit and library security
- Crisis-response teams
- Property damage and theft
- Repeated contacts with nonprofits that never culminate in sustained recovery
Cedar Hills placed its costs in one visible column. Today’s system distributes them among King County, Seattle, KCRHA, Public Health, Medicaid, hospitals, police, courts, transit agencies and nonprofit providers.
That fragmentation makes the present system appear less expensive than it is. It also makes accountability nearly impossible. Every organization can report that it delivered its assigned service while no organization is responsible for getting the person through the entire recovery process.
We fund the encounter, the shelter night, the outreach contact, the overdose reversal and the supportive-housing unit. But who is responsible for restoring the person’s ability to live independently?
Housing is not treatment
King County’s homeless population is not one homogeneous group.
A working family displaced by a rent increase does not need the same intervention as someone experiencing schizophrenia. A senior priced out of an apartment does not need the same intervention as someone committing repeated crimes to sustain a fentanyl addiction.
At minimum, the system must distinguish among:
- People experiencing an essentially economic housing crisis
- People whose disabilities require long-term supportive care
- People whose homelessness is driven primarily by severe addiction
- People cycling among addiction, crime, emergency care, jail and the street
Housing assistance may solve the first person’s homelessness. It may be an indispensable part of caring for the second. But housing alone does not treat the third or interrupt the destructive cycle of the fourth.
When severe addiction is the principal disabling condition, placing someone indoors without a serious recovery plan may change the location of the addiction without changing its trajectory.
The current emphasis on low-barrier services has produced some important tools. Naloxone saves lives. Methadone and buprenorphine can reduce cravings, prevent fatal overdoses and help people stabilize. Outreach can establish the relationships through which someone eventually accepts treatment.
But keeping a person alive is the beginning of a recovery strategy, not its completion.
A system devoted primarily to harm reduction can become a system of permanent maintenance if it lacks places where people can stabilize, recover and rebuild their lives.
KCRHA demonstrates the cost of fragmentation
KCRHA’s 2026 adopted budget is approximately $203 million. Seattle and King County contribute most of the money, with additional state and federal funding.
Yet a 2026 forensic financial review found millions in unreconciled accounts and administrative overspending. Seattle and King County subsequently announced that they would reclaim control over most of the locally funded service contracts beginning in 2027.
Those financial problems are serious, but the deeper problem is structural. KCRHA was supposed to unify a fractured homelessness system. Instead, it became another administrative layer in a system that still divides responsibility among governments, funders and providers.
Even flawless bookkeeping would not answer the most important questions:
How many people entered treatment?
How many completed it?
How many remained in recovery one year later?
How many moved from public support into employment or greater self-sufficiency?
How much did we spend on each person across all public systems?
How many people repeatedly returned to the street, emergency room or jail?
Counting beds, contacts and contracts is not the same as measuring recovery.
Rebuild the missing middle
King County does retain residential treatment beds and is adding capacity. Thunderbird Treatment Center on Vashon Island is reopening with 92 substance-use-treatment beds, and smaller programs are being developed elsewhere. The county is also creating crisis-care centers where people can stabilize and connect with services.
Those are worthwhile investments. But crisis stabilization is not the equivalent of a sustained residential recovery campus.
What King County needs is a modern successor to Cedar Hills—not necessarily one enormous institution, but a network of regional recovery campuses with a complete continuum of care:
- Medical stabilization and detoxification
- Ninety-day or longer residential treatment when clinically appropriate
- Medication for opioid-use disorder
- Psychiatric evaluation and treatment
- Daily structure and personal accountability
- Education, vocational training and transitional employment
- Graduated recovery housing
- Family involvement where appropriate
- Court-supervised treatment alternatives for people repeatedly cycling through crime and addiction
- Public tracking of treatment completion, relapse, housing and employment outcomes
This is the missing middle between handing someone naloxone on the sidewalk and sending that person to jail.
If approximately one-tenth of KCRHA’s annual budget—roughly $20 million—were directed toward a recovery-campus model, King County could begin rebuilding substantial residential capacity. That funding should not simply be taken from effective shelters or housing programs. It should come from reorganizing the broader homelessness response around clearly differentiated needs and measurable outcomes.
We should also conduct a true cross-system cost analysis. For people experiencing chronic, addiction-driven homelessness, calculate the combined annual cost of shelter, outreach, emergency medicine, policing, courts, jail, sanitation, supportive housing and behavioral-health services. Then compare that figure with the cost and outcomes of sustained residential treatment.
Until government performs that comparison, it cannot credibly claim that treatment is too expensive.
We are already paying
The choice is not between spending money and saving money. We are already spending extraordinary amounts.
The real choice is whether we spend primarily to manage deterioration or to create a credible path out of it.
Cedar Hills was imperfect and expensive. Any modern replacement would require strong medical standards, protection of patients’ rights and independent measurement of results. But Cedar Hills embodied an understanding that King County has largely lost: people with severe addictions often need time, distance, structure and sustained treatment before housing can become stable.
We did not eliminate the cost of residential treatment when we closed Cedar Hills. We transferred that cost into shelters, hospitals, streets, jails, public spaces and a $200-million homelessness bureaucracy.
It is time to put recovery back at the center of the system.