Over the years, I've seen a number of people die from alcohol and, usually, it's a long, slow, fairly sickening process.

The body is surprisingly resilient and can take decades of abuse, culminating in what Dylan Thomas's doctor called "a massive insult to the brain", before it finally comes to a sorry and bewildering end. Yet what the drinker's friends and family find just as distressing are the many dangers attendant on this long fall: the arrests, the accidents, the discovery in some wet alley, the thefts and lies, the assaults. Sometimes the worst thing is simply not knowing the whereabouts of someone you love, someone hopelessly vulnerable, for days or weeks at a time – where they are, who they are with, what they are doing, what might, at any moment, be done to them. As it happens, I have been on both sides of this scenario and I know that, for the drinker, it's a matter of almost unbearable shame and self-disgust. For the loved ones, the process can be likened to a campaign of attrition, a long and monstrous betrayal inflicted on them for no apparent reason.

It would seem obvious, then, that the provision of a safe place for those drinkers who do not want to be "saved" or "cured", would be a welcome development – and, at the St Anthony Residence, in St Paul, Minnesota, this is exactly what drinkers are offered, free of charge. For years, this "wet house" (one of four in the state) has provided shelter to its hopelessly alcoholic residents, at a cost of $18,000 per person per year. Nobody has to attend therapy sessions; there is no 12-step programme and no homilies about hope or the future.

Similar facilities are available elsewhere in the US, and in Canada, where a study based around Ottawa's "wet shelter" found that emergency room visits and arrests were reduced by around 50%, saving the individual drinker untold humiliation and pain and significantly reducing the bills of local taxpayers, while freeing up medical staff and police officers for other jobs. Can it be doubted, then, that such programmes provide a win-win situation? The drinker is taken off the street and out of the emergency room, the local community benefits and, though this is not altogether a solution to their problem, friends and family are eased of at least some of the pain that goes with loving a chronic drunk. Meanwhile, within the limits of their condition, drinkers attending facilities like St Anthony's are surprisingly happy.

And that, perhaps, is the problem. Hopeless drunks aren't supposed to be happy: they're supposed to suffer until they see the error of their ways and submit to a cure. Critics of the wet houses never say this, of course; they talk about wet houses "giving up" on people, about "writing people off" – and yet, though they may well be sincere, their opposition to harm reduction programmes raises serious questions about liberty and civil rights. When a grown man who, whether drunk or sober, maintains, often with real cogency and persuasiveness, that he does not wish to be treated for what other people may think of as a "condition" but which he sees as an essential part of his identity, what right does anyone have to oblige him to seek therapy? It may not be desirable (or rather, we may not see it as desirable) to be a chronic drinker, but it is not so long since it was seen as equally undesirable to be gay. When Alan Turing was forced to endure female hormone treatment ("chemical castration") in an attempt to "treat" his homosexuality, many people thought this was an appropriate course of action and attributed his suicide to his unstable – ie deviant – personality. That was in 1954. Will some future observer, say 50 years from now, look back on the treatment programmes that so many drunks have to endure and see a clear infringement of their most basic civil liberties?

The question, here, is whether or not being a drunk is an essential component of a person's identity and, though there is no definitive answer yet, studies suggest that there is at least some evidence for alcoholism being a genetic condition. According to the American Academy of Child and Adolescent Psychiatry, children of alcoholics are four times more likely than other children to become alcoholics. While environmental factors may be a factor in some cases, long-term studies of alcoholism in twins conducted in America and in Sweden suggest that environment cannot explain this disproportionately high figure – which in turn raises rather disturbing questions.

Not everyone who becomes a drunk remains a drunk – some are healed, if not cured – just as not everyone born with a genetic illness is beyond help. But some are, and surely the incurable alcoholic should be treated with the same consideration and care that anyone else who inherits a fatal illness receives. The wet house may not be ideal, but surely it's infinitely preferable to a life on the streets and in jail cells, or a midnight trip to the morgue to identify someone you used to know, but now barely recognise.

• This article was amended on 21 April 2011. The original referred to a doctor calling Dylan Thomas's alcoholism "a massive insult to the system", rather than "to the brain". This has now been corrected