Rx for Homelessness: Recovery First

(10-minute read)

“Recovery First” means making recovery from mental illness and addiction the front and center primary focus for addressing homelessness. It offers triage followed by instant humane and supportive shelter solutions and mulitiple recovery pathways leading to various stages of earned autonomy. Nobody gets to pass go and collect $100 without a plan and implementation of that plan and anyone who is ready is served immediately or “recovery on demand” as they say.

Recovery is Housing, but Housing is Not Recovery

“Housing First” is the the idea of providing no-strings-attached permanent housing to homeless people hoping that something good comes from that. While it made some sense when people were losing their jobs and homes during the Great Recession, it’s no match for fentanyl.

In Seattle, we’re learning that Housing First, like Link Light Rail, makes for a lot of publicly-funded construction projects, but unfortunately neither solves the real homelessness or transportation problems at hand. We’ve also learned that four walls and a door don’t prevent overdoses.

The SPD Twitter feed frequently mentions “unresponsive bodies” at publicly-funded housing projects. A visit to the squalor of some of those places would blow your mind, so the deaths are not surprising. It makes it abundantly clear that independent housing opportunities should be reserved for folks who have reached stability, earned their autonomy, and can safely live alone.

Meanwhile, catchall terms like “wrap around services” is loosely thrown around to make us think that we’re really taking good care of these incredibly unwell people, but we’re not. We’re failing them miserably.

The Housing First approach emphasizes optics. It implies that if you can’t see it, it doesn’t exist anymore. Instead of clearing encampments and moving people to recovery or jail, Housing First meets them where they are and leaves them there. Perhaps even keeps them there. Low-barrier shelters, hotel rooms, tiny homes, and apartments don’t stop the life-threatening and city-destroying habits of the addicted and their entourages. After getting housing, many keep tents in the encampments for drug use and dealing, human trafficking, selling stolen goods, and other criminal behaviors.  

Let’s get real for a moment. Legal stealing, free housing, and drugs everywhere are the recipe concocted by the people we elected and their bureaucrats to solve homelessness. The result is inflow, of course. How would we ever expect the numbers of homeless to go down by giving everyone with a drug addiction an apartment of their own? It’s nonsense.

Within hours of arriving in Seattle, you can get $400/mo cash assistance, feeding programs and food banks galore, and a drug dealer who makes tent calls.

Interestingly, I recently learned that the King County Regional Homelessness Authority is only chartered to come up with housing solutions. That’s a tragic flaw, but consistent with the “we can build our way out of this” conflicts of interests at hand. The KCRHA desperately needs to be re-tooled for recovery because that will solve homelessness while the $11.5B worth of housing recently proposed by the authority won’t. Or perhaps the KCRHA needs to go away all together.

Without blaming people for where they are, we can give them agency to change their circumstances. Places like Bybee Lakes Hope Center in Multnomah County, Oregon do that. And while we can’t recover for people, we can make recovery and re-entry a choice that a person in the free world will make.

We can also have logical consequences for law-breaking addicts who won’t choose recovery – jail for instance.

Switzerland’s Four Pillars

Prevention, Mental Health and Addiction Services, (real) Harm Reduction, and Law Enforcement are the Four Pillars that have supported Switzerland’s success managing their massive public camping and heroin addiction problem in the 80s. It’s still working today. It’s a good starting point for any city trying to solve homelessness and drug addiction.

Triage and Strategic Approaches

To build on that, the strategies for our drug addicted homeless crisis should be prevention, enforcement, intervention, recovery (including economic), and re-entry because thoughts and prayers are nice, but fixing the problem is better.

When people are living in squalid encampments teeming with rats and rapists, selling stolen goods or their bodies for sustenance, and murdering or getting murdered by mystery-meat drug deals, it’s our moral and civic duty to deploy effective interventions. To do that, we must be diligent about triage because the homeless population is obviously not monolithic.

We can start with criminal or non-criminal and ready to recover or not ready to recover. For dangerous drug addicted criminals, recovery while incarcerated is a winning strategy. For non-criminals and criminals that are not dangerous, triage must further disaggregate issues.

Determining who is currently ready to recover and willing to pursue available options for recovery is key. Immediately addressing the low-hanging fruit that is the people who are ‘right this minute’ ready is very important. Those people need to immediately gain entry to humane detox programs followed by integrated residential and non-residential rehab programs with therapeutic care that gets them back on the job train and helps them address their healthcare needs all at once.  

Pushing people into dishwashing jobs for minimum wage is not necessarily a sustainable solution. There’s a lot of untapped talent out there in the tents and social mobility is possible for many homeless people. Unless we risk putting them right back where they were, job training for family-wage jobs is essential. Afterall, kids often suffer the brunt of these tragic situations.

Clearly, reliably sober housing options are essential because throwing people who want to be sober in with addicts who don’t simply doesn’t work. Trust and verify is important in that way, so that people who maintain their sober status aren’t disrupted by those who won’t. This also applies to therapeutic and medicinal care for chronic mental illness like schizophrenia. People willing to take the meds they need should not be subjected to episodic psychotic shelter mates.

A lot of homeless people also need legal help because it’s common that homeless men fall into situations where child support arrears mean there’s always a warrant out for their arrest. It’s one big reason why some don’t even want pieces of identification to get recovery started. We can do much better there.

Finally, accurate diagnostic assessments need to test for brain injuries, not just mental illness, and addiction, because Traumatic Brain Injury (TBI) recovery is completely different than mental illness or addiction recovery.

Interestingly, the percentage of people in jails and prisons that have TBIs is estimated to be 60% but may be as high as 80%.  TBIs are often the result of blasts in war zones, fights, and car accidents – all of which mainly involve young men. These injuries, which can alter behavior, emotion and impulse control can keep people cycling through jails and homelessness their entire lives.

With a Recovery First approach, housing comes with recovery, not in lieu of it. For dangerous criminals that means Recovery While Incarcerated (RWI) and mandated strategies and programs on release to prevent recidivism and promote successful re-entry into society. For others, diversion programs could work.

Harm Reduction Today Enables Addiction

As we move toward Recovery First, we need to do no harm – that would be no harm to the mentally ill and drug-addicted homeless themselves, but also no harm to families, businesses and communities suffering from failed drug, criminal justice, and homelessness policies.

Needle exchanges to prevent the spread of AIDS and hepatitis have morphed into mobile head shops providing foil, pipes and instructions for inserting drugs into your butt. Yikes.

Tangential phenomenon including the vilification of police, the wholesale abandonment of law enforcement during the COVID pandemic, and the weakening of state and local laws related to shoplifting, drugs and public camping during those same years have exacerbated the situation. For instance, the threshold for felony theft went up to a thousand dollars which provided a formal invitation to organized crime to come set up shop and they did.

$1000 is hardly someone stealing a sandwich because they’re hungry.

On that note, I like to remind people that there is absolutely no reason for anyone to steal a sandwich in Seattle. Free food is everywhere. In fact, there’s so much rotting food in the encampments that it’s disgusting. People want to help, so they bring food, but most of it goes to rats and maggots. That’s not helping.  

No More One-legged Stools

One thing we have learned is that the war on drugs cannot be won by law enforcement alone. That does not mean that we should abandon the war on drugs or that it can’t be won. The old approach was a one-legged stool and that’s why it failed.

A strategic combination of prevention, enforcement, intervention, recovery, and re-entry will do it. No need to reinvent the wheel, we can look to Switzerland and Portugal to see what works. Alberta is showing promise, too.

When people say it’s America’s demand for drugs that is the problem, they’re half-right. We do have a long way to go to curtail the demand side with prevention strategies. Too many prescriptions of Oxycodon and Adderall certainly set the stage for illegal drugs and addiction. Kids who don’t use drugs by the end of middle school are unlikely to ever use them, so a focus there would be useful. Perhaps free healthy activity vouchers for youth would make sense as they have in Iceland. Lots of kids say there’s nothing to do since everything is pay to play. Still, it’s the drug dealers themselves that keep their businesses going by building demand. Free starter doses become paying customers.

The vast supply of drugs is a factor as well. The drugs coming from Latin America or China via Latin America is staggering. With tiny fentanyl-laced pills, it’s easy to avoid detection and weak immigration enforcement at the border makes things worse.

AMLO, the president of Mexico, says that America just needs to hug their kids more. That could be true, but meanwhile the cartels control most of the geography of his country and they’re well established here, too. He once recommended hugging cartels. How’s that working out for him?

AMLO denies that fentanyl is made in his country and Biden’s denies that his open border policy has made things worse. Reality says that the folks coming north of the border to work include lots of drug dealers.

Thoughtful Reform, Not Impatient Abolition

Debating whether all drugs should be legal is useless. Legalizing or even providing drugs or places to use them does not get people to recovery and does not keep the black market away. Remember there will always be an illegal supply and that kids will mostly access drugs from the black market, no matter what’s legal for adults. Decriminalization should mean we can do something with public use and dealing other than jail. Perhaps jail and prison should be restorative like Sweden. I’ve often thought we should buy a place like Camp Sealth over on Vashon and create a restorative place like that for younger people.

The gangs and cartels set up shop right across the street from “supervised consumption sites” in BC, SF, and elsewhere. Squalor develops in the environs and meanwhile less than 1% of visitors seek treatment. That simply does not work. Again, we don’t have to reinvent the wheel. Portugal and Switzerland figured it out decades ago. Make the choice to recover an irresistible option.

Until we get serious, dealers will continue to build up their clientele with freebies until they’re hooked just like now. Pimps use the same strategies. Those drug addicted women on the streets and in the encampments are not sex workers, they’re sex slaves.

Continuing the counterargument to legalization, it’s certainly worth mentioning that we legalized weed for adults, but now the kids vape pure THC or smoke “dabs” and waxes that one could easily classify as another drug altogether. We’re at the point where cannabis use disorder is triggering schizophrenia in men. Yikes. Dabs are not your grandma’s weed, people.

And abolishing jails will not make crime go away just like abolishing mental institutions didn’t make mental illness disappear. People who profess such things rather than meaningful reforms are theorists, not realists. Prevention, better laws, enforcement and prosecution, ubiquitous recovery infrastructure and productive incarceration will fix the problem. But first and foremost, we must arrest people for public drug use and associated crimes and usher addicts into recovery. That is basic.  

Peripheral problems mushroom up with a lack of enforcement, too. If we want to put a lid on weapons trafficking, we’d do well to crack down on drug dealers because the proceeds from their drug sales buy them a boat load of weapons.

Behavioral Health Infrastructure

King County Executive Dow Constantine’s successful ballot proposition for five new crisis centers for the region could help but building them is way off in the distance and the plan lacks a finer grain triage network to get people to the right destination from local hubs.  

Yes, the five crisis centers will take some heat off the hospitals, especially Harborview, but if we’re going to build five regional crisis centers, what does the rest of the plan look like? Is this another construction project like housing first? If so, that’s never going to address the real infrastructure problem we have which is a lack of ubiquitous on-demand recovery facilities for thousands and thousands of people in King County alone and humane well-staffed institutions for people who can’t be out in the world. The five centers are a start, but a couple hundred beds is not appropriately scaled to the problem. They’ll be full before the paint is dry.

Why can’t people report to someplace hyper-local when in crisis?

Developing lots of walk-in crisis centers that are perhaps co-located with fire stations across the county and state might help. From there folks could be triaged. It may prove useful for people in crisis and their loved ones to know that help could be as close as the nearest fire station. There are 146 fire stations in King County, and they’re already distributed geographically and demographically. There’s huge potential there.

Successful Re-Entry Means Learning New Habits

Once people are stable, they need a longer-term plan to take it to the next level. Personal planning can help people develop permanent routes out of homelessness and despair. A 5-year plan has immediate and long-range goals that are always adjustable. The key is that friends, coaches, mentors and others can act like a personal board of directors to help keep people on track and accountable and guide them to success.

I’m currently finding that helping re-entering people with budgeting is key. I call my role “budget buddy”. I meet with my friend and mentee every payday to disperse pocket money cash while he saves everything else in preparation for being able to move from the Salvation Army shelter to his own apartment one year into his meth recovery and having stabilized his schizophrenia. I keep his debit card in my possession. Before trying that, his compulsion to spend was self-defeating. He was always broke just a few days after payday. This is the first time he’s saved money in his life.

In summary, recovery first strategies need to largely replace housing first strategies because recovery is housing, but housing is not recovery. When will the electeds and bureaucrats get the memo?

Loud ideological activists can drown out facts and other opinions including voices of reason. I’ve been ambushed more than a few times when I’m out litter picking with We Heart Seattle. The loud-mouthed radicals have training mills and online networks that prepare them to trounce at a moment’s notice, smearing reputations all along the way. Electeds have learned to dance to their tune or pay the price with protests and negative online campaigns.  

Signs of Hope

There are signs that electeds are beginning to sour on the radical activists’ dystopian visions and savage tactics.

New organizations like North America Recovers bring together hundreds of thought leaders and organizations across Canada and the U.S. to counter the prevailing narratives and conventional wisdom that got us to the drug-related homelessness crises we’re in. They target electeds with their resolutions which is effective.

Meanwhile, subscription-based media outlets like Substack are helping us read authentic content from authors and journalists like Michael Shellenberger who are fed up with the culture and preferred narratives of the editors at mainstream media outlets, not to mention the thought police that censor social media who would have us convinced this is nothing but a housing shortage.  

Thankfully, it’s beginning to feel like a political slack tide. When electeds sniff the wind and sense that their re-election is endangered, they change their positions. Implementation of real solutions can’t be far behind.