This past fall, I began working full time in researching questions surrounding homelessness to inform state homelessness policy. A few ideas in particular have sprung up such that I’ve been writing and reflecting on them actively myself, and I thought I’d publish a piece with a few of these learnings and musings together.
These learnings have come from a whole lot of time spent reading medical reviews, listening to those who have worked with the homeless for a long time, and listening to the homeless themselves. From these, there are a handful of narratives and things I’ve come to believe to be true that here I offer as a reflection point for myself and anyone else interesting. Better understanding those who are homeless will help us to love them well, whatever our particular role may be.
Causes of homelessness
Most of the time, a person becomes homeless because of a combination of factors including a lack of relationships and/or ruptured relationships, struggles with addiction, and struggles with mental health. Occasionally an economic reason is a primary cause of homelessness, but it appears that ruptured relationships and addiction that are more decisive factors in exacerbating economic struggles and leading to homelessness. Ruptured relationships also leaves a person without others to fall back on when situations take a turn for the worst.
Brokenness in relationships isn’t just about practical measures. Often it is connected with particularly troubled histories, often including abuse or serious brokenness in their families. Individuals who are victims of abuse and neglect struggle to maintain relationships, particularly when they are strained further from mental health struggles or addiction.
When on the streets, their relationships are further challenges. For one, their self-image is beaten down and twisted by being ignored by passers by and the occasional jeer to “get a job.” Relationships with other individuals on the streets and street providers tend to suffer also, because of how common it is to have one’s possessions stollen and how often service providers overpromise them things (trying to motivate them to sign up for such and such service) and underdeliver (or not deliver). Further, even out of those who come to provide resources to the homeless, a portion of them are more there to feel better about themselves than to really love their neighbor, using the homeless person in this way as opposed to trying to see or understand them for who they are.
Separate but related a certain extent to the overall problem, Americans have a bad relationship with money. Just one stat – 60% of Americans are living paycheck to paycheck. This is not so much because of a lack of opportunity, as much as a culture of spending and consumerism. It may be to some extent also contributed to by the high prices of large assets like homes, though I am wrestling with this right now and it seems to be like a chicken and egg problem or just an unbalanced reality due to lack of virtue or a lack of understanding of the good life. All in all, this bad relationship with money puts many individuals in poor positions to be generous with their time and money to help friends or others on the street to recover whatever it is they need to recover from.
Helping the homeless
When approaching the homeless, it is easy to fall into one of the extremes, neither of which see them as human. The one, looks at them with disdain and questions why they don’t fix themselves, and the other, an inhumane acceptance, which treats them more as if they were an animal – giving food, a bed, and not seeing or caring much humanly more in this human relationship.
What is freedom? Is freedom simply not having anyone tell me what to do, that I can make any choice immediately accessible to me? Or is it a sort of ability to live to the full, the freedom to choose that which leads to fullness of life?
If we humans are more than disinterested cells, only seeking not to harm others and only driven to act out of a selfish desire to make oneself feel less guilty about the apparent suffering on the streets, and instead we recognize that in some true sense a certain man or woman sitting there on the side of this road is a brother or sister, than we may actually desire their good.
And if there is a good life, it is not living addicted, fearful, without self-esteem, and without good relationships. It is higher than this.
There then is the question of role. It is not my role to help the masses. But it may be my role to learn the name of this one man on this one street I tend to frequent or perhaps help another I ran into the other day. For when we look at the one, we act, whereas if we look at the masses, we won’t. (Mother Theresa) In this, there is a sort of prudence, a dance in life, to see where my role may lie. It is, perhaps, to roll down my window and strike up a conversation with Garfield over here and ask him how the Broncos game was. Or taking a friend from the street out to dinner. These are the small acts the Russian writers Dostoevsky and others thought would save the world.
This is also where Mother Theresa and the Missionaries of Charity come in. The lover of Christ, radiating Christ, bringing light into the darkness, love where there is no love. This sort of love is tied to truth, that is, the good of the person. It sees every man and woman as Christ truly, the image of God. This is a rooted love that wants the good of the other.
Mother Theresa dealth with leprosy in Kolkata. When she came to the US, she said that loneliness is the leprosy of the west. Her sisters here have continued her work in bringing light to those who struggle with this suffering unique to our time and place.
This is where much of our role is, as individuals working with the homeless (and otherwise in our lives). This is the role of “charities”, in a more true sense of the word. This is the role of larger organizations. Material help could here be the byproduct, but is rarely the fundamental need.
In this conversation, there comes also the question of the role of government, that we too participate in to some extent. What is the role of government? Big question. According to the principle of subsidiarity, that government should help smaller communities / individuals contribute more effectively to social well-being and supplement their activity when their needs exceed their capabilities to fulfill them and these needs go unaided by small and medium sized organizations.
Before we look into this question, let us gather a few other points
The ultimate goal: to help those on the streets to live fully alive
part of this is living with a good relationship with themselves, God, and others
It appears that what helps a person get off the streets and pursue this direction of change include:
them seeing themselves as worthy, wanting to reconnect
them hitting a rock bottom, and it just not being worth it anymore to be out there
Harm reduction
The philosophy:
It stresses the individual drug user’s choice – what their goals are:
“If a person who uses drugs chooses to continue, how can we help them reduce any negative consequences of that use?”
On the one hand this is a problematic set up
it is not good to facilitate a harm, even toward some instrumental end
such actions can easily spill into justifying enabling use, or at least normalizing drug use in such a way that it twists it to appear neutral or good
while it recognizes an individuals dignity in giving them the choice, it denies that dignity in refusing to recognize them as deserving a better life
addiction is predominantly a matter of compulsion in the brain, where one cannot make the right choice. It’s like someone is enslaved by a harsh master, not rightfully nor legally, and we would be over here just trying to decrease their likelihood of getting a disease and often ineffectively at that.
Caritas in Veritate - the union of truth and love
“Charity in truth, to which Jesus Christ bore witness by his earthly life and especially by his death and resurrection, is the principal driving force behind the authentic development of every person and of all humanity.”
“Without truth, charity degenerates into sentimentality. Love becomes an empty shell, to be filled in an arbitrary way.” “Truth frees charity from the constraints of an emotionalism that deprives it of relational and social content.”
Currently some of the narratives have taken this empty shell that was once “love” and filled it with narratives and ideology
“Without truth, charity is confined to a narrow field devoid of relation.”
Without truth, the there is only the social law at play: “free to be me, free to be you”. If there is no objective good, then a person can choose anything rightly, even a hell-like life of brokenness, living according to this brokenness, and medicating and escaping with drugs – often feeling too whole unworthy and in darkness.
One step beyond this is a different claim to “truth”, that of ideology. It is important to notice the ideologies at play in the culture and homeless narratives today so as to parse them out from the internal impulses we have naturally as humans that draw us toward a more true view and love of the homeless person before us.
But as it is, there are three main ways in which it has appeared others have been mis-steered in their approach to the homeless:
“I just think, you know, this could be me”
A restless feeling within oneself, a God shaped hole, that compels them to try to fill it by fixing social problems or helping others (with varying degrees of right intention and focus)
this can devolve into a religion of itself, a way of seeing the world, seeing others, one’s guilt, purpose and salvation – the ideological narrative I was mentioning
Apathy, diversion, blame, looking to others, and not seeing it at all
not getting to the love piece at all
Unfortunately, some of these unrooted narratives have come to dominate within the homeless services space, and have evolved into narratives and services that fail to serve the poor well. Among others, these have yielded groups:
like the efficient food service group, that announces how many plates they served at the end but did not look at or engage with these people
that further enable a life of internal hell by making it easier to be on the streets without providing the bread of real life that is fundamentally relational and sacrificial
But instead of condemning all solutions that come out of narratives not rooted in truth, it is better to examine these solutions and paths individually and see where truth might be found within them, that we might affirm the true and support its unfolding while also exposing the bad to light. God is a creative God! Let us be as open to Him as we are holding fast to Him.
When looking into these solutions, we ought to examin them prudently – looking at past experience and the present situation, docile to the opinion of others, shrewdly looking into how we can better assess this situation, reason out these in balance, and then to be provident, circumspect and cautious in the phase of judgment before taking action. This can be both truly prudent and entrepreneurial.
Without trying to cover every speck and scope, here I will break down some key ideas from a number of sources – first from an evidence brief report I helped put together, second from a couple particularly insightful articles I’ve read recently, third from some research on housing and shelter, and then also a few ideas from some books I’ve read recently.
Harm reduction report
Drug use has health and mortality implications for both the method of use and the effect of the drug itself. Method of use, especially injection, inhalation, intranasal, have consequences from contracting diseases (inherent to type of use like gum diseases or from shared consumption tools like sharing needles) to skin infections and also impact the amount of drug consumed. Consuming drugs themselves also increases mortality, with methamphetamine and opioid users are six times likely to die than the general public.
Some harm reduction strategies appear to be more effective and have fewer downsides than others.
Some key ideas:
Overdose hotlines > supervised injection sites
bc it decreases overdoses, interacting and growing relationship with someone who isn’t using but can share info and encourage toward abstinence as able
and not surrounded by others using → not a social thing
nor attracting drug dealers to that area or same increase in social disorder and violent crime to an area
Needle exchanges do more harm than good
doesn’t appear to help in reducing the spread of disease, especially HCV which is more the problem between drug users
lead to increases in drug-related crime (16 percent), overdose mortality (13-15 percent), and theft (24 percent)
though it’s a goal, they rarely get hard to reach individuals to engage with more services
though it does perhaps bring in hard to reach individuals to other services, this number is very low. there are other ways to reach these individuals especially for a comparable rate
Medication-Assisted Treatment can be good to help people get off illegal opioids.
But not universally so. Often individuals will be on MAT and still be on illegal drugs, one study finding this accounted for 67%. That being said, for those just on MAT, this is a good step forward in recovery, even though they are still daily taking an opioid.
Naloxone
A good opioid overdose-reversal drug. But a recent study found that broadening access leads to more overdoses in those places in a causal and not just correlatory relationship. Can this be more easily at hand, but not such that it increases individuals use and overdose likelihood?
Good Samaritan Protections, Fentynol Test Strips and “Information, Education, and Counseling”, according to current studies that I am aware of, appear to address the negative consequences of drug use effectively without quite as sizeable tradeoffs.
Articles
On the one hand, there are certain negatives to drug busts in that they cause spikes in deaths afterwards because disruptions in trusted supply chains leads dealers and users to get from new sources often without some being burned. It is also so easy, cheap and quick to build drug labs for many of the more popular drugs right now that spiral into a game of whack a mole. https://www.rstreet.org/commentary/if-we-care-about-overdose-deaths-we-must-go-all-in-on-harm-reduction/
How to Think about the Drug Crisis - Charles Lehman
Main points
Drugs are now much more lethal than they used to be, and overdose death is becoming much more of an issue
this is because
more meth and heroin users (and the general rise in opioids with increased prescriptions starting in the 90s)
synthetics like fentanyl are more easy to produce and very strong, cheap and easier to hide from law enforcement
more drugs adultered with fentanyl
arguments against harm reduction
not only should we not facilitate addiction even for a positive end
but harm reduction less a fit for a death-inducing drug crisis
Drug users - different populations
the 20% that use 80% of the drugs
and the 80% that use 20% of the drugs
For those in the former…
Treatment is the least bad solution
→ increase treatment options
MAT (for opioids), psychotherapy, and inpatient treatment
→ don’t make it easy to live life in hell
“As Stanford addiction specialist Keith Humphreys has argued, while addiction is a disease, it differs from other diseases in that its symptoms entail "intense neurological reward." As a result, many people do not enter treatment because the incentives to continue using outweigh the incentives to quit. In many cases, then, the best way to help people is to compel them into treatment.”
it is not compassionate to make it easy to continue living on the streets by providing for strictly material needs. If there is a legitimate relational or spiritual gift within the interaction, because these are of the foremost need for many living on the street, this outweighs any potential drawback from the “making it easier” to be on the street and is not comparable on the same grounds. But robots distributing food or providing tents for anyone to sleep in is not compassion. Though the external matters, hell is primarily an internal thing than an external one.
strategic police enforcement enforcing drug crimes on streets, provided that diversion courts are set up with the option of mandated treatment and that treatment programs are transparent and high quality
to this end, I don’t know if I would go as far as this article goes, but it makes some legitimate points: https://www.wsj.com/health/healthcare/addiction-treatment-can-work-even-when-its-not-voluntary-a81f86ac
For more casual users who use less
busting isn’t especially effective for this type of treatment
leaning into “realistic and educational” drug info may be the most help
Housing
Harm reduction and housing: PSH
When it comes to housing, the Housing First / harm reduction narrative argues for Permanent Supportive Housing – providing a house (usually for free or very cheap) with no responsibilities or strings attached.
When examining the studies, individuals who are given PSH do not yield any decrease in drug use, nor any improvements in thier quality of life, mental health, physical health, or relationships. The only upsides in this area are a slight decrease in drinking for those addicted. The metric used in the PSH narrative is the amount of individuals who are likely to stay versus others in other housing programs. This, however, is a success metric for “getting people out of sight”, not actually improving their life nor helping them toward freedom. It is also a number that has been artificially manipulated by these groups with magical landlord incentives, according to a HF insider I recently talked to who was frustrated with the dishonesty of the org he is working for.
There are other options that have been found to be effective. Talking addiction in particular, recovery housing and abstinence-contingent multifaceted treatment programs have been found to help those with addiction. It appears also that certain types of case management have been found to help more than others including Critical time intervention (CIT) and intensive care management (ICM) and peer interventions.
This is what studies show. But to break this down a bit further, let’s really steel man the PSH approach and then look at the alternative.
A PSH unit allows someone to get a good night of sleep consistently and to have their own place to be. There they are safe and no longer faced with the beating down of dignity that many deal with on the day to day, being ignored by passers by unless spoken to insultingly. In a PSH unit they are also in contact with a consistent group of service providers who are there to provide services if you so choose. This consistency allows them to build a relationship, and the relationship is prioritized over the service, making sure to not cut ties or get any tenants to shut down. They are also not faced with quite so many physical challenges, and are then perhaps not so reliant on substances to cope, alcohol in particular, which has been shown to decrease in use slightly when in PSH versus when on the streets.
But to this steel man, there are a few questions. How good is this relationship between service providers and tenants? If it is correct that relational aspect is one that is particularly broken for the homeless, and that growing in good, authentic relationship is a key part of solution, then these relationships developed – with service providers and other tenants – don’t appear to be of help to the point of seeing any sort of improvement result.
Additionally, these PSH units are pretty bad environments to be in. A friend who works at one of these groups in the PSH units described routinely seeing people shooting meth in their apartments, and witnessing many with severe mental health, pimping and prostitution, reports of human trafficking, and even a murder that occurred in one of the apartments. This is not a very good environment to be trying to consider getting off of drugs or taking care of your apartment, especially when the housing org will bend itself backward to try to make sure you don’t lose the room, even if fines are owed on it for damages that would keep it from passing an inspection, because that is how PSH orgs compete and keep their funding – for their high retention rates (also explained by a friend on the inside of one of these firms). On top of this, many dislike being alone in these apartments, and will end up giving back to the streets to lose that sense of loneliness.
It is quite crazy, though, that the quality of life stats do not go up for those in a PSH. This really indicates to me that the addiction, mental health struggles, lack of real relationships, the dangerous and negative conditions, and also the loneliness from being suddenly alone in their apartment that are the driving forces here, and are more to be focussed on than the roof over their heads. It also takes away the dignity of responsibility and any material positive incentive or direction when there.
Also, this program is extremely expensive. It would have to yield really good results to be better than other approaches, and it pretty clearly is no where close to delivering.
Another common occurrence in homelessness services today is the handing out of tents, food and other resources like a factory line. This makes this subhuman life of living on the street a lot easier, and doesn’t seem to offer any real human dignity or relationship.
In a PSH, it is a little animalistic to say “no conditions” and have it be a very transactional relationship. It just doesn’t seem very loving.
An approach different and also in contrast to this:
Christ in the City, going out listening to people and getting to know them, growing in relationship with them, “I love you”, “I want your good”
Same with the MCs – loving them lived out
Christ, in the story of the hemorrhaging woman, not enough for her to be healed but to be “family”
Christ gave us free will, calls us to participate with him in the bringing about of the new creation
There are many other little and big ideas not included here, and even some of the ones I have included are not well edited or explained. I also still have a ton to learn, and I would not be suprised if in spending another few years in this area I may think about a couple of these points completely differently. But the best we can do right now is this best. And I hope these ideas, these mere seeds, may grow and bear fruit that will last.
This past fall, I began working full time in researching questions surrounding homelessness to inform state homelessness policy. A few ideas in particular have sprung up such that I’ve been writing and reflecting on them actively myself, and I thought I’d publish a piece with a few of these learnings and musings together.
These learnings have come from a whole lot of time spent reading medical reviews, listening to those who have worked with the homeless for a long time, and listening to the homeless themselves. From these, there are a handful of narratives and things I’ve come to believe to be true that here I offer as a reflection point for myself and anyone else interesting. Better understanding those who are homeless will help us to love them well, whatever our particular role may be.
Causes of homelessness
Most of the time, a person becomes homeless because of a combination of factors including a lack of relationships and/or ruptured relationships, struggles with addiction, and struggles with mental health. Occasionally an economic reason is a primary cause of homelessness, but it appears that ruptured relationships and addiction that are more decisive factors in exacerbating economic struggles and leading to homelessness. Ruptured relationships also leaves a person without others to fall back on when situations take a turn for the worst.
Brokenness in relationships isn’t just about practical measures. Often it is connected with particularly troubled histories, often including abuse or serious brokenness in their families. Individuals who are victims of abuse and neglect struggle to maintain relationships, particularly when they are strained further from mental health struggles or addiction.
When on the streets, their relationships are further challenges. For one, their self-image is beaten down and twisted by being ignored by passers by and the occasional jeer to “get a job.” Relationships with other individuals on the streets and street providers tend to suffer also, because of how common it is to have one’s possessions stollen and how often service providers overpromise them things (trying to motivate them to sign up for such and such service) and underdeliver (or not deliver). Further, even out of those who come to provide resources to the homeless, a portion of them are more there to feel better about themselves than to really love their neighbor, using the homeless person in this way as opposed to trying to see or understand them for who they are.
Separate but related a certain extent to the overall problem, Americans have a bad relationship with money. Just one stat – 60% of Americans are living paycheck to paycheck. This is not so much because of a lack of opportunity, as much as a culture of spending and consumerism. It may be to some extent also contributed to by the high prices of large assets like homes, though I am wrestling with this right now and it seems to be like a chicken and egg problem or just an unbalanced reality due to lack of virtue or a lack of understanding of the good life. All in all, this bad relationship with money puts many individuals in poor positions to be generous with their time and money to help friends or others on the street to recover whatever it is they need to recover from.
Helping the homeless
When approaching the homeless, it is easy to fall into one of the extremes, neither of which see them as human. The one, looks at them with disdain and questions why they don’t fix themselves, and the other, an inhumane acceptance, which treats them more as if they were an animal – giving food, a bed, and not seeing or caring much humanly more in this human relationship.
What is freedom? Is freedom simply not having anyone tell me what to do, that I can make any choice immediately accessible to me? Or is it a sort of ability to live to the full, the freedom to choose that which leads to fullness of life?
If we humans are more than disinterested cells, only seeking not to harm others and only driven to act out of a selfish desire to make oneself feel less guilty about the apparent suffering on the streets, and instead we recognize that in some true sense a certain man or woman sitting there on the side of this road is a brother or sister, than we may actually desire their good.
And if there is a good life, it is not living addicted, fearful, without self-esteem, and without good relationships. It is higher than this.
There then is the question of role. It is not my role to help the masses. But it may be my role to learn the name of this one man on this one street I tend to frequent or perhaps help another I ran into the other day. For when we look at the one, we act, whereas if we look at the masses, we won’t. (Mother Theresa) In this, there is a sort of prudence, a dance in life, to see where my role may lie. It is, perhaps, to roll down my window and strike up a conversation with Garfield over here and ask him how the Broncos game was. Or taking a friend from the street out to dinner. These are the small acts the Russian writers Dostoevsky and others thought would save the world.
This is also where Mother Theresa and the Missionaries of Charity come in. The lover of Christ, radiating Christ, bringing light into the darkness, love where there is no love. This sort of love is tied to truth, that is, the good of the person. It sees every man and woman as Christ truly, the image of God. This is a rooted love that wants the good of the other.
Mother Theresa dealth with leprosy in Kolkata. When she came to the US, she said that loneliness is the leprosy of the west. Her sisters here have continued her work in bringing light to those who struggle with this suffering unique to our time and place.
This is where much of our role is, as individuals working with the homeless (and otherwise in our lives). This is the role of “charities”, in a more true sense of the word. This is the role of larger organizations. Material help could here be the byproduct, but is rarely the fundamental need.
In this conversation, there comes also the question of the role of government, that we too participate in to some extent. What is the role of government? Big question. According to the principle of subsidiarity, that government should help smaller communities / individuals contribute more effectively to social well-being and supplement their activity when their needs exceed their capabilities to fulfill them and these needs go unaided by small and medium sized organizations.
Before we look into this question, let us gather a few other points
The ultimate goal: to help those on the streets to live fully alive
part of this is living with a good relationship with themselves, God, and others
It appears that what helps a person get off the streets and pursue this direction of change include:
them seeing themselves as worthy, wanting to reconnect
them hitting a rock bottom, and it just not being worth it anymore to be out there
Harm reduction
The philosophy:
It stresses the individual drug user’s choice – what their goals are:
“If a person who uses drugs chooses to continue, how can we help them reduce any negative consequences of that use?”
On the one hand this is a problematic set up
it is not good to facilitate a harm, even toward some instrumental end
such actions can easily spill into justifying enabling use, or at least normalizing drug use in such a way that it twists it to appear neutral or good
while it recognizes an individuals dignity in giving them the choice, it denies that dignity in refusing to recognize them as deserving a better life
addiction is predominantly a matter of compulsion in the brain, where one cannot make the right choice. It’s like someone is enslaved by a harsh master, not rightfully nor legally, and we would be over here just trying to decrease their likelihood of getting a disease and often ineffectively at that.
Caritas in Veritate - the union of truth and love
“Charity in truth, to which Jesus Christ bore witness by his earthly life and especially by his death and resurrection, is the principal driving force behind the authentic development of every person and of all humanity.”
“Without truth, charity degenerates into sentimentality. Love becomes an empty shell, to be filled in an arbitrary way.” “Truth frees charity from the constraints of an emotionalism that deprives it of relational and social content.”
Currently some of the narratives have taken this empty shell that was once “love” and filled it with narratives and ideology
“Without truth, charity is confined to a narrow field devoid of relation.”
Without truth, the there is only the social law at play: “free to be me, free to be you”. If there is no objective good, then a person can choose anything rightly, even a hell-like life of brokenness, living according to this brokenness, and medicating and escaping with drugs – often feeling too whole unworthy and in darkness.
One step beyond this is a different claim to “truth”, that of ideology. It is important to notice the ideologies at play in the culture and homeless narratives today so as to parse them out from the internal impulses we have naturally as humans that draw us toward a more true view and love of the homeless person before us.
But as it is, there are three main ways in which it has appeared others have been mis-steered in their approach to the homeless:
“I just think, you know, this could be me”
A restless feeling within oneself, a God shaped hole, that compels them to try to fill it by fixing social problems or helping others (with varying degrees of right intention and focus)
this can devolve into a religion of itself, a way of seeing the world, seeing others, one’s guilt, purpose and salvation – the ideological narrative I was mentioning
Apathy, diversion, blame, looking to others, and not seeing it at all
not getting to the love piece at all
Unfortunately, some of these unrooted narratives have come to dominate within the homeless services space, and have evolved into narratives and services that fail to serve the poor well. Among others, these have yielded groups:
like the efficient food service group, that announces how many plates they served at the end but did not look at or engage with these people
that further enable a life of internal hell by making it easier to be on the streets without providing the bread of real life that is fundamentally relational and sacrificial
But instead of condemning all solutions that come out of narratives not rooted in truth, it is better to examine these solutions and paths individually and see where truth might be found within them, that we might affirm the true and support its unfolding while also exposing the bad to light. God is a creative God! Let us be as open to Him as we are holding fast to Him.
When looking into these solutions, we ought to examin them prudently – looking at past experience and the present situation, docile to the opinion of others, shrewdly looking into how we can better assess this situation, reason out these in balance, and then to be provident, circumspect and cautious in the phase of judgment before taking action. This can be both truly prudent and entrepreneurial.
Without trying to cover every speck and scope, here I will break down some key ideas from a number of sources – first from an evidence brief report I helped put together, second from a couple particularly insightful articles I’ve read recently, third from some research on housing and shelter, and then also a few ideas from some books I’ve read recently.
Harm reduction report
Drug use has health and mortality implications for both the method of use and the effect of the drug itself. Method of use, especially injection, inhalation, intranasal, have consequences from contracting diseases (inherent to type of use like gum diseases or from shared consumption tools like sharing needles) to skin infections and also impact the amount of drug consumed. Consuming drugs themselves also increases mortality, with methamphetamine and opioid users are six times likely to die than the general public.
Some harm reduction strategies appear to be more effective and have fewer downsides than others.
Some key ideas:
Overdose hotlines > supervised injection sites
bc it decreases overdoses, interacting and growing relationship with someone who isn’t using but can share info and encourage toward abstinence as able
and not surrounded by others using → not a social thing
nor attracting drug dealers to that area or same increase in social disorder and violent crime to an area
Needle exchanges do more harm than good
doesn’t appear to help in reducing the spread of disease, especially HCV which is more the problem between drug users
lead to increases in drug-related crime (16 percent), overdose mortality (13-15 percent), and theft (24 percent)
though it’s a goal, they rarely get hard to reach individuals to engage with more services
though it does perhaps bring in hard to reach individuals to other services, this number is very low. there are other ways to reach these individuals especially for a comparable rate
Medication-Assisted Treatment can be good to help people get off illegal opioids.
But not universally so. Often individuals will be on MAT and still be on illegal drugs, one study finding this accounted for 67%. That being said, for those just on MAT, this is a good step forward in recovery, even though they are still daily taking an opioid.
Naloxone
A good opioid overdose-reversal drug. But a recent study found that broadening access leads to more overdoses in those places in a causal and not just correlatory relationship. Can this be more easily at hand, but not such that it increases individuals use and overdose likelihood?
Good Samaritan Protections, Fentynol Test Strips and “Information, Education, and Counseling”, according to current studies that I am aware of, appear to address the negative consequences of drug use effectively without quite as sizeable tradeoffs.
Articles
On the one hand, there are certain negatives to drug busts in that they cause spikes in deaths afterwards because disruptions in trusted supply chains leads dealers and users to get from new sources often without some being burned. It is also so easy, cheap and quick to build drug labs for many of the more popular drugs right now that spiral into a game of whack a mole. https://www.rstreet.org/commentary/if-we-care-about-overdose-deaths-we-must-go-all-in-on-harm-reduction/
How to Think about the Drug Crisis - Charles Lehman
Main points
Drugs are now much more lethal than they used to be, and overdose death is becoming much more of an issue
this is because
more meth and heroin users (and the general rise in opioids with increased prescriptions starting in the 90s)
synthetics like fentanyl are more easy to produce and very strong, cheap and easier to hide from law enforcement
more drugs adultered with fentanyl
arguments against harm reduction
not only should we not facilitate addiction even for a positive end
but harm reduction less a fit for a death-inducing drug crisis
Drug users - different populations
the 20% that use 80% of the drugs
and the 80% that use 20% of the drugs
For those in the former…
Treatment is the least bad solution
→ increase treatment options
MAT (for opioids), psychotherapy, and inpatient treatment
→ don’t make it easy to live life in hell
“As Stanford addiction specialist Keith Humphreys has argued, while addiction is a disease, it differs from other diseases in that its symptoms entail "intense neurological reward." As a result, many people do not enter treatment because the incentives to continue using outweigh the incentives to quit. In many cases, then, the best way to help people is to compel them into treatment.”
it is not compassionate to make it easy to continue living on the streets by providing for strictly material needs. If there is a legitimate relational or spiritual gift within the interaction, because these are of the foremost need for many living on the street, this outweighs any potential drawback from the “making it easier” to be on the street and is not comparable on the same grounds. But robots distributing food or providing tents for anyone to sleep in is not compassion. Though the external matters, hell is primarily an internal thing than an external one.
strategic police enforcement enforcing drug crimes on streets, provided that diversion courts are set up with the option of mandated treatment and that treatment programs are transparent and high quality
to this end, I don’t know if I would go as far as this article goes, but it makes some legitimate points: https://www.wsj.com/health/healthcare/addiction-treatment-can-work-even-when-its-not-voluntary-a81f86ac
For more casual users who use less
busting isn’t especially effective for this type of treatment
leaning into “realistic and educational” drug info may be the most help
Housing
Harm reduction and housing: PSH
When it comes to housing, the Housing First / harm reduction narrative argues for Permanent Supportive Housing – providing a house (usually for free or very cheap) with no responsibilities or strings attached.
When examining the studies, individuals who are given PSH do not yield any decrease in drug use, nor any improvements in thier quality of life, mental health, physical health, or relationships. The only upsides in this area are a slight decrease in drinking for those addicted. The metric used in the PSH narrative is the amount of individuals who are likely to stay versus others in other housing programs. This, however, is a success metric for “getting people out of sight”, not actually improving their life nor helping them toward freedom. It is also a number that has been artificially manipulated by these groups with magical landlord incentives, according to a HF insider I recently talked to who was frustrated with the dishonesty of the org he is working for.
There are other options that have been found to be effective. Talking addiction in particular, recovery housing and abstinence-contingent multifaceted treatment programs have been found to help those with addiction. It appears also that certain types of case management have been found to help more than others including Critical time intervention (CIT) and intensive care management (ICM) and peer interventions.
This is what studies show. But to break this down a bit further, let’s really steel man the PSH approach and then look at the alternative.
A PSH unit allows someone to get a good night of sleep consistently and to have their own place to be. There they are safe and no longer faced with the beating down of dignity that many deal with on the day to day, being ignored by passers by unless spoken to insultingly. In a PSH unit they are also in contact with a consistent group of service providers who are there to provide services if you so choose. This consistency allows them to build a relationship, and the relationship is prioritized over the service, making sure to not cut ties or get any tenants to shut down. They are also not faced with quite so many physical challenges, and are then perhaps not so reliant on substances to cope, alcohol in particular, which has been shown to decrease in use slightly when in PSH versus when on the streets.
But to this steel man, there are a few questions. How good is this relationship between service providers and tenants? If it is correct that relational aspect is one that is particularly broken for the homeless, and that growing in good, authentic relationship is a key part of solution, then these relationships developed – with service providers and other tenants – don’t appear to be of help to the point of seeing any sort of improvement result.
Additionally, these PSH units are pretty bad environments to be in. A friend who works at one of these groups in the PSH units described routinely seeing people shooting meth in their apartments, and witnessing many with severe mental health, pimping and prostitution, reports of human trafficking, and even a murder that occurred in one of the apartments. This is not a very good environment to be trying to consider getting off of drugs or taking care of your apartment, especially when the housing org will bend itself backward to try to make sure you don’t lose the room, even if fines are owed on it for damages that would keep it from passing an inspection, because that is how PSH orgs compete and keep their funding – for their high retention rates (also explained by a friend on the inside of one of these firms). On top of this, many dislike being alone in these apartments, and will end up giving back to the streets to lose that sense of loneliness.
It is quite crazy, though, that the quality of life stats do not go up for those in a PSH. This really indicates to me that the addiction, mental health struggles, lack of real relationships, the dangerous and negative conditions, and also the loneliness from being suddenly alone in their apartment that are the driving forces here, and are more to be focussed on than the roof over their heads. It also takes away the dignity of responsibility and any material positive incentive or direction when there.
Also, this program is extremely expensive. It would have to yield really good results to be better than other approaches, and it pretty clearly is no where close to delivering.
Another common occurrence in homelessness services today is the handing out of tents, food and other resources like a factory line. This makes this subhuman life of living on the street a lot easier, and doesn’t seem to offer any real human dignity or relationship.
In a PSH, it is a little animalistic to say “no conditions” and have it be a very transactional relationship. It just doesn’t seem very loving.
An approach different and also in contrast to this:
Christ in the City, going out listening to people and getting to know them, growing in relationship with them, “I love you”, “I want your good”
Same with the MCs – loving them lived out
Christ, in the story of the hemorrhaging woman, not enough for her to be healed but to be “family”
Christ gave us free will, calls us to participate with him in the bringing about of the new creation
There are many other little and big ideas not included here, and even some of the ones I have included are not well edited or explained. I also still have a ton to learn, and I would not be suprised if in spending another few years in this area I may think about a couple of these points completely differently. But the best we can do right now is this best. And I hope these ideas, these mere seeds, may grow and bear fruit that will last.
Subscribe to Jack Brustkern
Subscribe to Jack Brustkern
Jack BrustkernJack's Gardening Services
Hi there! I am a Dartmouth student taking some time off of school, and I am happy to help you with your gardening needs. I have more than 8 years of experience leading gardening projects -- everything from light weeding to large-scale garden restoration projects. I am a hard worker, and take pride in doing a good job. My experience is in:weedingplantingpruningwateringraking leavesMy current rate is $35/hour. If you’d like more information, or to discuss whether I might be a good fit for your ...
Jack BrustkernLet's talk Adam Smith
This past fall, I sat in on a wonderful course taught by the respected Professor Henry Clark discussing Adam Smith and his ideas. In order to learn the material well I made the goal of giving a lecture (to a singular patient and generous family member) which I recorded, for on the one hand to motivate myself to be thorough and disciplined in my study of Smith, and also to have something to look back on and share with others if they ever happy to have a hankering for some Smith.
Jack BrustkernSketches in the Extreme: Dostoevsky’s Sodom and Paradise
Last quarter I took the best course I have ever taken. Dostoevsky rocked my world. You really have to go to the books to get the good stuff, but here’s the final paper I wrote for the course, looking into Dostoevsky’s depiction of paradise and sodom:Dostoevsky deals in extremes. His characters find themselves in the depths of Sodom in one scene and the heights of Paradise in the next. Their coming into these extremes is primarily the result of the state of these characters’ souls and states o...
Jack BrustkernJack's Gardening Services
Hi there! I am a Dartmouth student taking some time off of school, and I am happy to help you with your gardening needs. I have more than 8 years of experience leading gardening projects -- everything from light weeding to large-scale garden restoration projects. I am a hard worker, and take pride in doing a good job. My experience is in:weedingplantingpruningwateringraking leavesMy current rate is $35/hour. If you’d like more information, or to discuss whether I might be a good fit for your ...
Jack BrustkernLet's talk Adam Smith
This past fall, I sat in on a wonderful course taught by the respected Professor Henry Clark discussing Adam Smith and his ideas. In order to learn the material well I made the goal of giving a lecture (to a singular patient and generous family member) which I recorded, for on the one hand to motivate myself to be thorough and disciplined in my study of Smith, and also to have something to look back on and share with others if they ever happy to have a hankering for some Smith.
Jack BrustkernSketches in the Extreme: Dostoevsky’s Sodom and Paradise
Last quarter I took the best course I have ever taken. Dostoevsky rocked my world. You really have to go to the books to get the good stuff, but here’s the final paper I wrote for the course, looking into Dostoevsky’s depiction of paradise and sodom:Dostoevsky deals in extremes. His characters find themselves in the depths of Sodom in one scene and the heights of Paradise in the next. Their coming into these extremes is primarily the result of the state of these characters’ souls and states o...
<100 subscribers
<100 subscribers
Share Dialog
Share Dialog
No comments yet