Homeless substance abuse – can street addicts be treated?

Learn how a D.C. based addiction treatment program has helped the homeless for more than 25 years. We review the best practices in homeless substance abuse treatment. More on substance abuse and the homeless here.

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Drug and alcohol abuse and homelessness

Earlier in this series on addiction and homelessness, we reviewed the relationship between addiction and the homeless.  In other words, how many people who live without a home are addicted to drugs?  And can drug and alcohol addiction cause or contribute to homelessness?  To summarize, YES, drugs and alcohol can play a significant role in getting people to the streets and to staying on the streets.  It’s estimated that about 42% of chronically homeless people are living with disability, including mental illness and drug addiction.  More stats on homeless addicts here.

Three stages of homeless addiction treatment

Samaritan Inns has been providing a housing and treatment program for addicts in D.C. for 25 years.  Their program has significant success rates. At one year, people who had completed the long term program experience on average

* 96% uninterrupted sobriety
* 98% employment
* 98% improved family relationships
* 99% safe housing
* 15% purchased home or condo

Why does their program work so well?  I believe it to be a combination of the 12-step model and the graded stages of increased responsibility.  The program moves participants through three stages of treatment:

1. Intensive recovery (like an inpatient rehab)
2. Transitional living (think halfway house)
3. Independent living (think 3/4 way house)

Three criteria for addiction treatment among the homeless population

We recently spoke with the President of Samaritan Inns, Larry Huff.  Given the success rates and results after one year of treatment, I was interested to learn about the criteria for admission to the program. Here’s what Larry told me are the three (3) criteria which work for them:

1. Personal choice – The biggest and first criteria for participation in our program is personal choice.  The interview process can be very fragile.  Even if a person is not totally sure about whether they want to go through the program, that’s OK.  Ultimately, there has to be some committment (even to one day) to the program.

Our program is very success oriented.  We have our eye on the end game from day one.  If we don’t think that a person has any chance of being successful, then they will probably not be admitted.  At the get-go, the basic criteria that any man or woman has to make is the decision to enter recovery.  If there is no clear desire (Ex. the court sent them, a family member dropped them off) and a person is not interested in recovery, then it’s not going to work.

2.  Medical diagnosis and treatment – Second, clients who commit to the program must be committed to following medical advice, if necessary.  We don’t have a medical staff on board.  We do employ addiction counselors and certified professionals, but no doctors…so if there is a medical disorder, a man or woman going through the program need a diagnosis and must agree to take medication if prescribed.  If a severe mental disorder is present that has not been diagnosed, or if a person doesn’t want to take meds, we don’t accept them.

3. General medical condition – Third, anyone who is admitted to program must be medically fit to do so.  Part of our prorgam is a daily exercise and a walk 4 blocks to program facilities.  If applicants physically cannot do this, we cannot admit a man or woman to participate.  Or if applicants have a significant health problem that we can’t manage, we cannot accept them.  These include severe heart problem, cancer, or something that requires daily care.

Addiction treatment replication

What I like about Samaritan Inns is that the program can be replicated anywhere in the U.S.  Again, Larry says of the three-step residential program, “It’s generic enough.  It can be replicated anywhere.  We’ve been blessed by having the housing pieces to support it all.  The biggest challenge is to be able to acquire housing pieces to build independent living with apartments.  Location is not so much an issue.”

So…why not treat addicts on the streets?

After considering this topic for a while, I think that the biggest barrier to getting ANYONE into recovery is allowing addiction to run its course.  And that Samaritan Inns’ #1 criteria of personal choice is THE DETERMINING FACTOR in any treatment for addiction.  Nonetheless, I do believe that if there were more programs like this (structured, organized, 12-step based) ready for people and admission, transformation could occur. And that “If you build it, they will come.”  Perhaps this is a little naive?

What do you think?  Should we build addiction treatment programs modeled on those successful models which show results IN ADVANCE of need?  or do we need to wait until the need overwhelms us?  Is homelessness even your problem at all?  What does homelessness and addiction say about our society at large?

About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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