Managing addiction

Sobriety model doesn't help many street people

AS someone who has worked in the field for over 20 years, even I was
stunned to see the tabulated costs of providing police and ambulance
services as reported by the Winnipeg Police Service (38 street people
costing millions, Free Press, Feb. 2).

On a day-to-day basis, you know it is costing money somewhere, but the
totals still astound. Coun. Gord Steeves had it right when he said:
"There has to be a better way to do this" in response to the report,
and he's also right when he said that the answer is some form of
"long-term care." I hasten to add, however, that the type of long-term
care we need is unlike anything that is available now. Some better
solutions are out there if we want to change our thinking a bit.

The Main Street Project has been providing emergency shelter, detox
services, and "dry" transitional housing in Winnipeg's core for
decades now and we have success stories of people who are able to
maintain long periods of sobriety, sometimes with our help. But our
enthusiasm is always tempered by the knowledge that many of these
folks will have few places to go after leaving here other than the
street, where many will fall into the same cycle of addiction and
homelessness. The obstacles to permanent sobriety, including
psychiatric illness, poor social support, lack of stable housing and
the long duration of the addiction, all make for a tough path.

Abstinence-based programs should always be the preferred approach, but
for some people, it does not work and it never will. We can lament
this and harshly judge people for their lack of will, but none of that
is really going to change anything and people will continue to find
themselves in a cycle that will cost our community a lot of money for
police, hospital and ambulance services, among many other bad things.

What you find when you dig into the literature and the experience,
however, is that it is not the actual addiction itself that drives
many of the emergency costs, but the related tangles of the daily
challenge of finding and consuming alcohol and living outdoors.

I'm sure there are many alcoholics living and functioning in Tuxedo
who cost the emergency system nothing because they have the money to
buy liquor, a safe place to drink it and the social supports needed to
continue to function.

We need to apply some practical "harm reduction" principles to this
challenge and create a housing-based program here in Winnipeg where
some of the street addicts can live and manage their addiction, rather
than programs that only create temporary islands of sobriety. In the
long run, it might actually be cheaper.

This is not just idle speculation. An article in the January 2006
edition of the Canadian Medical Association Journal reported on an
Ottawa study that actually administered daily doses of alcohol to a
carefully selected sample of 17 homeless alcoholics over a period of
16 months.

The results were impressive. Police encounters decreased by 51 per
cent, and emergency department visits dropped by 36 per cent.
Blood-test markers of alcohol use remained stable and "participants
and client care workers reported improvements in health, nutrition and
hygiene." Compliance with medications and treatment also improved.

Perhaps most striking was that psychiatric evaluations and follow-up
were found to be successful for those who also had some kind of
co-occurring mental health problem -- more common than not,
unfortunately.

Even more promising was the finding that two of the participants
actually embarked on a path to abstinence, successfully detoxified and
moved to mainstream housing, even though that was never foreseen as
part of the program.

I say again, this is not the preferred choice for anyone, and it is
only an appropriate last resort for a carefully selected few. In this
study, the average age was 51 years, and the mean duration of
alcoholism was 35 years. Each subject had made repeated attempts to
stop drinking and each had failed.

We should never take lightly the decision by anybody to remain an
addict for the rest of their lives, but there is a certain point where
the die is cast and it remains for us to be practical and provide
whatever comfort, value, and dignity we can for those afflicted. The
fact that the right and humane thing may also be the most economic
appears to be an idea worth exploring.