READY-MADE SOLUTIONS' AREN'T FOR US, ADDICTS SAY

Drugs-Or-Welfare Government Plan Called Naive

Rick W. has no plans to take his welfare cheque and inject it.

For one thing, he's no longer on welfare. He's living in the shelter system
and surviving on a Personal Needs Allowance of $3.75 daily.

The other reason is that he doesn't use heroin. He smokes crack - even
though his addiction brings with it an inevitable self-loathing.

``I hate myself, I kick myself, every time I break down and do it,'' says
the 35-year-old, who's been struggling with the drug for years.

Rick has tried, through treatment programs and on his own, to stop.
Sometimes he's successful, going days or weeks without feeding his
addiction. Sometimes, his abstinence is measured in scant hours.

When he's broke, which is often, he helps other people score crack in
return for a little kickback. It's never too hard to find someone with cash
- - doctors, lawyers, teenagers - who cruise the downtown core looking to buy
a few rocks.

``There's always people up and coming,'' he says, ``new addicts all the time.''

Ultimately, Rick W. says he'll beat this. But that victory, and he stresses
this, can only come when he's ready - and living in a stable environment.

``There are no ready-made solutions to addictions,'' he says. ``It's a
life-long battle. For social services to tell someone - boom - stop using
it, it's impossible.''

On Nov. 14, the minister of community and social services announced plans
to screen welfare recipients to identify those addicted to substances.
Those people would then be required to take part in treatment or lose their
benefits. The rationale, John Baird said at the time, was that the province
doesn't want recipients ``shooting their welfare cheques up their arms.''

The announcement prompted an immediate outcry from many professionals in
the addictions, health and social justice fields. They argued such a
policy would target the poor and vulnerable, increase the stigma of
addictions and lead to additional homelessness. Many suggested it
reflected, at best, a simplistic view of the complex nature of substance
dependence. The Canadian Medical Association Journal confirms an upcoming
editorial will condemn the plan.

``The people I know in this field are completely outraged by this,'' says
Dr. Philip Berger, chief of Family and Community Medicine at St. Michael's
Hospital. ``I hate imputing motivation, but in this one it's very difficult
to resist, because it appears punitive, vindictive and meant to humiliate
sick and poor people. And I'm not alone in that opinion.''

The minister doesn't see it that way. Quite the opposite, in fact.

``Our basic motive, I think, is one of compassion,'' he says.

Baird says addiction can be a ``barrier to employment,'' and that people
successfully treated will be able to rejoin the workforce. He sees the
proposed plan as being analogous to Ontario Works - where welfare
recipients participate in skills training and job placements in exchange
for their cheque.

``The fundamental premise of our welfare program is that there's not just
an expectation, but a requirement for you to participate,'' he says. ``It's
not a money-for-nothing welfare policy. That's a fundamental shift in
thinking, and I don't take issue with people who honestly disagree with
that policy.''

When it comes to applying that concept to addictions, however, many do
disagree. Health authorities say addictions are an illness, a disability,
that significantly alters the way in which decisions are made. Choosing to
participate in a jobs program, they say, cannot be equated with choosing to
take part in treatment.

`This policy suggests drug use, on a day-to-day basis, is a choice. For
someone who's dependent on drugs, their brain chemistry changes in a way
that they feel a strong compulsion to use drugs.' - Dr. David Marsh, Centre
for Addiction and Mental Health

``This policy suggests drug use, on a day-to-day basis, is a choice,'' says
Dr. David Marsh, clinical director for addiction medicine at the Centre for
Addiction and Mental Health.

``For someone who's dependent on drugs, their brain chemistry changes in a
way that they feel a strong compulsion to use drugs, the same kind of
compulsion that we feel to eat food when we're hungry. And for them, it's
not a simple matter of choosing: `Okay, today I won't use heroin or
cocaine.' ''

``People don't understand the seriousness of addictions,'' says Beric
German of Street Health. ``They think it's like a virus that you would give
some drug or treatment to and you get over it. And that isn't the case.''

Nor is it the case that addictions are usually a barrier to work, say
professionals. Given that substance dependence exists at all rungs of the
socioeconomic ladder, they say the theory is the exception rather than the
rule.

`The premise that addiction causes unemployment is the biggest fallacy
around . . . Most people who have a substance abuse problem are working -
and in all kinds of fields.' - Ginette Goulet, Ontario Federation of
Community Mental Health and Addiction Programs

``The premise that addiction causes unemployment is the biggest fallacy
around,'' says Ginette Goulet, associate director of the Ontario Federation
of Community Mental Health and Addiction Programs. ``How many people right
now are addicted to something and are working? Many. Most people who have a
substance abuse problem are working - and in all kinds of fields.''

Goulet and others expressed grave concern that the minister's announcement
further stigmatized both welfare recipients and those with problems of
addiction. A poster unveiled for the program depicted a man injecting himself.

``The image of a person injecting drugs does not raise compassion, it
raises fear,'' states a federation position paper opposing the plan.

There's also the problem that the infrastructure for mandatory treatment
simply does not exist in Ontario. Waiting lists are chronic - and that's
for people who want to take part. Baird says he'll fix it.

``We need to put a significant new investment into this, probably in the
tens of millions of dollars,'' he says. ``I recognize that and I'm prepared
to go to bat and to fight for that money.''

But will it work? Can someone with a serious addiction be forced into
treatment and successfully kick their habit?

The ministry says `Yes,' and points to a handful of U.S. studies indicating
positive outcomes with mandatory treatment. But the majority of subjects in
those studies were incarcerated populations, or women faced with a choice
between treatment and having their children taken away.

``In all of those (studies), you're talking about mandatory treatment based
on something that's black or white - you're either incarcerated or you're
not, you either have your children or you don't,'' says Marsh. ``I don't
know of any studies looking at mandatory treatment in this context, where
someone's welfare benefits are dependent on their participation in treatment.''

Nor, in the few U.S. states that apply mandatory treatment, is it quite as
mandatory as the word implies. In Oregon, some welfare case managers do not
support - or follow - the policy. At least one state applies its sanctions
by degree, rather than the all-or-nothing approach pitched here.

``In some aspects, I suspect we'll be the first in what we do,'' says Baird.

Despite widespread concern among professionals, the plan does have
supporters. One of them is Dr. Suan-Seh Foo, an addictions specialist with
the non-profit Canterbury Clinic.

``I appreciate their (colleague's) concern; it sounds punitive,'' he says.
``But what is the alternative? I ask you, is it right for the government to
knowingly give out $3, $6 or even $900, knowing full well that a portion of
it is going to be used for drugs? . . . If you really want to help the
individual you mandate the therapy - even if they don't want it.''

Foo also agrees with those who've suggested that, if you're going to screen
and treat those on welfare, why not screen and treat all individuals whose
salaries are publicly paid.

``I have no problems with that,'' he says.

The minister says because mandatory treatment was a prominent plank in the
1999 election, there's already been a referendum of sorts on the issue. He
also rejects the suggestion that the policy unfairly links welfare
recipients with substance abuse.

``I don't think for a moment that anyone who's on social assistance is any
more likely to be abusing drugs. I suspect there are more people on social
assistance where their addiction is a barrier to employment,'' he says.

Those who work at street-level say that living on welfare, in and of
itself, is so difficult that it may even contribute to the abuse of
substances. A single person receives a total of $520 per month, $325 of
which is to be used for accommodation. That leaves $195 for all other
personal expenses - including food, clothing, transportation. Such an
impoverished environment, say professionals, is not ideal for recovery from
substance abuse.

``For anyone, but particularly for individuals with mental illness or
substance use disorder, social environment is a key factor to their
recovery,'' says addiction specialist Dr. Marsh. ``The more that they're
able to have reliable housing, a steady, well-balanced diet and a
supportive social network, the more likely they are to recover.''

Boris Rosolak, superintendent of Seaton House, one of the largest men's
shelters in North America, suggests it's very difficult to survive on
welfare - let alone complete a treatment program.

``If I was a single guy, living on $525 a month in the most expensive city
in the country, I think I may be prone to some substance abuse just to
escape the misery that I'm facing every day,'' he says.

Rosolak believes treatment would benefit some of the clients of Seaton
House. But he doesn't think a coercive approach is the answer.

Rosolak and others suggest that a more positive approach would be to offer
incentives over and above the regular welfare cheque. Maybe it's extra
money, better housing, training for a career of choice - things that
improve people's lives and offer hope. Incentives, even small ones, have
been shown to improve outcomes with addiction treatment.

It's an approach Toronto's commissioner of community and neighbourhood
services, Shirley Hoy, supports.

``From our experience in counselling people and a number of years in
running the old general welfare program, we have always found that positive
incentives tend to be much more effective in encouraging people to get
help, get treatment,'' she says.

Then there's the question of what impact, if any, the new policy might have
on programs known as `harm reduction.'

Services like needle exchanges or wet hostels do not offer `traditional'
treatment. These are non-judgmental programs that help people minimize the
harm caused by their addiction. As clients of such programs engage over
time with staff, many do eventually make the choice to seek help.

``Harm reduction is very important,'' says Dr. Patrick Smith,
vice-president of addiction programs at the Centre for Addiction and Mental
Health. ``And Canada has been one of the international leaders.''

Baird says he cannot yet say whether such programs would be considered a
form of treatment for a welfare recipient. But he does emphasize there will
be a firm expectation that people attempt, even repeatedly, to overcome
their addiction. Refusal will lead to a cessation of welfare benefits.

``We're not, for a moment, saying that people have got to succeed. But
they've got to try,'' he says.

That may be politically popular, but many say it's clinically unsound.

``The minister has an undeveloped, unevolved and unsophisticated analysis
of addiction,'' says Dr. Philip Berger, who's also on the methadone
committee of the College of Physicians and Surgeons of Ontario. ``It's
astonishing to me that we have people in leadership in government making
very serious decisions who have a completely uninformed and unsubstantiated
analysis of very profound and serious social problems.''

What is undoubtedly the most troubling aspect of the plan, say critics, is
that those unwilling or unable to embrace treatment will be at great risk
of homelessness. They may also turn to other, perhaps more harmful, ways of
supporting their addiction.

``It just shows how out of touch our government is with the understanding
of people with addictions,'' says Sister Susan Moran, co-founder of the Out
of the Cold program.