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Substance Abuse & Homelessness: Getting Past Stigmas and Identifying Effective Solutions for Sustained Recovery

As of the writing of this article, we’ve just left behind May now recognized nationally as “Mental Health Awareness Month.” We celebrate the strides in destigmatizing mental health which was unfortunately a part of our culture for far too long. The idea of visiting a therapist is no longer seen as negative, but as necessary as seeing a dentist for an aching tooth, or a doctor for chronic pain. This month is also a time to not only look back and appreciate how far we’ve come as a society, but to also assess our modern day thinking and work towards removing harmful stigmas we are still holding onto today. Two such stigmas still needing to be faced is that addiction and homelessness are moral failings. 

What causes addiction? 

In a recent episode of Real Hope Podcast, we heard from Marie Williams, Commissioner of the Tennessee Department of Mental Health and Substance Abuse Services. In the podcast, she brings up what researchers now believe to be the major causes of addiction: 

  • Genetic
  • Environmental Exposures
  • Poverty and Impoverished Communities

Marie states there comes a point in the brain where a chemical switch occurs and the person no longer has a choice, but now has a substance addiction needed for their survival. She equates asking addicts to stop after the chemical switch occurs to asking someone having a heart attack to stop, or asking someone to stop having high blood pressure. To reinforce Marie’s point here, we can look at a Surgeon General’s report from November 17th, of 2016. It concluded what many in the medical field had known for years, addiction is a disease. 

The report shows that one in seven Americans are expected to develop a substance abuse problem, most come as a result of prolonged episodes of substance misuses that result in chemical changes to the brain. And of those 14%, only one in ten will ever receive treatment. This report spotlights not only the amount of Americans facing addiction, but also shows in real numbers, the harmful effects of the stigma around addiction. By calling it a moral failing, individuals become isolated with their disease and as a result, do not seek out treatments. Instead, they try to solve the problem on their own. 

Once the moral stigma is gone, a person can stop the downward spiral of trying to fix the disease on their own and instead work towards recovery in a group setting. In those group settings, an individual will have access to some of the most effective solutions: case management, professional assessments, family group therapy, and sometimes for those also facing homelessness, monetary support.  

But won’t they just spend it on alcohol? 

Another detrimental stigma that is held by many still today is a general unwillingness to trust those homeless individuals with monetary support from fears that the money given will be wasted and spent on alcohol, drugs, or other immoral practices. However, we’re now seeing data come in that suggests otherwise. The truth is, like addictions, most homeless Americans are not in their current situation due to decisions they have made. Research shows that the leading causes of homelessness in America today are:

  • Lack of Housing
  • Lack of Income
  • Sickness
  • Escaping Domestic Abuse
  • Racial Inequality

Pilot programs are pushing back on stereotypes

“Miracle Money”, a pilot program started by the non-profit Miracle Messages in California, set out to answer the question, “What would happen if we gave homeless people guaranteed income, and trusted them to spend it in the best way possible.” The results may surprise you. The program started with a crowdfunding goal of $15,000 but ended up with $40,000. Those funds were given to 14 unhoused people at $500 a month for a total of six months, with the intention of helping them find homes. Kevin Adler, the non-profit’s founder, said he had “zero expectations that anyone was going to get housed.” But at the end of the six months, 7 of the 14 receiving funds were able to find housing. 

One of the recipients, Drake Alabanza had developed severe sciatica causing him to lose his job as a nurse. As a result, Drake ended up living on the streets. With the funds, Drake was able to secure a SRO unit. Two recipients used their money to purchase service dogs needed for their PTSD and another bought a blender because he couldn’t eat solid foods. Adler added, “If it was just us telling people what to do, we wouldn’t have used the money as well as they used the money.”

More data continues to push against old stigmas

A similar pilot program was started in Canada by Dr. Jiaying Zhao in collaboration with Foundations for Social Change. This program worked as a research study to determine the impact of a $7,500 cash transfer to 50 unhoused individuals. Again, the results push back on current stigmas. Recipients moved into stable housing faster, spent less money on alcohol and drugs, kept more than $1000 in savings, and attained food security sooner than a control group who did not receive a cash transfer. 

Another key benefit of the program was a savings of $8,172 per person per year because they didn’t need the local shelter system. The program was funded by a federal grant, and the foundation’s hope is that more projects will be possible due to the pilot’s success. 

The value of autonomy

These are just two examples of successful programs giving unhoused people the resources necessary to address their individual needs via guaranteed income. When these types of programs work in conjunction with accountability and community, the evidence continues to show strong results. Trusting people to make smart decisions builds a level of self worth in the individual – a factor not often prioritized in our standard answer to the homelessness and addiction problems. 

Marie mentions in the Real Hope podcast that her time playing high school basketball taught her the importance of teamwork. She draws the parallel of winning games as a team and beating addiction as a team. We wouldn’t expect a single person, no matter how talented, to win a ball game on their own. And as more data comes to us showing addiction and homelessness are best beat with a community of support, it’s time to update our thinking. 

If the final goal is sustained recovery, then implementing modern solutions should be our main focus. And if the stigma of moral failing is a roadblock keeping individuals from seeking effective group solutions, then it is incumbent upon us to tear down those stigmas and thereby create a path to effective and prolonged recovery. 

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