When is Drug and Alcohol Treatment Going to Advance?

This American Life over the weekend (Episode 554--"Not It") had a feature on Puerto Rican residents being flown to the cities within the continental U.S. and dropped in unlicensed treatment facilities.  The reporter and the host seemed surprised over all of this, but I kept waiting for something shocking.  The Alcohol and Drug treatment folks have done an awful job of helping people deal with their addictions for decades.  They have focused on the punitive approach and avoided the healthcare and behavioral health aspects of addiction.   They have a one size fits all approach to the addiction (12 steps), and have not changed for 70 years despite a 90% failure rate. They set up artificial barriers to participation and then dismiss the majority of the people seeking help.

This program interviewed an HIV positive citizen of San Juan who was promised a better life in Chicago.   When he got to Illinois, he failed out of the program and now does not speak the language and does not have access to his HIV medicine.  He is homeless and none of the things promised materialized.  These promises were made by the city health officials in San Juan and what is the equivalent of our state government.  He was not told that these facilities he was going to were not licensed by the City or the State of Illinois.  He was not told that if he cannot maintain his sobriety he would be on the streets in a rough climate, and he was not told that he would have to find his own way back home.   It is radically different to be homeless in the tropical island of Puerto Rico compared to the mean, cold streets of Chicago.  The government and agency officials that the reporter talked to were not sympathetic.  They said that there is such a huge problem with addiction that they can not handle the number of people who need help. 

They governor of Puerto Rico said that he would welcome his brothers back, but did not see a huge problem with this strategy.  Most seemed to believe that these big cities would be able to handle the problem.  There was not the embarrassment or deer in the headlight moment of, "Mr. Wallace, you caught me--now get out!" Instead, we got a big shrug from all the officials.  The person in both Chicago who received these refugees and the program director in San Juan both spoke openly about the program.  They were not making money off the shipping people off the island.  They did not see the harm.  They felt that the people who failed were weak or irresponsible. 

In my 20 years of working at NEOCH, this is what I have seen up and down the Alcohol and Drug system.  They screen most people out because they don't want the negative element to contaminate the whole bunch, and then most of the people fail out of the program.  Never does anyone say, "This is not working, lets change our strategy."  There is no medicine or combination of medicine and treatment to help people with this brain disorder.  There is the 12 steps and nothing else.  Those that fail out are punished with homelessness and alienation from their family.  They are viewed as toxic and shunned for fear of their "disease" spreading.  There are waiting lists for help, and then everything revolves around talk therapy.  The day the addicted individual is ready to stop drinking, they have to have money or insurance or they wait for detox and treatment.  We lose so many people who go back to drinking because on the day that they make the decision to quit there is no space and so they go back to the streets and drink. 

Why haven't we come up with alternatives to 12 steps and making people homeless if they fail out of a 12 step program?   We could clean up 60% of the problems associated with homelessness if we just had some effective treatments for the behavioral health problem known as addiction.  If we treated it as a health concern and not a lifestyle choice, we could begin to make progress.   This casting people to the wind and hoping that they get better is only surprising in how far they had to travel in the This American Life radio story, but it is no different than evicting people from transitional programs to live on the streets of Cleveland.  Or kicking people out of their suburban home because their addiction is out of control.   I know how difficult family members are who are spending all their money on drugs or alcohol or those who cannot take care of their kids because they are drunk every night.  I just refuse to believe that our advanced society has not come up with an answer that does not involve homelessness and sleeping on the streets of Chicago or Cleveland to deal with addictions. 

Brian Davis

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PS Our staff person Joyce, will be on the WCPN series Cleveland Tough this Thursday morning.  Tune in for the Brian Bull stories about individuals who have overcome so much.  Many of these stories are struggles to overcome addiction.