by Michael Gallo, Psy.D
I am a Doctor of Psychology (Clinical) with over 25 years of experience, often treating individuals with substance abuse problems and housing challenges. In 1995 I specifically worked at the Tampa, Florida, VA hospital in a program designed to help such individuals attain rehabilitation in terms of social life behaviors, health maintenance skills (physical and mental), and daily living/housing challenges. In the latter part of my career, I worked for the U.S. Department of the Army with active-duty soldiers, many of whom were experiencing struggles with drugs and alcohol, and PTSD.
My clinical experiences have led me to conclude that a “Housing First” strategy toward helping unhoused drug and alcohol abusers is unsuccessful most of the time. Essentially, an individual who is provided housing, while still being permitted to use drugs/alcohol actively, will ultimately not be able to sustain their housing situation in an appropriate manner. In short, they will soon become evicted from the particular housing situation due to problems resulting from drug use and become homeless again. Substance abuse rules a person’s life and precludes them from behaving in a socially congruent manner. Similarly, we can not treat someone’s mental illness while they continue to abuse mind-altering substances, as the intoxicating chemicals dominate a person’s mind. Treatment with psychiatric medicines/psychotherapy will not work because drugs/alcohol precludes healing.
It is unrealistic to think that good housing alone will result in the individual beginning to live in a healthy manner. Before anything else, the person must become abstinent from drugs and alcohol.
In a recent Burien City Council meeting, I witnessed an individual who worked for the City in an official capacity, state (paraphrased) “that a drug abuser/addict may need ‘years,’ along with ‘relationships’ (not defined operationally by this official) before they come to the point where they will accept treatment and rehabilitation.” This hypothesis has not been supported by any existing credible research that I know of. Moreover, most drug addicts do not have years. With the advent of fentanyl, a single tablet can kill. Official tolerance for continued drug addiction, while we wait until someone is ‘ready to quit,’ exposes the individual to multiple other threats (e.g., health decline, medical emergencies, overdose, criminals, etc.).
An alternative exists which combines compassion with a “tough” form of caring. Individuals should be compelled to accept treatment/rehabilitation closely coupled with good shelter, meals, medical care, and other life necessities. This should initially be involuntary commitment, but transitioned to a less restrictive situation as soon as possible, as is warranted individually. People who enter the criminal justice system via the new Washington State Drug Enforcement Law should not be put in jail, but rather in secure treatment/rehabilitation facilities, where they can receive all the services I mentioned above.
The above outlined approach would be especially effective in helping persons living unhoused in public places ( i.e., campers.) We must honestly acknowledge that no mentally healthy person would choose to live in this type of situation. Cold, heat, snow, rain, great discomfort, disease, fire danger, and, most importantly, criminal attacks are omnipresent. Moreover, drug dealers have an easily accessible, centralized location to push the poisons they sell.
City ordinances should be designed to firmly motivate unhoused individuals to vacate encampments and avail themselves of public and private shelters and treatment services. These would be acts of charity, not cruelty. We should not allow our fellow citizens, who are unable or unmotivated to help themselves (because of mental illness and/or drug/alcohol addiction), to wither in misery and decline towards illness and death. We are obligated to help them firmly but compassionately start on the road to a healthy, happy life.
Michael Gallo, Psy.D