4 ms·

Homelessness != Substance Use Disorder Moreover, why does treatment have to come at the expense of self-determination? The reality is that people want to recei

Homelessness != Substance Use Disorder Moreover, why does treatment have to come at the expense of self-determination? The reality is that people want to receive treatment--if they don't, it is because they encounter a barrier to treatment. Barriers to treatment include: lack of treatment facilities (hospitals do not count), poor quality of existing treatment facilities, unwillingness of treatment facilities to take anything but an abstinence-only approach, lack of other treatment options, such as medically assisted treatment. So I would say yes to all your points, except number 2. If people don't want to recieve treatment, then we should assume that the treatment isn't good enough and needs to be improved. But indefinitely detaining someone in a place that they don't want to be is frankly a human rights abuse, and contradicts your first point.

ksenzee 8y ago
> Homelessness != Substance Use Disorder True. But the Venn diagram overlaps a _lot_. If we magically solved homelessness for everyone with a substance-abuse problem, the people still left homeless would be the ones cities are already able to help.
- nyghtly 8y ago
  If you solved homelessness (not with magic, but with money) for everyone with a substance use disorder, then a lot more people would seek treatment, and a lot more would be successful. Even better, you could make that housing into supportive housing, which would prevent deaths from substance use in isolation.
  - Domenic_S 8y ago
    One of the features of addiction and many other mental health issues is a total denial of a problem. It's one of the symptoms of the disease. That's why the first step in 10-step programs is _admit you have a problem_.
- darpa_escapee 8y ago
  The majority of homelessness is caused by economic issues like the loss of a job, lack of sufficient income, lack of affordable housing and domestic violence. I did some work for an Australian charity that works with the homeless, so I have this graphic[1] on hand. Here's a relevant graphic for the US[4]. The top three obstacles to obtaining permanent housing in SF are lack of affordability, unemployment and lack of housing availability[2]. The figures I've seen put substance abuse and alcoholism between ~10% and ~20% of the reasons for homelessness[3]. [1] https://probonoaustralia.com.au/wp-content/uploads/2016/08/what-causes-homelessness-in-Australia-1024x630.jpg https://probonoaustralia.com.au/wp-content/uploads/2016/08/w... [2] http://www.socketsite.com/archives/2016/02/san-franciscos-homeless-crisis-is-homegrown.html http://www.socketsite.com/archives/2016/02/san-franciscos-ho... [3] https://www.spur.org/sites/default/files/wysiwyg/Figure%206_0.png https://www.spur.org/sites/default/files/wysiwyg/Figure%206_... [4] http://www.homelesshouston.org/wp-content/uploads/2012/09/loss_of_job_pie.gif http://www.homelesshouston.org/wp-content/uploads/2012/09/lo...
  - wjossey 8y ago
    Thanks for taking the time to provide background data. This is all really great. I'm skeptical of the percentages you shared, not because I think people are liars, but that rooting out causative effects is complex, especially in self-reported cases. I have an aunt who was homeless for the better part of a decade. If you had spoken to her during this period of time about why she was homeless, she would have said many things such as (1) she lost her job (2) she got evicted (3) her family kicked her out. In reality she is a paranoid schizophrenic, who does not understand when she's not on her medication that she has schizophrenia. So, was she homeless because she lost her job? Yes. Did she lose her job because she was scaring customers due to her mental disorder? Yes. When my father was in the hospital and detoxing from his alcohol abuse, he was asked repeatedly "Russ, do you have an alcohol problem?" He uniformly responded "No I do not." He only changed his tune when he believed answering in the affirmative would get his release. My general point is that homelessness and substance abuse are deeply intertwined, and that if we pull on the thread long enough in someone's backstory, we'll often find that substance abuse was a catalyst in the chain reaction that resulted in their homelessness, but they aren't willing to, or aren't self aware enough, to recognize it.
ameister14 8y ago
>The reality is that people want to receive treatment--if they don't, it is because they encounter a barrier to treatment. It sounds like you don't know many people with Schizophrenia.
wjossey 8y ago
>The reality is that people want to receive treatment--if they don't, it is because they encounter a barrier to treatment. While I agree that there are huge barriers to treatment, I'll respectfully disagree that people with substances abuse regularly want to receive treatment. Getting someone to just admit they have a substance abuse problem is remarkably challenging (the story of my father is just one of many in my family). Then, it's another hurdle to get them to recognize they can't do it on their own. Then, it's another hurdle to get them to stick with a program. Then, it's another hurdle to get them back into a program once they relapse. So, I'm right there with you that we need to improve access dramatically. But, just improving access won't open the floodgates, sadly.
- Nomentatus 8y ago
  Certainly, where I am, far, far more people want treatment than can get it. So much so it's impossible to guess how many don't want it (yet.) How effective current treatment is - other than naltrexone perhaps, is another story. I'm pessimistic there, too.
  - wjossey 8y ago
    I don't think our two statements are at odds with one another. There is absolutely a resource shortage to deal with these issues. In addition, there's the pernicious side effect of the disease in that it keeps you from wanting to seek treatment.
mullingitover 8y ago
> Homelessness != Substance Use Disorder An officer of the Commissioned Corps of the Public Health Service told me that in the greater Boston area, he estimates ~90% of the homeless population has a substance use disorder. I agree that not all homeless are in their condition because of substance use disorders, but I suspect it's a clear majority who are in this condition. > The reality is that people want to receive treatment--if they don't, it is because they encounter a barrier to treatment. Everyone, really? That's a bold claim, where is the evidence?
dragonwriter 8y ago
> Homelessness != Substance Use Disorder True, but a very large portion of the homeledd population has such a disorder, and an overlapping very large portion has at least one mental health disorder; they are deeply intertwined problems. > The reality is that people want to receive treatment The reality is that they often don't.

ksenzee 8y ago

> Homelessness != Substance Use Disorder True. But the Venn diagram overlaps a _lot_. If we magically solved homelessness for everyone with a substance-abuse problem, the people still left homeless would be the ones cities are already able to help.

nyghtly 8y ago
If you solved homelessness (not with magic, but with money) for everyone with a substance use disorder, then a lot more people would seek treatment, and a lot more would be successful. Even better, you could make that housing into supportive housing, which would prevent deaths from substance use in isolation.
- Domenic_S 8y ago
  One of the features of addiction and many other mental health issues is a total denial of a problem. It's one of the symptoms of the disease. That's why the first step in 10-step programs is _admit you have a problem_.
darpa_escapee 8y ago
The majority of homelessness is caused by economic issues like the loss of a job, lack of sufficient income, lack of affordable housing and domestic violence. I did some work for an Australian charity that works with the homeless, so I have this graphic[1] on hand. Here's a relevant graphic for the US[4]. The top three obstacles to obtaining permanent housing in SF are lack of affordability, unemployment and lack of housing availability[2]. The figures I've seen put substance abuse and alcoholism between ~10% and ~20% of the reasons for homelessness[3]. [1] https://probonoaustralia.com.au/wp-content/uploads/2016/08/what-causes-homelessness-in-Australia-1024x630.jpg https://probonoaustralia.com.au/wp-content/uploads/2016/08/w... [2] http://www.socketsite.com/archives/2016/02/san-franciscos-homeless-crisis-is-homegrown.html http://www.socketsite.com/archives/2016/02/san-franciscos-ho... [3] https://www.spur.org/sites/default/files/wysiwyg/Figure%206_0.png https://www.spur.org/sites/default/files/wysiwyg/Figure%206_... [4] http://www.homelesshouston.org/wp-content/uploads/2012/09/loss_of_job_pie.gif http://www.homelesshouston.org/wp-content/uploads/2012/09/lo...
- wjossey 8y ago
  Thanks for taking the time to provide background data. This is all really great. I'm skeptical of the percentages you shared, not because I think people are liars, but that rooting out causative effects is complex, especially in self-reported cases. I have an aunt who was homeless for the better part of a decade. If you had spoken to her during this period of time about why she was homeless, she would have said many things such as (1) she lost her job (2) she got evicted (3) her family kicked her out. In reality she is a paranoid schizophrenic, who does not understand when she's not on her medication that she has schizophrenia. So, was she homeless because she lost her job? Yes. Did she lose her job because she was scaring customers due to her mental disorder? Yes. When my father was in the hospital and detoxing from his alcohol abuse, he was asked repeatedly "Russ, do you have an alcohol problem?" He uniformly responded "No I do not." He only changed his tune when he believed answering in the affirmative would get his release. My general point is that homelessness and substance abuse are deeply intertwined, and that if we pull on the thread long enough in someone's backstory, we'll often find that substance abuse was a catalyst in the chain reaction that resulted in their homelessness, but they aren't willing to, or aren't self aware enough, to recognize it.

ameister14 8y ago

>The reality is that people want to receive treatment--if they don't, it is because they encounter a barrier to treatment. It sounds like you don't know many people with Schizophrenia.

wjossey 8y ago

>The reality is that people want to receive treatment--if they don't, it is because they encounter a barrier to treatment. While I agree that there are huge barriers to treatment, I'll respectfully disagree that people with substances abuse regularly want to receive treatment. Getting someone to just admit they have a substance abuse problem is remarkably challenging (the story of my father is just one of many in my family). Then, it's another hurdle to get them to recognize they can't do it on their own. Then, it's another hurdle to get them to stick with a program. Then, it's another hurdle to get them back into a program once they relapse. So, I'm right there with you that we need to improve access dramatically. But, just improving access won't open the floodgates, sadly.

Nomentatus 8y ago
Certainly, where I am, far, far more people want treatment than can get it. So much so it's impossible to guess how many don't want it (yet.) How effective current treatment is - other than naltrexone perhaps, is another story. I'm pessimistic there, too.
- wjossey 8y ago
  I don't think our two statements are at odds with one another. There is absolutely a resource shortage to deal with these issues. In addition, there's the pernicious side effect of the disease in that it keeps you from wanting to seek treatment.

mullingitover 8y ago

> Homelessness != Substance Use Disorder An officer of the Commissioned Corps of the Public Health Service told me that in the greater Boston area, he estimates ~90% of the homeless population has a substance use disorder. I agree that not all homeless are in their condition because of substance use disorders, but I suspect it's a clear majority who are in this condition. > The reality is that people want to receive treatment--if they don't, it is because they encounter a barrier to treatment. Everyone, really? That's a bold claim, where is the evidence?

dragonwriter 8y ago

> Homelessness != Substance Use Disorder True, but a very large portion of the homeledd population has such a disorder, and an overlapping very large portion has at least one mental health disorder; they are deeply intertwined problems. > The reality is that people want to receive treatment The reality is that they often don't.