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Virtually every homeless shelter will refuse to house someone who is drunk, on drugs, or belligerent. This article only makes a passing reference to people who

Virtually every homeless shelter will refuse to house someone who is drunk, on drugs, or belligerent. This article only makes a passing reference to people who refuse shelter so they can continue their substance abuse, but this is a salient reason for homelessness given by many people on the streets (especially in SF).

FireBeyond 3y ago
In discussing this issue with the EMT and paramedic students I teach, absolutely this. "If your life had descended to a point where you had to go to the bathroom in an alley and use scrap paper to wipe, or were eating your lunch that you fetched from a trash can on the street in the rain, there's a good chance you would use opioids to numb the pain of that existence, too." And once you start using some of the most powerfully addictive substances we know, it's not about "flaws of character" or anything else, now you've messed with brain chemistry, in some cases, permanently.
- wizerdrobe 3y ago
  Is the typical pipeline homeless-to-opioid? I’m asking because as a teenager I lived in motels and homeless with pill-mill turned heroin addict parents and my anecdotal experiences with the broader transient public suggest a downward spiral involving substances first.
  - red-iron-pine 3y ago
    more opioid to homeless. Uncle Bob gets hurt, can't work for a while, and gets put on Percocet, but that's to expensive and has limitations. Eventually he gets on other pills, and then a neighbor mentions he sells pills sometimes, and can get other stuff. Few years later Bob can't take pills, can't afford them, but can snag bags of H. That's stable for a second but eventually it screws his life up more, and he's homeless. A lot of young folks end up there cuz their home life was bad and it was easy to party / forget abuse at home, and just end up stuck.
  - FireBeyond 3y ago
    I'd hesitate to say 'typical'. I think your use of the word 'spiral' is entirely appropriate because it becomes this revolving descent. Casual substance use becomes substance abuse becomes poverty becomes ... and similarly mental health becomes poverty becomes self-medication via substance use and abuse.
  - seanmcdirmid 3y ago
    A lot of it is substance abuse first, a lot of it isn't. Homeless advocates don't want to emphasize the former cases, however, since it drains empathy faster than just assuming everyone is in the latter category (although it doesn't really matter, empathy is drained quickly in either case). The same debate rages over between groups of people who wind up unhoused locally vs those who arrive already unhoused (you get more empathy for the former and less for the latter, both categories are significantly non-empty).
  - brian_cunnie 3y ago
    > suggest a downward spiral involving substances first. Anecdotally, as a person in San Francisco who's been in recovery 23 years, all the people I know who were once homeless became homeless because they were abusing drugs and alcohol. Sometimes mental illness was at play, too. There's a strong selection bias in my sample set — they're all alcoholics/addicts (thankfully in recovery, thankfully housed).
  - doctorpangloss 3y ago
    I can't find a firm answer to the question "Among the homeless, what fraction have opioid use disorder; a history that contains a legitimate medical visit connected to the prescription of opioids; and no history of substance abuse prior to that visit?" We'd need a Danish style medical records system to answer queries like that, or you can study it with VA data. Opioid use disorder is crazy common, nearly 5% of Americans (https://www.nih.gov/news-events/rates-nonmedical-prescription-opioid-use-opioid-use-disorder-double-10-years); https://www.nih.gov/news-events/rates-nonmedical-prescriptio... but also 9% of the population uses cannabis (https://www.cdc.gov/drugoverdose/deaths/index.html https://www.cdc.gov/drugoverdose/deaths/index.html). It's unclear how many overdose deaths happen to homeless people every year generally, and you can conclude that since homelessness is rare, so too will be "homeless given overdose death." However, the flip side - overdose death as a fraction of all deaths given homeless - can be 17% in one study (https://drugfree.org/drug-and-alcohol-news/more-homeless-die-from-drug-overdoses-than-from-aids/ https://drugfree.org/drug-and-alcohol-news/more-homeless-die...). So overall, I think you're right. Opioid disorder is so much more common than homelessness generally, homelessness is not going to possibly explain opioid use disorder in the general case. Of course it can interfere with treatment. However, when so many people use cannabis, and I haven't even investigated alcohol, the right idea is that substance abuse is so prevalent in America, you'd need more serious interventions earlier on. The issue that can be acted by just medical professionals, which is the prescription of painkillers due to legitimate medical visits that lead to substance abuse, I think there is action on this but I'm not sure what it is.
  - mc32 3y ago
    That’s my experience as well. The path all the homeless and couch surfers I’ve known was drug abuse and dependence leading to loss of job then eventual homelessness due to not paying rent, roommates getting fed up, or parents getting fed up. I know that some homeless are different and became homeless first and then became addicted to substances, but I have not known them. As another poster, Sean, points out most homeless advocates are loath to admit to this for obvious reasons.
- cogman10 3y ago
  I'd also add that the homeless are often victims of abuse with pretty much no societal support. Several homeless people were murdered here and it was basically a "what are you gonna do about it?". For good reason, many homeless also don't trust cops as they are just as likely to abuse or harass them as anyone else. Channel 5s recent discussion on this is something everyone should watch to get a good picture of what they are dealing with.
- deleted 3y ago
  [deleted]
seanmcdirmid 3y ago
There are non-sober shelters out there, but homeless are afraid of them because they allow drunk, on drugs, or belligerent residence, so they refuse to use them. Drug addicts don't want to room with other drug addicts, they feel like (and are often correct that) they have better chances sleeping outside.
theossuary 3y ago
They'll also refuse to house you if you have a pet, smell like alcohol, have a tent, or they just filled up already. There is rarely consistency in a shelter, so most are better off finding an alternative that's consistent. Otherwise you end up with no shelter some nights, with no way to manage it. I can't stand how everyone keeps brushing over the fact that it's completely legal to clear an encampment if there's somewhere for them to go. Instead of immediately starting housing first initiatives; these cities pretend there's nothing they can do and continue to sue for the right to inflict cruel and unusual punishment on their citizens. It's insane.
- bradleyjg 3y ago
  If you lost your job and couldn’t find another one, you’d land on a couch somewhere. Most of us would. Other people may be glossing over some legal technicality but the “it’s easy, we just need to spend more money” crowd constantly and deliberately glosses over the fact that the population we are talking about are not people down on their luck and just need a helping hand to get back on their feet. They are people that have alienated everyone in their lives and that no else in this world—-including each other—-wants to share space with.
  - deleted 3y ago
    [deleted]
  - thecrash 3y ago
    > If you lost your job and couldn’t find another one, you’d land on a couch somewhere. Most of us would. Another way of saying this is that your safety net is the excess capacity of your social network. If your network is composed of people with stable jobs and guest rooms, it's practically guaranteed that someone will accommodate you for as long as you need. After taking all the time you need to get back on your feet, you will probably pay it forward to others in your social network. If your social network is composed of people with low income, lots of dependents, and unstable housing, it's less likely. Sometimes because your peers have no capacity to help, but mostly because the network is already saturated - you're not the only one of your friends who needs a couch and a ride to work. A term to describe this phenomenon is "class", which is a concept so thoroughly erased from American culture that we have to rediscover it through thought exercises like this.
koheripbal 3y ago
I know someone who works as a social worker in a homeless shelter. She is the sweetest young woman in the world. It is a hellish job. I cannot even imagine her managing belligerent addicts. She would quit in a heartbeat. These rules are in place for the simple reason that workers demand it
jorblumesea 3y ago
It's more nuanced than that. People who are homeless sometimes have preexisting conditions that caused them to become homeless (mental issues, substance abuse issues) and obviously their addictions just get worse. People who are on the street turn to any kind of drug they can find to numb the harsh realities of living on the street. Alcohol and cheap opioids. It would be a struggle to find a homeless person without some kind of substance abuse problem. Addict to homeless process, or homeless to addict process.
- atdrummond 3y ago
  You’re stripping these people of way too much agency. As a formerly homeless heroin addict, I assure you that the vast majority of addicts and dual diagnosis individuals can get off the street. Estonia and Switzerland have accomplished this for fentanyl and heroin respectively, in addition to stimulant and alcohol abusers. The issue is there’s a cohort who thinks that the solutions that enable safe streets require too much sacrifice of one’s individual liberty - even if said individual abuses their freedom to harm themself and others.
- PaulDavisThe1st 3y ago
  > numb the harsh realities of living on the street not just the street; schizophrenia and schizo-affective disorder are substantially over-represented in the homeless population, and many of the people who suffer from these conditions are self-medicating to try to "cope" with them. This is of course a double or triple tragedy: first, we have quite effective drugs that they could use which be much more beneficial than alcohol, opiates and nicotine; secondly, it is much easier to treat these conditions if they are caught early, but the nature of the intersection between US healthcare and poverty means that it very often is not. ps. I learnt all this last night at a training program for first responders.

FireBeyond 3y ago

In discussing this issue with the EMT and paramedic students I teach, absolutely this. "If your life had descended to a point where you had to go to the bathroom in an alley and use scrap paper to wipe, or were eating your lunch that you fetched from a trash can on the street in the rain, there's a good chance you would use opioids to numb the pain of that existence, too." And once you start using some of the most powerfully addictive substances we know, it's not about "flaws of character" or anything else, now you've messed with brain chemistry, in some cases, permanently.

wizerdrobe 3y ago
Is the typical pipeline homeless-to-opioid? I’m asking because as a teenager I lived in motels and homeless with pill-mill turned heroin addict parents and my anecdotal experiences with the broader transient public suggest a downward spiral involving substances first.
- red-iron-pine 3y ago
  more opioid to homeless. Uncle Bob gets hurt, can't work for a while, and gets put on Percocet, but that's to expensive and has limitations. Eventually he gets on other pills, and then a neighbor mentions he sells pills sometimes, and can get other stuff. Few years later Bob can't take pills, can't afford them, but can snag bags of H. That's stable for a second but eventually it screws his life up more, and he's homeless. A lot of young folks end up there cuz their home life was bad and it was easy to party / forget abuse at home, and just end up stuck.
- FireBeyond 3y ago
  I'd hesitate to say 'typical'. I think your use of the word 'spiral' is entirely appropriate because it becomes this revolving descent. Casual substance use becomes substance abuse becomes poverty becomes ... and similarly mental health becomes poverty becomes self-medication via substance use and abuse.
- seanmcdirmid 3y ago
  A lot of it is substance abuse first, a lot of it isn't. Homeless advocates don't want to emphasize the former cases, however, since it drains empathy faster than just assuming everyone is in the latter category (although it doesn't really matter, empathy is drained quickly in either case). The same debate rages over between groups of people who wind up unhoused locally vs those who arrive already unhoused (you get more empathy for the former and less for the latter, both categories are significantly non-empty).
- brian_cunnie 3y ago
  > suggest a downward spiral involving substances first. Anecdotally, as a person in San Francisco who's been in recovery 23 years, all the people I know who were once homeless became homeless because they were abusing drugs and alcohol. Sometimes mental illness was at play, too. There's a strong selection bias in my sample set — they're all alcoholics/addicts (thankfully in recovery, thankfully housed).
- doctorpangloss 3y ago
  I can't find a firm answer to the question "Among the homeless, what fraction have opioid use disorder; a history that contains a legitimate medical visit connected to the prescription of opioids; and no history of substance abuse prior to that visit?" We'd need a Danish style medical records system to answer queries like that, or you can study it with VA data. Opioid use disorder is crazy common, nearly 5% of Americans (https://www.nih.gov/news-events/rates-nonmedical-prescription-opioid-use-opioid-use-disorder-double-10-years); https://www.nih.gov/news-events/rates-nonmedical-prescriptio... but also 9% of the population uses cannabis (https://www.cdc.gov/drugoverdose/deaths/index.html https://www.cdc.gov/drugoverdose/deaths/index.html). It's unclear how many overdose deaths happen to homeless people every year generally, and you can conclude that since homelessness is rare, so too will be "homeless given overdose death." However, the flip side - overdose death as a fraction of all deaths given homeless - can be 17% in one study (https://drugfree.org/drug-and-alcohol-news/more-homeless-die-from-drug-overdoses-than-from-aids/ https://drugfree.org/drug-and-alcohol-news/more-homeless-die...). So overall, I think you're right. Opioid disorder is so much more common than homelessness generally, homelessness is not going to possibly explain opioid use disorder in the general case. Of course it can interfere with treatment. However, when so many people use cannabis, and I haven't even investigated alcohol, the right idea is that substance abuse is so prevalent in America, you'd need more serious interventions earlier on. The issue that can be acted by just medical professionals, which is the prescription of painkillers due to legitimate medical visits that lead to substance abuse, I think there is action on this but I'm not sure what it is.
- mc32 3y ago
  That’s my experience as well. The path all the homeless and couch surfers I’ve known was drug abuse and dependence leading to loss of job then eventual homelessness due to not paying rent, roommates getting fed up, or parents getting fed up. I know that some homeless are different and became homeless first and then became addicted to substances, but I have not known them. As another poster, Sean, points out most homeless advocates are loath to admit to this for obvious reasons.
cogman10 3y ago
I'd also add that the homeless are often victims of abuse with pretty much no societal support. Several homeless people were murdered here and it was basically a "what are you gonna do about it?". For good reason, many homeless also don't trust cops as they are just as likely to abuse or harass them as anyone else. Channel 5s recent discussion on this is something everyone should watch to get a good picture of what they are dealing with.
deleted 3y ago
[deleted]

seanmcdirmid 3y ago

There are non-sober shelters out there, but homeless are afraid of them because they allow drunk, on drugs, or belligerent residence, so they refuse to use them. Drug addicts don't want to room with other drug addicts, they feel like (and are often correct that) they have better chances sleeping outside.

theossuary 3y ago

They'll also refuse to house you if you have a pet, smell like alcohol, have a tent, or they just filled up already. There is rarely consistency in a shelter, so most are better off finding an alternative that's consistent. Otherwise you end up with no shelter some nights, with no way to manage it. I can't stand how everyone keeps brushing over the fact that it's completely legal to clear an encampment if there's somewhere for them to go. Instead of immediately starting housing first initiatives; these cities pretend there's nothing they can do and continue to sue for the right to inflict cruel and unusual punishment on their citizens. It's insane.

bradleyjg 3y ago
If you lost your job and couldn’t find another one, you’d land on a couch somewhere. Most of us would. Other people may be glossing over some legal technicality but the “it’s easy, we just need to spend more money” crowd constantly and deliberately glosses over the fact that the population we are talking about are not people down on their luck and just need a helping hand to get back on their feet. They are people that have alienated everyone in their lives and that no else in this world—-including each other—-wants to share space with.
- deleted 3y ago
  [deleted]
- thecrash 3y ago
  > If you lost your job and couldn’t find another one, you’d land on a couch somewhere. Most of us would. Another way of saying this is that your safety net is the excess capacity of your social network. If your network is composed of people with stable jobs and guest rooms, it's practically guaranteed that someone will accommodate you for as long as you need. After taking all the time you need to get back on your feet, you will probably pay it forward to others in your social network. If your social network is composed of people with low income, lots of dependents, and unstable housing, it's less likely. Sometimes because your peers have no capacity to help, but mostly because the network is already saturated - you're not the only one of your friends who needs a couch and a ride to work. A term to describe this phenomenon is "class", which is a concept so thoroughly erased from American culture that we have to rediscover it through thought exercises like this.

koheripbal 3y ago

I know someone who works as a social worker in a homeless shelter. She is the sweetest young woman in the world. It is a hellish job. I cannot even imagine her managing belligerent addicts. She would quit in a heartbeat. These rules are in place for the simple reason that workers demand it

jorblumesea 3y ago

It's more nuanced than that. People who are homeless sometimes have preexisting conditions that caused them to become homeless (mental issues, substance abuse issues) and obviously their addictions just get worse. People who are on the street turn to any kind of drug they can find to numb the harsh realities of living on the street. Alcohol and cheap opioids. It would be a struggle to find a homeless person without some kind of substance abuse problem. Addict to homeless process, or homeless to addict process.

atdrummond 3y ago
You’re stripping these people of way too much agency. As a formerly homeless heroin addict, I assure you that the vast majority of addicts and dual diagnosis individuals can get off the street. Estonia and Switzerland have accomplished this for fentanyl and heroin respectively, in addition to stimulant and alcohol abusers. The issue is there’s a cohort who thinks that the solutions that enable safe streets require too much sacrifice of one’s individual liberty - even if said individual abuses their freedom to harm themself and others.
PaulDavisThe1st 3y ago
> numb the harsh realities of living on the street not just the street; schizophrenia and schizo-affective disorder are substantially over-represented in the homeless population, and many of the people who suffer from these conditions are self-medicating to try to "cope" with them. This is of course a double or triple tragedy: first, we have quite effective drugs that they could use which be much more beneficial than alcohol, opiates and nicotine; secondly, it is much easier to treat these conditions if they are caught early, but the nature of the intersection between US healthcare and poverty means that it very often is not. ps. I learnt all this last night at a training program for first responders.