5 ms·

Homelessness, especially in places such as the SF Bay Area, really doesn't boil down to just affordability. Yes, there are some folks who just faced economic he

Homelessness, especially in places such as the SF Bay Area, really doesn't boil down to just affordability. Yes, there are some folks who just faced economic headwinds and are living in a car while trying to find a way out. But there is also a huge population of people who couldn't function if given keys to a free apartment. For one, drugs won the war on drugs, addiction is a big part of the problem, and we don't really know how to fix it; harsh punishments don't work, quasi-decriminalization isn't a success, and treatment for people who don't want to be helped is hard. We also don't like to institutionalize people anymore, so folks with severe mental illness often end up on the streets too.

jeffbee 2y ago
Wrong on all points. The places with the most addicts (W. Virginia) have the least homelessness (W. Virginia again). There really isn't any more too it than supply and demand. The only reasons that is seems like all homeless are addicts are 1) only a small fraction of homeless are obviously homeless, and 2) addicts are less able to cope with high housing costs. But that's a marginal effect; plenty of drug abuse happens within the community of housed people.
- zeroCalories 2y ago
  it's really hard to afford a sf apartment AND a crippling drug addiction, for several reasond
  - chrischen 2y ago
    I’m not sure if getting rid of the addiction would automatically make SF houses affordable. Certainly doesn’t help. But it’s also not SF’s job to house the entire nation’s homeless population.
    - waveBidder 2y ago
      it seems like it is if they're former SF residents priced out of their homes.
      - shuckles 2y ago
        It's very unlikely that former residents (in the sense of paying for housing for extended periods of time with their own wage income) comprise a significant portion of San Francisco's street homeless.
        doctorpangloss 2y ago
        This is another one of your misconceptions. > Nearly 8 out of every 10 unhoused people in Oakland were living in Alameda County when they lost their housing. https://www.sfchronicle.com/projects/2021/homeless-project-oakland/ https://www.sfchronicle.com/projects/2021/homeless-project-o... > Primary Cause of Homelessness (Top five responses, Fig. 19) > Family or friends couldn't let me stay or argument with family/friend/roommate: 27% > Eviction/Foreclosure/Rent increase: 25% > Job loss: 22% > Other money issues including medical bills, etc.: 13% > Substance abuse: 13% https://homelessness.acgov.org/homelessness-assets/docs/reports/Data-Resource-Guide_2022-PIT-Count-Survey-Findings-2022_10_04.pdf https://homelessness.acgov.org/homelessness-assets/docs/repo... It's possible that many frequent flyers to emergency rooms have been dumped from other communities. But most homeless people are just that, people who have lost their homes in their community. And anyway, how could it really be any different? > with their own wage income Of course poverty is the number one reason they are becoming homeless. Why are you talking about wage income. They have too little income. Who the hell wants to live on the street!
        seanmcdirmid 2y ago
        Greyhound bus stations. If you’ve ever taken a bus across country before, they pick up a lot of people at prisons and they stay on until some west coast city (LA, SF, Portland, or Seattle). That accumulates, and once they stick around for at least a year, they are considered resident (for some definition of housing lost, that means even if they were housed in a hotel once, or couch surfed at the start). Surveys that rely on self reporting are incredibly inaccurate. One was done in Seattle, and found out that 80% of King county’s homeless population was previously housed in pioneer square, an absurdity that put the entire survey in doubt. It really is in the self interest of homeless oriented agencies and NGOs to present the problem as local as possible. If it isn’t local, then giving out housing will only make the local problem worse (people will start arriving for their free housing from other areas of the country), you can judge your success by how much worse the problem gets, which isn’t popular with local voters. Without good information, at any rate, it isn’t weird that we are seeing the problem get worse for every billion we throw at it. Eventually the popular cities will just give up trying very hard because they never had the power to fix it in the first place.
- shuckles 2y ago
  > The only reasons that is seems like all homeless are addicts are... The Point in Time count data indicate the vast majority of homeless people have issues with drug abuse. A substantial majority of those also have dual diagnoses. Maybe you are trying to argue that drug abuse is not sufficient, or something, but you have not brought that nuance. The OP is more correct than you: drug abuse has a large role to play in the street homelessness of San Francisco. (An alternative view: if rents were the primary causal factor, then why is the problem substantially worse than a decade ago when San Francisco rents peaked? Why did the problem get so much worse during COVID when nonpayment evictions were held for many years and low income renters got billions in cash transfers, increasing their aggregate income while rents dropped?)
  - DoreenMichele 2y ago
    Maybe you are trying to argue that drug abuse is not sufficient, or something, but you have not brought that nuance. Millionaire rock stars go in and out of rehab repeatedly and don't end up homeless. There is no direct cause-and-effect relationship between drug abuse and homelessness. We only make that connection after the fact. I know of zero credible sources predicting homelessness based on "He's an addict! So it's inevitable!" There are lots of problems with the stats we keep on homeless people and such people are by their very nature tough to track. There are political agendas driving how the questions get asked and the data gets framed, all of which contradicts my firsthand experience with homelessness and what I have heard for years from actual homeless people. In a nutshell: California has about 12 percent of the US population, 25 percent of the US homeless population and more than 50 percent of the nation's unsheltered homeless. I do not find it credible to claim these people are all "locals" and I firmly believe California is the dumping ground for the nation's homeless problem.
    - brynb 2y ago
      grapevine knowledge, but i have been told (and credibly, i think, given how adaptive humans are, and how they adapt for very specific parameters while devaluing others) that many homeless will go to great lengths to seek out new locales that seem willing to help sustain their needs without requiring wholesale change of their lifestyles. some people do indeed prefer it (or at least fear the alternative, i.e. “proper” integration into society and all that comes with that), as much as some people on this website cannot fathom that
- 01100011 2y ago
  A lot of folks in Appalachia seem to live in conditions tantamount to a tent encampment. They're more spread out and not in the way of urbanites so we don't talk about it much.
  - EasyMark 2y ago
    It also helps the cost of living is 1/4 what it is in a place like SF
reducesuffering 2y ago
It doesn’t just boil down to affordability, but how many people got down in the dumps struggling to afford their expensive apartment, got stressed out and depressed, caused relationship issues and drug use, and led to a downward spiral where they ended up in a place with severe mental illness and couldn’t function with free keys after 5 years of that?
mistermann 2y ago
> For one, drugs won the war on drugs What a great line.
bruceb 2y ago
"harsh punishments don't work" They do if they are very harsh, see Singapore, Indonesia etc. America doesn't want to that.
- ceejayoz 2y ago
  Indonesia? The country that has active guerrilla wars that date back to the 1960s?
derefr 2y ago
I can’t speak for general solutions, but at least one portion of the addicted just have chronic pain; were prescribed extremely strong and addictive painkillers (as the only thing that would work!); and then got cut off from the medical system. These people try and try to solve their debilitating chronic pain problem (which they still have, and likely will always have) through increasingly-desperate and illegal measures; and go through many harrowing things due almost solely of the illegality of acquiring these same drugs outside of medical channels: the difficulties of finding a source and potential for arrest; the income-eating expense (no insurance to cover costs, plus 10x risk markup); the heightened spike-dose addictiveness of street forms of these drugs, that leads to a quick fiending withdrawal and need to redose, leading in turn to loss of employment due to spending all your time on the street hunting for the next dose; and of course, the unpredictable dosing and potential for adulteration, leading into high potential for OD. Most of this particular problem can (and in some trials, has!) been solved just by prescribing these people the drugs they need again. When you go from unpredictably doing random shots of freebase heroin/fentanyl/etc with a dirty needle alone in an alley, back to predictably being able to get precisely-dosed extended-release pills from a pharmacy and take them on a set schedule, a lot of “addict behaviors” for these chronic-pain “addicts” just evaporate.
- tpmoney 2y ago
  This is definitely a problem. Turns out once you start getting to the "going to destroy your liver / stomach" levels of NSAIDs and Tylenol, there really isn't anything other than opioids for pain management. Unfortunately the war on drugs and America's latent puritan streak means that since some people in some places use opioids to get high, then all uses of opioids should be avoided whenever possible, and when they are used, they should only be used grudgingly and with extreme skepticism of the person receiving them. Surely nothing will be better for the health of an individual than barely managing their condition, constantly forcing them to stop effective treatment to make sure they're not growing tolerant of the medication and treating them as only slightly more trustworthy than a criminal conman. Sure, opioids are addictive, and you might find yourself in a situation where you're stuck on them for life and that's not great. And ultimately we have to ask "so what?" There are many conditions and medications that are lifelong and we don't treat the patients or their conditions the same way. Imagine telling a person taking SSRIs that they can't have a higher dosage because they're getting "tolerant" of the medication. Imagine telling a diabetes patient that you're not going to give them metformin or insulin because they might be on it for life. There are huge amounts of chronic conditions for which the ongoing treatments suck and have a lot of negative side effects, but living with the condition un-treated is worse than the negative side effects. Chronic pain (and the conditions causing that pain) seem to be the only category that we don't accept the possibility of long term negative consequences as the price of dealing with the chronic condition. And the hell of it is, I agree with concerns about pill mills. My family that has had to deal with this has had to deal with pill mills too. And it's bad just having higher and higher doses thrown at you. I agree that treatment needs to include more than just escalating opioid doses. But those same family members that were stuck in a pill mill were there for years longer than they needed to be because finding a way out was nearly impossible. If you want to change pain management doctors, 99% of them will not prescribe you opioids on your first visit. But you likely have a contract with your current pain doctor that says you won't go to other doctors for pain medications, so you can't see a different doctor while getting pain management from your current doctor. Then even if you could get them to prescribe your medications, they almost all want to start you from zero again. Imagine you want to change heart doctors but before they will treat you they want you to stop all your heart medications for a few months so that they can "get a baseline" for your condition. That would be an insane thing to ask for any other chronic condition, and yet that's a common thing to be asked of pain patients all the time. Overall as a society we're terrible at dealing with the concept of a chronic condition. We don't really grok the idea that some folks just won't ever "get better", and our entire system is set up to assume you will. The sad reality is some people are going to be in constant pain for their entire lives, and there's nothing we can do to stop that from being the case. Restricting these people from being able to safely access treatments to manage that pain because they might get addicted is misguided, cruel and missing the forest for the trees.

jeffbee 2y ago

Wrong on all points. The places with the most addicts (W. Virginia) have the least homelessness (W. Virginia again). There really isn't any more too it than supply and demand. The only reasons that is seems like all homeless are addicts are 1) only a small fraction of homeless are obviously homeless, and 2) addicts are less able to cope with high housing costs. But that's a marginal effect; plenty of drug abuse happens within the community of housed people.

zeroCalories 2y ago
it's really hard to afford a sf apartment AND a crippling drug addiction, for several reasond
- chrischen 2y ago
  I’m not sure if getting rid of the addiction would automatically make SF houses affordable. Certainly doesn’t help. But it’s also not SF’s job to house the entire nation’s homeless population.
  - waveBidder 2y ago
    it seems like it is if they're former SF residents priced out of their homes.
    - shuckles 2y ago
      It's very unlikely that former residents (in the sense of paying for housing for extended periods of time with their own wage income) comprise a significant portion of San Francisco's street homeless.
      - doctorpangloss 2y ago
        This is another one of your misconceptions. > Nearly 8 out of every 10 unhoused people in Oakland were living in Alameda County when they lost their housing. https://www.sfchronicle.com/projects/2021/homeless-project-oakland/ https://www.sfchronicle.com/projects/2021/homeless-project-o... > Primary Cause of Homelessness (Top five responses, Fig. 19) > Family or friends couldn't let me stay or argument with family/friend/roommate: 27% > Eviction/Foreclosure/Rent increase: 25% > Job loss: 22% > Other money issues including medical bills, etc.: 13% > Substance abuse: 13% https://homelessness.acgov.org/homelessness-assets/docs/reports/Data-Resource-Guide_2022-PIT-Count-Survey-Findings-2022_10_04.pdf https://homelessness.acgov.org/homelessness-assets/docs/repo... It's possible that many frequent flyers to emergency rooms have been dumped from other communities. But most homeless people are just that, people who have lost their homes in their community. And anyway, how could it really be any different? > with their own wage income Of course poverty is the number one reason they are becoming homeless. Why are you talking about wage income. They have too little income. Who the hell wants to live on the street!
        seanmcdirmid 2y ago
        Greyhound bus stations. If you’ve ever taken a bus across country before, they pick up a lot of people at prisons and they stay on until some west coast city (LA, SF, Portland, or Seattle). That accumulates, and once they stick around for at least a year, they are considered resident (for some definition of housing lost, that means even if they were housed in a hotel once, or couch surfed at the start). Surveys that rely on self reporting are incredibly inaccurate. One was done in Seattle, and found out that 80% of King county’s homeless population was previously housed in pioneer square, an absurdity that put the entire survey in doubt. It really is in the self interest of homeless oriented agencies and NGOs to present the problem as local as possible. If it isn’t local, then giving out housing will only make the local problem worse (people will start arriving for their free housing from other areas of the country), you can judge your success by how much worse the problem gets, which isn’t popular with local voters. Without good information, at any rate, it isn’t weird that we are seeing the problem get worse for every billion we throw at it. Eventually the popular cities will just give up trying very hard because they never had the power to fix it in the first place.
shuckles 2y ago
> The only reasons that is seems like all homeless are addicts are... The Point in Time count data indicate the vast majority of homeless people have issues with drug abuse. A substantial majority of those also have dual diagnoses. Maybe you are trying to argue that drug abuse is not sufficient, or something, but you have not brought that nuance. The OP is more correct than you: drug abuse has a large role to play in the street homelessness of San Francisco. (An alternative view: if rents were the primary causal factor, then why is the problem substantially worse than a decade ago when San Francisco rents peaked? Why did the problem get so much worse during COVID when nonpayment evictions were held for many years and low income renters got billions in cash transfers, increasing their aggregate income while rents dropped?)
- DoreenMichele 2y ago
  Maybe you are trying to argue that drug abuse is not sufficient, or something, but you have not brought that nuance. Millionaire rock stars go in and out of rehab repeatedly and don't end up homeless. There is no direct cause-and-effect relationship between drug abuse and homelessness. We only make that connection after the fact. I know of zero credible sources predicting homelessness based on "He's an addict! So it's inevitable!" There are lots of problems with the stats we keep on homeless people and such people are by their very nature tough to track. There are political agendas driving how the questions get asked and the data gets framed, all of which contradicts my firsthand experience with homelessness and what I have heard for years from actual homeless people. In a nutshell: California has about 12 percent of the US population, 25 percent of the US homeless population and more than 50 percent of the nation's unsheltered homeless. I do not find it credible to claim these people are all "locals" and I firmly believe California is the dumping ground for the nation's homeless problem.
  - brynb 2y ago
    grapevine knowledge, but i have been told (and credibly, i think, given how adaptive humans are, and how they adapt for very specific parameters while devaluing others) that many homeless will go to great lengths to seek out new locales that seem willing to help sustain their needs without requiring wholesale change of their lifestyles. some people do indeed prefer it (or at least fear the alternative, i.e. “proper” integration into society and all that comes with that), as much as some people on this website cannot fathom that
01100011 2y ago
A lot of folks in Appalachia seem to live in conditions tantamount to a tent encampment. They're more spread out and not in the way of urbanites so we don't talk about it much.
- EasyMark 2y ago
  It also helps the cost of living is 1/4 what it is in a place like SF

reducesuffering 2y ago

It doesn’t just boil down to affordability, but how many people got down in the dumps struggling to afford their expensive apartment, got stressed out and depressed, caused relationship issues and drug use, and led to a downward spiral where they ended up in a place with severe mental illness and couldn’t function with free keys after 5 years of that?

mistermann 2y ago

> For one, drugs won the war on drugs What a great line.

bruceb 2y ago

"harsh punishments don't work" They do if they are very harsh, see Singapore, Indonesia etc. America doesn't want to that.

ceejayoz 2y ago
Indonesia? The country that has active guerrilla wars that date back to the 1960s?

derefr 2y ago

I can’t speak for general solutions, but at least one portion of the addicted just have chronic pain; were prescribed extremely strong and addictive painkillers (as the only thing that would work!); and then got cut off from the medical system. These people try and try to solve their debilitating chronic pain problem (which they still have, and likely will always have) through increasingly-desperate and illegal measures; and go through many harrowing things due almost solely of the illegality of acquiring these same drugs outside of medical channels: the difficulties of finding a source and potential for arrest; the income-eating expense (no insurance to cover costs, plus 10x risk markup); the heightened spike-dose addictiveness of street forms of these drugs, that leads to a quick fiending withdrawal and need to redose, leading in turn to loss of employment due to spending all your time on the street hunting for the next dose; and of course, the unpredictable dosing and potential for adulteration, leading into high potential for OD. Most of this particular problem can (and in some trials, has!) been solved just by prescribing these people the drugs they need again. When you go from unpredictably doing random shots of freebase heroin/fentanyl/etc with a dirty needle alone in an alley, back to predictably being able to get precisely-dosed extended-release pills from a pharmacy and take them on a set schedule, a lot of “addict behaviors” for these chronic-pain “addicts” just evaporate.

tpmoney 2y ago
This is definitely a problem. Turns out once you start getting to the "going to destroy your liver / stomach" levels of NSAIDs and Tylenol, there really isn't anything other than opioids for pain management. Unfortunately the war on drugs and America's latent puritan streak means that since some people in some places use opioids to get high, then all uses of opioids should be avoided whenever possible, and when they are used, they should only be used grudgingly and with extreme skepticism of the person receiving them. Surely nothing will be better for the health of an individual than barely managing their condition, constantly forcing them to stop effective treatment to make sure they're not growing tolerant of the medication and treating them as only slightly more trustworthy than a criminal conman. Sure, opioids are addictive, and you might find yourself in a situation where you're stuck on them for life and that's not great. And ultimately we have to ask "so what?" There are many conditions and medications that are lifelong and we don't treat the patients or their conditions the same way. Imagine telling a person taking SSRIs that they can't have a higher dosage because they're getting "tolerant" of the medication. Imagine telling a diabetes patient that you're not going to give them metformin or insulin because they might be on it for life. There are huge amounts of chronic conditions for which the ongoing treatments suck and have a lot of negative side effects, but living with the condition un-treated is worse than the negative side effects. Chronic pain (and the conditions causing that pain) seem to be the only category that we don't accept the possibility of long term negative consequences as the price of dealing with the chronic condition. And the hell of it is, I agree with concerns about pill mills. My family that has had to deal with this has had to deal with pill mills too. And it's bad just having higher and higher doses thrown at you. I agree that treatment needs to include more than just escalating opioid doses. But those same family members that were stuck in a pill mill were there for years longer than they needed to be because finding a way out was nearly impossible. If you want to change pain management doctors, 99% of them will not prescribe you opioids on your first visit. But you likely have a contract with your current pain doctor that says you won't go to other doctors for pain medications, so you can't see a different doctor while getting pain management from your current doctor. Then even if you could get them to prescribe your medications, they almost all want to start you from zero again. Imagine you want to change heart doctors but before they will treat you they want you to stop all your heart medications for a few months so that they can "get a baseline" for your condition. That would be an insane thing to ask for any other chronic condition, and yet that's a common thing to be asked of pain patients all the time. Overall as a society we're terrible at dealing with the concept of a chronic condition. We don't really grok the idea that some folks just won't ever "get better", and our entire system is set up to assume you will. The sad reality is some people are going to be in constant pain for their entire lives, and there's nothing we can do to stop that from being the case. Restricting these people from being able to safely access treatments to manage that pain because they might get addicted is misguided, cruel and missing the forest for the trees.