Weaknesses in the addiction treatment system in the District of Columbia are hindering recovery for hundreds of the city’s homeless residents, according to a series of interviews conducted by Street Sense with shelter staff, city officials, service providers and homeless residents.

In interview after interview, Street Sense has found that chronic substance abusers among the homeless face significant impediments to recovery beyond the physical and emotional stresses of addiction. These impediments include a “treatment gap” caused by limited capacity at residential rehabilitation programs, temptation in the form of drug dealers operating in close proximity to overnight shelters and an aggravated desire to abuse drugs due to poor living conditions.

The Treatment Gap

At a basic level, there are simply too many people seeking entry into rehabilitation programs, according to staff at private service providers So Others Might Eat (SOME) and Gospel Rescue Ministries.

Twenty-seven percent or 1,542 of the District’s 5,757 homeless were identified as chronic substance abusers in 2007, according to a “snapshot” of the homeless on a given day in 2007 conducted by city government and released by a regional organization of Washington area governments.

These numbers are consistent with a 2006 United States Conference of Mayors survey that indicated that 26% of the homeless population in 23 cities surveyed was dealing with substance abuse.

Addicts among the homeless population looking to get clean can find themselves competing with the larger population for the limited capacity at residential treatment programs that provide both rehabilitation and housing.

About 60,000 D.C. residents were addicts in 2003, according to the most recent data available from the Department of Health’s Addiction Prevention and Recovery Administration. Dependency on illicit substances or alcohol in the District is almost twice the national average, according to the 2003 study.

The same report showed public treatment programs served only 14% of those addicts, admitting about 8,500 individuals in 2002. The numbers point to a treatment gap that “denies almost nine out of 10 individuals needing treatment,” the study concluded.

While the numbers are dated, they form the basis of the District’s substance abuse strategy and no equally comprehensive survey has been conducted since then, according to the Addiction Prevention and Recovery Administration.

Residential treatment programs are critical to homeless addicts’ recovery, said Margaret Simmons, a substance abuse counselor at SOME, a nonprofit that provides a wide array of services to the city’s homeless.

But in the District, “There aren’t enough residential beds or they aren’t (available) long enough,” Simmons said. District-run residential programs last from 60 to 90 days depending on the addict’s ability to complete the treatment regime, said Stephen Wright, director of satellite services for the Addiction Prevention and Recovery Administration. A client’s history and severity of drug use determine assessments, and their housing status is not a consideration, Wright said.

“We are not a housing unit,” Wright said. “So we can’t guarantee the homeless anything but detoxification and treatment. Once they get sober, we then can refer them to transitional housing.”

SOME does provide two residential programs in West Virginia, but its capacity as a private organization is restricted. About 125 people went through the three-month program in 2007.

Gospel Rescue Ministries’ Transforming Lives Ministry, another rehabilitation program based in downtown D.C., currently has 28 men in its yearlong rehabilitation program, said David Barnes, the program director. About 40% of participants will complete the one-year treatment, Barnes said. Men who drop out of the program are not reaccepted, he said.

The residential program provides wrap-around services, including job development, alumni groups and a two-year after-care program.

Kenneth Baldwin, 40, attributes his recovery to similar wraparound services. He was a resident of the rehabilitation program at the 801 East shelter, where holistic treatment dealt with the homelessness aspect first, then addressed his various motivations for drug use. The program reaffirmed his sense of self-worth and abilities, he said.

Forced into homelessness because of drug use, Baldwin found the program a way to get out of the cold and into treatment quickly, without a referral or a waiting list.

“The longer I stayed on the street, the more I was putting myself in harm’s way. I was grateful that the doors were open,” Baldwin said.

But with so many who need to be treated, private service providers cannot handle the scope of the need.

And although after-care programs help reinforce drug treatment strategies, “the call of the street” continues to be one of the biggest problems in recovery, said Barnes of Gospel Rescue Ministries.

Temptation Strikes

The call of the street, or the temptation to use, rings louder for those living in the shelter system, where the proximity of drug dealers combines with the stresses of the homeless condition to weaken individuals’ resolve.

Homeless people see drugs “everywhere in shelters,” said Simmons of SOME. “What a shame that they can’t seem to keep the shelters clean.”

A homeless woman, who requested that her name not be used, stays at John L. Young Center, a woman’s shelter adjacent to the CCNV complex on 2nd and D streets. Drug dealing does happen in the shelter vicinity, she said, despite a consistent police presence.

“I am aware of that activity going on,” the woman said. “But that’s life and that’s how things are in the city.”

Neither the Community for Creative Non-Violence or Clean and Sober Streets, an organization serving homeless addicts that adjoins the CCNV building, agreed to comment when contacted by Street Sense.

The Office of Shelter Monitoring at the D.C. Department of Human Services evaluates shelter facilities and service delivery. In response to a Street Sense inquiry, the department released the following statement:

“Shelter clients are prohibited from using or possessing alcohol or illegal drugs on shelter premises. ... Any illegal activities that occur outside the shelter premises are not in the jurisdiction of the Department of Human Services.”

However, service providers do have an interest in limiting the drug use in the areas around their shelters. Such proximity makes recovery more difficult for residents trying to stay clean, said George Jones, the site coordinator for Franklin shelter, a 300-bed facility for men at 13th and K streets, NW.

Franklin shelter staff, along with the Department of Human Services, the police and the community, has led a yearlong crackdown on dealing, Jones said.

The added effort drastically reduced dealing both on shelter grounds and in the neighboring Franklin Square Park, he said.

Kenneth Lovejoy, a 52-year-old construction worker who used to stay at the Franklin shelter, attributes the decline in drug dealing activity to an evening lock on the back courtyard gate, as it forced dealers to come in past staff and security through the front door.

The shelter “has cleaned up quite a bit from a year ago,” he said. Drugs, such as crack, “keeps a lot of them in there,” he said, gesturing to the red brick shelter.

When Franklin staff was alerted to the drug-related activities at the shelter, they immediately took actions to address it, said Chapman Todd, the division director of Catholic Charities, the service provider that runs Franklin.

“This is a situation where you want zero activity,” Todd said.

The shelter then relied on an increased police presence in the neighboring park to reduce the level of drugs to the frequency it is now, Jones said.

Since areas like parks remain out of shelters’ jurisdiction, community and police partnerships are needed to monitor and restrict activity.

For the most part, those supplying drugs are not part of the shelter population, Jones said. “Our clients are probably victims.”

Stephanie Gooden, a Street Sense vendor who uses the clinic at CCNV’s 2nd and D streets, NW, complex, noted that a person’s commitment to staying “clean” is threatened by easy access to drugs.

When a person thinks about their behavior, there is usually a process of thought that goes from compulsion to usage, Gooden said. Having drugs immediately available keeps these stages very close together and eliminates the time needed for a person to make a better decision, she said.

If a person needs to travel farther than a street corner to fulfill an initial desire to use, he might rethink that decision, she said.

Even a lack of money may not keep such a person from procuring drugs, she said. The same user who does not have the 50 cents to call a loved one or get on a bus to go somewhere that offers help may be able to get credit from a dealer, she said. In that case, using drugs becomes easier than staying clean.

But not everyone agrees that reducing drug activity around shelters would help homeless addicts.

“Whether they get it there or they get it somewhere else, they get it,” said the woman at the John L. Young shelter.

Chapman Todd of Catholic Charities said the transition to rehabilitation programs remains difficult regardless of the living situation of the individual.

Service providers should rely on case management to help those recovering from addiction to move on, he said.

“The leverage we have is to build personal relationships,” Todd said, noting that everyone has unique circumstances to deal with during recovery.

“Even if you’re not looking, there are temptations that will jump up in front of you,” he said.

Burning Motivations

Shelter conditions and the stresses of being homeless can aggravate such temptations, according to one resident at the CCNV shelter who wished to remain anonymous.

One tool for recovery taught by Narcotics Anonymous, a substance abuse support group, is altering your environment to avoid temptations, said the resident.

“Being homeless and living in a shelter, you aren’t able to use it [the tool]. You can’t change your people, places or things,” she said.

Besides the lack of control, homelessness amplifies the psychological triggers for drug use, she said.

“The shelter compounds your life issues,” she said. “It induces, at least for me, a constant sense of anxiety.”

Things are constantly stolen, people are desperate and there is little sense of safety, she said. Such a situation, combined with the easy accessibility of illegal substances, makes staying clean harder.

“It’s just hell,” she said.

Baldwin, the resident from 801 East, said that in his case, substance use caused him to be homeless, but noted that for others, homelessness could lead to drug use.

The homeless face rejection, alienation and belittlement from the public and may turn to drugs as a coping skill.

So while programs like 801 East, Gospel Rescue Ministries and SOME provide successful treatment to homeless addicts, their work can sometimes seem like a Band-Aid over the District’s large treatment gap for those who need it. And while shelters like Franklin work to reduce dealing in their vicinity, their residents’ hurdles to recovery remain pervasive.

On the Friday night intake line to enter the Franklin shelter, residents linger in the alley to smoke cigarettes and mingle with friends. As Lovejoy and Jones noted, the shelter has cleaned up significantly in the last year, although some men will talk of their own substance abuse or that of other shelter residents.

Ask where the dealing is going down, and invariably a nod, a smile or a blunt response still leads a reporter just a few yards away, to the diagonal paths and black benches of Franklin Square.

For Ray Mitchell, a 71-year-old Franklin resident, individual motivation is important in staying clean.

But, he says, standing in the alley across from the park, housing chronic substance abusers so close to the source of their addictions is dangerous.

“If they come out the door and it’s right there for them, what are they going to do?” Mitchell asks.

“If you go to the hot dog stand, sooner or later, you’re going to buy one.”

April 30, 2008