It is important to put my following comments in context. The number one cause of homelessness today is poverty, and more social services aren't needed, it's about needing jobs! Vancouver's 12 block DTES area is an exception -- most are addicted or have mental health issues. It has the highest concentration of IV users in North America.
My compassion for the homeless in Vancouver's DTES was initially stirred reading In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Mate. My previous experience with the homeless was limited to occasional visits to shelters. I did know some folks in AA who had been homeless for brief times and now had functional lives, but few long timers at the missions really showed any interest in AA or what churches had to offer.
As a counselor I was effective with those who had been abused as I had been helped so much in my own treatment and therapy. I knew many of the long term homeless were horribly psycho-socially-spiritually damaged. They rarely recovered and I didn't understand why. Traditional thinking was they haven't reached a bottom but when someone has almost died a number of times, lost everything, and only staying alive due to shelters, I was puzzled what would a bottom look like?
The following
diagram by Ric Matthews (Executive Minister of New Way Community) helped to clarify my understanding of homelessness.
The first circle outside MAINSTREAM are the MARGINALIZED,
or those not fitting in due to addiction and mental health issues. Even though poverty is
the number one cause of homelessness but I often question which came first...poverty or addiction? Society attempts to repair or contain these folks in institutions (recovery groups, church, treatment, hospitals
and prisons). Those we can't seem to help, slip out to the next circle or the
HOMELESS. One of the errors we make is expecting them to be rational but
addiction and mental illness are not rational conditions. The most damaged often
don't fit the barriers of many shelters and become PREMATURE DEATHS from drug
overdosing, related medical conditions and inclement weather.
Generally addiction in seen in four stages: Experimentation, Misuse,
Abuse, and Dependency. My problem is by these criteria, my diagnosis when
practicing my addiction was the same as the homeless in DTES. For a number of
reasons, I wasn't as damaged and had so many more opportunities in life
compared to so many who are homeless. With help I was able to recover and be
restored to the MAINSTREAM at the center of the diagram without slipping into
homelessness.
So many I meet and spend time with in Vancouver's DTES have not
responded to traditional treatment and other assistance. I think first of all
we need to rethink how we discuss and understand stages of addiction.
It is multi causal but addiction can be seen as a brain disease. Other
diseases are seen in four stages. The fourth stage is so critical in cancer that patients
are told it has metastasized to other regions of the body and is rarely
considered curable. Patients with fourth stage heart disease, cirrhosis, and
kidney disease must have transplants to live.
To understand the marginalized homeless I am proposing
understanding addiction in four stages.
Stage 1: Initial
Motivation is pleasure...
“They
Abuse and Live”
Stage 2: Chronic
Motivation is relief...
"They Live to Abuse”
Stage 3: Acute
Motivation is maintenance...
“They Abuse to Live”
Stage 4: Terminal
Motivation is escape to
oblivion...
“They Abuse and Die”
Stage 4 addicts do not seem to have moments of clarity or
respond to a bottom. They are not currently criminal enough to end up in prison
or considered mentally ill enough to end up in psychiatric care. So what would
be involved for them to recover?
My next post will focus on the Harm Reduction controversy
and its impact in the context of Stage 4 addiction.
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