Addiction: It's a Mindset

On Monday, I was talking about how providing free housing to homeless people reduces healthcare expenditures on those people and mentioned an experiment with providing free housing for homeless people, an experiment which has been duplicated with positive results in several different cities, by the way. Well, this experiment yielded a separate, unlooked for result. It showed that providing housing to homeless people also "cured" the majority of them of their addictions and/or addiction behaviors.

Whaaat?

Yeah, you heard me.

This shouldn't have been as surprising as it was because we've known for a long time that one of the drivers of addiction is hopelessness and despair. It should be obvious that people with nowhere to live instead dwell with hopelessness and live in despair. Take those things away -- yes, I know; it's not always that easy -- and suddenly the impetus to "drown your sorrows" is gone.

But it's about more than that. It's about purpose.

So let's take a step back a moment.

When this experiment, the one about providing free housing to homeless people, was first proposed, many of the critics said it would never work because all of the drug addicts (including those addicted to alcohol) -- and face it, a majority of those who are homeless suffer from some kind of substance abuse issue -- would just sell off all of  the furnishings (which are also provided) to buy drugs and end up living in what amounted to no more than a flop house or a drug den. While it was acknowledged that that was a distinct possibility, enough people wanted to see what would happen to go through with it. After all, it was an experiment.

I don't think what happened was what anyone really expected to happen but it is, nevertheless, what happened, and that's that people cleaned up. Not gradually, either, but almost immediately. Sure, there were some people who did sell off all of the furniture for drugs or whatnot, but those cases were relatively few and, when they did, the furniture was replaced -- yes, even over and over again -- and many of those people also cleaned up, as soon as they realized that what was happening was real.

The consensus was that it was about more than hope; it was about purpose. These people, these people who had been living on the streets, some for years and years, had had no purpose. They had simply been existing but, given a place they could call home, they suddenly found purpose in their lives and the need for the drugs (including alcohol) dissipated. They had something to live for, even if it was just caring for their new living space, which the vast majority took great pride in.

So now let's get a little philosophical.

For a long, long time we've know that our current method of trying to break people from drug addiction doesn't work. That method amounts to taking the drugs away from them and telling them "no!" Most people who go through rehabilitation programs relapse because the programs, though they get they drugs out of the addict's system, don't do anything to address the causes of the abuse. What we really expect is for people to just "power through it" and through an effort of willpower to say "no" to the drug everyday. Even when that's not what they want to do.

I use that term "want" in the same way someone who is overweight might say, "I want to lose weight," while never taking any actual action to accomplish that. Or someone might say, "I want to have a clean house," while never actually cleaning up. Or, "I want to write a book," while never putting pen to paper. What these statements really mean is, "I want to have done it," but the people saying them don't really want to expend the necessary energy to accomplish their "goals."

Most addicts who go through programs "want" to be clean in that same kind of way. Generally, they are not there by choice but because someone they care about has somehow coerced them into it. So, sure, they "want" to have never gotten hooked to begin with but they don't really want to quit.

And they don't really want to quit because they have no reason to quit.

Look, when you talk to any addict who has cleaned up his/her life, you'll find it's because the person found something else to live for, even if that something else is actually being sober. That can be the purpose; it's just usually not.

Oh, by the way, another big contributor to everything that happened in these free housing experiments was community. Suddenly, the homeless didn't feel alone. They lived in communities with each other, and that helped with... everything. Loneliness and alone-ness are big factors in addiction. And, even when you love someone, even when you believe that person is not alone, that may not be how the addict feels.

So what is it I'm saying? I'm saying two things:
1. As with healthcare costs, we can cut addiction among the homeless population (which also affects healthcare costs) by doing the simple thing of providing them living spaces. For free. No strings.

2. We can cut addiction in the rest of the population by striving to help these people find purpose. It's not so simple as just taking away the drugs and saying "no." And, yes, I realize this is not an easy thing I'm saying here. It's not an easy fix with a one-step solution like taking away the drugs and saying "no." It's a solution that would take some work, but it's a better solution.

And it's why I said, "Let's get philosophical," because the solution will be different for every person. What is "purpose" for one person is not necessarily so for another. Maybe I should have said, "Let's get psychological."

Look, I'm not saying that addiction is all in the mind and that you can just think your way out of it. If that were true, addiction wouldn't be a problem at all. However, we can do much more to approach addiction in a mentally appropriate way, and that starts with getting to reasons why addiction happens in the first place.

The Homeless/Healthcare Connection

Healthcare is a big deal. It's probably a bigger deal these days than it's ever been. Or maybe that's just my age talking. Maybe it's always been a big deal but, for most of my life, I just didn't pay attention to any talk about healthcare. Certainly, young people, unless something bad just happens to happen, don't give healthcare a second thought. They just assume the health part and don't stop to think about it.

Which is not an indictment against the youth of today. I certainly didn't think about healthcare, ever, until after I had kids. Or, really, until we were trying to have kids and my wife almost died from a miscarriage. But, certainly, once we had kids, it was a big deal.

There was this period when we didn't have any health coverage. I was working in a church making next to nothing and with no health benefits. Our coverage came through my wife's job, then her department was dissolved, and we were suddenly without any kind of health insurance.

Which would have been fine except that my younger son, maybe a year and a half at the time, got sick. Not a little sick, either. He was running a temperature of 105-106, and we were freaking out, because we couldn't get it to come down. And, well, no one wanted to see us.

The first day he was sick was the last day of our coverage, so I took him to his doctor. They were worthless, gave us some ibuprofen, and told us to keep an eye on him and bring him back the next day if he wasn't better. The second day was when his temperature topped 105. I called them about an appointment, but they said they wouldn't see him because we didn't have coverage anymore. I took him to the office anyway (remember, freaking out), and they actually locked the door when they saw me coming in with him and told me to go away.

We ended up in the emergency room where they left me sitting with him for hours because, well, no coverage. They didn't want to see him either, but they couldn't actually tell me to leave, so, instead, they let me set with him while he burned up in my lap. For HOURS. While I sat and worried about brain damage. [This is the son who is super smart, the one I did the education series on a while back, so you might think, "Well, it seems like everything was fine with that, then," but I sometimes wonder if he would have been even smarter if they hadn't left him with that fever for so long.] Eventually, I kind of forced someone to bring him something for the fever, and, hours after that, a doctor finally saw him.

Not that they offered any better advice or anything to do other than keep his fever down. We didn't take him back again and, a couple of days later, he got better. We still don't know what he had. However, we did get a bill from the hospital for over $1000.00 when he saw a doctor for less than 30 minutes and all they did was give him some liquid ibuprofen and leave us sitting around for something like eight hours.

And that's what it's like not to have health insurance.

And it's the kind of thing homeless people deal with all the time when they're sick, because they have no other alternative. They have no other alternative because there is this sort of endemic belief that "those" people don't deserve healthcare. I mean, why should we pay their medical bills when they're just going to end up back out on the street with their drugs and their alcohol and sick again. They should just get it together, get themselves jobs, earn their keep, and be worthwhile human beings, right? Then they can pay their own medical bills. After all, that's what the rest of us do, isn't it?

Well, actually, no, but I'm not going to get into that, right now.

I'm also not going to try to convince you from any kind of humanitarian argument about how providing healthcare to people is "the right thing to do." Clearly, that argument has not worked and the people (Republicans) who do not want to provide universal healthcare are not going to be swayed by it.

So let's take one brief, very practical look at dealing with healthcare for the homeless.

One of the issues with the way we do healthcare is what are called "super users." This is the small percentage of users who use the system way more than everyone else, essentially using the most dollars from the system. These users tend to be older, chronically ill, and, yes, frequently homeless with no kind of healthcare coverage. This means that when a hospital sees one of these people (through the emergency room because they have no other option), the hospital passes on the costs to everyone else. I don't have the exact figures in front of me and I'm not going to look them up right now, but let's say (because this is a pretty close to correct number) these people spend 90% of all healthcare dollars.

There are two solutions to this issue:

1. Give everyone healthcare.
But let's toss that one away because, obviously, with the Republicans in charge, that's not gonna happen. (Why would they ever provide anything to anyone who "doesn't deserve it"?) But, also, that doesn't keep those same people from being super users. It does lower the cost of them being super users, and that's good, but it doesn't address they actual issue.

2. Get rid of the homeless issue by giving them free housing and food.
Oh, no, I hear you already. If we're not going to give them healthcare, why would we give them housing?! That's crazy talk!
And, yeah, I agree that it sounds like crazy talk. BUT!
There have already been some experiments done with this and, from just a practical standpoint, this is the most efficient way to eliminate unwanted healthcare costs. See, just from providing housing to homeless people, it automatically makes them healthier people! No kidding. There are lots of whys and wherefores of this and you're free to go do the research if you'd like, but I'm going to let that statement stand and you can go do the research yourself. [Trust me; it's good for you.] For those with chronic conditions (like diabetes, which is very common), it allows for preventative healthcare (because we know where they are) rather than always having to resort to emergency care. Preventative care is always cheaper.

But what abut the housing costs? Sure, there are housing costs, but there are plenty of options for low coast housing, and all of them cost much, much less than what is currently being spent on healthcare for the same pool of people. Much, much less. Hundreds of millions of dollars less, even with the food costs.
"But they don't deserve it!"
Sure, and why don't you continue to stab yourself in the nose to spite your face, because now you're at the point of choosing to keep these people homeless as nothing more than punishment, and that's totally on you.

Look, if nothing else, you wouldn't have to complain about the homeless cluttering up your streets anymore. It's a win-win. Maybe even a win-win-win.

All Children

All children believe in feeding the hungry.

All children believe in taking care of the sick.

All children believe in clothing the poor.

All children believe in providing homes for the homeless.

All children believe in protecting the Earth.

All children want to save the animals. Especially the cute, furry ones. (Okay, maybe not all children want to save all the bugs, but, still...)

All children believe in the concept of sharing (especially when it means that someone else is going to share with them, but they also believe that they should share even when they don't want to).

I guess this means that all children are liberals.

Matthew 18:3 "Truly, I tell you," he said, "unless you change and become like little children, you will never enter the Kingdom of Heaven."