Our Approach

 

Reducing Demand: A Model that Works

Other cities have faced problems of homelessness, addiction, and untreated mental illness, similar to our current crisis, and solved them. The most famous examples are in Europe: Amsterdam, Lisbon, Frankfurt, Vienna, Zurich. But Calgary, Alberta is also making big strides to solve its homelessness crisis.

Though there are minor differences, every successful city has followed the same basic principles to solve acute crises:

  1. The authorities must shut down open-air drug scenes. 

  2. Psychiatric and addiction treatment must be available to all, including mandatory treatment for those who present a danger to themselves or others, or can no longer care for themselves. 

  3. Sufficient emergency shelter must be provided, with more comfortable and private housing available as a reward for those who achieve treatment objectives like sobriety, taking medications, and participating in job training.

In addition to solving the immediate crisis, our mission is to enable people and communities to thrive. Part of that is preventing drug addiction and untreated mental illness in the first place. Another part is supporting people in recovery so they can continue to grow and thrive rather than relapsing.


Prevention, Intervention, Treatment, and Recovery

One way to think about our policy proposals is with four major pillars: prevention, intervention, treatment, and recovery. These represent a continuum of care that can benefit everyone in a community.

1) Prevention

Education

Youth and young adults across North America must be properly educated on the effects of the illness of addiction, including:

  • Addiction is an illness that exists within the person, not a specific drug. 

  • How to recognize the behaviors of addiction

  • The consequences of addiction

  • Where to seek treatment and recovery

Every young person in North America must be taught that recovery from addiction is possible for every person no matter who they are. 

Increasing recovery capital

Recovery capital is the sum of the internal and external factors that a person can draw upon to enter and maintain their recovery should they develop the illness of addiction. Good support systems reduce the likelihood that someone will become addicted in the first place, and also help prevent relapse during recovery.

2) Intervention

Drug addicts, by definition, lack control over their need to consume drugs — they cannot simply decide to stop using and basing public policies and programs on that assumption is naive and irresponsible. To quit their habits and begin to build a new life, most require some kind of intervention. 

This intervention can come from family, the workplace, friends or colleagues. But many addicts have long been estranged from everyone they once knew in their pre-addiction lives, and now know only other addicts. For these people, intervention can only come from the community at large.

Intervention in the Current System

Currently, the primary way that the community intervenes in the lives of addicts is through the police and the criminal justice system. This can produce positive outcomes: countless addicts have found recovery only by being arrested and incarcerated. But there are far better ways to steer addicts into recovery than jail. 

Another emerging means of community intervention in the lives of addicts is through recovery-oriented homeless outreach workers.  Constraints to how and what social workers can offer addicts reduce potential outcomes.  

Compassionate Intervention Process

We propose a form of compassionate intervention that is not a criminal process, but rather a compassionate public safety and healthcare response to help people struggling with addiction to pursue recovery. 

Many people living with serious mental illness or the illness of addiction have lost the capacity to recognize they are ill and seek treatment. They are no longer in control of their own behavior and deserve our compassionate intervention to support them in their long-term recovery. 

The Process

  1. The police should have the authority to apprehend people who are a danger to themselves or the community, possibly with a social worker or EMS worker accompanying.

  2. Police would then take the individual to an administrative commission for the dissuasion of drug addiction – not a criminal court. 

  3. The commission would assess the individual for their addiction, and recommend treatment options for their addiction. 

  4. Should an individual refuse a referral for treatment and they remain a danger to themselves or others in the community they would be sent before a judge to determine whether the individual should be mandated treatment for their addiction.

Community Support

When someone falls ill with addiction or serious mental illness, families and workplaces are both most immediately affected and most able to intervene. Intervention must also include education for families and workplaces on how to intervene and assertively support individuals to pursue recovery. 

Infrastructure

This model requires a critical mass of treatment capacity that is affordable and accessible to any citizen, as well as the cooperation of the healthcare system and the criminal justice system.

We don’t have to choose between compassionate treatment and healthy communities.

This system balances the welfare and liberty of the drug user on one hand, and the rights of the public to safety and order on the other. It also uses the power of the state as a last resort to compel people who have lost the capacity to help themselves toward a life of independence, health and dignity. 

3) Treatment

Addiction is a chronic illness, and with the appropriate treatment, recovery can and should be expected. The goal of addiction treatment is to initiate recovery from addiction and teach people how to maintain their recovery over the long-term. Treatment must be affordable, accessible, and ideally available on-demand.

People with addiction need a range of treatment options:

  • inpatient residential treatment 

  • transitional “recovery housing”

  • long-term therapeutic communities 

  • medication-based opioid addiction treatments such as Suboxone and Sublocade

  • outpatient group therapy 

  • individual counseling

4) Recovery

Supporting individuals in their long-term recovery from addiction is the final piece of the puzzle. Where treatment is the brief intervention that is used to initiate recovery in people with addiction, supporting long-term recovery after treatment is just as important. 

To effectively support recovery over the long-term, policy and funding across North America must focus on improving the recovery capital of individuals and their communities. 

Recovery capital is the sum of the internal and external resources that a person can draw upon to enter and maintain recovery. This includes ensuring people have their basic needs met in recovery through recovery housing, it includes supporting people in recovery to seek employment and regain independence, it includes creating communities where people are supported in the improvement of their relationships with other people and their spiritual life. 

Control

Society should empower everyone to achieve their full potential—addiction recovery and a life lived with purpose is our ultimate goal. Discouraging non-medical substance use of all kinds, including legalized drugs like alcohol, tobacco and marijuana, is part of the picture.

Medical vs. Non-Medical Use

The authority to define accepted medical use of drugs lies with neutral, scientific institutions and authorities such as the Food and Drug Administration. 

In the case of marijuana, corporate interests and lobby groups promoted the idea of medical use, with very little neutral scientific evidence. Corporate or political attempts should not  define “drugs as medicine” or influence these scientific institutions.

Drug Use by Young People

If someone does not misuse a drug before age 21, they are unlikely ever to do so. This includes legalized drugs such as alcohol, tobacco and marijuana. Policies should include rigorous youth education on the harms of addiction, and should aim to make drugs less accessible to young people.

Policy Examples

Federal, state, and local policies should discourage or seek to reduce the volume of the non-medical use of drugs available, including alcohol, tobacco, marijuana, and so forth. Some effective policies to reduce use of legalized drugs include:

  • Increases in taxes

  • Restrictions on advertising

  • Potency restrictions

Culture

Discouragement of drugs should come from multiple sectors in society, including laws (e.g. keeping drugs illegal), community norms, corporate standards, and public awareness campaigns. Non-medical users, particularly those in addiction, should always be given the opportunity to achieve a life of recovery.

Supply Reduction and Interdiction

Purpose

Efforts to control the supply of drugs should be done with the objective of making drugs more expensive, and harder to obtain. 

A Realistic Approach

Supply reduction, once the dominant US policy paradigm, has waned in both influence and funding in recent years. But a holistic solution to the crisis must address drug supply as well as demand. This includes everyone from street-level dealers to major international kingpins of transnational criminal organizations. 

The expectation that a supply reduction strategy will eliminate all drugs is unrealistic. But when we can make drug prices go up, lower availability, and reduce the ease by which drugs are obtained and sold in the streets, our communities are safer.

A coherent supply reduction strategy would include efforts to both interdict drugs on our borders and work with countries, cooperatively, to reduce their drug production.

Federal Policy Reform Agenda 

Federal policy on homelessness, mental illness and addiction treatment, and illicit drugs have harmed individuals and communities and made it harder to enable and empower the vulnerable from thriving. While certain policies, such as the Continuum of Care Program at the Department of Housing and Urban Development, are merely ineffective, other policies, such as those that subsidize addiction or that seek to reduce harm, are creating deadly unintended consequences. 

Therefore, North America Recovers supports the following federal reforms to HUD programs, Social Security and SAMHSA programs, and drug policies: 

HUD reforms to CoC program:

  • Eliminate Housing First as the primary approach

  • Expand eligible uses of funds and require funding for transformational programs, FBOs, and trauma-informed wraparound services

  • Replace system performance measures with outcomes measures and prioritizing self-sufficiency measures

  • Use contingency management to push participation in treatment plans

  • Block granting funds to states

Reform Social Security Act and SAMHSA programs to:

  • Repeal the IMD Exclusion or exempt the untreated and unhoused population from its application

  • Integrate Certified Community Behavioral Health Clinics with permanent supportive housing programs

  • Stop subsidizing addiction through the SSI and SSDI programs

  • Prioritize SAMHSA programs toward the untreated and unhoused

  • Prioritize Recovery-Oriented Systems of Care in SAMHSA drug treatment block grants

Drug Policy:

  • Utilize interdiction strategies cooperatively to reduce drug supply

  • Discourage the use of drugs at all levels

  • Use federal funding to states and local governments to discourage open air drug markets and supervised injection sites