What If We Treated People Who Use Drugs as Full Human Beings?

By Mattea Kramer who writes on a wide range of topics, from military policy to love and loss, and Dr. Sean Fogler, the co-founder of the public-health organization Elevyst. Originally published at from TomDispatch.

Amid ongoing emergencies, including a would-be autocrat on his way to possibly regaining the American presidency and Israel’s war on Gaza (not to mention the flare-ups of global climate change), the U.S. has slipped quietly toward an assault on civil liberties as an answer to plummeting mental health. From coast to coast, state lawmakers of both parties are reaching for coercive treatment and involuntary commitment to address spiraling substance use and overdose crises—an approach that will only escalate despair and multiply otherwise preventable deaths while helping to choke the life out of America.

In December, we wrote about how loneliness has become a public-health crisis, according to the Surgeon General, and the ways in which it drives widespread substance use. We reach for substances to ease feelings of isolation and anguish—and when the two of us say “we,” we mean not just some hypothetical collective but the authors of this article. One of us, Sean, is a doctor living in long-term recovery from a substance-use disorder and the other, Mattea, is a writer who uses drugs.

And we’re anything but unique. Disconnection and loneliness aren’t just the maladies of a relatively few Americans, but the condition of the majority of us. Vast numbers of people are reaching for some tonic or other to manage difficult feelings, whether it’s weed, wine, work, television, or any mood- or mind-altering substance. These days, there’s scarcely a family in this country that’s been unscathed by problematic drug use.

Not surprisingly, under the circumstances, many elected officials feel increasing pressure to do something about this crisis—even as people who use drugs are widely considered to be social outcasts. In 2021, a survey of thousands of U.S.-based web users found that 7 in 10 Americans believed that most people view individuals who use drugs as non-community members. It matters little that the impulse to use such substances is driven by an urge to ease emotional pain or that the extremes of substance use are seen as a disease. As a society, we generally consider people who use drugs as rejects and look down on them. Curiously enough, however, such social stigma is not static. It waxes and wanes with the political currents of the moment.

“Stigma has risen its ugly head in almost every generation’s attempts to manage better these kinds of issues,” says Nancy Campbell, a historian at Rensselaer Polytechnic Institute and the author of OD: Naloxone and the Politics of Overdose. Campbell reports that she finds herself a target of what she calls “secondary stigma” in which others question why she even bothers to spend her time researching drug use.

Perhaps one reason to study such issues is to ensure that someone is paying attention when lawmakers of virtually every political stripe seek to answer a mental health crisis by forcing people into institutionalized treatment. Notably, such “treatment” can increase the odds of accidental death. Allow us to explain.

“Treatment” Can Be a Death Sentence

Across the country, the involuntary detainment and institutional commitment of people with mental illness—including those with a substance use disorder—is on the rise. Deploying the language of “helping” those in need, policymakers are reaching not for a band-aid but a club, with scant or even contradictory evidence that such an approach will benefit those who are in pain.

“The process can involve being strip-searched, restrained, secluded, having drugs forced on you, losing your credibility,” said UCLA professor of social welfare David Cohen in a 2020 statement about his research on involuntary commitment. He co-authored a study that found its use rose nationwide in the decade before the pandemic hit, even as there was a striking lack of transparency regarding when or how such coercion was used.

Today, many states are expanding laws that authorize mandatory treatment for people experiencing mental-health crises, including addiction. According to the Action Lab at the Center for Health Policy and Law, 38 states currently authorize involuntary commitment for substance use. None of them require evidence-based treatment in all involuntary commitment settings, and 16 of them allow facilities to engage in treatments of their choice without the individual’s consent. Nearly every state that ranked among the highest in overdose rates nationally has an involuntary commitment law in place.

In September, the California legislature passed a bill that grants police, mental healthcare providers, and crisis teams the power to detain people with “severe” substance use disorder. The Los Angeles County Board of Supervisors subsequently voted to postpone implementation of the law, with Board Chair Lindsey Hogarth noting the risk of civil rights violations as a reason for the delay. In October, Pennsylvania state legislators introduced a bill that would permit the involuntary commitment of people who have been revived following an overdose. While many mental health advocates acknowledge the good intentions of legislators, the potential for harm is incalculable.

New research shows that people who attended abstinence-based treatment programs were at least as likely, if not more likely, to die of a fatal overdose than people who had no treatment at all. By contrast, those who had access to medications like methadone or buprenorphine for opioid-use disorder were less likely to die. Those medications, however, are not considered “abstinence” and so are not uniformly provided in treatment settings. Though there is extensive evidence of the effectiveness of medications for opioid use disorder, abstinence still remains widely regarded as the morally upright and best path, even if it makes you more likely to die. The reason for the elevated risk of mortality following abstinence-based treatment is no mystery: Abstinence reduces the body’s tolerance. If a person who has been abstinent resumes use, the ingestion of a typical dose is more likely to overwhelm his or her bodily system and so lead to death.

Disturbingly, both The Atlantic and The Wall Street Journalrecently ran columns favoring mandatory treatment, with the Journal citing as evidence a 1960s study in which individuals fared well after 18 months of mandated residential treatment that included education and job training—a standard of care that’s virtually nonexistent today. The Atlantic referenced a study of 141 men mandated for treatment in the late 1990s whose outcomes were comparable to individuals who entered treatment voluntarily; the study’s own authors had, however, cautioned against generalizing the findings to other populations due to its limited scope—and since then, the potent opioid fentanyl has entered the drug supply and raised the risk of a fatal overdose following a period of abstinence.

Meanwhile, as policymakers turn to coerced treatment, consider this an irony of the first order: There are far too few treatment options for people who actually want help. “There is no place in this country where there is enough voluntary treatment. So why would you create involuntary commitment, involuntary treatment?” asks Campbell. The reason, she suggests, is the inclination of lawmakers not just to do something about an ongoing deadly crisis, but in no way to appear “soft on drugs.”

Just to put the strange world of drug treatment in context, imagine elected officials wanting to seem tough on constituents who have cancer or heart disease. The idea, of course, is ludicrous. But 7 in 10 Americans think society at large views addiction as “at least somewhat shameful” and people who use drugs as significantly responsible (that is, to blame) for their substance use. No surprise, then, that politicians would find it expedient to punish people who use drugs, even if such punishment only layers on still more shame, with research indicating that shame, in turn, exacerbates the pain and social isolation that drives people to use drugs in the first place. As Dr. Lewis Nelson, who directs programs in emergency medicine and toxicology at Rutgers New Jersey Medical School, pointed out to USA Today, the science of addiction and recovery is frequently overlooked because it’s inconsistent with ingrained social ideas about substance use.

“I Still Don’t Need Saving”

Punishing people for substance use worsens the pain and isolation that make drugs so appealing. So rather than punishment—and in our world today this will undoubtedly sound crazy—what if we treated people who use drugs as full and complete human beings like everyone else? Like, say, people with high blood pressure? What if we acknowledged that those who use drugs need the very same things that all people need, including love, support, and human connection, as well as stable employment and an affordable place to live?

Research on this, it turns out, suggests that human connection is particularly good medicine for the emotional pain that so often underlies substance use and addiction. Stronger social bonds—namely, having people to confide in and rely on—are associated with a positive recovery from a substance use disorder, while the absence of such social ties elevates the risk of further problematic drug use. Put another way, perhaps you won’t be surprised to learn that a powerful means of healing widespread mental distress is to connect with one another.

When people in distress have friends, attendant family, and healthcare providers who are genuinely there for them no matter what, their own self-perception improves. In other words, we help one another simply by being nonjudgmentally available.

Jordan Scott is a peer advocate for Recovery Link, which offers free digital peer support to people in Texas and Pennsylvania. She identifies as a person who uses drugs. “I felt like the message got reinforced that there was something wrong with me, that there was something broken with me,” she told us. “Anything that isn’t abstinence, or anything that doesn’t include total abstinence as a goal, is constantly positioned as less than.”

New research published in the journal Addiction draws a contrast between treatment focused exclusively on abstinence and a broader array of wellness strategies, including reducing drug use rather than eliminating it entirely. The study found that reduced use had clinical benefits and that health can distinctly improve even without total abstinence. Director of the National Institute on Drug Abuse Nora Volkow, for instance, supports a nuanced approach that includes many possible paths of recovery along with a shift away from the criminalization of drug-taking to a focus on overall health and well-being. And the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, has identified four dimensions critical to recovery: health, home, purpose, and community.

Most important of all, a person doesn’t necessarily need to be abstinent in order to make gains in all four areas. This makes good sense when you remember that addiction or other problematic substance use is a symptom of underlying pain. Rather than exclusively treating the symptom—the drug use—addressing the underlying loneliness, trauma, or other distress can be a very effective approach. “Family can be a valid pathway to wellness,” Scott pointed out, while adding that her own path went from 12-step meetings like Alcoholics Anonymous to active civic engagement.

For someone else, quality time with his or her kids or even exercising and eating well might be a linchpin for staying mentally healthy. In other words, healing from the pain that underlies substance use disorder can look a lot like healing from any other health challenge.

Yet policymakers continue to call for intensifying the use of coercive treatment. “I think we’re going to see more [involuntary commitment] before we see less of it,” said Campbell, who studies historical patterns in the social response to drug use. There’s nothing new, she noted, in the move to “help” people by institutionalizing them—even if such a move constitutes an erosion of basic civil rights.

“I think most of the time people are genuine in wanting to help,” said Scott, who has been a target of such “help.” The problem, she explained, is the idea that there is a group of people considered “normal” and therefore superior, who think they’re in a position to save other members of society.

“I didn’t need saving. I am a drug user now. I still don’t need saving,” Scott told us. These days she’s focused on being a part of her community through volunteerism while drawing on a support network of people who respect her path.

As for the two of us writing this article, Sean is spending time with his children, staying connected with friends, practicing meditation and yoga, and has for years facilitated a group of physicians in recovery. Mattea has started a new habit of going to the gym with her uncle to ease her loneliness, while also confiding in close friends for support. And all of that truly does make a difference.

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  1. Alex

    I have no opinion on the pros and cons of involuntary treatment vs other alternatives, but there are at least two fallacies in the article.

    Mattea has started a new habit of going to the gym with her uncle to ease her loneliness, while also confiding in close friends for support.

    Mattea, “a writer [for The Guardian, The Nation, Mother Jones, Guernica, and The Washington Post] who uses drugs” is not at all similar to the typical person who would be affected by involuntary treatment laws!

    what if we treated people who use drugs as full and complete human beings like everyone else

    I doubt that the authors would not want people who would be involuntary confined to babysit their kids or care for their elderly relatives. So treating everyone “as full and complete human beings” makes for a nice slogan but the devil is in the details, like who gets to live near these people.

    No surprise, then, that politicians would find it expedient to punish people who use drugs, even if such punishment only layers on still more shame, with research indicating that shame, in turn, exacerbates the pain and social isolation that drives people to use drugs in the first place

    Yes, but social shaming prevents *other* people from abusing drugs, or makes them keep their habit under control. I have no data but would be surprised if the effect was zero.

    I have nothing against other treatments, but the article doesn’t honestly consider the pros and cons of each method.

    1. Kyle

      Speaking from personal and professional experience, shaming and forcing treatment upon people is never the answer – it is what we have been doing for decades and it doesn’t work.

      The only way “forced” treatment works is if you are willing to provide wrap around services – housing assistance, employment assistance, and a community for them to lean on.

      If you throw them into a facility and say “you must stay sober with no life skill support” – it will fail 9/10 times.

      We should treat substance users like a normal human – because I am willing to bet my mortgage you already live by a ton of users and don’t know it.

      We have destroyed our sense of community and replaced it with rugged individualism which has left people isolated – add on the guilt and shame they feel from using, so they never seek out help.

      Judgement and stigma have to be completely removed before we can proper tackle substance use.

      I work at the org that operates the only syringe exchange in my city and we have immense success meeting these people where they are and offering compassion through recovery.

      1. Heather

        I agree 100% with you. My sister is almost 70 years old and is a gay alcoholic. She started drinking when she was 14 years old and was abused and raped by several men before she was 20, due to being drunk so much of the time. As she got older she began to accept her gayness and she eventually fell in love with a woman who told her if you don’t stop drinking, I won’t stick around. Our parents had tried to get her into several treatment programs, but nothing ever took, until she met Barbara. We all loved her so much, but didn’t know how to help her. And now Barbara is failing and losing her memory and my sister is turning into a caretaker! Who would have thought it? I am so incredibly proud of her!
        People need love and acceptance and to be met wherever they are. My 2 cents.

  2. Robert Hahl

    I have attended many support group meetings sponsored by NAMI, and have spoken to dozens of people with children and siblings who can’t take care of themselves, apparently due to drug use. Permanent schizophrenia and related mental disorders resulting from street drugs is not widely recognized as the real problem. Instead we hear they are addicted, mentally ill, homeless, depressed, etc. One of the common symptoms of these people is a complete lack of insight into their mental illness. They might know they need help because life is hard, but don’t think that they are crazy and resist most attempts at treatment.

  3. WillyBgood

    “When people in distress have friends, attendant family, and healthcare providers who are genuinely there for them no matter what, their own self-perception improves. In other words, we help one another simply by being nonjudgmentally available.” There is no simply about it. Anyone who has had a loved one or friend who has become a non-functional drug user understands the complexity of continuing that relationship. A person beyond control becomes a black hole of need, beyond most peoples ability to give. People who are “genuinely” there is doing a lot of work. This, as always, is not a binary problem of use/not use. There are degrees and at some point you will have become a dangerous liability (family members have stolen from/physically harmed grandmas and others offering support without judgement in my experience). At the extreme, the help is for those around the user who have been repeatedly harmed giving unconditional help to the user.

    1. Steve H.

      : “their own self-perception improves.”

      This is an ambiguous and potentially misleading statement.

      If it means they have a clearer understanding of their situation, and are better oriented to their circumstances, they might be situated to work to make their situation better. Or they might make the calculation and kill themselves. Love you, Cairrill.

      It could also mean a raised self esteem and sense of importance. This is the introduction of bias into the system, which can be very destabilizing.

      In the past month, two people that Janet and I sent resources and a mechanism of raised agency to flamed out into criminal behavior. In both cases the increased sense of personal power was coupled with the extra cash getting turned into drugs. In both cases, the person who brought them in got singed and wants nothing to do with them. Leaving the drug user even more isolated.

      No easy answers, not even the right questions. But I’m guessing creating more iron-law institutions won’t lead to less misery.

    2. t

      …Americans believed that most people view individuals who use drugs as non-community members. It matters little that the impulse to use such substances is driven by an urge to ease emotional pain…

      That is where they lost me. Black hole of need indeed – completely ignoring people, especially parents, who have been there over and over and endlessly and ruthlessly exploited by the user. And people use drugs for all kinds of reasons, including the emotional pain of waking up every day to find out that the rest of the world doesn’t worship them as the most special of snowflakes, or because it seemed like harmless fun until it wasn’t, or because of the physical pain and exhaustion of being overworked.

      1. CarlH

        Really? Is this seriously how you view addicts and alcoholics? There but for the grace of god and all that. I hope you never find yourself on the other side of your heartless outlook. Your sense of superiority is peeking through. Might want to hide that.

        1. t

          Yep. There are a few other broad groups in the long list of my personal experience, but I was keeping it short and other comments cover them. (I don’t think anyone has mentioned permanent injury from a catastrophic accident.)

          Did you write the article? Have you read other comments? Like the one I replied to?

          1. CarlH

            I apologize. I realize this is an emotionally thorny issue and that dealing with addicts and alcoholics is extremely difficult in any number of ways. I needn’t have been so strident in my sentiments. I should never reply in anger.

            PS- I’m not sure why I am double posted, but didn’t mean to clutter up the board.

        2. CarlH

          Also, most addicts and alcoholics I know, and that is a large number due to my being one of them (thankfully in recovery) are self medicating due to past untreated trauma or mental health issues, both of which are nearly impossible for most Americans to get help for due to living in a heartless country that values nothing but wealth and power. But keep thinking it is because of “the emotional pain of waking up every day to find out that the rest of the world doesn’t worship them as the most special of snowflake.” What an unbelievably ignorant, mean spirited thing to say.

      2. CarlH

        I hope you never find yourself on the other side of that equation. And don’t think you can’t because you most certainly can. Most addicts and alcoholics I have met, and that number is large because I was/am one of them, are self medicating to drown out past trauma or other mental health issues that are almost impossible for people to get help for in our demonic country.

        “And people use drugs for all kinds of reasons, including the emotional pain of waking up every day to find out that the rest of the world doesn’t worship them as the most special of snowflakes”

        Do you really believe this? This comment fits in well with our society and it is attitudes like this that have helped get us to where we are.

        1. Arizona Slim

          Actually, I really do believe this because it describes the twenty-something Slim to a tee. Suffice it to say that I was a hot mess.

          One fine day during the summer of 1984, I dropped in on a Narcotics Anonymous meeting in Pittsburgh. Talk about a smoke-filled room. And I didn’t smoke then, nor do I smoke now.

          But something inside me clicked. I realized that if I didn’t get my [family blog] together, I wasn’t going to be dropping in on NA meetings. I would have to go back and choke on that [family blogging] cigarette smoke.

          So, I quit doing drugs — cold turkey — and got help for my laundry list of problems. Let me tell you, that help came with a lot of Pittsburgh tough love, and it saved my life.

          My helpers made it very clear that Job #1 for me was to grow up. Truth be told, that’s a project I’m still working on.

      3. CarlH

        Also, most addicts and alcoholics I know, and that is a large number due to my being one of them (thankfully in recovery) are self medicating due to past untreated trauma or mental health issues, both of which are nearly impossible for most Americans to get help for due to living in a heartless country that values nothing but wealth and power. But keep thinking it is because of “the emotional pain of waking up every day to find out that the rest of the world doesn’t worship them as the most special of snowflake.” What an unbelievably ignorant, mean spirited thing to say.

    3. chris

      We have family members who just want to get high everyday. All day.

      In some cases we gave them a house, an allowance, a car, access to case workers, regular check-ins with family. It didn’t matter. They trashed the house. Crashed the car. Assaulted the case workers. Spent the allowance on things they could pawn for drug money.

      In other cases, I’ve helped family members after they’ve returned from incarceration. They returned to drug use as soon as they could.

      Normal people, and anyone with anything close to typical resources, cannot be expected to assist people who have decided to use drugs. Expecting people to accept these situations and the people involved who may be destroying the family as well as themselves is impossible.

    1. chris

      Not a particularly useful question since people who abuse alcohol are also treated as addicts in need of similar services/care, and, for whatever reason you like, alcohol is legal and is not anywhere near as addictive as opioid or other narcotics.

      I can also easily test, non-invasively, for the level of alcohol in someone’s system, and then have a good idea how long ago they ingested it, and how long it will take for their body to process it. I can’t do either with most of the drugs we’re talking about. We can’t even do that with marijuana. This entire issue is a fundamentally different set of problems for our society than alcohol use, even if you were to consider alcohol a drug.

  4. lyman alpha blob

    Well I’m glad one writer can at least label Biden as the autocrat that he is, what with starting wars without consulting Congress, abusing the govt. agencies to go after political opponents, routinely censoring speech, etc. But they should have pointed out that Biden is behind Israel’s genocide on Gaza and the Zionists aren’t doing it on their own. Baby steps I guess!

    I will now read the rest of the article.

    1. chris

      Not a coincidence that one of the people discussing these claims is a writer. I can’t think of many other jobs or vocations where being high is acceptable.

      This seems to be the cost of our Demon’s bargain. We have made life impossible for so many that they are choosing illegal substances to help them cope with the insanity of it.

  5. Amfortas the Hippie

    when i see stuff like this…as well intentioned as it may be…i think about that guy, maybe 10 or 12 years ago…who made waves talking about a rat study with cocaine water.
    in one cage, was a lonely rat…no buddies, no toys or other stimuli…bored out of his mind…and with a choice between coke water and regular water. the rats put in this cage regularly OD’d.
    but another cage, with the coke water and regular water…but also with lots of toys and stimuli and rat buddies…the rats would try the coke water…and even indulge sometimes…but they generally didnt OD.
    the guy who was waving this study around summed it up: we need better cages.
    ie: tame care of Maslow’s heirarchy of needs, and the problem of substance abuse goes way down.
    now, in my experience…especially my experience of bumping along the underbelly of our ever so virtuous society…you’re always gonna have a few who are prone to going overboard…take away their drug of choice, and they’ll huff gasoline or steal freon from the neighbor’s AC unit(yes, ive witnessed this,lol)…but how much of that behaviour is due to unknown trauma and/or biological problems in the brain?(we dont know, because we willy nilly lump everybody into the binary of good/bad…abstinance/ drug use.)

    in my own case…i drink more since i lost my best friend…and cant yet figure out how to find an analog to her.
    this fits with the above Better Cages thing.
    when she died, everybody expected that i would crawl in a bottle and never emerge….stoic philosophy and a rather extreme self discipline has prevented this outcome…but in the form of more or less Moderation, rather than Abstinence.

    i reckon we should run an experiment for 10 years…say…in Texas.
    make a living wage , reasonable rent, healthcare without bankruptcy, abundant healthy food access and less social stigmata for what amount to minor differences of opinion the law of the land…and let us see if the incidence of overdose doesnt go down.
    were all so surprised when dog eat dog policy writ large ends up with a lot of dogshit all over the place.

    1. Extroverted Intorvert

      Hola Amfortas, Thank you, you have nailed the essence of issue in a short concise manner. I’ve used the devils lettuce off and on for most of my 60 years, yes self-medication for the issues you detail above. Been through the medical/mental health system with frankly no help. Hope you can continue to find some balance after your loss.

  6. Vicky Cookies

    Class-blindness. The renewed focus on coercive treatment and involuntary commitment is an attempt to remove homeless people from shopping districts; there is no concern whatsoever for whether or not these people use drugs or are in distress. To obscure this is to fall into the trap liberals in Portland and Seattle did, where decriminalization in the name of destigmatization set the scene for the crackdown. This is what we mean by ‘scratch a liberal, bleed a fascist’.

    Two facts need to be faced by the political class in order to seriously address drug abuse, and the crises of overdoses and, to an extent, homelessness, which are outgrowths of it:
    1. The fact that drugs-producing nations in the global south are encouraged to produce and export these substances by economic structure, set by the U.S.
    2. The fact that a certain amount of unemployment is required of our own economic structure, leading us to throw people away when they are no longer useful to the rich. Unless and until these things are addressed honestly in policymaking circles, the cycle will continue.

    Incidentally, I wonder if anyone here knows of resources which might shed some light on the rise of fentanyl. It occurs to me that we didn’t start seeing it here in America until after the military destabilized Afghanistan, which produces ~80% of the worlds heroin. I doubt that there was an intent to disrupt supply routes, given who our allies were (the ‘Northern Alliance’). The Taliban banned the poppy in 2022, just like they attempted to do in 2001.

    1. Amfortas the Hippie

      prescription painkillers=> heroin(taliban comes back)=> fentanyl.
      a few acquaintances involved with cartels/mexican mafia tell me that the cartels like fentanyl because its stupidly cheap to make, doesnt set off the dogs, and can be shipped in tiny packages because the end user gets so much bang for their buck.
      when the CIA heroin pipeline dried up, fentanyl was an obvious replacement.
      around here, its meth thats the big problem(aside from good ol amurkin alcohol)…and the local cornbread mafia hires its own cooks, locally…altho they also procure it from mexico.
      sheriff’s department is, historically, either wetting their beak or directly involved…depending on who sits in that chair.
      current sheriff is retired houston police drug task force(30 years)…so, a foreigner,lol..he campaigned on cleaning up all that.
      but its old money behind it(sons of pioneers) vs the new money(wine people and oil people building their million dollar doomsteads) who want it cleaned up.
      so its a battle under the carpet….and the new money has a lot more money than the old money does.
      i stay out of all of that…grow my own noble pasturage, and do all my beer drinkin way out here.
      (the numerous bars and wine tasteries are where at least a portion of the meth trade happens…at least for the casual users.(the hard core get home deliveries,lol)

  7. VH

    Since we are also talking about mental illness, either causing the perhaps self-medication of drugs or alcohol or the other way around, the drug use causing mental illness, and the same facilities will sort of try to treat all of these conditions, isn’t it the medical system that is the culprit here? As others have said in the comments, trying to help or at least not harm someone in your immediate orbit with one of these problems can turn your life upside down. They can cost you money, your health, even your job if they show up and go nuts at your workplace. How is the average person supposed to deal with this? People do need some kind of professional help. I’m not saying take anyone and lock them up but if there were more places that practiced medicine kindly and not behave the same a prisons, wouldn’t it be better for a recovering addict or mentally ill person to be off the street? There are no easy answers obviously but the support of friends and family has great limitations. A person who self-medicates to dull pain needs years of therapy and other health support for the body they have ravaged. Who in America can help someone like this while they are trying to keep their own life together with minimal resources? The average person with a job and health insurance and no major health problems still winds up getting stressed out by the medical system and paying way more than they should for just regular stuff. The American medical system is broken for the average person, so clearly it can’t do much for these extremely complex problems. Politicians are just trying to get votes, stay in their jobs so they want a quick fix, PR moment by trying to lock people up but they don’t have many options. Believe me I don’t think politicians should be defended and they are the reason our healthcare sucks.

  8. Jeff N

    Most opiate addicts need to steal to pay for their habit, and they all eventually end up spending some time in county jail; so “involuntary treatment” is already kind of happening. Here in Chicago, they have some sort of methadone program in Cook County Jail, and then there is a drug diversion program for them when their trial arrives.

    1. Bugs

      Come now, do you have any data whatsoever to support that statement? Happy there’s not cold turkey in Cook County as punishment but jeez, my friend, people who use opiates aren’t all eventually gone thieving to get their fix.

    2. Adam Eran

      Well…except in Switzerland where they de-criminalized heroin. Crime declined 85% around the dispensing clinics.

  9. Rick

    I’ve had several family members with a substance abuse habit that have resulted in serious problems, including death. In one case, I had to break off contact entirely. For others, I could continue to have some sort of relationship without trying to control or cure their problem. Whatever relationship I can have with them, I will. What I have given up is thinking their substance or mental illness issues will change through my intervention.

    As a society, though, we in the US do need to be more humane. The class disparities are out of control and we are losing any sense of collective good which in a country this large does not bode well.

  10. Anonymous 2

    I am not sure how you get from the present situation to the right place, but here in the UK we certainly have shown how to get from a reasonably good place to a bad one.

    Time was, around 1970, here in the UK, addicts could get their drugs prescribed for them by their doctors, paid for by the state. The result was that there were hardly any addicts at all – about 1000 out of a population over 50 million. Then, thanks to Nixon, the UK was pressurised into joining the war on drugs. Doctors were prohibited from prescribing the drugs, so the addicts went to the black market, which incentivised people to go into business supplying the drugs illegally. Last time I looked at the figures the number of addicts in the UK was estimated to have gone from one thousand to one million.

    Seems to me that the solution, if it can be called such, is to treat addiction as an illness and involve the medical profession. In the US, I imagine you would need to socialise the health system in order to do that so I am not going to hold my breath. After all, here in the UK, having abandoned a reasonably successful approach 50 years ago, we are still unsuccessfully pursuing our War on Drugs. Stupid is as stupid does.

  11. Tommy S

    As usual some very good comments here. I’ve been in the underground music scene in SF since the 80’s and I can tell you, I know of not ONE person that said kicking in jail (or two week program, however you phrase it). worked. All who survived did it with yes gov’t help, but mostly people help, and long term care, within those gov’t programs. Never jail . And be assured, that is what Newsom has done, and Mayor Breed is pushing for. Even ‘left’ SF does NOT have treatment on demand. There is a huge waiting list. And there is NO housing even for natives, on demand…there are years’ waiting lists. And when people safe, seemingly secure against the brunt of rising rents, and can afford medical or find it, I would suggest to ponder…… 110,000 overdoses a year, compared to 10,000 at the most during the ‘epidemic’ in the 80’s, when housing was actually cheap in our cities, to wonder….if that many people are dying every goddamn year, and I see them right in front of me, many young still health looking people, how many are actually addicted? Is our gov’t really planning on being able to throw millions into forced treatment centers…which don’t even exist as it is?????

  12. Antagonist Muscles

    I once met a woman named Angela. I asked her if she had ever heard the Rolling Stones song Angie. Her eyes lit up. “Antagonist, I love that song! That’s my song. It’s one of my favorite Rolling Stones songs.” I think, “Well, I’m glad you like the song because I too like it, but did you notice Angie is a very sad song?” I definitely should not judge anybody about misinterpreting lyrics since I seldom pay attention to song lyrics.

    Nevertheless, the titular Angie can be construed as a lovely woman, but Angie is really a metaphor for drug addiction, specifically heroin addiction according to Keith Richards. From Angie:

    But ain’t it time we said goodbye
    Angie, I still love you
    Remember all those nights we cried?
    All the dreams we held so close
    Seemed to all go up in smoke

    Those lyrics and the above article capture just how awful addiction is. I should know considering my own past problems with addiction. With the notable exception of caffeine (which I successfully quit), my addictions were mostly behavioral addictions. Most insidiously, I was addicted, and I didn’t even know it. It took me years to realize my addictions were detrimental to my physical and mental health. When I first realized, I still denied it (ain’t it time we said goodbye). I couldn’t think clearly and my plans would “go up in smoke.”

    I am doing well now. I spend a good amount of time researching and understanding addiction, as the neuroscience of addiction gives me a good framework to understand my past actions. I highly recommend Nora Volkow’s work, which the above article mentions.

  13. Albe Vado

    Perhaps I’m an outlier, but as someone who actually works with addicts every day, I firmly feel there is absolutely a place for forced institutionalization of addicts. The best model is a push and pull, carrot and stick approach. There are people who you simply cannot reach to get them on the long path to recovery until after a period of forced detox. Because they’re simply never going to detox any other way. And with fentanyl so rampant, now compounded with things like tranq being used as filler, the bodies simply will not stop dropping. If they can’t get off on their own, not at least attempting to force them off effectively means just waiting for them to inevitably OD. And in the case of one guy I know who is himself a dealer who keeps turning up connected to fatal and near fatal ODs, how many people is he going to drag down with him before he finally offs himself?

    A few other examples: I know at least two people who can tell you in their own words how a long stay in jail, one of which very nearly went to prison until his public defender managed to get the sentence reduced, forced them to drastically reassess their course in life and change themselves. And part of that was because the very act of getting thrown in a cell for a few months was defacto detox. It wasn’t nice, at all, but it was what they needed.

    Another example is how the recent deep freeze in my area essentially shut down the whole drug trade for a week. People couldn’t get to their dealers for days. Their behaviors and general coherence went up drastically by the time the weather warmed up (many of then were also really, really mad as they were now suddenly dopesick).

    Push and pull. You can’t simply jail and prosecute this problem away, but what you can do is make jail and forced recovery part of a larger ecosystem of services. Use jail as the initial contact point to get people in the system and connect them with other services. Ideally after they leave jail other options can help them and they never have to see the inside of a cell again. The hammer exists as part of a toolbox for a reason. It isn’t the solution to every problem, but it is a useful tool that has a genuine purpose.

    Forced treatment often fails, but I’m talking about a subset where all attempts at voluntary treatment, of even just detox before actual treatment, have consistently failed. The forced approach very well may fail too, but so has everything else.

    For the record, I’m typing this on my phone as a guy tweaked out of his mind on at least meth, and probably fentanyl, stumbles and twitches his was past me, after taking a half hour in the shower when he knows, because it’s been explained to him many times, the time limit is ten minutes. He will not be getting another shower for another week, because actions have consequences and the hammer is part of the toolbox for a reason. Maybe he’ll learn to stop depriving other people. Or maybe not, but at least for the next week other people won’t have to run the risk of time running out before they can get in the shower.

    1. RookieEMT

      It’s setting up a series of check marks before someone finally is elegible for a stay at an asylum. Chronic homelessness and getting a criminal conviction with violence. Mutiple arrests with drug possession. A diagnosed mental illness. It’s tough but at one point the options run to zero with a small number of patients.

      Asylums won’t solve America’s social crisis. Actually they would get overwhelmed on day one. Hospitals would try to dump patients into it in desperation. I’m guessing a ‘state of the art’ facilility with several hundred beds would be full in a week in my state. Hence the strict criteria.

      Give em’ therapy, maybe some of the drugs or the related medications to prevent horrific withdrawals. Give em’ job training a month in if progress is made. Maybe after a few months transfer to a halfway home or whatever other program they qualify for.

      Otherwise they will continue being homeless. In jail. Or dead.

      I’m scared about the possibility of permanent residents. That’s a criteria I’m not approaching.

      1. chris

        I agree. The only thing large scale institutional care would do in the US, as this country is currently set up, is give authorities a new hole to throw people into and forget them.

        It would be kinder if we still had the punishment of “transportation” – off you go to the colonies! – than what passes for the system for most people in many cities. I’m afraid that what will happen when the US adopts Canada’s right to assisted death rules is we’ll see millions sign up to die. Because that is the only choice they’ll have left.

  14. David in Friday Harbor

    Heroin is my mother and my lover

    I once elicited this testimony from a person who had spent 25 years ripping-off everyone who had ever loved him who was about to be sentenced to 25-to-life.

    Why do people attach such shame and stigma to addiction? Because substance-use is a form of masturbation, something one does not do in front of other people without their consent or in public. But no matter how much shame is attached to it, people use substances because they make them feel good. But please don’t get behind the wheel on a public street!

    How many drug treatment professionals does it take to change a lightbulb? Just one, but the lightbulb’s got to want to change.

    People who have become addicted due to what Dr. Vincent Fellitti called Adverse Childhood Experiences, or due to economic deprivation and social isolation, are not going to respond well to involuntary treatment no matter how well-intentioned, unless it addresses the adversity in their lives. Otherwise they will simply be further brutalized by their incarceration.

    The Chinese government points out that 80 percent of the world’s addicts are Americans. What is it about America that drives this, when there is virtually zero domestically-produced street fentanyl or methamphetamine? Could it be de-industrialization and open borders for goods that have made every street corner a virtual pharmacopeia?

    People have self-medicated since the beginning of human history. Perhaps if our federal government were to get serious about closing the borders to the most dangerous substances people would die from them a lot less.

  15. Albe Vado

    I was talking about addicts, not the insane, but if we are going to talk about that, yes, bring back the asylums. No, they won’t solve the homeless crisis. They’ll take a big bite out of the mental health crisis though, and make things easier for everyone trying to alleviate the homeless crisis.

    I’m on the front line of helping the homeless. My conviction about this grows even as I’m typing this: we are not equipped to deal with the insane. You can name a hundred different reasons why you think asylums are a bad system, but right now what we have is no system whatsoever. A huge number of people doing this work are volunteers, and of the people who are paid, few if any of them have qualifications for dealing with the mad. Many have some degree or other in social work, but that doesn’t remotely qualify someone to be a mental health nurse. The patchwork of charities, non-profits, and underperforming government offices that are attempting to get people off the streets are absolutely not equipped to deal with the insane when they come through the door.

    As for the addicts, give them therapy and withdrawal medications…when they refuse the therapy? This is circling back to my entire point about forced treatment in some cases.

  16. Jake

    “What if we acknowledged that those who use drugs need the very same things that all people need, including love, support, and human connection, as well as stable employment and an affordable place to live?” Because unfortunately there are a lot of people in America who will ALWAYS choose drugs over everything else. I’ve lived near a non profit that gives handouts to drug addicts no matter what the drug addicts are doing. It creates a situation where drug addicts congregate by this non profit and terrorize the people just trying to live their lives without being bullied and attacked each and every day by the exact same drug addicts. These people have to be dealt with and it isn’t always pretty. But pretending that every single drug addict just needs a little help and they will be just fine is insane. It’s destroying our cities right in front of us. And it’s turning people republican. I had never voted for a republican in and election of any kind until I started watch bleeding heart liberals screaming about criminalizing homelessness, telling me I hate homeless people, or accusing me of being republican. At this point I am so sick of hearing these sob stories about how people just need to be treated like humans and everything will be okay when that is so obviously not true. Some of you have already heard me bitch about this many, many times. But, it’s traumatic for the people who live where the bleeding hearts bring all of the drug addicts, turning regions of large cities into huge, completely unmanaged, zero law enforcement allowed meth camps. I fought those people for 14 years only to see my own city council try to appease them. I finally had to move. The “What if we acknowledged that those who use drugs…” people stole my home, and then my home town. It has to stop. And just FYI, feel free to respond to my post, but please understand the I suffer greatly from the trauma described above and I am not able to read responses.

    1. RookieEMT

      Im’a just share a story of a veteran EMT from Grady EMS, north of Atlanta. He gave up on being an urban EMT precisely because of what your dealing with above.

      He greatly enjoyed responding to the gunshot victims and the car wrecks. He loved the adrenaline factor. There were many great EMT’s and still are at Grady.

      It was the chronic homeless that got under his skin. When the signs of severe stress showed up. He became much more hardened l, defensive. Self assertive when pushing back on the non-coperative and combative patients.

      For example a homeless man addicted to alcohol who would drink mouth wash. Fighting with EMT’s in the back of the ambulance and in the hospital as they confiscated his minty mouth wash.

      What made him quit was watching how a co-worker was evolving scared him. An EMT kind of specialized in behavioral emergencies. Much more hardened than my friend. Apparently corrupted as he took joy in using chemical restraints. A smile on his face as he approached patients from behind with a benzo syringe at the ready, sadism.

      My friend did not want to become that. So he moved to a quieter mountain town and joined the rescue squad and their local EMS. Probably has a little PTSD but now he’s having fun on the job.

      I want to be an EMT one to two year tops. Not career worthy, not even close. I’ve talked to nurses who worked in behavioral wards, not worth it either. They are happily no longer nurses. The pay isn’t as good as it used to be.

  17. Victor Sciamarelli

    My own view is that drug addiction is a form of slow-motion suicide and addition should be treated as such to save their life.
    I get the drug thing, sure, you feel like King Kong for 4-hours but then you feel like a sack of shit for two days, and it’s really hard finding job paying a decent salary to hang around the office as a ball of dust.
    People need a reason to live. If society doesn’t care about the people in it, then that is certainly a big problem. Addicts, imo, don’t need love and attention, they need a reason to live and love themselves, and then they will be able to love other people.

    1. Albe Vado

      They do need love and attention. But my position would be that being nice is not always the loving approach.

      I’m getting really tired of attending memorials for fatal fentanyl overdoses, and as far as I can see all of the people writing pieces like this have no real solutions beyond lecturing us on how we can’t do X, Y, or Z because somehow it’s dehumanizing or whatever.

      Coercive treatment indeed won’t work in many cases. You know what also often doesn’t work? Whatever the hell were pretending to be doing right now. I’m all for coercion as a Hail Mary. Sometimes it sticks.


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