Tag: Addiction

Using Private Funding, King County Provides Alcohol and Cigarettes to Patients at Isolation Sites

Beer, Mug, Refreshment, Beer Mug, Drink, Bavaria
Image via Pixabay.

King County has been providing alcohol, tobacco, and, until two weeks ago, cannabis products to some patients with diagnosed or potential COVID-19 infections who are staying at the county’s isolation/quarantine and assessment/recovery sites, The C is for Crank has learned. These sites serve people who are homeless or who cannot isolate safely at home.

The program, which is not funded through public dollars, is similar to efforts in other cities, including San Francisco, to enable patients who have tested positive for COVID-19 or have been exposed to the virus to remain isolated safely while mitigating or preventing withdrawal symptoms.

“Limited and controlled quantities of alcohol and nicotine have been provided by the health and behavioral health clinicians on site as part of clinical management of withdrawal symptoms and harm reduction practices to support patients to safely stay in isolation,” Department of Human and Community Services spokeswoman Sherry Hamilton says. “In all cases, this clinical review and approval for a requested item is required.”

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While programs like King County’s have been controversial in other cities, they are based in the principles of harm reduction, a set of strategies at reducing the negative consequences of drug and alcohol use. Other examples of harm reduction include methadone clinics, needle exchanges, and the Downtown Emergency Service Center’s 1811 Eastlake project—not to mention things like nicotine gum and marijuana as an alternative to heroin.

Hamilton did not say how many people had received alcohol, nicotine, and cannabis products, but said that the department’s director, Leo Flor, has been paying for these items out of his own pocket while the county secures “private foundation funding as a more sustainable approach to funding moving forward.” It’s illegal to spend public funds on alcohol, tobacco, or marijuana. Hamilton was not able to immediately provide details about how much these “initial harm reduction supplies” had cost.

Providing people with substances they would otherwise seek out makes it easier to keep people from spreading COVID-19 in the community surrounding the county’s quarantine and isolation sites, and makes it more likely that people will stay at those sites for their entire isolation period instead of leaving against medical advice. In the case of alcohol, it also may be saving lives—for heavy, daily drinkers, withdrawing from alcohol without specialized medical intervention can cause seizures, heart failure, and death.

“For those who cannot do so, or who do not have a home, the County has created isolation and recovery sites,” Hamilton said. “We try to keep guests safe, stable and comfortable so they will stay the entire time, and harm reduction is one strategy that helps to achieve that goal for some of our guests.”

I have asked for more details about funding for this program, including how much DCHS director Flor has spent out of his own pocket, and will update this post when I learn more.

Addiction Treatment Centers Struggle To Serve Patients As COVID-19 Spreads

This excerpt originally appeared at HuffPost, where you can read a full version of this story.

The spread of COVID-19 has presented a unique challenge to those fighting another life-threatening epidemic: substance use disorders, which affect about 20 million American adults each year. Residential treatment centers, which are based on a model of group therapy and interaction among patients, are scrambling to adapt to the Centers for Disease Control and Prevention’s guidelines.

Those treatment centers are also facing a more existential threat: As potential patients stay away for fear of contracting the coronavirus, many smaller and publicly funded centers could run out of money and close their doors at a time when social isolation is driving many people with addictions to relapse.

“Historically, whenever there’s a crisis in the U.S., alcohol sales and illicit drug sales increase dramatically,” said Dr. Marvin Seppala, the chief medical officer at the Hazelden Betty Ford Foundation in Beaverton, Oregon. “Day-to-day things are suddenly stressful …. In the long run, there’s going to be an increased need for treatment.”

Treatment centers are considered “essential critical infrastructure” under the federal guidelines that most states are using to determine which services are exempt from requirements to shelter in place. But in order to keep people safe, they’re being forced to adapt in ways that go against normal methods of treatment, forgoing things like group meetings, family visits and open-door policies.

Melody McKee, who until last week was the clinical program director for Olalla Recovery Services in Olalla, Washington, said her treatment center made “the difficult decision” to implement a triage system for admissions.

“The way it will work is, like, ‘Is this person literally not going to make it if they do not enter this location?’” said McKee.

A person experiencing homelessness with no ability to access tele-health would rank high on the triage list, as would someone leaving detox who seems likely, based on their medical history, to go out and drink or use again.

Other factors that might push someone to the front of the line: frequent falls, past failure to follow through with opiate replacement therapy, suicide attempts and meth-induced psychosis. Those who don’t rank high on this kind of triage list may be turned away from treatment.

It’s a brutal calculus and a stark shift for treatment providers and advocates who have spent decades arguing for treatment on demand.

“No one can just walk up to a treatment center anymore,” said Dr. Paul Earley, president of the American Society for Addiction Medicine, which put out its own COVID-19 guide for providers. “The overarching issue here is to balance the risks of the two illnesses: the risk of contracting coronavirus and developing COVID-19 versus the risk of not getting treatment for the disease of addiction.”

Inpatient Facilities Make Tough Choices

McKee said the need to implement social distancing — for example, by reducing the number of patients who sleep in the same room — can be hard to balance with the desire to take care of as many patients as possible.

“Do you know what kind of burden it is to say, ’We know this person needs this level of care, but we also have people right here who are sitting ducks [for infection]?” she said.

If tests for COVID-19 were available, she said, her treatment center would be able to admit or reject patients. For now, all they can do is screen for symptoms and hope for the best.

The tight quarters at residential treatment centers and the medically fragile condition of most people with serious, long-term addiction make them ideal breeding grounds for infection. Long-term intravenous drug users often suffer from a heart infection called endocarditis; people who smoke crack, meth or marijuana may have diminished lung capacity; and heavy drinkers may have multiple organ failure and a suppressed immune system.

“These are not healthy individuals,” said Lauren Davis, executive director of the Seattle-based Washington Recovery Alliance. “People whose disease is advanced enough that it would necessitate inpatient treatment are pretty much universally in the high-risk category.”

To keep the virus out, treatment centers are cleaning more thoroughly and often, checking both staffers’ and patients’ temperatures regularly, and implementing social distancing in all group activities. That means putting space between chairs in group therapy, spacing out or canceling mass lectures, discharging some patients early if they seem stable enough to leave without relapsing, banning hugs and eliminating visits from friends and family, among other measures that fundamentally change the nature of rehab.

Read the rest of the story here.

Recovery in the Time of Coronavirus

Image via Pixabay

This piece originally appeared at HuffPost

“Keep coming back, it works if you work it, and we’re all worth it!”

That’s the chant at the end of most meetings of Alcoholics Anonymous in the Seattle area, done while everyone is still holding hands after saying the Serenity Prayer. It’s an affirmation that a program rooted in mutual, in-person support can keep people sober, as long as they keep coming back to meetings.

But here at the epicenter of the coronavirus crisis in the United States, where county officials have officially banned all gatherings of more than 50 people and imposed strict requirements on smaller gatherings, mutual support groups like AA, Narcotics Anonymous and Smart Recovery are struggling to cope.

Meetings that were once held in churches, hospitals and retirement homes have been canceled or moved online. Those gatherings that continue to take place are sparsely attended as residents hunker down. Several regional events for AA and NA members have been canceled or postponed.

Brian, an AA member in Snohomish, Washington, just northeast of Seattle, said he hasn’t gone to his usual weekly meeting since the outbreak hit the area a few weeks ago, and he’s feeling the effects.

“Anytime I don’t get to go to meetings, it impacts me, whether I think so or not,” said Brian, who asked that we use his first name only. “The meeting where I usually go is in a hospital, so that’s canceled.”

Amir Islam, a Seattle NA member who works in the music business, said he’s still going to meetings despite warnings to stay away from groups. On Friday, he said he had just chaired a meeting where people tried to avoid touching at the beginning but ended the meeting with their arms around each other — the NA equivalent to AA’s hand-holding ritual.

“People were doing the elbow bump and the fist bump at the beginning, and then it goes from that to everyone hugging at the end,” he said. “It was like, ‘Really? Are we avoiding each other or not?’”

Read the rest of this piece at HuffPost. 

Can You Drink (and Puke) Your Way Sober? A Seattle Rehab Says Yes.

Image via Pixabay.

 

This piece originally appeared at HuffPost.

By the time Tara wound up at Schick Shadel Hospital, a 10-day inpatient rehab facility just south of Seattle, she had hit a personal low. She’d always been a drinker — alcoholism runs in her family — but things had spiraled over the past few years. More than once, she found herself sobering up in jail, trying to remember what made her husband call the cops the night before.

She had already tried traditional rehab at an inpatient facility in Eastern Washington, as well as Antabuse, the drug meant to help patients stay sober by making them violently ill when they drink. Neither kept her sober for more than a few days. Alcoholics Anonymous was a bust, too: “I went to my first meeting, cried all the way through it, then went out and proceeded to get massively wasted.”

Tara, who is being referenced by a pseudonym to protect her privacy, realized that if she didn’t do something, she was going to lose her family. It was her husband who pushed her to try Schick Shadel, a treatment center in Burien, Washington, that promises to eliminate cravings within 10 days and claims a success rate of nearly 70%.

There, Tara found a type of treatment altogether different than the spiritual transformation emphasized in most 12-step-based programs. Schick Shadel treated addiction with brute force, like a physical foe. “It was nice to have permission to reject AA,” Tara said.

But Schick Shadel’s treatment involves some strategies experts consider fringe, even borderline unethical. The center administers high doses of alcohol combined with a nausea-inducing drug or mild electric shocks‚ a method called “aversion therapy.” It also involves interviews with counselors when the patient is under sedation. A 10-day stay at the center costs roughly $22,000.

And although Tara and others say they have benefited from the program, Schick Shadel’s unconventional methods don’t appear to be any more effective than other kinds of treatment. The most comprehensive long-term study of Schick Shadel’s success over time showed that 77% of former patients had returned to drinking after 10 years.

Drinking — And Puking — At ‘Duffy’s Tavern’

Dr. Charles Shadel founded Shadel Hospital outside Seattle in 1935 offering aversion therapy in a “homelike setting — the same year Bill Wilson started Alcoholics Anonymous in Akron, Ohio.

Decades later, a stay at Schick Shadel includes mandatory counseling, aftercare planning and other trappings of traditional treatment. But its most distinctive feature remains aversion therapy, which is based on the idea that if you associate a substance with an unpleasant experience, you’ll want to avoid it.

Schick Shadel patients are given a nausea-inducing drug followed by a cup filled with their drink of choice, which is repeated over and over again, and again, and again. If a patient’s body can’t handle vomiting, they can opt to swirl alcohol in their mouths while getting a series of mild electric shocks; if a patient is a drug user, Schick Shadel offers authentic-looking simulacra to snort or smoke.

The treatment room is like a bar from a nightmare — fluorescent lighting turned up to 11, a rolling cart stocked with warm gallon jugs of Fireball and vodka, and a giant mirror over a stark steel basin that is easy to imagine brimming with 85 years’ worth of vomit.

Although other former patients say the process of repeatedly drinking and throwing up was miserable, Tara was willing to try anything. “I was a serious bulimic for like 10 years, and they asked, ‘Is that going to be a concern?’ and I was like, ‘I don’t care about throwing up,’” she said. “I had done enough unsavory things that I never thought I would do that I said, ‘Fuck it, [my husband] really wants me to do this; maybe it’ll work.’”

Schick Shadel refers to these vomiting sessions as “duffies” — a reference to a fictitious bar that doubles as an in-joke among people in the program. On days when patients aren’t doing “duffies,” they have “sleepies” — interviews under sedation that are supposed to give counselors direct contact with a patient’s subconscious mind.

Until fairly recently, Schick Shadel used sodium pentothal, the so-called “truth serum,” for these sessions, but that drug became unavailable in the U.S. after European suppliers objected to its use in executions. Schick Shadel switched to propofol, a drug commonly used in general anesthesia.

“There’s a reason that they don’t put in the advertisements that you’re going to be given a duffy or an electric shock,” said Pete, another former patient using a pseudonym who went to Schick Shadel after his 12-drink-a-day habit started giving him morning shakes. “They know that if you knew that going in, you probably wouldn’t go.”

In the hospital, the aversion sessions are treated like a kind of shared trauma. Many wear navy “I had my last drink at Duffy’s Tavern” hoodies, which are available for $30 near the reception desk, over their green hospital scrubs.

“People say they need something more physical,” said Mark Woodward, Schick Shadel’s director of business development and marketing. People come here because of the promise behind all that suffering: that they will lose the compulsion to drink by permanently turning off brain receptors that lead to cravings.

“We are confident that we can help a patient lose their cravings in 10 days,” Woodward said.

Does Aversion Therapy Work?

The research on aversion therapy for addiction is sparse, and much of it has been funded or conducted by people associated with Schick Shadel, including its longtime medical director, the late James Smith, and Schick Razor Company founder Patrick Frawley, a onetime Shadel Hospital patient who purchased the hospital through a spinoff company in 1965.

Like most studies that treatment centers conduct, the results are limited to self-reporting from former patients who responded to surveys, and rarely include results beyond one year after treatment. The most comprehensive modern study of Schick Shadel’s method was in 1993, and suggested that about 65% of former patients surveyed said they were still sober after a year; however, 29% of the patients contacted did not respond to researchers at all, so the real “success” rate was likely much lower. Studies show that reported one-year relapse rates vary from 30 to 70% for all kinds of treatment, including one-on-one therapy. A more meaningful number would be the number of people who manage to get and stay sober over a longer period, but treatment centers, for various reasons, don’t typically track patients long-term.

Fred Muench, the president of the nonprofit Center on Addiction in New York, considers aversion therapy “outdated” and said it only works as long as the negative reinforcement is present. “When you’re in treatment, almost anything works, because you’re in a controlled environment,” Muench said.

Read the rest of this story at HuffPost.

Five Years

Five years ago today, I made a decision that would change the trajectory of my life, and lead—with many steps along the way—to the creation of the website you’re reading right now.

On February 6, 2015, I called a cab, packed a bag, and checked in to a detox center in Kirkland, where I stayed for five days before returning home and starting over—no job, no prospects, and no real faith in myself, but an ineffable feeling that this time, things were different.

I won’t belabor everything that it took to get me to Fairfax that rainy morning—suffice to say, this wasn’t the first time I’d checked myself in to a place where the doors locked from the outside—but something had clicked. More than six years after I first sought help—thinking, in my ignorance, that detox would be a “reset button”—I was done.

But putting it that way makes it sound like a foregone conclusion, and of course it wasn’t. Most people who struggle with substance use struggle to quit, and most of us relapse before we “get it.” Some of us have loving, supportive families who try to help; some of us lose the support of those families after a stint at treatment doesn’t “work,” and many of us don’t have support from family or friends at all, because we’ve burned every last bridge or never had bridges to support us in the first place. I had every advantage—a decent job, a family who wanted to help even if they didn’t know how, and friends who never stopped showing up for me, even when I was at one of my many “rock bottoms”—a concept, by the way, that is just a story we tell ourselves.

One of the reasons I write about homelessness and addiction with such conviction is that I know what it’s like to be addicted and I know the privilege that prevented me from becoming homeless myself. Another reason is that I want to dispel the myths about addiction that people choose to believe because it’s easier than acknowledging the ways in which we’ve failed people who don’t have comfortable cushions to fall back on.

For every conservative armchair addiction expert who says, “My brother was an alcoholic but he just decided it was time to quit,” there’s someone who tells me that they were doing fine on medication but then their doctor cut them off and they switched back to meth.

For every person who tells me they support a zero-tolerance policy for people who want to live indoors, there’s a guy who was able to quit drinking only after getting stable in a place where people didn’t judge him for having a disease.

For every person who says people live in tents and shoot heroin because they want life to be a nonstop party with no consequences or accountability, there’s me, an alcoholic, telling you that maintaining an addiction from day to day is some of the hardest work I’ve ever done.

The people you see on the street muttering to themselves or committing crimes to feed a drug habit or living in squalid, deplorable conditions didn’t start out that way; they fell farther than I did, and probably farther than anyone you know, because they ran out of resources, and probably didn’t have many to begin with. The job of a just society isn’t to look at people who are struggling with a life-threatening, time-consuming, soul-annihilating disease and shame them for not curing themselves on their own. It’s to ask them what they need and help them get it.

My bias is for compassion toward people that too many others view with contempt and want to sweep away. This isn’t because I’m a better person than anyone else. It’s because I know that the cure for addiction isn’t tough love or making people’s lives harder or forcing them into treatment and then blaming them when a 28-day spin-dry doesn’t “work.” The cure for addiction is realizing that there isn’t one cure for addiction, that recovery looks different for every person, and that some people may never “get it.” That doesn’t make them less deserving of respect and human rights; it just means that they didn’t defeat a life-threatening disease.

It’s hard to fit public policy into a framework of uncertainty, but everything else is a waste of time.

Unlike many of the people I write about, I had resources, and I got sober in time. I could have become homeless. I could have died. But I didn’t.

And here are some of the things I’ve done because I didn’t: I got a job at a nonprofit that fights for reproductive rights. I created this website. I got a book deal, left the job at the nonprofit, and started writing full-time. I moved out of a lousy apartment in a great location and got a place with a view in a better one. I expanded this site into a full-time enterprise, supported by hundreds of readers in Seattle and beyond. I rebuilt my old relationships and built some new ones. I wrote that book. I stayed here, one day at a time.

Seeking a Medical Approach to Meth Addiction, Seattle Researchers Look to Other Stimulants

As meth use and overdoses spike, particularly on the West Coast, researchers in Seattle are proposing a taking a medical approach to addiction‚ replacing with other stimulants in much the same way as methadone and suboxone replace heroin with alternative opiates. But propaganda painting the drug as uniquely addictive makes funding a challenge.

Here’s an excerpt from my latest piece at HuffPost; check out the whole story As meth use and overdoses spike, researchers in Seattle are proposing a medical solution that replaces meth with other stimulants. But propaganda painting the drug as uniquely addictive makes funding a challenge. Check out my latest at HuffPost.

At some point between their son’s stints at sober houses, jail and 14 rehab centers, Annie and Richard Becker gave up hope that he would ever stop using meth.

The Beckers, who live in Seattle, haven’t seen their son in more than a year. Before meth, their son was “really caring, very funny and likable,” the kind of guy who “didn’t like to see anybody else picked on or harmed,” Richard said.

After meth, he was scary and unpredictable ― the kind of guy who thought nothing of throwing a brick through his parents’ window or threatening his mom, Annie said.

“I think when he was most dangerous to us is when he was in withdrawal and couldn’t get drugs, and we became the target,” she said.

There are medications to help with opioid addiction, including methadone ― in use since the early 1970s ― and buprenorphine, which became widely available in the last decade. Both drugs are substitute opiates that can take away the destructive urge to use and give people a chance at housing, medical care and stable relationships. But there are currently no similar treatments for methamphetamine addiction.

“I’ve always felt like, is anybody paying attention to the fact that there’s all these meth users who don’t have any kind of treatment?” Richard said.

While there have been some studies that tried substitute stimulants to treat methamphetamine addiction, the results have been mixed, leading some to conclude that a medical treatment for meth addiction is unlikely.

But a team of researchers in Seattle wants to challenge that theory. Their plan is to give relatively high doses of methylphenidate ― better known as the ADHD drug Ritalin ― to patients who are already in treatment for opiate use disorders and also use meth. The proposed pilot, which still needs about $500,000 in funding, is not yet underway. It would be a joint effort between Evergreen Treatment Services (ETS), the University of Washington and the Seattle Public Defender Association. Although the Seattle City Council declined to provide public funding for the program in its last budget cycle, researchers are optimistic that grants or federal dollars will come through. If researchers see significant results, the pilot could be expanded to include more patients.

“What we really want to see is a very substantial reduction in use, so that you could say this is making an impact on people’s lives, in terms of improving physical health, psychological health, reducing criminal activity, and improving their ability to take care of the basic things in life,” said Dr. Paul Grekin, the medical director at ETS.

Seattle seems primed for this kind of experiment. Meth use has been growing quietly across the United States for years in the shadow of the opiate epidemic, but the increase has been particularly acute on the West Coast, where meth now causes more overdose deaths than any other drug. In Washington state, meth overdoses killed about one person every day in 2016. In King County, which includes Seattle, there were 164 meth overdose deaths last year, outpacing heroin as the leading cause of overdose deaths.

Meth has become cheaper, more contaminated and more potent in the last several years, according to front-line emergency service and case workers, leading to an increase in dangerous symptoms like cardiac arrest, strokes and hyperthermia, a condition where the body essentially burns itself alive. That’s on top of the more common symptoms of meth use, such as psychosis, dental problems, injuries, malnutrition and diseases transmitted through needles or risky sex.

Continue reading at HuffPost.

At HuffPost: 28-Day Rehab Isn’t Evidence-Based. So Why Do We Keep Sending People There?

When we talk about “treatment,” whether it’s in the context of a loved one’s addiction or addressing homelessness, we’re usually referring to traditional 28-day rehab—the “solution” of choice for insurance companies, policymakers, and desperate people looking for help. The problem is, 28-day treatment is one of the least effective methods to get people sober, leading to cycles of treatment and relapse that can cost patients hundreds of thousands of dollars without results.

I recently wrote an in-depth story about the growing consensus that 28-day rehab is the wrong approach. Check out the intro, then read the full story at HuffPost.

 

When Jessye first “graduated” from a 28-day treatment center outside Seattle, she knew she wouldn’t be able to stay clean. She became addicted to pain medication while dealing with endometriosis, and by the time she showed up at the doors of the private, for-profit rehab, she had been using Percocet for four years.

“When that got too expensive, I turned to heroin,” said the 34-year-old, who asked us not to use her last name out of concern that it might harm her professionally.

Fresh out of rehab, she was jobless, homeless and sleeping in her car, which was owned by an aunt. Then her family took away the car, because they didn’t want to enable her. After a couple of weeks, she started using again.

“I was really afraid,” said Jessye. “I really wanted to stay clean, and I really tried, but ultimately, they didn’t set me up for success.”

Addiction treatment is a big business. More than 2 million Americans spend a total of $28 billion every year on treatment at nearly 15,000 facilities across the country, according to the National Survey on Drug Abuse. About 12 percent of those opt for four-week treatment, which can cost anywhere from $10,000 to more than $30,000 a month. Many clients return multiple times before it sticks.

According to the Substance Abuse and Mental Health Services Administration, two-thirds of people who go to treatment end up going back at least once, with 20 percent entering treatment five times or more. The money flowing through private treatment companies creates perverse incentives for treatment centers ―  if treatment failed, patients and their families are told, it’s probably because the patient failed at treatment.

The solution? More treatment.

Read the rest of this story at HuffPost.

In Crosscut: After 15 years, Seattle’s Radical Experiment in No-Barrier Housing Is Still Saving Lives

If you’re interested in harm reduction, homelessness, and evidence-based responses to chronic homelessness and addiction (and if you’re a reader of mine, you probably are), check out my new piece in Crosscut about 1811 Eastlake, the 15-year-old program that provides no-strings-attached housing for chronically homeless people with alcohol use disorders. Here’s a teaser:

It was the late 1990s, and Seattle leaders were trying to decide what to do about an addiction epidemic. Residents of several center-city neighborhoods, including Capitol Hill and Pioneer Square, complained about public urination, trash and the constant parade of ambulances ferrying people to Harborview Medical Center. People told stories about coming home to find homeless addicts passed out in their yards. A task force was assembled to come up with solutions.

Back then, the substance at the center of the debate wasn’t heroin — it was alcohol. But the conversation about how to deal with what were then known as “chronic public inebriates” would be familiar to anyone following the opiate epidemic in 2019. “These people would be urinating, defecating, sleeping in doorways,” says former Seattle Police Chief Jim Pugel, who was then commander of the Seattle Police Department’s West Precinct. “We were spending $1,000 just to send people a mile up the road to Harborview. That’s the most expensive detox you can deliver.”

The best solution the city could come up with — creating special alcohol impact areas, where stores would be barred from selling certain kinds of high-alcohol malt liquor that low-income and homeless drinkers favored — was unpopular with store owners, the beverage industry and residents of nearby neighborhoods, who argued that the bans would simply push the problem into their front yards. “We were stuck in the middle,” Pugel recalls.

Into this impasse stepped Bill Hobson, the head of the Downtown Emergency Service Center, offering a third option: “Wet housing,” where chronically homeless people with alcohol use disorder would be allowed to live, and drink, without judgment or expectations. Hobson’s theory was that people could move successfully from the streets to housing without first going through treatment or other interventions — a controversial position, given the prevailing view that people living on the streets would “fail” at housing unless they got sober first.

Today, the concept of “Housing First” is enshrined in city housing policies across the country, including Seattle and King County. (The authorizing legislation for the proposed new regional homelessness authority, for example, explicitly mandates “evidence-based, housing first” policies.) So it can be easy to forget how radical the idea was just 20 years ago, when most programs targeting chronically homeless people required sobriety and intensive case management as prerequisites.

“We were skeptical — hell, yeah, we were. We thought, if you want someone to stop drinking, you should just make them stop drinking,” says Pugel, currently running to represent District 7 on the Seattle City Council: “My views have evolved since then. I’m not a Cro-Magnon anymore.”

The result of Hobson’s vision, known simply as “1811 Eastlake,” now sits on the edge of the South Lake Union neighborhood and has been serving Seattle residents for the past 15 years. The unobtrusive blue-and-gray, four-story building houses 75 formerly homeless men and women with severe alcohol use disorders and provides them with meals, counseling and health care, no strings attached. The program has saved money, and lives, by using the principles of “harm reduction,” which holds that reducing the harm people cause themselves and others through their substance use is beneficial in itself, whether or not the person quits using the harmful substance.

Pugel recalls that Hobson, who died in 2016, would declare loudly, “This is housing for drunks!” to anyone who seemed to misunderstand the purpose of what DESC was doing. Although current DESC Director Daniel Malone doesn’t remember him using “those exact words,” he says Hobson was always clear that the purpose of 1811 wasn’t to get anyone sober or to turn clients into clean-cut, productive members of society; it was to provide housing for people who had “failed out” of abstinence-based treatment and housing programs multiple times, were chronically homeless and had less than a 5% chance of “achieving and maintaining sobriety.” The point wasn’t to stop alcoholics from drinking; it was to improve their quality of life and reduce the amount they cost the public, in that order.

Read the whole story, complete with excellent photos by Matt McKnight, at Crosscut.

Georgetown Sobering Center Canceled, Sound Transit’s Tone-Deaf Fare Enforcement Tweet, and Seattle Times Loses Another African American Writer

In keeping with how quickly news piles up the moment after Labor Day ends, here are a few quick-hit items—in two parts!—from City Hall and beyond.

Round 2, non-City Hall edition:

1. An overnight sobering center, which was supposed to relocate from downtown Seattle to the Georgetown neighborhood this summer, will not open as planned. Neighborhood residents filed a lawsuit to stop the center in June, alleging that the city had filed to do an environmental review of the site or consider impacts on the small neighborhood before approving a permit for Community Psychiatric Clinic to purchase the site. (CPC planned to run the center through a contract with King County).

“Aspects of the Georgetown Neighborhood that make it especially unsuitable for the new facility include lack of supportive services and public transportation, a burgeoning homeless and RV population, pollution, and a proliferation of bars and entertainment venue,” the lawsuit said.

Since then, CPC has merged with Sound, another local mental health-care provider, and withdrawn plans to build the sobering center on the site. Currently, King County has not identified a new location for the center, which was designed to take pressure off local emergency rooms and serve as a place for people experiencing homelessness to sober up under supervision in case any medical emergencies do arise.

2. Sound Transit’s social media manager blew up local Twitter today when the agency’s official account responded to a tweet by local activist and teacher Jesse Hagopian about fare enforcement officers hassling students on the first day of school.

Sound Transit responded in probably the worst way possible, by responding that if the kids in the photo are “like my kids,” the fare enforcement officers probably “gave them a one-day paper ORCA card that covers today. It’s good to remind folks how the system works. And officers have discretion to issue warnings instead of fines.”

This tone-deaf response set off a firestorm of criticism that had Sound Transit listed as the top trending topic on local Twitter for most of the day. Among other things, people pointed out that the author’s kids probably aren’t “like” the kids in the photo, in that they’re probably white kids who are far less likely (statistically speaking) to be hassled by fare enforcement officers. An audit last year found that King County Metro’s fare enforcement policies disproportionately impacted low-income people and people of color, and that most people who failed to pay fare did so because they couldn’t afford the fare.

At the time, Sound Transit board members raised concerns about Sound Transit’s more punitive approach, which can result in a criminal record, but the agency defended the practice. Board member Claudia Balducci, who represents Bellevue on the King County Council, says, “I really think kids riding our trains and taking our buses are the future riders of the system, and we should be doing everything possible to make them into future riders. .. What the audit says is that we should focus on making it possible for people to ride… and that’s not what’s happening.”

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3. Marcus Harrison Green, the founder of the South Seattle Emerald who was hired as a South King County reporter for the Seattle Times last year, has left the Times. He is the third African American writer (along with former homelessness reporter Vernal Coleman, who left for a job in Boston, and former columnist Tyrone Beeson, who took a position in LA) to leave the Times editorial department in the last year. The Times has historically had trouble retaining African American writers (and people of color in general—two other staffers of color, Mohammed Kloub and Jennifer Luxton, also left this year).

Earlier this year, white columnist Nicole Brodeur was demoted to general-assignment reporter after asking a black woman who was interviewing her for a school assignment if she could touch her hair; the incident came after Broduer wrote several racially insensitive columns, including one suggesting that African American parents should stop letting their kids “run[…] wild” and another saying Columbia City had been a dangerous “pass-through” zone until white businesses moved in.

 

A New Criminal-Justice Approach That Acknowledges “Addiction Isn’t a Choice”

This story originally appeared in the August issue of Seattle magazine.

On a day in late spring, David Lucas, 26, is standing in front of Seattle Municipal Court Judge Damon Shadid, waiting to find out if he gets to go home.

Lucas (not his real name) has been locked up in the King County Jail in downtown Seattle for nearly a month. Today, he’s facing a charge of trespassing at a grocery store—the same store where he’s been arrested many times, usually for stealing food. He’s been homeless off and (mostly) on for about a dozen years, and has a chronic mental illness that’s been exacerbated by his habit of smoking meth. Unless he can convince Shadid that he’ll stay out of trouble, he could be going back to jail for a while.

Lucas is part of Seattle’s visibly homeless population, the cohort featured in a KOMO-TV special called “Seattle Is Dying,” which aired in the spring. Although this group makes up a small percentage of the city’s overall homeless population, its members commit an outsize percentage of the kind of low-level drug and property crimes—such as shoplifting, trespassing and public urination—that KOMO highlighted in its special, which amplified the conversation about this subset of the homeless population.

Cases like Lucas’ pose a fundamental question: Is the arrest of people with severe addiction and mental illness who break laws a solution to chronic homelessness? Or is patience and compassion a more effective approach?

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Under ordinary circumstances, a judge might look at Lucas’ file—which includes dozens of arrests since 2011—and send him straight back to his cell. But Lucas is no ordinary defendant, and this is no ordinary court session. Like many other clients who sit at the defendants’ table in this courtroom every Wednesday morning, Lucas is supported by a new program that provides case management, legal aid and mental health services to people who, like him, have complex mental health challenges and whose competency to defend themselves in court has been called into question. His advocates this morning include Daniel Garcia, his case manager; Heather Aman, the prosecutorial liaison with the Seattle City Attorney’s Office; and Judge Shadid, who talks at length about the progress Lucas has made.

After a few minutes of deliberation, Shadid decides to release Lucas on the condition that he stay away from the neighborhood where he keeps getting arrested. And when Lucas leaves jail tomorrow, he’ll leave with Garcia, who has been assigned to help him stay on track. He’ll go to sleep tonight not on the street, but in transitional housing, a kind of way station between homelessness and permanent housing. Later in the week, he’ll have an appointment with the occupational therapist who is helping him with the life skills he’ll need to stay out of this courtroom. And his mental health care will be supervised by a team from the Downtown Emergency Service Center (DESC), including a mental health professional who will monitor his progress and adjust his meds if needed.

All of these services are available to Lucas thanks to a $3 million, 18-month expansion of the existing Law Enforcement Assisted Diversion (LEAD) program, a collaboration between law enforcement agencies, the Public Defender Association and Reach, the street-based case management program for which Garcia works. The expansion, which zeroes in on offenders with mental illness, traumatic brain injuries, addiction and other debilitating cognitive conditions, was funded by a 2018 settlement in a landmark case known simply as Trueblood. The settlement created a pool of money for programs to help defendants at risk of being “warehoused” in jails while they await hearings on their competency to stand trial.

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