Re: Is drug addiction usually a cause or consequence?

Graeme Bacque (
Wed, 27 May 1998 01:27:20 -0400 wrote:

>      As usual, I'd like your feedback on the following TP Feedback
> question:
> On Sat, 23 May 1998 21:58:06 EDT Jeevan <>
> wrote:
>     What would you say were the most common causes of someone becoming
> homeless.  Is drug addiction usually a cause or a consequence?  As a
> future physician, or if I were to start up an organization catering to
> health needs of the homeless, would you have any advice as to what
> concerns need to be met first?

Right now there's a fascinating debate going on  in another list I'm subscribed
to. The state of South Dakota is on the verge of passing legislation which could
force pregnant women who drink into involuntary inpatient treatment for alcohol
abuse. Whatever negative effects alcohol might have on the fetus aside, I find it
very alarming that any legislative body would seek such a punitive, judgemental
approach to a personal (and entirely legal) lifestyle choice which happens to
have consequences for one's health. This whole issue of personal autonomy has
sparked a furious debate which has been going on for the better part of a week.
(I think my own opinion is among a pretty small minority.)

As a causal factor in homelessness, I would have to answer yes *and* no to the
above, with strict qualifications on the 'yes'... if alcohol or drug use causes
behavioral issues or compromises someone's economic situation, then it would be a
factor. But then again this has to be viewed in the context that real economic
freedom belongs only to a very few to begin with, and as well this society isn't
kind to the human soul and seeking relief from pain seems an entirely natural
response to an often unlivable situation.

If you own a home and have good income these issues are usually shielded from
outside scrutiny but if you're homeless or inadequately housed - or simply poor -
these things are much more in the public eye and are often met with harsh
judgement. The one thing which I can state with certainty (from painful firsthand
experience) is that substance use/abuse, or for that matter any debilitating
condition of body, mind or spirit can only be aggravated by homelessness. When it
comes to actual causes of  homelessness, the most common by far in my opinion is
economic inequity complicated by an inadequate supply of affordable housing.

I'm a firm  believer in a harm reduction model involving teaching people about
safer approaches to substance use or sexual expression, while placing an emphasis
on the fundamental needs like shelter, good nutrition, development of a
supportive community and other things which bolster someone's general well-being,
while reminding people that more concrete assistance can be obtained with
specific issues (such as addiction) if, and only if, they choose. The immediate
priority is  keeping people alive and in the best possible state of health.

Force, or threat of legal sanctions, are totally counterproductive when someone's
actions have not posed a clear threat to anyone else and should be avoided  Many
people who would otherwise seek assistance are deterred from doing so simply due
to fear of persecution or mistreatment. (More qualification here on the subject
of force - people have the right to protect themselves from harm, and likewise
to assist others in the vicinity in deflecting a threat. What most people don't
understand that once any immediate threat is past, they have an obligation to
walk away and not pursue the matter further. 'Preventative' action aimed at
placing physical or other  limits on persons who aren't an immediate source of
risk is in itself a violent act. Any approach should focus on protecting people
from harm rather than punishment.)

Looks like you guys got me rambling tonight!  :)
APA - No Way!! Toronto, June 3, 1998