We need to acknowledge that San Francisco has spent billions over decades on homelessness programs, yet the crisis persists, leaving us to ask: Is this truly the best we can do? Are we investing efficiently, or are we simply maintaining a broken system?
For meth, crack, etc there are effectively no pharmacological interventions available. And many (most?) of the street homeless have dual addictions to a stimulant and an opioid, so even if they did manage to switch from fentanyl to buprenorphine they would almost certainly be extremely unstable with their stimulant addiction.
Obviously there are psychological interventions and peer support groups, but these require quite a lot of stability to stick to and get to, which I think is extremely difficult for someone in a very chaotic addiction cycle.
To me, it seems some of the billions that cities spent on social services for homeless should be diverted (or in addition to) to pharmacological research. There is so little funding available for this - I read Prof David Nutt was doing an interesting PET study for kappa opioid response in addiction but ran out of funding. The funding requirements were low-medium hundreds of thousands of dollars and couldn't find it to continue the research.
The current status quo seems a bit like trying to treat TB without antibiotics. The treatment back then was basically similar to current 'rehab' programs - send them to a quiet place and give them care and help. Obviously not a bad thing to do; but once you had antibiotics the prognosis improved by many orders of magnitude almost overnight (and a lot less costly to provide).
I’ve lived here for a decade, in 6 different neighborhoods (including 6th street). I now live near Golden Gate Park where this article is mostly set. I found it inspiring, not insulting.
I would nlt he shocked if similar issues are happening in SF. at best very inefficient spending on minor factors, at medium they may be "fixing homelessness" by paying for more security than actual homes (this was one of the LA factors). Or at the damndest it's hurt outright Embezzlement.
Things that might help would be housing, food or treatments. But those real-world things are often very hard to come by, and often encumbered by the very people who profess to want to help.
For example, maybe building more homes would help - but developers are often hamstrung in their ability to do so - and often by exactly the same people that want to fund homeless programs.
So what happens when we give people a lot of money to "solve" a problem, but then prevent them from taking the actions that might help? Well, they still will always find a way to "use" the money (I'm not necessarily implying fraud here), but the results will never materialize. What this looks like in practice is funding studies, working groups, paper-pushing bureaucracies, etc.
So the money is gone, any we don't have anything to show for it.
Isn't that still treating a symptom, rather than the core problem? If homelessness is caused by drug addiction, what causes drug addiction? Underlying mental health? Lack of opportunity? Government welfare dependence?
One can argue that certain people are more predisposed to enjoy being high, I'm one of those people. When you see incredibly rich and successful people like Jimi Hendrix, Janis Joplin, Chris Farley, and Philip Seymour Hoffman ultimately losing it all to that desire, I feel like it's hard to blame something like lack of opportunity or government welfare dependence.
The "bad" drugs, crack/meth/opioids/etc. make your brain feel a way sober-type people can't really imagine. I don't know what the answer is.
I bet if you gave the average HN user meth or crack every day for three weeks, almost certainly nothing would change except their toilet flushing slightly more frequently!
My point was not about basic mechanism of dependence which sure will happen to anybody. It was about what causes them to seek out and take those things in excess in the first place.
> One can argue that certain people are more predisposed to enjoy being high, I'm one of those people. When you see incredibly rich and successful people like Jimi Hendrix, Janis Joplin, Chris Farley, and Philip Seymour Hoffman ultimately losing it all to that desire, I feel like it's hard to blame something like lack of opportunity or government welfare dependence.
Individual cases and especially these extreme outliers are no good. It's not that one single government policy or social problem is the cause of all drug addiction, but they could contribute to the issue on a population level.
End of the day, it's still societal issues that's causing some people to go down this path. Most of the drug addicts have some level of "atypical" upbringing. Maybe abusive childhood, constant foster care, growing up in a bad neighborhood with the wrong influence etc. Seems like we should be focusing on solving those issues, which not only benefits the topic at hand but society and communities in general.
My hunch (not as an expert) is that people who are very prone to addiction have a maladapted brain system of some kind. I think this system 'malfunction' can either be genetic and/or caused by trauma/environmental reasons in their life. I suspect this because nearly everyone I know that has had addiction problems has had a parent with similar. It's surprisingly rare to find someone with an addiction problem that isn't in the family. Strangely, not all siblings seem to have the same issue.
Problem is, we don't know which system(s) it is yet. The research on kappa opioid receptors is very interesting as the KOR regulates stress response, and we know that stress causes many relapses in previously addicted individuals in recovery.
I also think we may find there are multiple types of addiction, caused by different systems/reasons. These all present very similarly, but similar to the discovery years ago that some infections were caused by viruses and some bacteria, it could be similar for addiction.
So really I think it goes something like this:
People are predisposed to addiction -> they become addicted -> they become homeless and trapped in a chaotic loop which a tiny percent of people can recover from
When I believe the best response for people that are affected by addiction would be something like this
Addicted person (homeless or otherwise) -> some sort of diagnostic (genetic testing?) -> new tailored medication -> recovery
It may be also these maladaptations cause all the mental health problems themselves. But not everyone that has mental health problems becomes addicted, despite experimenting with substances.
I think it's much more likely some sort of genetic trait underlying it.