I Support Forced Inpatient Recovery For Dysfunctional Street Addicts
the coercion of incarceration vs. the coercion of out-of-control opioid dependency
(Update, January 7, 2025: a view by Kevin Dahlgren, a Substack contributour who is actually on the streets helping to solve the problem, with his recommendations. He knows more than me about this subject. His ideas should be tried first, before a proposal like mine—which is both more coercive and much more expensive.
my thoughts are below:
I view the fentanyl overdose crisis as probably the most telling indicator of how much of a hold severe opioid dependency has over its users. The product being supplied on the street has never been less reliable in terms of its potency and purity. The next time someone uses it, it could kill them. Yet few of the addicts view that situation as so intolerable that it induces them to quit.
I've learned from my researches that one of the most important features of addiction is the foreshortening- and eventual foreclosing- of the future time horizon.
Most people have an imagined future of some sort, even as teenagers. They may not have a schematic outline, but the world appears like an open set of possibilities. A year can feel like such a drawn-out extent of time to a young person that it isn’t possible to even imagine oneself more than a few years in the future. That limitation of imagination is a foreshortened horizon, but not a foreclosed one.
That's a very different set from the grip of an illicit opioid dependency. Hard drug addicts on the street not only experience foreshortening of the future time horizon of the most drastic sort, they experience something like its foreclosure. Their future time horizon extends only as far as the hours when they're getting off on the drugs they're addicted to, and once the effect begins to wear off, the curtain begins to ring down. So their future horizon typically extends no more than 12 hours ahead. If they're at a point where their supply is running out- more often than not the case- much of that time is spent in crisis mode. They’re constantly planning within that window of time.
The addicts also obtain a reward- a physical gratification, as close to instantaneous as it gets. A reward so direct that it's able to provide the illusion that little or nothing else is required- even eating and bathing are often viewed as activities that aren't worth the effort. In any event, those chores always take second place to the top priority: getting the next fix. The search mode and GPS of addicts is always set to planning for that destination. And no further.
That's why I favor forced inpatient treatment for dysfunctional street addicts- a form of incarceration with a focus of abstention and rehabilitation, directed at the population who would not be involved in criminal activity, were it not for their need to obtain the funds to purchase their supplies in the illicit marketplace. (A category distinct from a much smaller cohort: criminals who happen to like drugs, and who would be inclined to engage in chronic criminality and antisocial behavior even without a drug dependency.) Anyone whose addiction has deepened into dysfunctionality, sleeping rough, and flaunting the law by disregarding citations and court hearings for petty offenses.
I define a 'dysfunctional street addict' as someone whose addiction has derailed their life to the point where they're violating laws other than those that criminalize the possession of forbidden substances- i.e., laws intended to preserve local public order (trespassing on private property; blocking the sidewalk; aggressive panhandling; scofflaw responses to citations; failure to appear in court) or public health (laws against discarding hazardous waste, like needles; laws against public urination and defecation, particularly the latter; trash dumps near encampments.) Particularly for recividist offenders.
All of the specified offenses are misdemeanors; the laws are already on the books to decree arrests and trial in criminal court, and to sentence offenders to jail terms (often of up to one year.) Those laws should be employed in a concerted fashion, in order to get the dysfunctional population off the streets and into inpatient rehabilitation as a necessary component of their incarceration.
This course is necessary because the offenders are not merely “drug users” being “criminalized for their drug use”, or drug addicts being “criminalized for their drug addiction.” They aren’t merely drug addicts; their addiction is so dysfunctional that they’re committing crimes other than drug offenses. The tacit corollary of that condition is that the addicts have no viable network to support a long-term process of stabilization, recovery, and rehabilitation. There’s a time dimension that needs to be taken into account in order to even provide the precondition for recovery, in the case of unhoused street addicts; as a rule of thumb, call it one year of abstention. A precondition that jail terms measured in a few days, weeks, or months are unable to supply, even if the confinement puts the addicts through physical withdrawal. Short-term inpatient rehab commitment of 30-90 days doesn’t work reliably well for addicts either, unless they’re able to connect with a functional social support network of relatives, workplace activities, and nonusing friends (along with, possibly, probation requirements for random drug screens.) In practical terms, rehab programs like those pretty much require a middle class- or above- economic stratum on order to provide the resources and means of accountability to get addicts to snap out of it. Outpatient rehab has an even lower rate of success. Drug maintenance regimes have almost no utility for addicts whose life circumstances have slipped so far that they’ve landed on the street.
That leaves long-term “inpatient” coerced abstention. Yes, it’s a form of jail. The offenders are serving their sentences for defecating in public, or sleeping on the sidewalk, or discarding their used needles on the street (or for breaking into automobiles or garages, shoplifting, battery,or failing to appear for a court hearing, etc.) But their time in confinement is focused on getting the addicts to break the habits that have undermined their lives so much that they’ve committed offenses against public order and public health, often chronically. Daily. More than daily.
Yes, I’m aware of the facile Fake Left Bourgeois position- that dysfunctional street addicts are “punished for being poor” on top of their “addiction problem.” The bottom line is that the population I speak of is committing crimes that degrade community, social cohesion, civic order, public safety, and public health. It’s easy to pontificate about “punished for being poor” if you’re almost never in physical proximity to the population. Who is in proximity to that population? The people who can’t afford the level of insulation to not be troubled by them, and who have had their public safety reduced and their amount of public space reduced- from sidewalks to public parks and playgrounds- by an antisociety of self-absorbed dysfunctional drug addicts. Many of the offenses might be said to fall into the category of “petty nuisance crimes”- but only if they were merely one-off indiscretions, and if the offenders had fulfilled their obligations to either pay the penalty of ticket infractions, or if they had shown up for their court hearings to dispute the charges or have their penalties reduced. The dysfunctional street addict population simply disregards the obligation and continues to offend.
There’s no question that most of the worst complications of drug addiction fall on unemployed, unhoused people. It’s indisputable that people growing up in poverty circumstances are more easily tempted to resort to addiction as a life path (although there are many dysfunctional addicts who landed on the street from circumstances that were originally more favored.) But only a certified member of the insulated affluent classes could fantasize that compensation to ameliorate the harms of poverty should take the form of allowing poor people de facto perpetual impunity for trespassing, vandalism, and offenses against public health, in order to allow them to live more conveniently on the street as drug addicts. The Let Them Eat Impunity argument also implicitly contends that unless dysfunctional addicts are allowed license to live on the street, the de facto legal impunity of wealthy and even affluent educated class addicts results in an intolerably unfair privilege reserved for them. The most interesting thing about that corollary is that it tacitly frames the use of potentially lethally poisonous drugs and the addiction to them as an unalloyed advantage, as long as someone is rich. That isn’t the way it looks to most of us as observers.
This is not a Freedom issue- except in the sense that law-abiding people find themselves basically forcibly restrained from taking their children to public parks, parking their cars on the street, or even walking down the sidewalks where they work, shop, or travel to and from their residences. Because oppression can come from more than one direction- it can emerge from the dysfunctional underclass- what Marx referred to as the lumpenproletariat, a group that includes the criminal classes- as readily as it emerges from incidents of State terrorism. The entire Drug War is directly an exercise in State terrorism, and has been for around 100 years. But that doesn’t mean that gangs and criminal organizations- and even concentrations of people in criminogenic environments, like unpoliced homeless encampments- don’t also exercise coercive rule by force, much more directly and summarily. Not with a 30% clearance rate for murders in Chicago. And not with a >99% impunity rate for criminal offenses related to the Denial of Public Space caused by maxed-out drug addicts too out of it to see more than a few hours in front of their face. Allowing that situation is not doing law-abiding poor people any favors.
Given that there’s no way to rewind the past: in terms of here and now, day to day challenges, the most coercive power being worked on street addicts is the drug that they’re using- a drug that reduces their future horizon of existence to less than 12 hours before the onset of the agony of withdrawal, and that might kill them with their next ingestion.
The addicts deserve the opportunity to break free of that harrowing existence. They deserve a future time horizon of at least 12 months, instead of 12 hours. And those of us who are law-abiding citizens deserve a functioning system of civic order, public safety, and public health. As far as I can tell, the regime most able to accomplish both of those purposes consists of a year of confinement for a population of chronically recividist street addicts, vetted as nonviolent offenders whose criminal behaviors can be traced directly to their drug addiction. The baseline recovery goal would be to enforce 12 months of abstention from drugs. The ideal recovery goal would be for the confined population to take advantage of the rehabilitation programs, social/occupational orientation programs, and educational programs made available for their participation. You can lead someone to water, but you can’t make them drink, of course. But some amount of insistence is proper. The crucial thing is that even the most recalcitrant inmates need to be put in a circumstance where they find out what it feels like to not have any drugs in their system for 12 months. After that, it’s up to them. There’s no effective way to stop anyone from continuing to use, or to relapse into addiction. However, they might also figure out how to carry on using drugs without landing on the street again. Maintenance programs may have a role to play in that regard- but only so long as the user demonstrates that they’re aren’t dysfunctional. If they end up on the street committing offenses against public health and safety again, the prospect of another year of forced abstention awaits.
The program I’m proposing will not be able to live up to its best potential unless it’s carried out within a wider regime of drug use decriminalization, regulated access for some substances, substance-assisted addiction recovery, and prescription addict maintenance (but NOT for chronic recividist criminal offenders. Especially violent offenders.) However, none of that should be required before putting this program in place.
The other [priority is that the facilities have to offer more than simply the stick of incarceration and random drug testing. That means they need staffing by therapeutic professionals and teaching staffs, and the resources to fund actual recovery, not just lockup. This program has to be considered as a prosocial investment, and a bargain in comparison with the money spent on “services for the unhoused” that barely make a dent in the crisis because of the manifest inability to address the root causes of personal dysfunction.