An older man walked into the drop-in I volunteer at. He had a towel wrapped around his left forearm and hand. On it, perched a baby bird. He had found his beaked companion a few days earlier, and since they’d become fast friends. Amidst the hustle of the drop-in, the noise of someone telling someone else to, ‘fuck off’, that bird didn’t move – offering only the occasional chirp. The man looked haggard, unshaven and his clothes were ill fitting. Yet, despite his own circumstances, here he was caring for this injured bird. The man and his bird struck me as being representative of the story of hardship and addiction. A scene of mental illness, poverty and dependence juxtaposed with compassion, kindness, and hope.
The older man left before I could get his story. I can’t say what combination of circumstances had led him to come to the drop-in that day. I do know that over the last few years, more people like him have been walking through the doors. They’re all ages, and all have a different story. Shortly before I saw the man with the bird, I was at the counter patiently waiting for a young man, in his early twenties I’d say, to decide between a blueberry or chocolate muffin. He could have had both, but something told me he needed to work through this decision on his own. Finally, he settled on the blueberry and apologized for taking so long saying, ‘sorry dude, I’m high as fuck’. No shit.
Most people who use the services at the drop-in are at some point of the addiction spectrum at any given time. Somewhere between high, not so high, withdraw, or worse case – overdosed. While tossing another bag of the garbage that manages to magically appear round the back of the building, I mention to one of the organization’s directors that new affordable housing has been announced, and I hear a new recovery focused centre could be in the works. He shrugs his shoulders, ‘that’s good. It doesn’t matter how many buildings you put up – the biggest problem is access and removing barriers to treatment’.
While development is needed, the solution to Niagara’s (and many other cities) addiction problems will be flesh and blood – not bricks and mortar. More RNs (registered nurses) trained in addiction medicine. Social workers capable of seeing the bigger picture, and who are more concerned with interacting that filing paper. And yes, housing. Importantly, housing first
Housing first is a simple concept that drop-in should not be based on an individual having to adhere to a criteria of abstinence. There’s good reason for this – it’s hard to get/stay sober if you’re too busy worrying where you’re going to sleep that night. In fact, society needs to change it’s very definition of ‘sober’. From the war on drugs, to other issues such as sex education, we’ve learned that the, ‘just say no’ approach rarely works. Abstinence based recovery programs often see a relapse rate in the range of 80 – 90%. If that’s not raising your eyebrow, consider this: those who place abstinence as the main goal of recovery often suffer more severe and prolonged relapses.
The reason for this is that recovery is a lifestyle, and can impact your very conception of self. If you live your life telling yourself that one drink will kill you, congrats, you’re right. If you make abstinence the core of your identity, be careful, the odds are against you – and a slip could mean an identity crisis, and not just a pint on a Tuesday night. All too often our approach to treatment is influenced by a long history of equating addiction with some kind of moral shortcoming. Addiction is not a moral issue, it’s a health issue. Like many complex health issues, there is no one-size-fits-all solution – despite whatever the Big Book of Alcoholics Anonymous tells you. However, for decades many in society have viewed abstinence as the gold standard, and frown on those who just seem, ‘constitutionally incapable of being honest with themselves’.
I’m not arguing against abstinence. In fact, it can be crucial to developing any kind of recovery program. What I am saying is that we, both as individuals and as a community, need to expand our understanding of recovery to foster an attitude that makes a variety of approaches more accessible to individuals dealing with substance issues. It’s hard enough getting your shit together, never mind worrying about what other’s think about how you get your shit together.
Accessibility is the key to recovery – and our healthcare system, and attitudes, are not designed for it. The window of opportunity when it is most important to help someone into recovery is all too often short. The moment someone reaches out for a different life, we need to be there. We’re not. Usually, that person is given an appointment in a few weeks for some kind of assessment. Assessments are important, but we need services that bridge the gap between asking for help, and getting it. Social, non-clinical services are key. One of the reasons AA has enjoyed such a long tenure is the fact that meetings, and the social support they offer, are accessible. Addiction does not operate 9-5, Monday to Friday. So why are we surprised when individuals are unable to adhere to clinic hours?
Sticking our hospital out in the West end of the city, away from the downtown core where many of the at-risk population resides, is just one example of accessible-blindness. Many in St. Catharines are perplexed as to why so many individuals have flung themselves off the Burgoyne Bridge. Not to sound callous, but maybe it’s just on the way? The problem isn’t the bridge not having barriers (btw, we’re spending $4million on those now), it’s our community not having accessible services.
There are some simple and effective possible solutions. Given that the Ontario Works office is on Bunting Rd, the hospital is in West St. Catharines, and many programs run out of downtown, why not provide free public transportation to those in need? It’s hard to make it to appointments when transportation/mobility is a barrier. And no, the current system of buss passes is not sufficient. One, there are rarely enough offered, and two, they should be full-on monthly passes – just like anyone else would have who needs the bus regularly. While we’re at it, why not think of a financial solution to banking problems. Many people do not have a bank account as they do not have a fixed address. They are on ODSP or OW. In order to get their money, they have to go to a payday store – a payday store that charges them a fee for cashing their cheque. Talk about getting kicked when you’re already down. None of this is rocket science.
When I started volunteering at the drop-in, one of the veteran staff gave me the best advice, ‘just remember, everyone out there is probably going through the worst period of their lives’. Thinking of this helps put the behavioural issues, outbursts and random pet birds in perspective. I’ll be back there, and I expect I’ll again be waiting for buddy to decide between blueberry and chocolate, but at least, even if it’s just for a short time, I know he’s safe. Maybe one day, instead of apologizing for being, ‘high as fuck’, he’ll ask for help.