Paying Addicts to Go to Treatment Is NOT the Answer

As I write this, today is the first day of the first month of 2023 — New Year’s Day. I’ve been watching the news every evening for years — and I can’t even remember how long the “Overdose Epidemic” in Vancouver’s Downtown Eastside has been going on. I don’t yet have the exact stats for how many people died as a result of opioid overdoses in 2022, but I do know that number is far too high.

I know a few other things too…

I am 35+ years clean and sober now, after recovering from a 15-year opioid addiction brought on by very addictive medications prescribed, over and over again, by my doctors for Crohn’s Disease. I have now had Crohn’s for close to 50 years. It’s true, abusing opioids wasn’t an easy addiction to recover from — especially with chronic pain continuing to be a large part of my situation all these years. But it was doable, and I am living proof of that. When I reached my suicidally low bottom in 1987 and made the conscious choice to live instead of die by overdose, I began putting one foot in front of the other and started my journey of recovery.

At 3 years clean, I decided I wanted to work in the addictions field and give back the kind of help that I had been given. I was hired as an Addictions Counsellor at a wonderful non-profit agency (Watari) in the Downtown Eastside (DTES). I had no idea that I would be there for 16 years, counselling the addicts and alcoholics who either wanted help or who were mandated — or that later, I’d be working primarily with their families to put a stop to their inadvertent enabling behaviours, so that their beloved addicts had at least a fighting chance of recovering. I received an education there that I could not have gotten anywhere else — and I loved the work.

I left the Downtown Eastside in 2007 to go into private practice. Now, 16 years later, that area of Vancouver is considerably worse than it was when I worked there. There are substantially more tents on the streets and in parks for the homeless, hundreds more addicted people, noticeably more mental health issues and subsequent crime — and seemingly fewer ideas about how to make it better. Most people in Canada, and perhaps in the world at large, have heard about Vancouver’s Downtown Eastside — and not in a good way.

Over the years, we have seen safe injection sites be touted as the best solution to reduce deaths. They weren’t. We’ve heard about the decriminalization of small amounts of drugs — but that hasn’t stopped the overdose deaths either. We have seen tent cities pop up — and stay up — on Vancouver streets. Every winter, we’ve watched with horror as the shelters fill up and more people freeze to death outside, some in their tents, from the bone-chilling, extreme Canadian cold. And yet the problem still exists. Why is this situation so difficult to deal with? How could it still be going on, and getting so much worse, so many years later?

And now we’re hearing a new idea being tossed around — that of paying alcoholics and drug addicts to go to treatment. On the news last night, I heard a recovering addict with 10 years clean touting the suggestion of giving addicts $20/day to be in a rehab program.

I’m sorry — whaaat?

Could I have heard that correctly — paying addicts to receive treatment? I had recorded the news program to watch later, so I played it back — and sadly yes, I had heard that correctly.

In other words, let’s continue to enable addicts to use, just like we have been for years. Great idea!

An enabled addict doesn’t recover, because — why should they?

I have specialized in working with the families and other loved ones of people struggling with addiction for over 3 decades because there is a definite gap in service. There is a lot of help out there for addicts who want it and very little help for the people who love them. I have written two award-winning books and done a TEDx talk about what happens when we enable addicts. What I know to be true today is that enabled addicts don’t recover because, really, why should they? One of the first things I do to help the families I work with is to give them a simple definition of enabling: It is when we do things for practising addicts that they can — and should — be doing for themselves. I help families understand that enabling is never a loving act because it only serves to keep the addict stuck in the addiction. When loved ones (or governments) give money to an addict — even when they know full well where that money is going to go — how can that be a good thing for the addict they love so dearly and really want to help?

We have been loving our addicts to death for far too long. It’s time to do what’s best for them, even when it might be uncomfortable for us. It’s time to start loving our addicts to life.

So — if, as a society, we start paying addicts to go to treatment, how exactly is that going to work? Do they get $20 paid to them each and every day, so that they can leave treatment against medical advice and go relapse? Or will we give them a lump sum of $600 at the end of their 30-day stint in rehab (which, by the way, I believe is way too short a time for a positive and lasting recovery), so that they can relapse with far more drugs and alcohol at that point?

But what if we…?

What if we looked more closely at what they’ve done in Portugal? I’m not saying their system is perfect — I don’t live or work there, so I cannot comment on that. But it does seem far more humanitarian to me. They appear to have systems in place that intertwine and work together, while ours seem to be quite separate from each other. And what we know is that their number of overdoses has gone down substantially — which tells us that something about their program is working.

What if we developed a system where an addict who agrees to go to treatment is guaranteed job training while they are there and a job when they successfully complete their program? What if stable housing was found for them before they venture out into their brave new world? What if alumni groups were not only offered for graduates but were mandatory for the first 6 months, and what if there was a buddy system so that graduates could be paired with others who have chosen to successfully rebuild their lives after rehab? What if we understood that certain mechanisms would need to be in place for a productive re-entry into the world that exists past the sheltered walls of a treatment centre? What if addicts who were choosing to recover from their addiction were treated respectfully and given what they truly need to make it in the ‘real’ world?

What if we took that $20/day that is being suggested for all addicts going into rehab and used it in much more appropriate and applicable ways?

What do addicts really need, in order to recover?

Now, I’m not naïve. I know I don’t have all the answers, and I know that some of this could be complicated and time-consuming to put into place. But wouldn’t it be better to get a start on something like this now, rather than continue to wring our hands and say we don’t know what to do? I actually believe that we DO know what needs to be done.

For addicts to choose recovery, they need:

#1 — Ongoing counselling to get underneath the addiction, to heal the trauma that has made them choose this path of self-loathing and self-harm in the first place — and begin to heal those faulty core beliefs

#2 — A safe place to live and nutritious food to put in their bodies so their brains can begin to function in healthier ways

#3 — Free access to a gym membership for their first year of sobriety

#4 — Job training and the prospect of viable employment when they graduate so that their lives can be so much better

#5 — To become part of a community of like-minded people who are also choosing to stay clean and sober — and have learned to live their lives in a much different way.

Is this not a possible way to achieve at least some of the desired results? Will we continue to stand by passively and do things as we’ve always done them? Clearly, what we’ve been doing has not been working. And if something isn’t working, doesn’t the next question have to be: Are we willing to try something different?

If nothing changes, nothing changes.

What I know for sure is that if nothing changes, then nothing changes. And in some cases, when nothing changes, things get a whole lot worse. In my opinion, this is exactly what’s happened with our “War on Drugs” in the DTES for all these years. But we CAN do better — yes, we can!

What if we start thinking outside the box that we’ve all been stuck in? Paying addicts to go to treatment isn’t the answer — in my professional and personal opinion. If we want to truly change this situation for the better, then treating addicts like the human beings they are and giving them what they actually need to survive in healthy ways is what needs to happen.

If not now, when? How much longer do we want to feel powerless over this horrific situation — especially when we’re not? Let’s start respecting our addicts and loving them to life — and let’s start doing that right now!