Jimmy stayed at LPCS on and off for many years. He was personable with a wicked sense of humor, and he was fiercely Irish. Jimmy was also deeply troubled by loss in his childhood and alcoholism in adulthood. He drank – a lot. He knew that it wasn’t healthy for him to continue drinking, acknowledging that it had ruined relationships and jobs, but he had an ambivalent relationship with sobriety.
When he came to LPCS he followed most of the rules but was not able to remain sober for more than one or two months at a time. At the time, LPCS was a “dry” shelter – zero tolerance for coming in under the influence. He was asked to leave over and over again. Whenever he got too sick or too tired or just sick of being sick and tired, he came back.
Because of our strict alcohol policies – and those of many other shelters and permanent housing programs at the time – he couldn’t achieve lasting stability and change. He considered us friends, but his true “home” was on the streets. He made his home on the streets for more than a decade after his last departure from LPCS. At a final moment last week, it finally caught up with him.
Last week another former Guest stopped by to let us know that Jimmy had passed away. He was just 55 years old.
The Zero Tolerance policies of the past shut out many of our neediest neighbors from receiving life-saving services. The strange irony of it is obvious now – in order to get into almost any long-term shelter program or permanent housing or even to receive the necessary critical mental health care – you had to become sober first. In order to get sober – a really important foundation in recovery – you needed to complete inpatient treatment. In order to get into inpatient treatment, you had to be on a bender. The system set in place to help people was, in actuality, preventing anyone from getting necessary help.
Alcoholism is widely recognized as a disease – a debilitating and life-threatening one. As such, a new standard of practice has emerged in the last 10 years called Harm Reduction. Harm reduction recognizes the ebb and flow of addiction and recovery, but keeps vital services and stable housing in place despite a person’s setbacks with the disease. Harm reduction considers housing a human right that should not be denied or taken away because of disease. Study after study has shown that a harm reduction approach to housing yields better health outcomes (including reduced drug and alcohol use) and is more cost effective, as it also reduces costly emergency room visits and incarcerations due to substance abuse.
If Jimmy had suffered from diabetes instead of alcoholism, we never would have required that he seek treatment before giving him shelter or housing. If he had subsequently died on the street of his diabetes, there would have been an outrage. Jimmy's death, in my mind, is no different. There is absolutely no reason that an otherwise healthy 55-year-old man should have his life cut so short. I can't justify it with any explanation of policy, resources, or social work practice. I can't believe that we (as a society) could possibly be better off because we refused critical services to someone who was sick.
Harm reduction is now considered the best practice and is even required by the U.S. Department of Housing and Urban Development for all new housing programs. LPCS adopted a harm reduction approach in our Interim Housing Community several years ago. Under it, Guests who experience relapse do not automatically lose their place here. Instead of stripping services, we now intensify them when someone is struggling to stay sober. Doesn’t that make more sense?
Harm reduction is a welcomed system to those of us who have always been uncomfortable with the paternalistic zero tolerance policies of the past. This is not to say that individuals do not bear personal responsibility for the choices they make. Yes, “tough love” and “rock bottom” are important concepts to recovery, but so are compassion and second chances.
One consolation is that when Jimmy died, he was not homeless. He was finally able to access affordable, supportive housing a couple of years ago. But the help that Jimmy was finally receiving was too late to undo a lifetime of disease and a decade on the streets. I take comfort in knowing that when the next Guest who has similar struggles as Jimmy arrives at LPCS, we will have a much different approach and, hopefully, a much better outcome.