When we talk about “treatment,” whether it’s in the context of a loved one’s addiction or addressing homelessness, we’re usually referring to traditional 28-day rehab—the “solution” of choice for insurance companies, policymakers, and desperate people looking for help. The problem is, 28-day treatment is one of the least effective methods to get people sober, leading to cycles of treatment and relapse that can cost patients hundreds of thousands of dollars without results.
I recently wrote an in-depth story about the growing consensus that 28-day rehab is the wrong approach. Check out the intro, then read the full story at HuffPost.
When Jessye first “graduated” from a 28-day treatment center outside Seattle, she knew she wouldn’t be able to stay clean. She became addicted to pain medication while dealing with endometriosis, and by the time she showed up at the doors of the private, for-profit rehab, she had been using Percocet for four years.
“When that got too expensive, I turned to heroin,” said the 34-year-old, who asked us not to use her last name out of concern that it might harm her professionally.
Fresh out of rehab, she was jobless, homeless and sleeping in her car, which was owned by an aunt. Then her family took away the car, because they didn’t want to enable her. After a couple of weeks, she started using again.
“I was really afraid,” said Jessye. “I really wanted to stay clean, and I really tried, but ultimately, they didn’t set me up for success.”
Addiction treatment is a big business. More than 2 million Americans spend a total of $28 billion every year on treatment at nearly 15,000 facilities across the country, according to the National Survey on Drug Abuse. About 12 percent of those opt for four-week treatment, which can cost anywhere from $10,000 to more than $30,000 a month. Many clients return multiple times before it sticks.
According to the Substance Abuse and Mental Health Services Administration, two-thirds of people who go to treatment end up going back at least once, with 20 percent entering treatment five times or more. The money flowing through private treatment companies creates perverse incentives for treatment centers ― if treatment failed, patients and their families are told, it’s probably because the patient failed at treatment.
If you’re interested in harm reduction, homelessness, and evidence-based responses to chronic homelessness and addiction (and if you’re a reader of mine, you probably are), check out my new piece in Crosscut about 1811 Eastlake, the 15-year-old program that provides no-strings-attached housing for chronically homeless people with alcohol use disorders. Here’s a teaser:
It was the late 1990s, and Seattle leaders were trying to decide what to do about an addiction epidemic. Residents of several center-city neighborhoods, including Capitol Hill and Pioneer Square, complained about public urination, trash and the constant parade of ambulances ferrying people to Harborview Medical Center. People told stories about coming home to find homeless addicts passed out in their yards. A task force was assembled to come up with solutions.
Back then, the substance at the center of the debate wasn’t heroin — it was alcohol. But the conversation about how to deal with what were then known as “chronic public inebriates” would be familiar to anyone following the opiate epidemic in 2019. “These people would be urinating, defecating, sleeping in doorways,” says former Seattle Police Chief Jim Pugel, who was then commander of the Seattle Police Department’s West Precinct. “We were spending $1,000 just to send people a mile up the road to Harborview. That’s the most expensive detox you can deliver.”
The best solution the city could come up with — creating special alcohol impact areas, where stores would be barred from selling certain kinds of high-alcohol malt liquor that low-income and homeless drinkers favored — was unpopular with store owners, the beverage industry and residents of nearby neighborhoods, who argued that the bans would simply push the problem into their front yards. “We were stuck in the middle,” Pugel recalls.
Into this impasse stepped Bill Hobson, the head of the Downtown Emergency Service Center, offering a third option: “Wet housing,” where chronically homeless people with alcohol use disorder would be allowed to live, and drink, without judgment or expectations. Hobson’s theory was that people could move successfully from the streets to housing without first going through treatment or other interventions — a controversial position, given the prevailing view that people living on the streets would “fail” at housing unless they got sober first.
Today, the concept of “Housing First” is enshrined in city housing policies across the country, including Seattle and King County. (The authorizing legislation for the proposed new regional homelessness authority, for example, explicitly mandates “evidence-based, housing first” policies.) So it can be easy to forget how radical the idea was just 20 years ago, when most programs targeting chronically homeless people required sobriety and intensive case management as prerequisites.
“We were skeptical — hell, yeah, we were. We thought, if you want someone to stop drinking, you should just make them stop drinking,” says Pugel, currently running to represent District 7 on the Seattle City Council: “My views have evolved since then. I’m not a Cro-Magnon anymore.”
The result of Hobson’s vision, known simply as “1811 Eastlake,” now sits on the edge of the South Lake Union neighborhood and has been serving Seattle residents for the past 15 years. The unobtrusive blue-and-gray, four-story building houses 75 formerly homeless men and women with severe alcohol use disorders and provides them with meals, counseling and health care, no strings attached. The program has saved money, and lives, by using the principles of “harm reduction,” which holds that reducing the harm people cause themselves and others through their substance use is beneficial in itself, whether or not the person quits using the harmful substance.
Pugel recalls that Hobson, who died in 2016, would declare loudly, “This is housing for drunks!” to anyone who seemed to misunderstand the purpose of what DESC was doing. Although current DESC Director Daniel Malone doesn’t remember him using “those exact words,” he says Hobson was always clear that the purpose of 1811 wasn’t to get anyone sober or to turn clients into clean-cut, productive members of society; it was to provide housing for people who had “failed out” of abstinence-based treatment and housing programs multiple times, were chronically homeless and had less than a 5% chance of “achieving and maintaining sobriety.” The point wasn’t to stop alcoholics from drinking; it was to improve their quality of life and reduce the amount they cost the public, in that order.
Read the whole story, complete with excellent photos by Matt McKnight, at Crosscut.
In keeping with how quickly news piles up the moment after Labor Day ends, here are a few quick-hit items—in two parts!—from City Hall and beyond.
Round 2, non-City Hall edition:
1. An overnight sobering center, which was supposed to relocate from downtown Seattle to the Georgetown neighborhood this summer, will not open as planned. Neighborhood residents filed a lawsuit to stop the center in June, alleging that the city had filed to do an environmental review of the site or consider impacts on the small neighborhood before approving a permit for Community Psychiatric Clinic to purchase the site. (CPC planned to run the center through a contract with King County).
“Aspects of the Georgetown Neighborhood that make it especially unsuitable for the new facility include lack of supportive services and public transportation, a burgeoning homeless and RV population, pollution, and a proliferation of bars and entertainment venue,” the lawsuit said.
Since then, CPC has merged with Sound, another local mental health-care provider, and withdrawn plans to build the sobering center on the site. Currently, King County has not identified a new location for the center, which was designed to take pressure off local emergency rooms and serve as a place for people experiencing homelessness to sober up under supervision in case any medical emergencies do arise.
2. Sound Transit’s social media manager blew up local Twitter today when the agency’s official account responded to a tweet by local activist and teacher Jesse Hagopian about fare enforcement officers hassling students on the first day of school.
On the #FirstDayOfSchool, the light rail fare enforcement is out in force busting high school students—before they get to school & get their ORCA cards that will allow them to travel to school for free.
Sound Transit responded in probably the worst way possible, by responding that if the kids in the photo are “like my kids,” the fare enforcement officers probably “gave them a one-day paper ORCA card that covers today. It’s good to remind folks how the system works. And officers have discretion to issue warnings instead of fines.”
This tone-deaf response set off a firestorm of criticism that had Sound Transit listed as the top trending topic on local Twitter for most of the day. Among other things, people pointed out that the author’s kids probably aren’t “like” the kids in the photo, in that they’re probably white kids who are far less likely (statistically speaking) to be hassled by fare enforcement officers. An audit last year found that King County Metro’s fare enforcement policies disproportionately impacted low-income people and people of color, and that most people who failed to pay fare did so because they couldn’t afford the fare.
At the time, Sound Transit board members raised concerns about Sound Transit’s more punitive approach, which can result in a criminal record, but the agency defended the practice. Board member Claudia Balducci, who represents Bellevue on the King County Council, says, “I really think kids riding our trains and taking our buses are the future riders of the system, and we should be doing everything possible to make them into future riders. .. What the audit says is that we should focus on making it possible for people to ride… and that’s not what’s happening.”
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3. Marcus Harrison Green, the founder of the South Seattle Emerald who was hired as a South King County reporter for the Seattle Times last year, has left the Times. He is the third African American writer (along with former homelessness reporter Vernal Coleman, who left for a job in Boston, and former columnist Tyrone Beeson, who took a position in LA) to leave the Times editorial department in the last year. The Times has historically had trouble retaining African American writers (and people of color in general—two other staffers of color, Mohammed Kloub and Jennifer Luxton, also left this year).
Earlier this year, white columnist Nicole Brodeur was demoted to general-assignment reporter after asking a black woman who was interviewing her for a school assignment if she could touch her hair; the incident came after Broduer wrote several racially insensitive columns, including one suggesting that African American parents should stop letting their kids “run[…] wild” and another saying Columbia City had been a dangerous “pass-through” zone until white businesses moved in.
This story originally appeared in the August issue of Seattle magazine.
On a day in late spring, David Lucas, 26, is standing in front of Seattle Municipal Court Judge Damon Shadid, waiting to find out if he gets to go home.
Lucas (not his real name) has been locked up in the King County Jail in downtown Seattle for nearly a month. Today, he’s facing a charge of trespassing at a grocery store—the same store where he’s been arrested many times, usually for stealing food. He’s been homeless off and (mostly) on for about a dozen years, and has a chronic mental illness that’s been exacerbated by his habit of smoking meth. Unless he can convince Shadid that he’ll stay out of trouble, he could be going back to jail for a while.
Lucas is part of Seattle’s visibly homeless population, the cohort featured in a KOMO-TV special called “Seattle Is Dying,” which aired in the spring. Although this group makes up a small percentage of the city’s overall homeless population, its members commit an outsize percentage of the kind of low-level drug and property crimes—such as shoplifting, trespassing and public urination—that KOMO highlighted in its special, which amplified the conversation about this subset of the homeless population.
Cases like Lucas’ pose a fundamental question: Is the arrest of people with severe addiction and mental illness who break laws a solution to chronic homelessness? Or is patience and compassion a more effective approach?
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Sorry to interrupt your reading, but THIS IS IMPORTANT. The C Is for Crank is a one-person operation, supported entirely—and I mean entirely— by generous contributions from readers like you. If you enjoy the breaking news, commentary, and deep dives on issues that matter to you, please support this work by donating a few bucks a month to keep this reader-supported site going. I can’t do this work without support from readers like you. Your $5, $10, and $20 monthly subscriptions allow me to do this work as my full-time job, so please become a sustaining supporter now. If you don’t wish to become a monthly contributor, you can always make a one-time donation via PayPal, Venmo (Erica-Barnett-7) or by mailing your contribution to P.O. Box 14328, Seattle, WA 98104. Thank you for keeping The C Is for Crank going and growing. I’m truly grateful for your support.
Under ordinary circumstances, a judge might look at Lucas’ file—which includes dozens of arrests since 2011—and send him straight back to his cell. But Lucas is no ordinary defendant, and this is no ordinary court session. Like many other clients who sit at the defendants’ table in this courtroom every Wednesday morning, Lucas is supported by a new program that provides case management, legal aid and mental health services to people who, like him, have complex mental health challenges and whose competency to defend themselves in court has been called into question. His advocates this morning include Daniel Garcia, his case manager; Heather Aman, the prosecutorial liaison with the Seattle City Attorney’s Office; and Judge Shadid, who talks at length about the progress Lucas has made.
After a few minutes of deliberation, Shadid decides to release Lucas on the condition that he stay away from the neighborhood where he keeps getting arrested. And when Lucas leaves jail tomorrow, he’ll leave with Garcia, who has been assigned to help him stay on track. He’ll go to sleep tonight not on the street, but in transitional housing, a kind of way station between homelessness and permanent housing. Later in the week, he’ll have an appointment with the occupational therapist who is helping him with the life skills he’ll need to stay out of this courtroom. And his mental health care will be supervised by a team from the Downtown Emergency Service Center (DESC), including a mental health professional who will monitor his progress and adjust his meds if needed.
All of these services are available to Lucas thanks to a $3 million, 18-month expansion of the existing Law Enforcement Assisted Diversion (LEAD) program, a collaboration between law enforcement agencies, the Public Defender Association and Reach, the street-based case management program for which Garcia works. The expansion, which zeroes in on offenders with mental illness, traumatic brain injuries, addiction and other debilitating cognitive conditions, was funded by a 2018 settlement in a landmark case known simply as Trueblood. The settlement created a pool of money for programs to help defendants at risk of being “warehoused” in jails while they await hearings on their competency to stand trial.
Earlier this year, Scott Lindsay—a former adviser to Ed Murray who unsuccessfully challenged city attorney Pete Holmes in the 2017 election—published a report in collaboration with the Downtown Seattle Association and other downtown groups called “System Failure.” The report, which was featured prominently in the viral KOMO 4 special “Seattle Is Dying,” highlighted 100 so-called “prolific offenders,” including 87 who had been arrested in Seattle more than four times in a 12-month period and another 13 who Lindsay felt had “a particularly high impact on public safety,” as SCC Insight reported.
The report included one particularly startling statistic: More than 30 percent of the time, “prolific offenders” were released from King County jail onto the streets at midnight, when social services and shelter are unavailable. “For homeless individuals struggling with substance use disorders and mental health conditions, this practice can be hazardous to the individual and to the immediate surrounding neighborhood,” Lindsay reported. The statistic was reported by most major local outlets, including Crosscut, KING 5, and the Seattle Times, which said the practice “put[s] at risk those who are homeless and struggling with substance-abuse disorders and mental conditions.”
“It’s not up to me to correct publicly the inaccuracy of the information they’re making public.”—Consultant Tim Ceis, who worked on the “System Failure” report
The real number of people being released from King County jail onto the streets at midnight, according to the county’s Department of Adult and Juvenile Detention? Zero.
“We researched the past year and determined that no inmate was released out of custody from DAJD facilities at midnight,” says Captain Captain Lisaye Manning, a spokeswoman for the King County Department of Adult and Juvenile Detention. “The terminology of ‘released’ refers to being released from the King County Jail and transferred custody to a different agency, not released out of custody to the streets. There are some occasions that those outside agencies aren’t available until late evening or early morning hours.”
Screen shot from “System Failure” Report
Manning said Lindsay and his fellow researchers should have used the county’s public booking database to determine when and why people were released from custody (and to whom). Instead, Lindsay apparently used used the county’s Jail Inmate Lookup System, a blunter instrument intended to help people look up information about specific inmates. That system does not specify the reason an inmate was released or whether he or she was released into the custody of another agency.
“The Executive’s Office conveyed to the report’s author, Scott Lindsay, that he did not use correct data in his evaluation,” Capt. Manning says.
Alex Fryer, a spokesman for King County Executive Dow Constantine, confirms that Constantine’s office told a consultant who helped Lindsay on the report, Tim Ceis, that the information in the report was wrong. DADJ provided The C Is for Crank with a link to what Fryer calls “the correct database, showing that we’re not putting people out on the streets of Seattle” at midnight. Fryer adds that Lindsay’s error was understandable, given that the jail list is the county’s public-facing database of inmate information. Ceis confirms that the county did inform him and Lindsay “that the information that we were seeing was inaccurate, for whatever reason,” but says he saw no reason to correct the record, since the errors, in his opinion, were the county’s.
“Their record-keeping and what they were putting out there in the jail records was not accurate,” Ceis says. “It’s not up to me to correct publicly the inaccuracy of the information they’re making public.”
Lindsay responded at 5:30 this evening to an email I sent three hours earlier. However, his response did not include answers to my questions about the apparent data discrepancy. I have sent him a more detailed list of questions and will update this post if I hear back.
Public Defender Association director Lisa Daugaard, who has said that the “System Failure” report should have been called “Systems Failure,” to emphasize that the justice system is not the only system failing chronically homeless people, says that if the county isn’t releasing people onto the streets at midnight, that’s a welcome change from something that “has been a problem in years past.”
Daugaard says that if the county isn’t, in fact, releasing prolific offenders into downtown Seattle at midnight, that just “underscores my feeling about the takeaways from the report —it’s less that the criminal justice system is failing, as that the criminal justice system, operating in the ways it inevitably does, is not the right system to address these problems, except at the margins and when other systems”—such as health care and housing—”have gaps.” Why, Daugaard asks rhetorically, “is this group [of “prolific offenders”] not prioritized in the large investments that have been made in each of those systems in recent years?”
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This article appeared in the June 2019 issue of Seattle magazine and was produced in collaboration with Crosscut. A full version of this piece is available at Seattle magazine’s website.
Laura and Dave Johnson* had always known that their older son, Eric, was different than other kids. Diagnosed with severe ADHD at a young age, Eric was smart, sensation-seeking and focused—the kind of kid, his mother says, who has “a brain for coding,” and is “smart in a way that we don’t understand yet.”
If he wasn’t racing his mountain bike downhill, he was bouncing parkour-style off the sides of downtown buildings or watching television with an intensity that unnerved his parents. “He could watch TV all day long,” says Laura Johnson.
Then, like most of his peers, Eric discovered video games—Mario Kart, Splatoon (a third-person game in which players splatter each other with ink), The Legend of Zelda. After that, Johnson says, things were never the same. Unlike most kids and adults who play video games, Eric, now 15, didn’t seem to have an “off” switch. By the time he was in middle school, games were all he could think about. It was like the games were doing the same thing for him that mountain biking did, Johnson says. “He likes that tactile [sensation] and he needs his brain to go fast and he needs feedback from something.”
The Johnsons live in a comfortable brick Tudor in Seattle’s Broadview neighborhood. There’s one TV in their house and just two computers: a desktop in the basement that Dave uses for work and Laura’s laptop. The idea that video games could become a problem, much less an addiction, was completely alien to them. Over time, though, they began to realize that their son’s fascination with games and other screens resembled an addiction. “He rushes through other things if he knows there’s ‘game time’ in his future,” she says. “And that ‘game time’ is on his mind [until] he gets it—regardless of what we are doing.”
While gaming—or tech—addiction is uncommon (and the label “addiction” remains controversial), Eric is not alone. Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, estimates that between 5 and 12 percent of young adults show signs of gaming disorder; a 2017 paper in the American Journal of Psychiatry, meanwhile, put the number at less than 1 percent of the general population.
Games (and social media such as Instagram and Twitter) have an additional characteristic that makes them habit-forming: They provide that kick of dopamine at unpredictable intervals, providing an incentive to stay glued to the screen.
The jury is still out on whether tech addiction is more prevalent in places like Seattle, where a higher-than-average number of people work in the tech industry, but anecdotal evidence suggests there could be a correlation. Hilarie Cash, the founder of a Fall City–based inpatient tech addiction treatment program called ReStart, says that when she started treating people for gaming disorder, back in the mid-1990s, most of her patients were adults working in the tech industry; today, she says, many of her clients have parents who work in the industry and who “tend to be very surprisingly oblivious to the impacts of screens on child development.”
Experts generally agree that too much screen time can inhibit kids’ ability to focus, develop social skills and engage in activities that don’t produce an immediate reward the way screens do. Cash also points to school districts in large, highly connected cities that, she says, have “drunk the Kool-Aid and are trying to get tablets and computers in the hands of every student, even in elementary school.”
In recent years, there has been significant interest in recognizing gaming disorder as a formal diagnosis, spurred largely by an international uptick in people seeking treatment for the disorder. Last year, the World Health Organization officially recognized gaming disorder as a condition in its International Classification of Diseases, and the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), has recognized “internet gaming disorder” as a “condition for further study” for possible future inclusion in what’s often called the bible of psychiatry. The state of research remains in its infancy, however, and experts disagree on everything from the best course of treatment to whether compulsive gaming should be classified as an “addiction” at all.
For the Johnsons, their attempts to curtail Eric’s obsession with gaming began by trying to restrict his access to technology. They established boundaries, one after the other—no games until he’d done something creative, or no more than an hour of gaming a day—but Eric broke every rule. “I tried so many different scenarios,” Johnson says. “No boundaries ever worked. Nothing ever worked.”
Over the course of Eric’s seventh-grade year, this “very smart, very savvy…fascinating” kid transformed into a person his parents barely recognized—a kid who spent all his time “speedrunning” (playing through games as fast as possible) and throwing fits when his parents tried to restrict his access to games. “He would run away,” Johnson recalls. “He jumped out of the car once while it was moving.” After the Johnsons took away his smartphone, Eric stole money from his brother, who is three years younger, got off the bus on the way to school and bought a second phone. (Then, when they took that phone away, he did it again.)
Over the course of Eric’s seventh-grade year, this “very smart, very savvy…fascinating” kid transformed into a person his parents barely recognized—a kid who spent all his time “speedrunning” (playing through games as fast as possible) and throwing fits when his parents tried to restrict his access to games.
At their wits’ end, the Johnsons sought advice from Ann Steel, a counselor who specializes in gaming addiction. Following her advice, they sent Eric to a wilderness camp on the Olympic Peninsula—an increasingly common, if still unproven method of treating kids whose gaming or screen time starts to negatively impact their lives—shortly before his 13th birthday. On his final night before he left for camp, Eric stole his mom’s laptop and stayed up all night surfing the web, like someone getting a last fix before going to rehab. After 10 weeks in the wilderness, Johnson says, Eric “did seem clearer in his head.” On the other hand, the day after he returned, he broke Johnson’s windshield.
Last year, after doing more research about its options and hiring an education consultant, the family sent Eric to Cherry Gulch, a therapeutic boarding school outside of Boise, Idaho, that offers individualized education and treatment to kids struggling with various issues, from grief to ADHD to digital addiction. Johnson says her son is doing well. After a year at Cherry Gulch, she says, “his growth has been huge. The most growth we’ve had in his 15 years of life.”
Still, it’s unclear what his parents will do when Eric graduates from Cherry Gulch this summer, and how they’ll keep him from slipping back into his old habits when he returns. He’s just coming to terms with the fact that he has an addiction to gaming and screens, Johnson says. “He isn’t quite at the acceptance phase.”
The notion that it’s possible to be addicted to video games, or any type of technology, has gained mainstream acceptance in recent years. Like gambling—the only behavioral addiction currently included in the DSM—video games seem to trigger some of the same chemicals in the brain as alcohol and illicit drugs, including dopamine, the so-called “reward neurotransmitter” of the brain. But games (and social media such as Instagram and Twitter) have an additional characteristic that makes them habit-forming: They provide that kick of dopamine at unpredictable intervals, providing an incentive to stay glued to the screen.
Think of it as a lab experiment, says Christakis. “If you try to condition a rodent to push a lever when a stimulus comes, and they get a reward every time, it doesn’t create an obsession,” Christakis says. Make the rewards unpredictable, and the rats are “much more likely to become compulsive. The reward could come at any second, and they might miss it if they aren’t paying attention.”
Gaming also gives people something of value that they may be missing in their lives—whether a person is a smart kid craving stimulus and mental challenges, like Eric, or an adult who lacks a sense of accomplishment in life. Alok Kanojia, a Boston psychiatrist who specializes in gaming disorders and says he was once addicted to video games himself, says, “People will play 40, 60, 100 hours of World of Warcraft”—a massively multiplayer online game, or MMO, in which people cooperate and compete with each other in real time— “and they derive a sense of value out of it. You may feel like you’re no one in the real world, but you’re someone in the game.”
