I am a huge believer in harm reduction. You have to be in the right place for abstinence and when social supports do not allow for harm reduction many people experiencing addiction can fall through the cracks.
Wet shelters limit options for city’s alcoholics
LUCAS OLENIUK / TORONTO STAR
John Bowley, who has been staying in shelters on and off for five years, outside of Osgoode Hall, where he often sleeps.
This day is no different. It’s shortly after 2 p.m., and his last drink was around lunchtime, a premixed whisky tallboy. Bowley, 50, says he’s also on methadone to kick a heroin addiction.
He doesn’t know where he will go tonight. While the official policy of Toronto shelters is not to deny people access solely because they’re drunk, Bowley’s experience tells a different tale.
There used to be two shelters Bowley could have gone to where he could drink inside, known as wet shelters. But now that the Schoolhouse Shelter has been converted to emergency beds as of Jan. 1, there’s only one left for adults.
That’s the Annex Program at Seaton House, where residents are given one standard drink every 90 minutes. The program helps prevent them from harming themselves, by getting into fights or becoming unconscious and vulnerable. It also helps connect them to health care and the system.
Harm-reduction advocates, like Holly Kramer, the co-ordinator of the Toronto Harm Reduction Task Force, warn that losing the Schoolhouse will have negative effects.
“If it’s not there, believe me I don’t think that means they’re going to stop drinking. We’re going to have more alcohol consumption in public places,” she said.
Operators of both abstinence-based shelters, where residents can’t drink, and the Annex Program agree on the need for shelters that allow the homeless to drink.
There are about 3,800 beds in city-run shelters on any given night. The Schoolhouse accounted for 55 beds, and the Annex program has 140 beds.
That doesn’t meet the need. “Alcoholism is quite high among the homeless — it’s probably on the order of 30 per cent. Mental illness and addictions are 70 to 80 per cent in total,” says Dr. Tomislav Svoboda, a physician at the Annex Program who wrote his thesis on the initiative.
He noted about 10 per cent of the residents will die in a shelter, but in conditions better than they would have experienced on the street.
Dr. Svoboda found an 85 per cent drop in days spent in prison overall and an 84 per cent drop in ER visits among problem drinkers in the program.
“(That’s) a pretty huge impact when you compare it to the lack of such a program or what it was like for them before they entered the program,” he said. “Their drinking improves … They have better access to health care, their emergency visits drop … Incarcerations on average drop from 30 days a year down to hardly anything.”
It also brings people on the street closer to doctors like Dr. Svoboda, allowing them to monitor their drinking and its effects on medications. Six months after the Annex Program launched in 1999, 14 of the clients were found to have tuberculosis, according to an article in the CMAJ. Drinking while on medication would have severely damaged their livers. Thanks to the program, they all stopped or cut back and the tuberculosis treatment was rendered effective.
The approach has met with success elsewhere in Canada too — a similar program in Ottawa was shown to dramatically reduce drinking.
“Typically we see over a period of time a reduction of about two-thirds (of alcohol),” said Wendy Muckle, executive director of Ottawa Inner City Health. She noted that it takes about three to five years to see change.
“For the first period of time you are what stands between them and chaos, then gradually they are able to take over more,” said Muckle.
Seattle has taken harm reduction a step further by offering alcoholics permanent housing, not shelters. The Housing First Initiative housed 95 chronic alcoholics in 2005 without demanding they change how much they drank.
Daniel Malone, director of housing at the Downtown Emergency Service Centre in Seattle, says the Housing First Initiative has been applied to chronic alcoholics in Seattle, which led to a drop in alcohol consumption for participants, and also saved taxpayers millions and has become a model for other cities.
“The net reduction in total cost of these crisis services of the initial cohort that moved into the building was $4 million (USD) over one year,” said Malone, adding the savings came from the reduced cost of emergency services, jail and outpatient care. The participants also reduced their “average peak drinks” — the most they would drink in a given day — from 40 to 26 drinks after a two-year period.
The Schoolhouse Shelter on George St. is in transition. Eleven men still call the shelter home as they wait for housing workers to find them a place to live. Meanwhile, construction crews are upgrading the building and staff are waging a never-ending battle against bedbugs.
Shelter manager Haydar Shouly stands in the shelter with David Reycraft, director of housing and homelessness services at Dixon Hall, a non-profit that has operated the shelter since 1999.
It was Dixon Hall that first approached the city about changing the Schoolhouse Shelter.
The program was running at a deficit. Dixon Hall would have needed $225,000 more a year to keep the wet shelter initiative going, which required around-the-clock support and programming.
“Really what we needed to change was to ensure that our per diem was enough to keep us whole financially,” said Reycraft, adding that the age of the 130-year-old building was also an issue.
The structure, built as a schoolhouse in 1886, requires $300,000 in repairs over the next five years. The city has committed to these repairs, but is reducing the number of beds and eliminating the wet shelter program, converting it into emergency accommodations, which are cheaper.
Like other city shelters, residents have to check their liquor into a booze lock-up on entry, and retrieve it when they leave.
John Lever, 59, a former resident of the Schoolhouse who is now sober, stayed there between 2005 and 2006.
“They did treat you a little bit like a human being. It really wasn’t that bad compared to the other ones,” says Lever. “If you came in with a couple drinks on your breath, that was fine.”
But by no means was it a party. Lever remembers doing odd jobs for cash so he could afford a few drinks. Asked how he felt during his time in the Schoolhouse, Lever is blunt: “Terrible,” he says.
“You’re (drinking) as a form of escapism because you’re depressed. You’re there, you’re going to do anything you possibly can, be it drugs, be it alcohol, be it even sex.”
Lever says he has been kicked out of shelters but was too drunk to remember where he ended up staying. He works as a part-time driver now, although he’s still in the shelter system, waiting for a permanent place to live.
John Bowley ended up sleeping in the crawl space under the steps of Osgoode Hall that Wednesday, with a bag full of beer to keep him warm while the temperature dipped to minus 6. He is still sleeping outdoors more than a week later.
His shaggy black hair has a few wisps of grey, but it’s clean thanks to the facilities at the Good Neighbours’ Club, a daytime drop-in centre in downtown Toronto. Bowley’s slouches into his chair in the second floor of the centre, out of the cold, and describes how he sometimes warms up by sleeping on the vents.
“You’re so tired and it’s so cold,” he says, pausing sporadically, his eyes drooping. “The warm air that’s blowing up, especially the ones on University, it can be so, just perfect. Just cross your legs and you don’t think about the embarrassment, or people that might know you … all your (humiliations) are — they all go away when you’re in that state.”
Hundreds of homeless people like Bowley have died while sleeping outdoors. The Annex program at Seaton House was established after a coroner’s inquest into the freezing deaths of three homeless men in 1996.
One of the recommendations was that the Toronto shelter system adopt harm-reduction principles. “Everyone is entitled to shelter services, whether or not they use substances,” reads the policy, which was adopted in the city’s shelter standards in 2002.
But stories from the streets reflect a different reality. “We often hear guys here talk about the challenges they have accessing shelter beds when they’re under the influence,” says Lauro Monteiro, director of the Good Neighbours’ Club.
Aklilu Wendaferew, assistant executive director at the Good Shepherd Ministries, an abstinence-based shelter on Queen St., says they deny people access only for inappropriate behaviour, and that the major concern with allowing alcohol to be consumed on-site is safety.
“If people are using, then there’s the possibility for all kinds of things to happen, including violence, including interfering in the ability of other people to have a safe environment during the night,” says Wendaferew.
The question is one of balance, experts say: Toronto needs both abstinence-based shelters and ones that accept people who have been drinking.
“There absolutely needs to be more wet shelters,” says Dion Oxford, director of the Salvation Army’s abstinence-based 108-bed Gateway shelter. “(A lot of people) stuck in the abyss of addiction simply cannot go cold turkey right away. There needs to be a place where people can use and be safe at the same time.”
Oxford, who has been working with people on the streets for more than 23 years, says the Gateway centre also turns people away because of behaviour, not on whether they’re under the influence.
Still, he noted, it can be difficult for clients trying to kick the habit to have people stay in the shelter who’ve been drinking.
Oxford says that Toronto’s services have always been weighted against harm reduction, and losing the Schoolhouse only made it worse.
“We need to understand addiction as far less black and white than we used to. There is a spectrum and we need to partner with each other,” says Oxford.
“We’ve lost yet another way to respond to the dire needs of homeless people in Toronto.”
The Annex Harm Reduction Program at Seaton House is the last remaining wet shelter for adults in Toronto.
The 550-bed facility cuts an imposing presence on George St. High metal fences surround a yard where men mill about, smoking and chatting.
Inside, a program on the fourth floor is underway. It’s a 140-bed wing with an alcohol dispensary that looks like a campground tuck shop. A chalkboard shows the times when drinks are served.
A handful of men sit in chairs, chatting while they wait for the metal grate to open and for staff to pour white wine from pitchers into Styrofoam cups.
“Hi, good morning,” shelter manager Karen Smith says to the men.
“You’re too late,” one of the men jokes to Smith — she just missed the first serving of the day, at 8:30 a.m.
“I’ll come back in an hour and a half,” she replies. The men laugh and continue to chat, holding their empty cups.
The clients pay a fee for their alcohol, usually around $100 a month. They can supply their own booze, in which case it is given to them in measured doses, one standard drink at a time.
The program is geared toward those who are not ready, willing or able to stop drinking.
“Our goal isn’t to reduce the amount of drinking, but to help manage it from the perspective of a person not getting so intoxicated that they’re incapacitated. It prevents them from getting into harms way, getting beaten up on the street, falling unconscious,” says Dr. Svoboda.
Harm-reduction centres can also provide respite until people are ready to quit completely, says Dr. Patrick Smith, CEO of Renascent, an abstinence-based drug and alcohol rehab centre.
“Jurisdictions that have done it best have been able to have a developmental model of all the right things in place, so that when someone reaches the next level of stability there’s an easy next step for them,” he says. “(Then) it isn’t like talking to someone in first grade about going to university.”
Peter Leslie, 53, is a former alcoholic who went to rehab 11 times before becoming clean for good — including two attempts while he was working as a paramedic for Toronto EMS, fighting alcohol and cocaine additions. After relapsing, he fell further, until he was smoking crack in the washroom at Tim Hortons.
In 2002, Leslie stayed in the Schoolhouse Shelter for a year. He now works as a peer educator with the Toronto Harm Reduction Task Force, which advocates for harm-reduction policies and educates front line workers on its benefits for people with drug problems. He protested the Schoolhouse’s closure this fall.
“I don’t think (the City) likes the fact that people drink, which is reality, and people use drugs, which is a reality. I think they see (harm reduction) as accommodating or enabling,” he says. “But every time there’s someone who dies outside, there’s a s—storm.”
After moving through transitional housing, Leslie now lives in an apartment. But he considers himself lucky. “I met hundreds and hundreds of men and women that abstinence was just not in the books for,” he says.
“Some people just can’t quit.”
Geography can do wonders for your mood and well-being but it’s becoming clear to me that wherever you are stationed does eventually become a source of stress, even if it once was an escape.
I went from high on life to screw everything, let’s self destruct, even if majority of it only happens in my head.
Clearly I don’t do alone. Probably especially more when someone angered me earlier today and I’ve had to sit and stew in it all morning, afternoon and evening.
I’m noticing that I am becoming a stress eater. I go for the crap food and snacks. I noticed this behaviour tonight though and I put the candy away and replaced it with some Palm Bay coolers. Cause you know, drinking and dancing alone is what all the cool people are doing.
It’s not helping, I knew it wouldn’t but it’s keep me occupied until I decide it’s time for bed.
I do have plans for tomorrow so that will be nice
At one point Fry briefly speaks about self medication and how he used cocaine and vodka to help him get through his manic depression. I personally used cutting, alcohol, the occasional drug and sex.
Something hit me though when I was listening to him speak and this I feel like the term “self medication” devalues our own ability to make ourselves feel better.
Just because a doctor does not prescribe a medication/treatment/whatever does not mean that what we chose to do should be looked down upon.
It is also interesting that self medication is usually, if not always, something that is labelled as bad. If it is something “good” then it’s not called self medication at all. It’s called coping or self care.
To cover my butt, I am not saying that abusing alcohol or self harming (etc) are good things. These can hurt you and sometimes kill you. I do acknowledge though that these are valid ways of coping that people use to get through live.
We need to believe that we are able to make decisions for ourselves. We know what will work for us and not all of those answers can come from doctors.
I was in a meeting last week where we were discussing how some people are not allowed to attend group sessions if they come under the influence of drugs or alcohol. This was becoming a little debate between those who believe in abstinence and those who believe in harm reduction.
Turning someone away from a part of their treatment if they are under the influence is not very harm reduction. At the same time it is not fair to the rest of the group, who did not use prior to group, to have to be around someone who may be triggering. This is supposed to be a difficult decision.
One person asked, “What is someone cuts before they come to group? Should they not be allowed to attend?” I responded that while cutting is maladaptive, like drugs and alcohol, it does not alter your state of mind the same way. Both women in the room disagreed with me (both are aware of my experience with self harm).
Without either of them having to explain to me why I do understand what they meant when they said that self harm can alter your state of mind. For those of us who engage in the behaviour we can admit that before, during and after the behaviour something does happen to our bodies (if it didn’t we wouldn’t engage in the behaviour in the first place).
At least for me, once the moment was over then that was it. I quickly returned to my usual functioning. The whole “mind altering” part maybe have lasted 5-10 minutes whereas a high can last much longer.
What it comes down to is we cannot have different rules for the different behaviours but we can work on a case by case basis. This is fair.
What does worry me about all of this, in particular in regards to self harming, is that it may promote secrecy. I would be so upset to learn a youth I worked with was hiding their self harm for fear of not being able to attend treatment. One of the women in the meeting pointed out though that if there is no change or an increase in the behaviour that this just meant we should take another look at their treatment because clearly what they are currently receiving isn’t working. Completely valid.
It’s been a very interesting experience for me to go from the frontline advocacy to the more policy side of mental health. It’s difficult. A lot of tough decisions that I do not agree with but I know have to be there. I’m glad that I play a role in it though because I can help change or modify.
drunkennessThis is the last part of my mini series on my substance use. This is the big one.
Alcohol. I was never addicted to alcohol but I abused alcohol badly.
Sober by Pink reminds me of how I felt when I was a teenager and drinking.
I had my first sip of alcohol at 2 years old. My neighbour left his beer on his porch and me, thinking it was apple juice, drank it. “Yucky apple juice Mommy!” I exclaimed. My Mom laughed, my neighbour felt horrible. Now, that is just a cute story but by the time I was 13 and had my first shot I knew drinking was something I was taught not to do for religious and legal reasons.
My drinking quickly escalated once entering high school. Since I wasn’t a fan of pot I would drink instead. I drank as a way to cope with my depression. Alcohol made me happy, it provided me with temporary relief and that’s why one drink was never enough. My memories of these times are fuzzy because of the alcohol so I’m going to write this entry as individuals thoughts not like a story line.
- I have a memory of calling my boyfriend’s school, claiming to be his sister, to get him out of school so we could drink. That afternoon I wandered around in the forest by our houses with two 26 oz bottles of Jack Daniel’s and Beefeater. I would take turns chugging from each bottle. They were not full when I got them, little less than half in each, but I finished them.
- I would trade. Since no one at my house drank I would give people who smoked pot money in exchange for alcohol and cigarettes.
- Binge drinking was the way to go. My friends and I believed that if you were hung over and didn’t remember anything the next day then it meant you had a good night.
- We partied every Friday and Saturday night. I also began drinking/getting drunk on school nights at my boyfriend’s house. I was basically just with him so I could have a steady supply of alcohol and cigarettes. Anything I wanted I could get from him.
- I could drink vodka, rum, and whiskey straight and I could drink a lot. I loved having chugging contests with the guys. I would most often win. I wanted to show people that I could drink a lot and in the end would black out. (See older blog for list of blackouts http://kaybaby666.xanga.com/726721375/teenage-blackouts/)
- I cut myself one night while drinking and well, that didn’t go over well.
- We used to joke and say that we have more alcohol than blood in our bodies.
- New years 2006 I drank a lot, plus I had overdosed on Prozac. I mixed the two, drank and the last person I remember was at 10pm. I was throwing up black and almost drowned myself in the toilet. I could not walk. I could not do anything. Two friends had to drive me home and lift me into my bed. They missed the count down.
- I developed a strategy on how I could come to a party with nothing to drink and leave drunk. When a drunker person would put down their drink I would drink it. They would come back and ask where their drink went and I would say, “Oh you must have finished it.” They would laugh, agree and go get another one. I would repeat this the whole night. Also being cute gets you drinks.
A lot of other things happen but I can’t remember or don’t want to talk about it.
I had a lot of fun at these parties. Most of my fondest memories were of partying with friends, dancing and thinking that I was invincible. I was falling apart and on self destruct but I was having a lot of fun.
I don’t drink much anymore. Socially mostly.
You need to be careful with alcohol. To much, only once, and you can die.
I’m glad I have it all moderated now. It wasn’t even an effort for me. Drinking stopped becoming so important.
I don’t need it to feel like I’m fun. I don’t need it to feel attractive. I don’t need it to be who I am.
My Dad said to me a few days ago, “Can’t you shut it off?” Can’t I shut off my constant need to immerse myself in the shit of the world? No, but I can take a little break! thebipolarplace posted a few interesting things about him and I can’t think of nothing I love more than talking about myself!
I have 4 cats, 2 at my parents house who I grew up with and two with my partner and I (Phoenix, Duchess, Omen and Vonnegut).
My favourite colours are black, red and purple.
I love rainbows.
As much as I love men, or my man, kissing girls is wicked awesome!
When I was 13 years old I wrote a 148 pages story that was a massive rip off of Harry Potter.
I’ve had two rabbits throughout my life, Rebecca and Kit.
I drink alcohol because I want too but I don’t drink a lot, casually mostly.
I started smoking cigarettes when I was 14 years old and quit at 21.
I have never broken a bone (knock on wood).
I am the oldest of 4 girls (23, 20, 18, 14).
My favourite number is 12.
My favourite food is pickles!
I am pro polygamy as long as, like with every relationship, all adults consent.
I was raised mainstream Mormon but left the Church emotionally around 2002 and physically in 2007.
I have only ever tried 2 illegal drugs in my life, pot and MDMA, and used to take prescription meds for the hell of it.
I played soccer and ran cross country when I was younger.
I look more my Mom.
I think that’s it for now!!!!
If you want to know more ask BUT you need to tell me 2 things about yourself in return!