The TYP held its fifth Public Conversation at 6pm on Wednesday, August 25, 2010 at the Cansler YMCA about addiction, addiction treatment, and how both of those relate to the TYP. Mary Thom Adams, a supporter of the TYP who works in development with Positively Living Park Ridge Harbor, Knoxville’s largest dedicated permanent supportive housing facility, acted as moderator. Hilde Phipps, Director of Adult Addiction Services, Helen Ross McNabb Center, discussed the nature and effects of mental illness, treatment options provided by Helen Ross McNabb Center, and other treatment modalities available in the community. The meeting was attended by about 45 people and the conversation, once again, was respectful and extremely informative.
[These are my notes. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post. Please tell us who you are and where you live.]
Attendees included several City Councilpersons: Vice Mayor Bob Becker, Marilyn Roddy, Nick Della Volpe and former Councilman Barbara Pelot. County Commissioner Finbarr Saunders was present, too. Ten-Year Plan staff were present as were Grant Rosenberg and Linda Rust of the County’s Grants & Community Development department. Several members of the service provider community were also present, including Volunteer Ministry Center’s Ginny Weatherstone and Gabe Cline; Helen Ross McNabb Center’s Leann Human-Hilliard; and Stacia West with Knox HMIS (Homeless Management Information System); and Steve Jenkins, Positively Living/Parkridge Harbor. My apologies if I’ve missed anyone.
The format of this meeting was one hour. The first twenty minutes were used for presentation, the second forty minutes hour was spent in open dialog.
Ms. Adams, in her role as moderator, focused this meeting’s topic on addiction and homelessness. She introduced Ms. Phipps and her topic. Ms. Phipps is the Director of Adult Addiction Services for Helen Ross McNabb Center. Ms. Adams focused the purpose of the meeting: The first half hour is reserved for presentation and the following half hour is reserved for discussion. We’ll stick to the topic: addiction and chronic homelessness.
Ms. Phipps introduced herself. She has worked for eighteen years in the field of addiction treatment and loves her work. She said “I’m here to talk about addiction in our community and the availability of resources to treat it.”
What is addiction?
Ms. Phipps defined addiction: Addiction is a chronic progressive illness that if left untreated is fatal, but if the illness is arrested at any point in time the addict can be restored to healthy, productive living.
- Chronic means that the disease is ongoing
- Progressive means that it gets worse over time unless treatment occurs. More on this below.
- With appropriate treatment, the illness of addiction can be arrested at any time in its progression, and the addict can be restored to productive, healthy living.
Impact of addiction
Addiction is very widespread and cuts across all societal boundaries. One in every four families is effected by addiction, and the effects can be devastating. BUT there is hope and there is the very real potential for recovery. Addiction does not have to be fatal, but it is always going to be painful. The illness effects sufferers physically, mentally, emotionally, spiritually. Addiction has a profound impact on every part of life and on every kind of ability.
Why are all of these areas effected? It’s a chemical issue. Something happens in the brain that tells an addict that he or she has to have the addictive substance in order to feel normal. The substance becomes necessary to survive.
Many kinds of substances can be addictive. Alcohol is still a commonly abused and very addictive substance. Opiod addiction is more and more common now because of the ready availability of prescription pain medication. Other kinds of psychoactive drugs can become addictive.
Factors that create the opportunity for addiction
Addiction has a physical component and a psychological component.
Genes: To become an addict, as opposed to someone who simply abuses substances without becoming addicted, a person needs a genetic predisposition to addiction. For example, the grandson of an addict is five times more likely to get addicted than is a member of the general population. Ms. Phipps pointed out that it is really hard for the general public to understand this. It’s not simply an issue of self control. One in four people have this genetic predisposition to addiction.
Access: The average age of first use is 12 years of age. In other words, the average addict has access to a substance that is addictive when he or she is very young.
Amount: To cross the line that separates the addict from the non-addict, you have to ingest a certain amount of the chemical to which you are addicted. And nobody knows how much this is. It’s a biologically-determined thing that is unique for each individual. A person might be able to ingest a substance fifteen times or fifteen hundred times before he or she becomes addicted to it. Nobody can predict where that threshold lies, and nobody wakes up and says “I think I’ll become a destructive addict today.” If we knew where the magic line was, everyone would simply stop before they got to the line. We just don’t know where that is, but by the time you cross it, it’s too late. Once a cucumber becomes a pickle, it can never again be a cucumber.
Ms. Phipps stressed that this is not a moral issue. Once the line is crossed, the relationship to the drug becomes the very most important relationship in life. The pleasure of using the substance is gone after the first couple of years. The addict will still chase that original high, but can’t catch it, and are miserable and tormented. They keep using more of the substance to try to recapture the original high. They can never get there, but they need to use more and more of the substance to try, they have to keep using the substance to feel normal, and thus the disease progresses.
Medical Detox: Duration–five to twelve days.
Residential Rehabilitation: Duration–21-28 days.
Certain substances will kill you if you try to get off without medical help. Alcohol, opioid drugs, benzodiazepines like Xanax, Halcyon, etc., are among those, and necessitate medical detox and residential rehab. These drugs aren’t inherently bad. When used properly, they’re extremely beneficial, but some people simply can’t use them without becoming addicts.
If addiction sets in very early in life, then recovery is more difficult because the addict has not developed coping skills earlier in life. Teaching daily living skills is a very important aspect of treatment. We give people chores not to punish or penalize them, but to start teaching about how to live with daily routine. Very busy and highly structured because they don’t have the ability to structure their own lives.
There is a direct correlation between the length of time in treatment and success in recovery.
Addiction sets us up for a lot of moral judgment. Part of what we do is to educate families and others who are affected by the illness. There is tremendous hope. If arrested, restoration is possible. Chemical dependency alone is stigmatized among illnesses. Most people have a choice about substance use in the beginning, but the addict loses the choice when he or she crosses the magic line.
Q: What is the connection between addiction and homelessness? Is there a connection? Ginny Weatherstone, CEO of Volunteer Ministry Center: Let me dovetail and feed back. The ramifications of addiction are severe and they effect every area of a person’s life. I think an addiction definitely can lead to homelessness. Ms. Weatherstone asked Ms. Phipps if she would concur? Ms. Phipps: 70% of all addicts are in the workplace, and obviously not all of them are homeless. But of course, if addiction damages a person’s ability to work, it will damage their ability to maintain a house payment or to pay rent. Ms. Weatherstone: I agree. The impact of addiction on relationships can also effect the ability of a person to remain in his or her family. When a person begins to ask how they can end the cycle of addiction, one of the answers will be the kind of treatment that they can get at Helen Ross McNabb Center. That’s why people experiencing homelessness and residents of supportive housing will be referred to their programming. Gabe Cline, VMC: The first thing I feel compelled to say about this is that by no means are all homeless people addicts. Part of what we do from the case management perspective is to look at the whole person. If addiction is an issue for you, we’ll work to get you connected with addiction experts, like those at McNabb. But we’re also looking at mental illness, housing, and other issues and the services available to help with them. People who are experiencing both homelessness and addiction live with a level of chaos that makes it very hard to follow an addiction treatment plan, to manage all the moving parts of a very chaotic life, while they are living in the streets. My experience is that housing plays a huge and very positive role in recovery.
Q: Bob Becker: You have spoken about what addiction is and that it can be cured. What gets you back on the other side of that line, out of addiction? Ms. Phipps: The first phase is medical intervention. That’s going to take a matter of a few days. That’s treatment. The next phase is longer term residential: 21-28 days. We don’t say that an addict is “cured.” We say that an addict is “in recovery,” and that’s what we try to draw people towards. We help them gain the skills they need to do things for the first time without using the substance to which they’d been addicted. How do you face the firsts of your life without using? How do you have fun? Attend a funeral? Go to work? Those are things you learn on the way to and during recovery. We encourage participation in recovery groups such as AA and NA and others. Recovery is a lifelong commitment.
Q: Dan Brown: Oftentimes in these sessions, we’re given the example of people who are homeless because they’ve gone OFF their meds. Is there a statistic that differentiates between that and becoming addicted? Could a person come off their meds and then become addicted to another substance? Ms. Phipps: There’s a difference between drugs and medications. Drugs are being used improperly. Medication has been prescribed by a health care or behavioral care provider for a certain set of symptoms. We encourage people to use medications. I think you’re talking about people using psychotropic medications. We encourage them to stay on those, and to use them properly, as prescribed, because they’re helpful.
Q: William Donegan: I’ve thought about this a lot. The fellowship of the recovery program is key and could be emphasized at this point. Involvement in community can reduce one’s need to find an external substance to medicate pain, because community and a sense of belonging can help with that pain. Gabe Cline: Community is helpful whether we’re talking about addiction or just alienation. There’s not good community on the street. Much of what we’re doing at Jackson Apartments and Minvilla is about building good community. We want residents of these apartments to learn to engage in healthy ways with the folks they live with. We encourage involvement in Circles of Support and other constructive and healthy groups. We emphasize skills development, too, in supportive housing. Mary Thom Adams: Would most supportive housing programs do the same things you’re describing? Ms. Cline: All of the supportive housing programs that I know of are doing that. Quality of life requires people connecting with other people.
Q: Eleanore Ripley: I am a recovering alcoholic. The smell of alcohol is still a trigger for me. Say for example that a person goes to Helen Ross McNabb Center for treatment. They finish and go into supportive housing, and their neighbor might be drinking. Have you made plans to accommodate that person so that you remove that trigger? Might a wing in an apartment building have a no alcohol policy, even if the whole facility is not a “dry” facility? I don’t know how else you would ensure that that person would be protected from relapse. My father was homeless in Knoxville for years. I wish there could be some way that once they go through treatment, they would not have to worry about their neighbor having a beer. Ms. Phipps: Triggers are as individual as people, and they might seem completely unrelated to the substance. For example, the trigger for some clients is a particular song. We can’t remove every trigger from every environment, not even in a treatment setting. We can’t remove them all, but we do all we can, especially in the early, most fragile time. Mary Thom Adams: Talk about VMC’s program. Ginny Weatherstone: I concur with Eleanore. If you’re recovering from addiction you don’t need to return to your old playgrounds. Can you remove all of the triggers from a given environment? I don’t know. All I can speak of is Minvilla, and there’s one part of the building where we could maybe control for that, but that remains to be seen. Leann Human-Hilliard: I oversee some of Helen Ross McNabb Center’s housing. Ours permits no alcohol on the premises. We struggle with that internally, but for us, that is what we have made the decision to do. We’re not out looking for violations of this policy, but if it becomes a problem, we address it; it’s part of their lease. Eleanore Ripley: Are you saying that there’s no alcohol and drug use allowed on the premises in housing for the homeless? Ms. Human-Hilliard: It’s whatever the people running the housing decide and how they set up their lease. Ms. Ripley: I’ve read that it’s allowed in TYP housing. Ms. Weatherstone: The true definition of housing first does not require sobriety at move-in. What research shows is that in housing, usage goes way down and residents with addiction issues are better positioned to succeed in treatment than are people with addiction issues who remain on the streets.
Q: Is Helen Ross McNabb Center part of the TYP? Ms. Human-Hilliard: The TYP is a document, and it is one that I can fully support. Permanent supportive housing is what we need to move towards as a community. The way that Helen Ross McNabb Center moves towards providing that type of housing might look different than the way another provider moves towards it. Ms. Adams: So the TYP does not lay down rules and regulations for providing supportive housing. It’s about coordinating the efforts of the different providers in the community. Jon Lawler, TYP Director: The TYP is about working with different agencies while respecting their distinctives. But the DNA of supportive housing will be the same as it expresses itself across all the agencies. Mike Dunthorn, TYP Staff: Each individual’s needs are assessed and that assessment helps to determine the best housing placement to meet the needs of the individual. Different agencies bring their own approaches to the table, and what’s best for one person might not be for another. One size does not fit all, and variety is a good thing within the basic framework of supportive housing. The TYP respects that.
To hopefully further clarify this point, I posted the following at KnoxViews on Friday, August 27. “Helen Ross McNabb Center, Peninsula, Volunteer Ministry Center, The Salvation Army, and just about every other service provider that I could name have been around a lot longer than the TYP. The TYP does not control or “regulate” these various agencies. Let me attempt to be very clear here. At its most fundamental level, the TYP exists to reorient a system that has historically focused on managing homelessness into a system focused on ending homelessness. The TYP is about helping those who work within that system to coordinate their efforts to maximize their effectiveness and to minimize cost.”
Q: Is the Flenniken project a TYP, a City or a County project? Vice Mayor Becker: The project will be managed by VMC and there will be a lot of different funding sources involved in making it work. And, back to Dan Brown’s question–please address the question of how many are addicted when you do next public conversation.
Q: William Donegan: Will statistics be created that can be used to assess the success rates and recovery rates of people in supportive housing? Stacia West, HMIS: We can talk a lot more about that in the next few years as we continue to input data into HMIS.
Q: In re. stats for recovery from addiction: recovery from addiction happens at a very low rate. What would be the stats for a situation like one we’re talking about here? Is there a difference between treatment for people who are homeless and people who are not? Ms. Phipps: It’s the same treatment regardless. People don’t come to treatment because they see the light, they come to treatment because they feel the heat. And it’s not what gets you through the door that determines outcome. The stuff we do is basically the same for everyone, but we know that some therapeutic modalities work better for some populations. Nationally, the addiction recovery rate is 20%. Ours at HRMC is around 60%. The longer a person is engaged in the process, the better the outcome. Everything that we can wrap around them is gonna help the outcome.
Q: Joe Minichiello: What is your position on no-barrier housing (active addiction when you enter the program)? What are their chances for success? We’re allowing people to drug and drink themselves to death in supportive housing. Ms. Adams: I think I’ve heard that question answered. The TYP is not a policy, it’s a document. There are 6-7 agencies that provide permanent supportive housing in this community. Is it possible that they might operate in different ways? Mr. Becker: It paints the picture of diversity. Housing and recovery are not the same thing. Ms. Weatherstone: Drinking and drugging themselves to death is what happens on the street. When they don’t want to do that anymore, they make the decision to stop the suicide by street and work with a case manager and get out of that cycle. Ms. Adams: Are you saying that when a person gets into permanent supportive housing, they’ve made a decision to get out of homelessness and to seek help for their addiction, if that’s their issue? Ms. Weatherstone: Yes, at VMC that is precisely the case. Ms. Adams: I think your question has been answered, wouldn’t you agree? Mr. Minichiello: Yes.
Q: Eleanore Ripley: So, how many times do people get to cycle back through all this? Gabe Cline: We would be leaving lots of people on the street if we had one-strike and you’re out policy. You must be living by terms of lease if you want to keep your housing. There can be no illegal activity. If a person goes back to the street life, they will probably lose their housing as a natural consequence of choosing to go back to that life. From the perspective of good case management, as long as that person is still working towards recovery, I’d hate to set up a situation that they’d lose their housing just because they relapse. If they stay in it with us, we want to keep them. Ms. Human-Hilliard: We all want to allows for more of a harm-reduction model to be in place. Reducing harm over time is very helpful and effective, over time.
The next public conversation is scheduled to take place at the Cansler YMCA from 6-7pm on Wednesday, September 22. The topic will be Who Are the Homeless? and the presenters will be Dr. David Patterson of the UT College of Social Work and members of his staff. A lot of this conversation will focus on HMIS, the database that is so helpful in helping us to understand people experiencing homelessness in our community. We’ll follow the same basic format as usual. First half hour presentation, second half conversation about the subject.