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iAUDIT! - According to Scott D. Philibin and John C. Crabbe, writing in Rosenberg's Molecular and Genetic Basis of Neurological and Psychiatric Disease , “Most clinicians would agree that the main feature of addiction is compulsive, out-of-control behavior despite adverse consequences.” One may become addicted to a substance, like fentanyl or alcohol, or to a behavior, like gambling. Addicts trade short-term pleasure for long-term consequences. Medical professionals also agree, while addiction may begin as a choice, it quickly becomes a serious medical condition. Philbin and Crabbe said, “The behavioral pattern of an addicted person becomes progressively focused on obtaining, using, and recovering from the effects of drugs. It continues despite illness, disrupted relationships and failures in life.”
People suffering with addiction disorders may be enabled by others who support their behavior while simultaneously hoping for a positive outcome. These people are known as being “codependent”, defined as “a psychological condition or a relationship in which a person manifesting low self-esteem and a strong desire for approval has an unhealthy attachment to another often controlling or manipulative person (such as a person with an addiction to alcohol or drugs).’’ A codependent person may rationalize a drug addict’s behavior by telling himself “My partner may have a drug problem but it’s not an addiction. She takes opiates to deal with physical and emotional pain. “I need to be there for her to make sure she doesn’t take an overdose or hurt someone else”. The codependent person may wish the addict would stop using drugs, but the supposedly supportive approach reinforces that behavior.
Codependency is the opposite of “tough love”, a widely misunderstood term in which a person requires changes from a loved one practicing self-destructive behaviors. Bill Millken, a proponent of tough love as a preventive measure to school dropouts, emphasizes “that a relationship of care and love is a prerequisite of tough love, and that it requires that caregivers communicate clearly their love to the subject”. It’s not being strict or mean for the sake of disciplining someone; it is an intentional act of care aimed at changing behavior by setting boundaries and expectations and holding someone accountable for their actions. Therapeutic approaches and tough love are not exclusive to each other. An example of tough love for a family member with a substance addiction could be allowing them to stay in your home as long as they are enrolled in a recovery program. It could also entail socialization programs to help a recovering addict find employment or connect with other people in recovery.
The key point is that addiction, defined medically, is not a choice, but a disorder. Purely punitive measures like jailing addicts are ineffective because they don’t address the root causes of addictive behavior. On the other hand, providing unconditional support may reinforce self-destructive habits while ignoring the root causes.
What does this have to do with homelessness programs in Los Angeles? Adapting the definitions for addiction and codependency, we can see a clear pattern, where program managers in public agencies and nonprofits continually turn to failed program models, with the result that homelessness and deaths due to exposure and overdose continue to climb. Local elected leaders fulfill the role of the codependent, continually supporting failed programs while hoping for different outcomes. Except for a few small successful NGO programs, no one is willing to adopt the tough love role and demand effective change.
Following the medical analogy of addiction, agencies continually use failed models like No Barrier Housing First because they cannot conceive of any alternatives. Like an addict who lives only for the next fix, agencies cannot see beyond the horizon of the next poorly managed shelter, or overpriced construction project, or ineffective Harm Reduction program. Funding agencies like HUD feed the addiction by only supporting Housing First programs, rather than encouraging innovation and adaptability. The result is an addiction to failure—the constant recycling of ineffective programs that have no result other than an increasing number of homeless people stranded on our streets.
Like other addicts, homelessness agencies rationalize their failures, and nothing is ever their fault. LAHSA’s inexcusable lack of reliable data on the number of people in its shelters is blamed on a shortage of trained staff. $67 million spent to house 255 people through Inside Safe is a sign of success. The County’s failure to provide vital support services is blamed on antiquated recruitment rules preventing the timely hiring of new employees. Increasing deaths from fentanyl overdose are attributed to nebulous social factors outside the control of intervention agencies.
The leaders and organizations we depend on to keep these agencies accountable feed the addiction to failure by providing a steady stream of money with no requirement for outcomes. Like many codependent enablers, they choose to believe the excuses they hear and convince themselves just one more fix of funding will turn failure to success. Leaders use the language of responsibility but fail to follow through. Just one example is the money poured into Inside Safe. According to LAist, Inside Safe sheltered 1,955 people by the end of November 2023. 255 have been “permanently housed”; 337 (1.3 times more than who were housed), fell back into homelessness. As of November 30, Inside Safe spent $93.8 million. That comes out to $47,980 per person sheltered. By LAHSA’s most recent count, there are 46,000 unhoused people in the city. Applying the cost per person to all 46,000 homeless, the total to shelter all of them would be $2,207,080,000—more than two billion dollars--and almost twice the City’s current homelessness budget. That would not be a one-time cost: the homeless population is not static, so there will be continuing costs well into the future. As the L.A. Times recently reported, the City Council approved $40 million for urgent repairs in housing managed by Skid Row Housing Trust, which financially collapsed earlier in 2023. To date, the City has spent more than $58 million purchasing and repairing the Mayfair Hotel, with more to come.
The City budgeted $255 million for Inside Safe in fiscal year 2023-24, and the City Council routinely rubber stamps new expenditures whenever the Mayor’s Office makes a request. This despite the Mayor’s failure to provide promised periodic updates until the late Spring of 2023—reports that indicated barely 1,000 people had been housed by that time. Even now that reports are made more regularly, the numbers are virtually meaningless. Last August, leaders threw a management analyst under the bus, making him admit to the City Council that LAHSA doesn’t always know when someone leaves an Inside Safe room. Councilmeber Monica Rodriguez called the program “the merry-go-round from Hell” and Bob Blumenfeld said LAHSA’s funding should be reviewed given its poor performance. Yet the flow of money continues unabated.
One of the consequences of chronic addiction is an increasing need for the object desired; addicts need more drugs to get the same high; gamblers bet more and more, hoping for the big payoff. The worse they perform, the more cash homeless programs need. LAHSA, the County, nonprofits and other agencies fail because failure pays. The more people who become homeless, the more funding these organizations receive. LAHSA’s fiscal year 2016-17 budget was $132.1 million, and it had 200 employees. The 2016 PIT count showed 46,874 homeless in L.A. County. By fiscal year 2022-23, LAHSA’s budget ballooned to $845,367,020 and it had 800 employees. The 2023 PIT count showed 75,000 homeless in the County. For a six-fold increase in budget, and a quadrupling of staff, the County saw a 48 percent increase in homelessness. In 2016, the City of Los Angeles allocated $138 million to homelessness programs; the current fiscal year budget is $1.3 billion, nearly ten times more. In 2016, there were 28,464 homeless people in the City; now there are more than 46,000. In the past seven years, we’ve been assured infusions of more money (Measures H and HHH, and now ULA) will turn the corner and we’ll see a reduction in homelessness. Each year, when the number of the unhoused increases, we’re promised there will be “game changing” initiatives from the alphabet soup of city, county and nonprofit agencies, and each year, these same agencies (LAHSA, HACLA, PATH, DMH, etc.) recycle the same tired excuses why nothing has improved; staffing shortages, economic forces beyond the agencies’ control, lack of state or federal support, and perhaps worst of all, the epithet of “NIMBY-ism”. When all else fails, agencies accuse the people they serve of being NIMBY’s and opposing shelters, treatment centers and affordable housing. They conveniently ignore the hard realities that many shelters are grossly mismanaged, treatment is virtually nonexistent, and affordable housing projects chronically run behind schedule and way over budget.
Like the alcoholic who refuses to admit his addiction, these agencies rarely show a hint of introspection. Apparently, it never crosses the collective minds of elected and executive leaders that they bear any responsibility for their failures. Perhaps the best example of this attitude can be summed up by LAHSA’s CEO statement when the 2023 PIT count showed a nine percent increase in homelessness: the results were “Disappointing but not surprising”. That statement shows how casually leaders accept their failures; it has no managerial or administrative value. Indeed, it suggests the CEO has no concept of the human suffering caused by her agency’s inaction.
Addictions rarely go away by themselves. Regardless of the specific method, addicts need some kind of intervention. It could be tough love or it could be medically-centered. It could be AA’s 12-step program or the five steps of psychoeducational recovery. What all of these programs have in common is that the subject has a desire to recover. Feeding the addiction is not an option, nor is a sudden and unreasonable cessation of the addictive object. Recovery takes time and consistent support.
Reforming homeless intervention programs doesn’t mean brutally cutting off funding. It means replacing excuses, lack of responsibility and no accountability with clear expectations, rewards for progress and consequences for failure. The goal of government leaders needs to move from supporting programs to supporting the people those programs serve. The question has to be “How do we help get people off the street”? instead of “How to we keep supporting the status quo”? Then perhaps we may end the addiction to failure.
(Tim Campbell is a resident of Westchester who spent a career in the public service and managed a municipal performance audit program. He focuses on outcomes instead of process.)
