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Addressing the complexities facing homeless addicts

April 18, 2013
by Shannon Brys, Associate Editor
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The Extension

Working with individuals in the homeless population adds a new dimension to the already complex world of addiction treatment. Not only does the substance abuse need to be addressed, but there are many other life skills and emotional tactics that need to be developed.

The theory of recovery at The Extension in Marietta, Ga., is work/therapy and comprehensive multi-mode therapy.  “In other words, it’s not about drugs and alcohol, it’s about a lifestyle that includes drugs and alcohol that has hijacked or reworked our brain,” says John (J.J.) Bremner, CACII, CCS, Director of Recovery Services at The Extension. 

Throughout an intensive 26-week life skills course, clients are retrained in areas such as balancing a checkbook, opening a savings account, interviewing for a job, and getting up for work.

Bremner explains, “Because when you’re out there homeless, you don’t have to worry about things like that. And if they did know it, they’ve forgotten it. We have to teach them like they’ve never done it before.”

While some individuals who are not in the homeless population may encounter similar life skills roadblocks, those in the homeless population have “taken it to a whole new level to where their entire life is in a plastic bag. It’s a whole lot different than someone suffering from trauma and living in a $150,000 house or who has a job, or has a vehicle. These people have nothing and the thing they lost more than anything else is hope,” Bremner adds.

Bremner believes that it takes a different mindset in a counselor to work with individuals in the homeless population. This is a completely different socio-economic level and most counselors never deal with this population. That being said, even if they have only a plastic bag to their name and they smell bad, that doesn’t mean they don’t deserve to be treated with dignity and compassion, Bremner says.  

Transitioning to independent living

Financial recovery should be included in the overall recovery, and is essential to end the homeless state, Bremner says.

Bremner says that although the organization’s mission is to take its clients into independent living, it doesn’t rely on service agencies to do that. Rather, budgets are set up for clients and their money is closely monitored. Savings accounts are mandatory for individuals in treatment at The Extension, as is paying child support, tax liabilities and other costs.

Each week, every client meets with a substance abuse counselor and a case manager and they are mandated to bring in tracking sheets for money they’ve spent. Any transaction over $50 must be approved by staff.

Clients at The Extension must pursue a GED coursework if they do not have a GED when they arrive for treatment.  Acertified teacher visits the facility 20 hours a week to help these individuals achieve their GED. Once this is complete, staff works with the clients to get them involved in steady employment. 

After this year-long program, an ideal transition client (The Extension doesn’t refer to former clients as graduates) will leave treatment with a year clean, permanent full-time employment, having taken care of their financial indiscretions, and $3,000 to 4,000 in the bank.

“All these things happen, but they happen because we plan, they plan, they buy into their plan, and they execute the plan.  That’s why it takes a year. It takes a long time to redo some of the dysfunction that they’ve been living in for 20 years,” says Bremner.

When the treatment is over, the staff helps move clients into the community by walking them through the process of finding an apartment. This is a major milestone for these individuals because they are picking out their own apartment, putting down a deposit, and becoming independent. “They no longer rely on anyone to take care of them,” Bremner adds.

Improving health

In addition to life skills, another area of emphasis is mental health. A large amount of trauma is found with this population and Bremner believes that has been highly overlooked by the field. 

“Being homeless is traumatic and very few agencies that we know of really treat the trauma,” says Bremner. At The Extension, specialized trauma counselors work on issues that come with being homeless and some of the high-risk situations that they had to live in, deal with and that perpetuated the addiction.

The organization’s clinical approach to trauma is the manualized “Seeking Safety” approach developed by Lisa Najavits. The behavioral modification tool for PTSD and substance abuse addresses varying levels of trauma. It teaches clients cognitive thinking skills of diving into the trauma and bringing them out the other side and feeling safe, Bremner explains.

General healthcare is another aspect of life that often becomes neglected when a person is homeless. As it’s important to get these individuals back on track with their medical visits, the organization has a volunteer medical director, dental clinics, a chiropractic college, and a psychiatrist visit often to work with clients. 

In regard to psychiatry, the organization tends not to medicate clients immediately. Only accepting less severe mental health issues such as depression, some bipolar issues, some ADD, etc., Bremner says he prefers to see how clients’ brains start to heal as they come off the drugs. 

“We know that post-acute withdrawal symptoms will mimic mental health problems and we don’t want to just give them medication up front; we want to see where they’re at after a period of time in sobriety,” he explains.

Modalities of treatment