Addiction in underserved populations is a major issue in the United States. One of these underserved populations is the episodically or chronically homeless. There is no agreement as to whether substance use disorders cause homelessness or vice versa, but no one disagrees that each exacerbates the other. While 235,823 homeless individuals were admitted to U.S. treatment programs in 2009, research findings suggest that services are still lacking for homeless populations.1,2
Some may consider the homeless population to be beyond hope and believe the solution involves occasionally making a small donation to a homeless person with a sign, but this is not true. Extensive research has pointed to hope of recovery for homeless individuals with addictions, and these citizens can be rehabilitated and go on to live productive lives.3,4
However, traditional professionally led recovery programs may not be best suited for the homeless population. Social model rehabilitation programs may better match the needs of these clients, because these individuals tend to be less trusting of traditional recovery systems and may require more extensive services. Also, research indicates that social model rehabilitation programs can be provided more cost-effectively than traditional programs, resulting in a net fiscal gain while increasing the quality of life for individuals with substance use disorders, their families and society as a whole.4
The development of effective interventions for homeless populations is especially important because of the prevalence of alcohol and drug problems in various subpopulations.4 These rates considerably exceed those of the general population, and substance use disorders (along with mental illness) are considered to be among the leading reasons why homeless populations are unable to break out of this destructive cycle.
In recent years, much attention has been focused on recovery using an Addiction Recovery Management (ARM) framework. The underpinning of this framework is that addiction is a chronic disorder, which requires recovery priming, recovery intervention, recovery maintenance, recovery re-intervention and continuity of care.5,6 ARM is more comprehensive in its delivery paradigm than traditional systems. While shorter-term residential or outpatient treatments essentially graduate participants with a simple suggestion of engaging in “aftercare,” those employing ARM actively engage with other service providers and indigenous sources of support to facilitate continuing care and recovery management.
Despite challenges inherent to the treatment of homeless populations, an ARM framework can be successfully integrated into social recovery programs for homeless individuals. In fact, principles of ARM integrated to a social recovery model seem to be especially effective for homeless individuals, as these programs seek to initiate “networks of indigenous and professional supports designed to initiate, sustain and enhance the quality of long-term addiction recovery for individuals and families and to create value and policies in the larger cultural and policy environment that are supportive of these recovery processes.”5
Replicated from the federally recognized Healing Place in Louisville, Ky., The Healing Place of Wake County in Raleigh, N.C., a nonprofit program for homeless people with substance use disorders, provides a model for integrating ARM principles into a comprehensive social model recovery and rehabilitation delivery system.
The Healing Place operates separate men’s and women’s facilities in Raleigh, providing overnight shelter, social detoxification, a long-term recovery program (12 to 18 months) and a supported living apartment complex for those who complete the program. The program implements all elements that Scott and Dennis7 describe as essential to a comprehensive ARM program in their acronym “TALER”: tracking, assessing, linking, engaging, and retaining. Using an ARM framework and offering unlimited, on-demand services, The Healing Place of Wake County shepherds clients who are likely to have high-severity addiction issues and low recovery capital from a life on the streets to a productive life of sustained, full recovery.
The Healing Place maintains multiple touch points and extensive community relationships to increase engagement in the recovery program and to facilitate post-recovery program support. Among The Healing Place's support functions are an overnight shelter, a clinic, daily addiction recovery mutual aid meetings, assertive linkage to addiction recovery mutual aid communities, a family program, and extensive relationships with providers. These services promote inspirational interaction between individuals who may be in the precontemplation or contemplation stage of change and program alumni, staff, current clients and others who may provide motivation to engage in recovery activities.
The Healing Place has carefully built symbiotic engagement/linkage relationships with community organizations, including local police departments, emergency medical services, hospitals, communities of faith, and other providers (i.e. mental health, addiction and homeless providers), as well as with addiction recovery mutual aid groups. These relationships provide linkages to professional and community support entities that are essential for clients before, during and after treatment. For example, it is not unusual for one of the local police departments to drop off someone in need of help, a sponsor to bring in a sponsee, or the judicial system to provide a recommendation to engage in the recovery program.