What does DTK need?

[ijmorlan]

Forced rehab should be a possibility, but I know that gets into a messy ethical situation. People on one hand will argue you can't stop people from doing drugs if they want, so we should just let them do it. But obviously we know having thousands of hardcore drug addicts living on the streets is bad for them AND the rest of us. So how do you deal with that, especially if rehab programs allow you to just tap out and hit the streets again? Very few successfully make it through and get clean. They try, but then they're back to nodding off in random public spaces soon after.

This crisis is costing thousands of lives, tens of millions of dollars, destroying families and friendships, endangers the general public, degrades our community and so much more. If someone refuses to improve, would it be so wrong to involuntarily commit them to a facility that can get them off drugs?

If the alternative to forced rehab is increasingly erratic behaviour until they do something criminal and are sentenced to prison, then it is absurd to oppose forced rehab. Either way, they’re getting locked up; better it be in a situation whose purpose is to help them free themselves from drugs, rather than to punish them (although I understand the word “penitentiary” goes back to an attempt to reform prisons to rehabilitate rather than just punish prisoners, so this isn’t a new debate).

That being said, I recognize that being forced into rehab isn’t the best, highest likelihood of success, way, and does raise ethical concerns that must be considered. But absolute opposition to forced rehab simply doesn’t make sense.

[danbrotherston]

Forced rehab should be a possibility, but I know that gets into a messy ethical situation. People on one hand will argue you can't stop people from doing drugs if they want, so we should just let them do it. But obviously we know having thousands of hardcore drug addicts living on the streets is bad for them AND the rest of us. So how do you deal with that, especially if rehab programs allow you to just tap out and hit the streets again? Very few successfully make it through and get clean. They try, but then they're back to nodding off in random public spaces soon after.

This crisis is costing thousands of lives, tens of millions of dollars, destroying families and friendships, endangers the general public, degrades our community and so much more. If someone refuses to improve, would it be so wrong to involuntarily commit them to a facility that can get them off drugs?

If the alternative to forced rehab is increasingly erratic behaviour until they do something criminal and are sentenced to prison, then it is absurd to oppose forced rehab. Either way, they’re getting locked up; better it be in a situation whose purpose is to help them free themselves from drugs, rather than to punish them (although I understand the word “penitentiary” goes back to an attempt to reform prisons to rehabilitate rather than just punish prisoners, so this isn’t a new debate).

That being said, I recognize that being forced into rehab isn’t the best, highest likelihood of success, way, and does raise ethical concerns that must be considered. But absolute opposition to forced rehab simply doesn’t make sense.

Is there a reason to physically confine some people because of mental problems? Yes.

But our history with that shows that it is not something to be taken lightly.

Let me ask you this, there are many many high functioning alcoholics, and high functioning more serious drug users as well. Their wealth usually allows them to maintain their habit without their life falling into disarray (at least, not right away). Now, many of these people routinely endanger others by driving while under the influence. Do you also support confining them?

I think that's an elucidating example, because the material difference between these groups is their wealth, not their impact on the actual (rather than perceived) safety of others.

[danbrotherston]

I for one am extremely relieved to finally see the injection sites shut down (and hopefully turned into rehab/addiction centres) - perhaps the people that use them can finally start to receive the care they need

Promoting them is cruel beyond words

I'm curious what research or experience you have treating people suffering addiction that leads you to an opinion so wildly divergent from what most of the experts believe about addiction treatment?

I'm also curious what mechanism you believe safe injection sites use to prevent people with addictions from accessing rehab or addiction programs? (Because the existing sites are being closed, not transformed, no new resources are available).

[ijmorlan]

If the alternative to forced rehab is increasingly erratic behaviour until they do something criminal and are sentenced to prison, then it is absurd to oppose forced rehab. Either way, they’re getting locked up; better it be in a situation whose purpose is to help them free themselves from drugs, rather than to punish them (although I understand the word “penitentiary” goes back to an attempt to reform prisons to rehabilitate rather than just punish prisoners, so this isn’t a new debate).

That being said, I recognize that being forced into rehab isn’t the best, highest likelihood of success, way, and does raise ethical concerns that must be considered. But absolute opposition to forced rehab simply doesn’t make sense.

Is there a reason to physically confine some people because of mental problems? Yes.

But our history with that shows that it is not something to be taken lightly.

Let me ask you this, there are many many high functioning alcoholics, and high functioning more serious drug users as well. Their wealth usually allows them to maintain their habit without their life falling into disarray (at least, not right away). Now, many of these people routinely endanger others by driving while under the influence. Do you also support confining them?

I think that's an elucidating example, because the material difference between these groups is their wealth, not their impact on the actual (rather than perceived) safety of others.

If they won’t stop drinking and driving, then absolutely, yes. It should be essentially impossible for someone to be convicted of impaired driving more than a few times, because they should be serving mandatory long prison sentences (or confined to mandatory treatment, if such a thing is possible) after the first few convictions. Also murderers should not be allowed to have their names on hospitals:

https://www.blogto.com/city/2022/06/nurs...hospitals/

(disclaimer: the word “murderer” reflects my ethical assessment of the situation, not a legal conclusion or court ruling)

I think we’re in broad agreement: you answer whether some people need to be confined with a “yes”, and then immediately point out that there is a difficult history of this sort of policy; and I say that under certain circumstances forced rehab is obviously needed, but also acknowledge that there are serious concerns that have to be addressed if this is to be done.

I strongly agree that the rules and the system should not come down hard on poor people while letting truly sociopathic rich people keep getting away with continued bad behaviour.

[danbrotherston]

Is there a reason to physically confine some people because of mental problems? Yes.

But our history with that shows that it is not something to be taken lightly.

Let me ask you this, there are many many high functioning alcoholics, and high functioning more serious drug users as well. Their wealth usually allows them to maintain their habit without their life falling into disarray (at least, not right away). Now, many of these people routinely endanger others by driving while under the influence. Do you also support confining them?

I think that's an elucidating example, because the material difference between these groups is their wealth, not their impact on the actual (rather than perceived) safety of others.

If they won’t stop drinking and driving, then absolutely, yes. It should be essentially impossible for someone to be convicted of impaired driving more than a few times, because they should be serving mandatory long prison sentences (or confined to mandatory treatment, if such a thing is possible) after the first few convictions. Also murderers should not be allowed to have their names on hospitals:

https://www.blogto.com/city/2022/06/nurs...hospitals/

(disclaimer: the word “murderer” reflects my ethical assessment of the situation, not a legal conclusion or court ruling)

I think we’re in broad agreement: you answer whether some people need to be confined with a “yes”, and then immediately point out that there is a difficult history of this sort of policy; and I say that under certain circumstances forced rehab is obviously needed, but also acknowledge that there are serious concerns that have to be addressed if this is to be done.

I strongly agree that the rules and the system should not come down hard on poor people while letting truly sociopathic rich people keep getting away with continued bad behaviour.

That's not confining someone for addiction...that's confining them for drunk driving. If a person on the street assaults someone they too would face jail time.

The point is, you want to pre-emptively confine someone based on your fear that they might do something problematic. In the case of a person on the street, acting erratically or in a threatening, but non-criminal manner.

Well, I'll make a bold claim here...damn near 100% of high functioning alcoholics in Canada drink and drive. They are the same statement. So for a high functioning alcoholic with a car, we'd have to confine them, or impound their vehicle.

In both cases, I don't actually think it's necessary. In the case of drunk driving, we need to normalize and facilitate non-driving, for the other I think we need better mental health and addiction support.

As far as acknowledging there are cases where people should be committed...as far as I understand, we already have tools for this. I have personal experience with this, which I don't want to go into detail, but it is entirely possible for those in power to forcibly confine someone who they feel is a danger to themselves or the public.

[tomh009]

The point is, you want to pre-emptively confine someone based on your fear that they might do something problematic. In the case of a person on the street, acting erratically or in a threatening, but non-criminal manner.

Well, I'll make a bold claim here...damn near 100% of high functioning alcoholics in Canada drink and drive. They are the same statement. So for a high functioning alcoholic with a car, we'd have to confine them, or impound their vehicle.

In both cases, I don't actually think it's necessary. In the case of drunk driving, we need to normalize and facilitate non-driving, for the other I think we need better mental health and addiction support.

A case in point: today I was overtaken in DTK by a screaming/swearing person. Not assaulted, but he was indeed loud (and did knock over a bunch of store signs while walking past them).

But a few minutes after overtaking me, he walked to the door of a multiresidential build, opened the door using a fob and entered the building. Definitely not a homeless person. Annoying, but not criminal.

[ac3r]

If the alternative to forced rehab is increasingly erratic behaviour until they do something criminal and are sentenced to prison, then it is absurd to oppose forced rehab. Either way, they’re getting locked up; better it be in a situation whose purpose is to help them free themselves from drugs, rather than to punish them (although I understand the word “penitentiary” goes back to an attempt to reform prisons to rehabilitate rather than just punish prisoners, so this isn’t a new debate).

That being said, I recognize that being forced into rehab isn’t the best, highest likelihood of success, way, and does raise ethical concerns that must be considered. But absolute opposition to forced rehab simply doesn’t make sense.

I think one hurdle would be having the public become accepting of the idea - and sure, the phrase "forced rehab" is lazy...I'm sure there are nicer ways to describe it, but that's besides the point. However this isn't impossible to do. Such a program and everything that comes with it - the facilities in particular - would have to be designed in such a way to be conducive to rehabilitation. We would need new facilities built and designed in such a way that they feel warm, inviting and a place where someone would actually choose to be versus their present life under addiction. They would have to look, feel and function as places for rehabilitation. In fact, it's a demonstrable and objective fact that good architectural design combined with well structured, ethical programs that actually work to help people have significant positive results. A big reason why people think things like "safe injection sites" and other fairly contemporary bandage solutions are bullshit is because they kinda are. They're half assed, even if the underlying idea is correct.

If we're to confine people who are so deep into drug addiction that they are a danger to themselves and a burden to society (burden meaning the huge cost to the social fabric and economics of our community and nation) then it needs to be in a place they don't feel like they're in jail. Thankfully, there are plenty of examples of facilities like this around the world we can look to for inspiration. But achieving this takes an unprecedented level of national willpower...which unfortunately I don't think we are ready for in Canada. It isn't just simply a matter of financially affording to design a coherent plan, designing and building facilities to treat people, integrating people back into the normal world et cetera. Before any of that, there would need to be a significant cultural shift in our attitudes to how we see this and I think because Western philosophy has long placed emphasis on individualism and autonomy, that's a huge obstacle to overcome. I guess looking at it through the perspective of mental health makes sense to me. We regularly involuntarily confine people against their will in psychiatric units/hospitals when they are deemed a danger to themselves/others. Someone living in a tent, stealing every single day and abusing drugs is just a danger to their life and those around them yet for some reason most of society thinks it's preferable to just shrug it off and let them do what they want until they pull themselves out of it or die. They're really two sides of the same coin.

This problem is clearly tearing our country apart and seemingly getting worse by the day. I look at states such as the USA in horror as to what we seem to be aiming for. So instead of handing out free needles and glass pipes, we should be legislating a concrete plan and be willing to spend the money on it. It's not as if the money isn't there. If we can spend tens of billions of our dollars giving weapons to people like the Saudi's and Israeli's, we can spend it fixing our own nation. It just takes a change of attitude. And maybe looking to places like Portugal and Netherlands to see that you can build facilities that work in addition to writing legislation that helps.

[Vojnik_Vahaj]

Forced rehab should be a possibility, but I know that gets into a messy ethical situation. People on one hand will argue you can't stop people from doing drugs if they want, so we should just let them do it. But obviously we know having thousands of hardcore drug addicts living on the streets is bad for them AND the rest of us. So how do you deal with that, especially if rehab programs allow you to just tap out and hit the streets again? Very few successfully make it through and get clean. They try, but then they're back to nodding off in random public spaces soon after.

This crisis is costing thousands of lives, tens of millions of dollars, destroying families and friendships, endangers the general public, degrades our community and so much more. If someone refuses to improve, would it be so wrong to involuntarily commit them to a facility that can get them off drugs?

The west generally, but particularly the UK and Canada refuse to do anything reverse the decline of their decaying societies because doing the neccessary dirty work is "too mean". No, round all the drug addicts up and ship them off to some rehab facility and don't let them out until they're no longer addicted.

The only issue is that in Canada from what I've seen since becoming old enough to be able to undertand these things is that corruption seems rampant and our tax dollars vanish and we somehow "don't have the budget" to do anything significant ever.

[Vojnik_Vahaj]

I think one hurdle would be having the public become accepting of the idea - and sure, the phrase "forced rehab" is lazy...I'm sure there are nicer ways to describe it, but that's besides the point. However this isn't impossible to do. Such a program and everything that comes with it - the facilities in particular - would have to be designed in such a way to be conducive to rehabilitation. We would need new facilities built and designed in such a way that they feel warm, inviting and a place where someone would actually choose to be versus their present life under addiction. They would have to look, feel and function as places for rehabilitation. In fact, it's a demonstrable and objective fact that good architectural design combined with well structured, ethical programs that actually work to help people have significant positive results. A big reason why people think things like "safe injection sites" and other fairly contemporary bandage solutions are bullshit is because they kinda are. They're half assed, even if the underlying idea is correct.

If we're to confine people who are so deep into drug addiction that they are a danger to themselves and a burden to society (burden meaning the huge cost to the social fabric and economics of our community and nation) then it needs to be in a place they don't feel like they're in jail. Thankfully, there are plenty of examples of facilities like this around the world we can look to for inspiration. But achieving this takes an unprecedented level of national willpower...which unfortunately I don't think we are ready for in Canada. It isn't just simply a matter of financially affording to design a coherent plan, designing and building facilities to treat people, integrating people back into the normal world et cetera. Before any of that, there would need to be a significant cultural shift in our attitudes to how we see this and I think because Western philosophy has long placed emphasis on individualism and autonomy, that's a huge obstacle to overcome. I guess looking at it through the perspective of mental health makes sense to me. We regularly involuntarily confine people against their will in psychiatric units/hospitals when they are deemed a danger to themselves/others. Someone living in a tent, stealing every single day and abusing drugs is just a danger to their life and those around them yet for some reason most of society thinks it's preferable to just shrug it off and let them do what they want until they pull themselves out of it or die. They're really two sides of the same coin.

This problem is clearly tearing our country apart and seemingly getting worse by the day. I look at states such as the USA in horror as to what we seem to be aiming for. So instead of handing out free needles and glass pipes, we should be legislating a concrete plan and be willing to spend the money on it. It's not as if the money isn't there. If we can spend tens of billions of our dollars giving weapons to people like the Saudi's and Israeli's, we can spend it fixing our own nation. It just takes a change of attitude. And maybe looking to places like Portugal and Netherlands to see that you can build facilities that work in addition to writing legislation that helps.

also this

[bravado]

The west generally, but particularly the UK and Canada refuse to do anything reverse the decline of their decaying societies because doing the neccessary dirty work is "too mean". No, round all the drug addicts up and ship them off to some rehab facility and don't let them out until they're no longer addicted.

The anglo west are individualist societies with little annoyances called "rights". This is an absurd take and calling it "necessary dirty work" is pretty damn sinister, if you ask me.

We simply can not lock people up who have not committed a crime.

Even in less progressive places like republican-led cities in the US, they've shown some actual progress on this file by just building housing all over the place and removing barriers to building housing. More houses = less homeless. We could learn something from this approach and spend a bit less time delegating city and province power to charities and NIMBYs where we could just be building housing and letting people sort out their own lives in safety with a roof over their head. But we'd rather have these weird culture wars, fights over the sanctity of parking lots, and denying that the market has any role to play in solving homelessness...

[tomh009]

The west generally, but particularly the UK and Canada refuse to do anything reverse the decline of their decaying societies because doing the neccessary dirty work is "too mean". No, round all the drug addicts up and ship them off to some rehab facility and don't let them out until they're no longer addicted.

The only issue is that in Canada from what I've seen since becoming old enough to be able to undertand these things is that corruption seems rampant and our tax dollars vanish and we somehow "don't have the budget" to do anything significant ever.

In the west, we have a thing called "human rights", and we simply do not round up people who have not committed any crime. And addiction is not a crime.

And I think you are still not old enough to what "corruption" means if you think that this is the cause for Canadian budget challenges.

[ac3r]

We simply can not lock people up who have not committed a crime.

How do you reconcile this statement with the fact we do lock people up who have not committed crimes? Legislation in all of our provinces and territories permit a person with sufficient authority to involuntary commit an individual to a hospital, including the ability to fully restrain them to a bed. Each day, thousands of Canadians across the country are in such a situation.

Indeed, we can argue that a drug addict is not equal to an individual deemed to be a harm to themselves (suicidal ideations, self-harm) but is an addicts reason faculties not just as unreasonable as the psychiatric patient? The addict is actively hurting themselves - potentially others - and could very well die. Using drugs that knowingly harm is not a normal state of being, so can you not argue they are of unsound mind, a danger to themselves and require some form of intervention, even if that requires an involuntary commitment? If not, then how do we ethically just carry on the way we are as a society and let them do this to themselves?

You also mention the obvious reality that more homes (which assumes they are easily available for everyone) equal less homelessness. That's an obvious truth, but overly simplifies the problems. Not all homeless are addicted to drugs or suffering from severe psychiatric issues, but a huge number of them are. Those are complex factors to take into consideration. Let's say we round up every homeless person with a substance abuse problem and/or psychiatric issues and give them an apartment. Do you think that would fix them of those problems? Certainly not.

Yes we need more homes for every Canadian, but these issues are much deeper than that. An addict with an apartment is still an addict. It's a big reason why the concept of transitional housing exists. Most people who get into transitional housing have participated in rehabilitation programs first. As they get clean and get reintegrated into the routine of "normal life", they may end up in transitional housing. From there they continue rebuilding who they are, perhaps finding work or need skills then finding their own place.

Viewing all these problems through the lense of urban planning is missing the point. This really has nothing to do such things like parking lots and culture wars. It's a massive public health issue that can only be solved by fighting on numerous fronts. And when it comes to helping those homeless who are on the streets because their mental health is in shatters or they have addictions - which is a lot of them - the solution starts first at treating that. It's hard, but maybe that's where the idea of obligatory rehabilitation programs can come in, rather than the laissez-faire approach we take now which boils down to "you can only help those who want it". I think in such cases that's a nonsense statement because going back to how we can and do involuntarily commit people for psychiatric problems, we already use the ability to intervene and attempt to help someone even if they don't want it.

We can build plenty of housing, but we also need bigger and better designed hospitals, rehabilitation facilities, transitional housing and everything in between.

[bravado]

It takes a long time to get everyone to agree on hospitals and rehab and new social supports, it doesn't take a long time to put a roof over someone's head and give them a place to sort their lives out and try to rebuild. Perfect is the enemy of the good here... Giving people a home is one type of rehab, maybe even the cheapest one we have in the toolbox. I genuinely think that for each public addict we see, there are 50 more "working homeless" behind the scenes that can turn their lives around with minimal investment from the state if they just had a place to do it that didn't consume 80% of their income.

As for involuntary commitment, I think that's an extremely high burden to clear with medical ethics to actually get someone committed. It's genuinely a political non-starter, especially with how the charter of rights has been interpreted for the last 40 years and all that built up precedent behind it.

[ac3r]

The west generally, but particularly the UK and Canada refuse to do anything reverse the decline of their decaying societies because doing the neccessary dirty work is "too mean".

This is true, if not a bit oversimplified. Specifically this is what I was referring to when I mentioned Western philosophy.

We can trace the roots of our current world around the 18th century when there began a schism in mainstream thought, perhaps best illustrated by the divide between analytic philosophy and continental philosophy after the rise of the Enlightenment. It was pretty binary at the time, though minds were expanding. Time went on, by the 20th century we realized there is a lot more nuance to things. Modernism gave us yet more new ways to view and interpret the world, placing a lot of emphasis on individualism and freedom (especially after the two World Wars). From the 1980s onward, philosophy entered an era of post-modernism and post-structuralism where basically anything goes since we've told ourselves anything can be correct, in a manner of speaking.

This isn't necessarily bad and I think we're a lot better off over here than other parts of the world since we place importance on things like free choice and the individual, while also mostly accepting that there is no grand, idealistic truth. But it's probably no coincidence that it feels like our societies are declining, large in part due to the fact at times we can't agree on what is right or wrong. Ethics is a bitch. One can make a compelling argument that it is only just to allow an individual to freely do whatever they want even if that will harm them or other people, so leave them be. Others will argue that no, if we actually cared about their well being, why should we not take them in and help them, as if they were as close as any family member?

[ac3r]

I genuinely think that for each public addict we see, there are 50 more "working homeless" behind the scenes that can turn their lives around with minimal investment from the state if they just had a place to do it that didn't consume 80% of their income.

As for involuntary commitment, I think that's an extremely high burden to clear with medical ethics to actually get someone committed. It's genuinely a political non-starter, especially with how the charter of rights has been interpreted for the last 40 years and all that built up precedent behind it.

This is a good point and one I wanted to point to, though I didn't want to make my post too long. A housing first policy most certainly would help the thousands of working homeless (another term I like is invisible homeless...invisible because they may still work, or have the benefit of living out of a car and so on) and I think we really need to look into what it would take to begin a project to help those people.

But it's the homeless addicts most of us think about and see - who recognize these individuals are worst off - who are quite a different story and who require a much more sophisticated solution if we are to help them.

Build houses. Build rehabilitation facilities. And also build a new framework of interpretation and solutions that can actually have a greater chance of success, because our hands off approach sure as heck isn't doing much.