After nine years as a homeless drug addict in Los Angeles, Jared Klickstein finally checked himself into a drug treatment center. Unlike the program he had gone to six years before, which had hot tubs, acupuncture, and trips to the beach, this one, in North Hollywood, was deadly serious about personal responsibility. Clients kept a strict schedule. They did chores. They scrubbed toilets. “No hot tubs,” Klickstein said.
Most important, they couldn’t use drugs. “If you use, they kick you out,” he said. “There’s consequences.”
It took him two attempts, but Klickstein, now 33, finally got clean. Four and a half years later, he’s independent, employed, and emotionally stable. “I was a person that you would see on one of these videos, screaming with blood and shit all over them,” he said. “And now I’m not.”
Klickstein attributes his success to the North Hollywood program’s emphasis on sobriety and accountability. “Without sobriety, there is no mental or emotional stability for me and most other drug addicts, meaning homelessness was inevitable,” he said. “Half measures and coddling do not work. Period.”
But tough-love centers like the one that turned Klickstein’s life around are becoming harder to come by. The idea that you have to quit drugs to recover from addiction has become old-fashioned, and treatment centers that insist on abstinence are disappearing. In California, changes in state law have made it virtually impossible for any program that accepts public funds to push clients to quit using.
... and before he got himself cleaned up. “Half measures and coddling do not work," Klickstein says. "Period.”
“You cannot intervene or even speak to someone regarding their alcohol and drug use,” said Reverend Andy Bales, who has worked in drug recovery in Los Angeles for decades. As a result, most homeless services and housing providers in the city allow, in his words, “a free flow of alcohol and hard drugs.” This permissive approach, Bales believes, is why California has more people living on the street than any other state in the country.
The repudiation of abstinence-based treatment in California and many other states represents the broad embrace of an approach called “harm reduction.” Instead of seeing addiction as a serious illness whose treatment ultimately requires addicts to stop using drugs, it casts addiction as a risky health condition to be managed, and insists that different people benefit from different management strategies, not all of which require abstinence.
But as the addiction crisis has deepened across the country, with the highly toxic and addictive opioid fentanyl killing addicts at record rates, homelessness exploding in California and throughout the West Coast, and drug cartels operating in the open in cities like San Francisco, the ascendance of a particularly dogmatic form of harm reduction may be exacerbating the crisis instead of mitigating it. By normalizing drug use, eschewing intervention, and shutting down abstinence-based treatment programs, critics of this radical harm reduction philosophy believe it’s keeping people trapped in addiction.
“It’s just going to end up with more death,” said Klickstein.