System Breakdown

California needs to get real about the addiction crisis.

Sergio is a 30 year-old Latino man who, in spite of an unfathomably hard life, could pass for twenty-three. He has big, milky eyes like a calf, which are so expressive that every emotion seems painted all over his face. When Michael Shellenberger and I spoke to him on a blazing hot Friday morning, he had just woken up in the tent he sleeps in, on a wooded knoll sandwiched between the 110 freeway and the concrete drainage ditch of the Arroyo Seco, in Northeast Los Angeles.

Sergio is an alcoholic. Alcohol is what started his problems, and got him kicked out of his mom’s house. Things got worse from there. Now he smokes meth and fentanyl. He has hallucinations about neighbors casting spells and aliens implanting communications devices into his ears. He bounces around between jail, the hospital, and sleeping on the streets. His eyes swelled with tears just describing it.

“I miss having a place to live,” he told us. “I miss my family. I miss being normal, like having my X-Box, and just like, playing some video games.”

Right across the freeway from Sergio’s encampment is a community of tiny homes, which Sergio is hoping to move into. It’s managed by an ex-meth addict named Eric, twelve years clean. Meth has changed since the days he used to do it, Eric told us. Back then, it was made from ephedrine, the stimulant found in Sudafed. But import bans on the substance in both the United States and Mexico forced meth cooks to come up with something different. The new meth is more potent and far more dangerous. It makes people crazy — literally psychotic. That’s probably what’s happening to Sergio. Along with fentanyl, it’s fueling a surge in acute mental illness throughout the state of California, which manifests in cases of bizarre criminality.

“Nudity, breaking into someone’s property, going into a store causing some sort of disruption in some way, walking in the middle of the street not knowing where they are, many of them, sad to say, nude, just having no awareness of their state or their condition,” said Blue Stoehr, a psychiatric social worker who manages severely mentally ill homeless addicts, describing the people the police bring to her private non-profit hospital in Northeastern L.A. County. She’s seen a flood of cases of psychosis, most of them probably meth-induced, that the county is simply unequipped to manage. “What we experience in the hospital is a breakdown of the system functioning — the county system,” she said. The problem is simple: “There’s no place for these individuals to go. There’s no homes. There’s no family. There’s no long term stays.” 

Once upon a time, when drug addicts were arrested, they were diverted into mandatory treatment. The system was highly imperfect but it achieved some level of success. Eric, the tiny homes supervisor, got clean only after being arrested and imprisoned. His rock bottom was in solitary confinement. “I needed the intervention,” he said. “Left to my own devices I would use again.” But today, he told us, that intervention may not have happened. “There’s not a lot of arrests these days,” he said.

Eric doesn’t want users to go to jail. “In the county jail, there’s no methadone, there’s no Suboxone, there’s none of that stuff,” he said. “There’s just cold turkey kicking and that’s what I went through and it’s horrible.” He wouldn’t wish it on his worst enemy. But he also understands that an arrest can create an opportunity to steer an addict into medically-assisted detox, a far more humane outcome. Given the choice between jail and mandatory treatment, he said, he believes the residents of his tiny homes would take the road to recovery. But unfortunately, that system doesn’t exist anymore. 

In the absence of such a system, Stoehr believes that the short-term treatment she and her colleagues are able to provide achieves nothing. “If you’re severely psychotic, and you don’t have the capacity to know that you need medication, then you need to go to a place for a long period of time and call it home,” she told us. She believes it should be somewhere far from the enabling environment of cities — in nature, ideally — and that the rehabilitation should involve manual labor. “You exercise the demons out of your body,” she said. “And you can have a clear mind.”

“I would agree with that,” said Emily Barker, a psych nurse in San Diego who deals daily with homeless addicts. She, too, believes that the help she provides daily amounts to little. Barker described her work in the behavioral health ICU as a “revolving door” in which she sees the same patients over and over again, to the point that they’re on a first name basis. The process is aimed at stabilizing and discharging patients rather than treating their addiction and mental illness. “Everything is decentralized. Nobody knows what’s going on on the other end,” Barker said of the current system. “We’re not helping people get off drugs, we’re not helping these people actually improve their mental health.” Like Stoehr, she believes that what’s needed for the people she sees is long-term treatment, far from the streets. “You can’t continue to put people back in their same environment and expect them to succeed,” she said. She described a facility being developed in Colorado for detox and mental health treatment, where patients stay for two to three years, getting clean, taking classes, and working on campus. She believes this is what’s needed in California.

She believes that what her patients need is a centralized system spanning every county that can see a patient all the way from stabilization to a full recovery. In other words, the vision at the basis of our gubernatorial campaign: Cal-Psych. If Cal-Psych existed today, Sergio could choose to get himself clean, or, the next time he’s arrested, he would be compelled to do so. He would enter into a system in which he was stabilized and detoxed, but then put into a system of long-term, supervised recovery, in a location far from the open drug scenes of Los Angeles. There he could receive counseling, learn tradable skills, be habituated into the structure of a workday, and, when ready, be placed into a decent job. He could be re-affiliated with his family, become normal again, play his X-Box in the evenings and on the weekends.

Instead, he’s churned through a system so dysfunctional that its frontline caregivers don’t believe their work adds up to anything of lasting value. Then he’s dumped back onto the same drug-infested streets, where he sleeps in a tent and is tormented by an imaginary transmitter in his ear.

This is the system we have. As much as we ignore it or normalize it, we see it every day, in our parks, beneath our freeway overpasses, on our public streets, on our buses and trains, in front of our kids’ schools. It feeds the growing blight of our cities and suburbs, and it’s a living hell for the addicts it fails to serve. It’s not just inhumane, it’s inhumanity itself. It must change — now. Or it will destroy California forever.