Homelessness

Divided Into Sub-Groups

Not all homeless are the same. However, I believe every person that finds themself homeless feels the rejection from society.

Group No. 1: Consists of people who have become homeless by some sort of tragedy. I know of people who lost their job and having no financial safety net have eventually become homeless. These people benefit greatly through services that hook them up with housing, job searches, temporary employment, maybe medical or mental health services. I also know of people who temporarily just could not cope and ended up living in their cars. These people tend to regain their footing rather easily and resume productive lives.

Group No. 2: These people may or may not also be addicted to either alcohol or illegal substances. These people need structure and consistency. They do well in transitional housing that provides not only accountability, but guidance on the steps necessary to gain independence. These are the people that may also have been out on the street for a while but have hit rock bottom and are ready to comply with the rules. Transitional housing puts a foundation under them. It gives them the time necessary to drop their cortisol levels where they can stop living in survival mode. These people do well with the programs presented to them in a shelter. These are the people I gravitate towards because many times they also need to examine their self-worth and what they believe about themselves. Who they are needs to be reframed for them.

Transitional housing has the first requirement of being clean, no drug usage. Sometimes they have to be clean for a month. That can be a substantial hurtle. But there are ways around it.

First let’s look at what happens during addiction. As a side note let me mention that Bessel van der Kolk does not believe drug addiction happens in a vacuum. He believes it is usually a result of trauma and the trauma response of dissociation. In laymen’s terms, finding a way to escape the emotional pain of the trauma. That aside, the result of drug addiction is the following changes in the brain.

Fact #1: Drug use changes brain chemistry. The use of narcotics such as cocaine, fentanyl, heroin, etc. affects the chemistry of the brain. These drugs introduce a surplus of what the brain believes is dopamine, serotonin and norepinephrine. Very simply with a surplus, the brain reduces its own production of these neurotransmitters.

Fact #2: This change in the production of neurotransmitters takes time to reverse. It can take up to 3 months or longer for the brain to return to normal levels of dopamine/serotonin production. And here’s the kicker, some people don’t have normal levels of these neurotransmitters to begin with.

Fact #3: During withdrawal the addict will experience irritability, cravings, anxiety, and depression. And during all this they know with one hit all of it will go away, temporarily. If the addict relapses they start from square one. When I was taking oxycodone after knee surgery, I was told that taking it for just one night to sleep would cause symptoms of withdrawal. Withdrawal symptoms for opioids will begin within 6 to 12 hours after the last dose. Withdrawal symptoms peak around 3 to 6 days after the last dose. For alcohol the symptoms will start in 6 to 12 hours and peak within 24 to 72 hours. For cocaine symptoms will start in 1 to 3 hours and peak in 4 to 7 days. The severity of symptoms is related to the dosage and length of time the person was using. It will always be a battle though. I know many recovering addicts that avoid certain locations and friends years after they have stopped using because they know being pulled back into addiction would be easy if they went there or saw those people.

If in order to enter a transitional shelter you have to stop using drugs, how do you do that with no resources?

Medicaid will pay for some rehab centers. Medicaid does NOT pay for a luxury rehab facility. We are not talking some sort of spa for the rich and famous.

The resources for rehab centers where the client does not have to pay in Oklahoma City are the following:

In-Patient Rehab Centers: Salvation Army Adult Rehabilitation Center, located at 2041 NW 7th Street. Firstep is another residential rehab. It is located at 11601 W. Stanley Draper Dr. Firstep has both men’s and women’s programs and they are separate. To reach the Men’s call 405.799.7540. To reach the women’s call 405.794.2834. Firstep has a work program where residents work for companies that contract with Firstep. Firstep takes 95% of the salary earned to pay for treatment.

Out-Patient Rehab: Valley Hope Addiction Treatment Center, 6110 NW 63rd St. 405.946.7337.

You must call to make an appointment with any of these rehab centers. Beds are limited and you may be placed on a waiting list. Keeping track of an appointment that is weeks out is not easy for the homeless. It also requires the determination to go to the appointment when it occurs. Task initiation, planning, reasoning and problem solving are all pre-frontal cortex abilities. Pre-frontal cortex development is frequently missing or impaired in the homeless due to their histories.

Group No. 3: This group will only cooperate with minimal structure. They most likely will not submit to treatment. This group will use a Night Shelter. They also are among the people that will be urged in bad weather to come inside. At a night shelter the person has a bed for the night. There are lockers to lock up their belongings. Some night shelters have pet kennels for pets. Reservations to stay at a night shelter are made in the morning and used at night. Only one night can be reserved. At Union Gospel Mission if you wanted to use their in-shelter dormitory at night you had to place your belongings in the building before you went to your bed. The normal routine was to bring in luggage, place it in the lobby, go eat a lunch and then go to the dormitories. In this case you could still be using, but you could not use while inside the shelter, supposedly. This gets tricky given the short amount of time a person on certain drugs can go without experiencing withdrawal symptoms. Therefore, many people will not avail themselves of a night shelter.

Group No. 4: Homeless who will use the Housing First Solution. There was, up until recently, a growing number of municipalities that were using a model called “housing first.” President Trump pulled the plug on housing first programs in July of 2025. That only means no government funding, it doesn’t mean private grants are not allowed. The original concept behind “housing first” was providing a stable living arrangement would eventually lead to seeking a change in behavior. Housing first accommodations have as one of their features access to services. In Oklahoma City our Day Shelter offers probably every service a person would require. In Housing First accommodations the resident can be using upon entry but cannot administer another dose while in the building. They are not required to enter any kind of structured treatment. Basically, there is very little accountability other than no violence.

Gabor Maté in his book, “In the Realm of Hungry Ghosts” recounts his time spent as a medical doctor servicing the residents of 3 hotels in Canada which had been converted into what could best be described as “Housing First” programs. Dr. Maté’s job was to dispense methadone primarily and health care secondarily. His stories are very sad and very human. The people he describes did not recover. They did not re-enter society as contributing individuals. They remained debilitated. However, the statistics show that as far as housing is concerned these programs have a high success rate. The program Maté was involved with also had long term residents, who were concurrently long-term addicts many on a maintenance program. Not to be too cynical, but if the goal is to get people off the street, then this works. If the goal is to get people rehabilitated and independent, then the jury is still out although this type of program has been around since the 1990s.

There are a few studies looking for statistics on drug use and homelessness in the Housing First category. The few I could find seemed to indicate that drug usage although a factor had been largely conquered prior to entering a Housing First program. It was also much less of a factor during the study in the Housing First group. Those who went the traditional route of entering transitional housing had a higher percentage of drug usage and were actively using during the study.

It is possible that the difference between the two groups is the need for accountability and structure. Every program I know of from AA to transitional housing provides accountability and structure. Without it quitting is very hard. I know a number of people that have been involved in AA for years. They are very proud of their sobriety. AA combines accountability through a sponsor and spiritual help. The one thing I found lacking and I was there to address was forgiveness of self. My job was helping people understand their past and how that contributed to their behaviors which led to their addictions. I think it is a better, more whole picture.

In summary, there’s not a one-size fits all solution to homelessness or addiction. I saw people relapse numerous times. There is a very touching new story of a tattoo artist who was asked to put 296 on someone’s arm. The client was memorializing how many days her child remained sober prior to relapsing and unfortunately passing away. She wanted to remember that he tried. We all need to keep that in mind. Sometimes trying and then trying again is all a person can do, but at least they try.