First comes dignity of the person

Addiction is not a lifestyle choice. It’s not a moral failing. It’s not a random disaster like lightning strikes and tornadoes. It is not a romantic foray into the dark night of the soul. It’s not a form of cultural decadence. It’s not just something sad that happens to other people.

Substance-use disorders are a medical condition, or a whole suite of them, almost always connected to trauma and mental illness. Addictions are a public-health crisis which cost Canada nearly 74,000 lives in 2020 — nearly 200 deaths a day. In its annual tally of the costs of addiction, the Canadian Centre for Substance Use and Addiction was at pains this last March to point out alcohol and tobacco account for over 85 per cent of those deaths.

The quiet drinkers and smokers out on their balconies have long been simply blended into the background of our culture. Sure, they will die early. But we can accept a little death to keep the peace in our families and our daily lives — to carry on without having to involve ourselves in their problems.

This blind spot leaves us with tunnel vision. We see addiction almost entirely in terms of homeless, dysfunctional, mentally ill untouchables clustered around shelters, clinics and drop-ins on the less fashionable streets of our downtowns.

But Christians can have no untouchables.

“We cannot stoop to the injustice of categorizing drug addicts as if they were mere objects or broken machines,” Pope Francis told the Pontifical Academy of Sciences when it gathered in Rome to share research and solutions to the global addictions crisis in 2016. “Each person must be valued and appreciated in his or her dignity, in order to enable them to be healed. The dignity of the person is what we are called to seek out.”

Instead we recoil in fear — or just turn away, accepting Satan’s whisper that nothing can be done. Thus, we cannot even understand how our cities came to fill up with dirty, unhoused, muttering wraiths.

At St. Michael’s Homes, the Church chooses to understand.

The psychotherapists, social workers, doctors and support staff at the tiny, downtown agency run a long-term residential rehab and recovery program that is focused on the hardest to serve — addicts who have been homeless for years, who are just out of jail, the ones other rehabilitation clinics won’t take because they’re on methadone or Thorazine.

At St. Michael’s Homes, addiction is a symptom of post-traumatic stress disorder, bi-polar disorder, schizophrenia and unresolved trauma. For 40 years, on a shoe-string budget, St. Michael’s Homes has bet the farm on healing and recovery for the walking wounded of downtown Toronto.

“For people with really serious substance-use challenges, recovery is an existential decision. It’s the choice of living or dying,” St. Michael’s Homes executive director Robin Griller told The Catholic Register. “For the guys we serve — I’m talking about people with really serious substance-abuse issues that include methamphetamines, or really heavy alcohol use where they end up seizing when they go into withdrawal — it’s a choice between living a life that is meaningful and engaged and… Well, the opposite of addiction is not sobriety. The opposite of addiction is connection.”

Connection, we might say communion, is not simple or easy.

“Our guys are disconnected from family. They’re disconnected from their faith community, often. They’re disconnected from work. They’re disconnected from education,” Griller said. “The only friends they have are their friends of use. They have lost all social embeddedness.”

“There are no simple solutions to a problem as complex as drug addictions,” Canada’s bishops wrote in a 2017 statement on the opioid crisis. “Whereas some kinds of human suffering are strictly physiological and can be addressed with a single, localized intervention, addiction is different; it touches equally on the physical, psychological, social and spiritual dimensions of the person, rendering the path to recovery more complex, diverse and long. A Christian approach to overcoming drug addiction needs to consider how someone trying to recover can be properly helped, supported and accompanied.”

The bishops do not prescribe any tut-tutting, finger wagging or disapproval.

“Within the Catholic community, people understand that the mission’s core is faith and not judgment — to save people from suffering,” said Griller. “People with serious substance use problems are not people who use substances because they want to use substances… Substance-use disorders are in my view epiphenomenal. What do I mean by that? It’s not the source of the problem. The source of the problem is the trauma that the person has experienced — the co-occuring mental health, the loss of relationships in jobs, in work, in education and in family. That results in trauma. Those are the things that cause people to get lost in substance use.”

Outside the Church there is no salvation — either for us or for homeless addicts. But by Church we don’t mean the building, the hierarchy, the liturgy, the episcopal corporation. We mean communion. We cannot save ourselves, because we need each other. If this third-century insight into what the Church is and what it is for is true for us, it is more true for the poorest, most broken, most helpless among us.

“Look, the substance use is not the starting point,” said Griller. “Substance use is where people get when their lives have become terrible and they think they’ve had no control over it.”

St. Michael’s Homes runs up to 30 beds in its three- to six-month rehabilitation program. There are another 47 beds in its longer-term (up to five years) recovery community. The wait list for its treatment program is now six to eight months, where before COVID it was eight to 10 weeks.

If it seems like the street population exploded over the pandemic years, your eyes do not deceive you. In 2019 St. Michael’s Homes and other treatment programs had their patients in semi-private rooms — two beds per room.

“You can’t, in the middle of a lockdown, have people sleeping in the same room together,” said Griller.

The immediate result was to cut the number of rehab beds in Toronto, in the country, in half.

“Interestingly, the current provincial government has been much more willing to add resources to the substance-use-care sector than previous provincial governments,” Griller said. “In the last couple of years the provincial government has started to expand budgets in the substance-use sector, to some degree — obviously, from a very low starting point and there is a long, long way to go. No, we don’t have the resources we need generally, overall in the sector.”

St. Michael’s Homes is the result of the Sisters of St. Joseph noticing, 40 years ago, that at the end of a week of detox (today called withdrawal management), the alcoholics released from the hospital out onto Queen Street had no place to go. With the help of donors and eventually Catholic Charities of the Archdiocese of Toronto, and 80-per-cent funding from the province (programs were funded at 80 per cent of the funding afforded to provincially-run programs), the Sisters found a way to complete the recovery process. Today, the provincial funding for St. Michael’s Homes has fallen to 56 per cent of the rate public-sector programs receive from government. It leans on Catholic Charities for about 20 per cent of its funding, but the needs for truly professional services (licensed psychotherapists and counsellors) has only grown.

It cost $2.3 million for St. Michael’s Homes to treat 120 clients in 2021-2022, despite pandemic bed limits. Ninety per cent of them completed the 90-day treatment program. Post-treatment, 70 men were living at St. Michael’s Homes for at least part of the year. The program delivered 1,465 psychotherapy sessions and served nearly 13,000 meals.

“We speak a lot about our mission to the poor,” said Griller. “Our program has always, from day one, focused on serving the people who are most marginalized, face the most barriers to access to care and who would not be included elsewhere.”

Outside of the Church there is no salvation.