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Many homeless face addiction problems

January 2nd, 2013

After being kicked out of his apartment in November, Nicholas Scott found himself on the street, in need of a job, transportation and a place to live.

Addiction counselor Amir Gombiner works the phone at the Middletown Addiction Crisis Center.

Addiction counselor Amir Gombiner works the phone at the Middletown Addiction Crisis Center.

“It’s a shock to me,” says the 33-year-old. “I’m used to having my own place.”

On a brisk December evening in the city of Newburgh, he wears a huge, fur-lined parka. His blood shot eyes and slow speech convey exhaustion. He doesn’t make eye contact.

“I’m a recovering alcohol and drug addict,” he says. “I’ve been clean for 18 months. Right now, I’m living in transitional housing.”

But, he explains, when he received housing assistance from Catholic Charities Community Services of Orange County, he was placed in an apartment above a nearby bar.

(Staff from the Orange County Youth Advocate Program, which oversees client housing in the building, confirmed this week that recovering residents were not permitted inside the bar.)

“They play the music real loud at night,” he says. “Every time I walk through the door I have to pass the bar. I’m worried about relapsing.”

The nature of the disease

Scott has struggled with drug and alcohol addiction since he was 16. His addiction has led to separation from family and loved ones, including his pregnant girlfriend.

“My main goal right now is to get stable and get a roof over my head so my girlfriend can move in with the baby,” he said.

Addiction and chemical dependency is a chronic disease, said Biju Salgunan, director of substance abuse services for the Middletown Addiction Crisis Center.

“Addiction is a relapsing and remitting disease like hypertension, diabetes or cancer,” Salgunan said. “If it’s not managed and continuously supervised it comes back. It’s the nature of the disease.”

When relapse does occur it often affects every area of a person’s life, Salgunan said.

“Say a person who is in recovery for six or eight months is back on their feet, doing well and then they relapse – they may lose their job, their housing, they may have relationship difficulties, or legal difficulties,” he said. “All of these issues come together at once and the situation tends to spiral downward.”

Relationships will often get pushed to their limits, he added. “Many addicts are shunned by friends, kicked out by family – due to their behavior – and they’re sent to the street,” he said.

This type of social isolation leads to more issues, he said. “The disease gets worse if we don’t accept these people – not the behavior – but the individual with illness,” he said. “It helps families to go to support groups. Once you understand what’s happening, it’s the first step on the road to healing.”

Earlier this month, Salgunan and a handful of addiction counselors met in the “observation room” at the crisis center. The room was surrounded with glass windows that looked out onto a 15-bed dormitory.

“We provide detox for patients who use substances – alcohol, cocaine, heroin, and other drugs – in a medically-monitored environment,” he said.

Nurses and counselors are on-hand to monitor patients on a 24/7 basis. “We’re a little like Grand Central Station,” he said. “Patients of all types come here. We assess their need and get them on their way.”

Patients needing a higher level of detoxification are stabilized and sent to hospitals; others are transferred to halfway houses or to in-patient treatment centers. About 75 percent of patients are men and more than 60 percent are homeless.

Salgunan said occupancy had gone up at the treatment center since he began working there four years ago. I think it’s partially due to cutbacks in our social services system,” he said. “This is not only in the county, but across the state. People really need help.”

Affordable housing is a huge part of the equation, he said.

“If these patients had access to low-cost, affordable housing, coupled with some form of treatment, whether it be outpatient services or at clinics, their level of relapse would be less.”

Local shelters do provide relief for people struggling with addiction, however temporary, he said. “About 50 percent of our guests are currently addicted to drugs or alcohol,” said Leslie Hoffman of the Newburgh Ministry emergency shelter on Johnston Street in Newburgh.

In order to ensure safety, the shelter does not allow guests who are high or drunk to stay at the facility. Hoffman said visual inspections and conversation were usually enough to identify an intoxicated person. The more familiar shelter workers are with guests, the easier it is to tell when they’re intoxicated, she said.

The mental health connection

Harder to recognize are the mental health issues inherent to the disease of addiction.

“A lot of addicts have comorbid issues,” said Salgunan. “They are dually-diagnosed with substance abuse and mental health issues. Approximately 50 percent of mental health patients have substance abuse issues and vice versa.”

Sometimes it’s hard to say which came first, he said.

Like addiction, mental illness tends to be cyclical in nature, said Domenick Fata, executive director Renwick Recovery, Inc., a state-licensed supportive living facility in the city of Newburgh.

Approximately 80 percent of the recovering residents at the facility also struggle with mental illness, Fata said. Finding housing can be an enormous challenge for these people, he said.

“When they’re cycling in and out of mental health, they may stop taking meds,” he said. “They’ll sometimes compensate when they can’t get the medications by self- medicating and then relapse. And then the downward spiral occurs- they end up in the hospital, or in jail, and it ends up costing the taxpayers money.”

The mentally ill often have a hard time navigating the social services system, said Fata.

“A lot of social workers don’t understand that this is a sick person they’re dealing with,” he said. “They make them jump through so many hoops. As social workers and addictions counselors, we’re supposed to meet these clients where they are. A lot of these people are being talked down to and they’re not being treated like human beings when they walk in.”

Clients arrive to the facility through referrals by hospitals, inpatient programs and other health agencies. On average, clients stay at the facility anywhere from six to nine months, Fata said.

But, the county Department of Social Services recently halted referrals to Renwick when, according to Fata, one client was allowed to stay for too long. “We kept him for three years,” said Fata. “He was in the nursing program at Orange County Community College and I wanted to make sure he finished his finals.”

Fata was unapologetic about the incident. “We discharge people when we think it’s appropriate,” he said. “We base the length of stay on the individual client and their individual needs.”

By Shantal Parris Riley

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