San Francisco Chronicle
New S.F. program uses rare approach
Probation project fights addiction with abstinence
San Francisco is beginning a program that will provide housing, therapy and drug and alcohol counseling for men instead of sending them to jail, or as a place to land when they get out. What’s noteworthy is that it uses a rare and sometimes controversial model in San Francisco to help participants who struggle with addiction.
The program isn’t a licensed drug treatment facility, and its organizers stress it promotes overall lifestyle changes, “not simply abstinence from drug use.” One goal, though, is for participants to stop using drugs without the help of medication to stave off the cravings, standard in most programs in San Francisco and supported by evidence as effective.
But with overdoses spiking in San Francisco, officials are trying new approaches. The initiative was the result of a coalition of those in recovery and advocates, many from the Black community, begging the city to fund an option that has helped some people stop using.
The new program, run under the Adult Probation Department, will house 86 formerly incarcerated men. The city is spending $3.3 million on the program, which is operated by Bayview-based nonprofit Positive Directions Equals Change. While elected officials celebrated the official launch Thursday, 22 residents moved in a month ago.
Mayor London Breed, who spoke at the opening of the newly refurbished five-floor building, a former motel on the northern edge of the Tenderloin, said she had lost fami
ly members to drugs and the criminal justice system.
“We can’t just say we want people who commit crimes to be locked up, not unless, when they come home, we have something available for them to turn their lives around,” Breed said. “As someone who grew up in this city, we see a lot of programs that are available that are supposed to be programs that serve a particular community, more specifically that serve African-Americans, but they don’t always work.”
“It’s not a one-size fits all,” she said, adding abstinence should not be a unique model. “We understand that health experts have a difference of opinion as it relates to providing treatment for people who have troubles with substance use, but ... this is a model that we know has proven effective for some people.”
The new program, which Supervisor Ahsha Safaí pushed for, aims to target the often overlapping challenges of criminal justice involvement, homelessness and addiction. In recent counts by the city, nearly 3 out of 4 people in jail had a history of severe mental illness and substance use, or substance use alone, and more than 1 in 3 people were homeless when arrested.
While addiction isn’t a requirement to get in the new program, the new initiative will be one of the first fully city-funded programs supporting people who struggle with substance use that promotes total abstinence.
That’s in contrast to the San Francisco Health Department, which practices a harm reduction model that invests in reducing overdose risks and increases housing, mental health and drug treatment.
San Francisco’s behavioral health director, Dr. Hillary Kunins, previously told The Chronicle abstinence is the goal of many treatment programs as part of harm reduction, but any program should include medications based on scientific evidence that they reduce the risk of overdose deaths.
Program director Cregg Johnson said he knows medication-assisted treatment is needed sometimes, but would refer participants to other treatment providers to get it or send them to detox in another one of his facilities.
“We never turn anybody away,” he said. “There is a need for more abstinencebased treatment in the city . ... The community is being made comfortable and not accountable.”
Some harm reduction advocates previously slammed the proposal as “drug jail.” But other experts said total abstinence programs shouldn’t be ignored — especially since overdose deaths continue to be high amid the current approach.
The new program includes peer-led recovery groups, therapy, community service, job and housing support, and a lifetime of aftercare. Residents stay in the program for six months, then transitional housing in the same site for up to two years, longer than state insurance-funded options.
People who have re-offended or are at risk of re-offending, are on probation, parole or release before their trial are prioritized. Others may attend as an alternative to sentencing. Participants can be referred by the district attorney, public defender or courts.
Lucas Cruz said this kind of program has kept him clean since December.
After getting out of custody, the 22-year-old from Berkeley entered a treatment program
in San Francisco, but he didn’t fit in the program, relapsing and leaving after three months. Instead, in December, he landed in another residential program run by Positive Directions Equals Change. He moved into the new site on Geary Street a month ago, is studying fashion at the Academy of Art University and visits his family in Oakland once a week.
“In my experience, many residential treatment programs confine people to being in a certain way, whereas here, we’re given more of a creative space to be who we are with the support and structure,” said Cruz. “It’s not so much do this, do that — it’s continue to do what you’re doing, but in this way instead.”