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Treating Substance Use Among Youth Experiencing Homelessness in California


Housing is one of the basic rights of any human being. Homelessness in California has been one of the top challenges the state has faced, especially after discovering gold, which led to the state’s population growing by about 250,000 from the original 14,000 only in four years. Once the Gold Rush died down, homelessness slowly increased over the years. As a result, this puts the youths in unstable housing situations at a higher risk of substance use. Out of the various methods employed to tackle the issue, Adaptive Therapeutic Strategies are the most promising solution to date.

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Problem Definition

Nationally the War on Drugs was the official answer from the state on how to tackle this, with negative effects overall. Professionally, Therapeutic Drug Monitoring (TDM) has been the preferred solution to significant failure. Via SMART analysis, an Adaptive Treatment Strategy (ATS) for substance use disorder is explored as a more viable solution for a concerning state-wide issue. The average cost of the proposed initiative is lower than $30.24 for the patient and $30.55 for the medical system (Inbal et al. 906). This boosts cost-effectiveness by only offering treatment services to those that need it most, allowing the community to invest in other areas.

As recent as 2016, California has led the US in homelessness. In that year alone, the state accounted for approximately 22% of all homeless individuals in the country. Significantly higher than the runner-up New York which contributed %16. While this has been an issue even before the infamous San Fransisco’s Proposition N, which effectively reduced welfare assistance by $336 to $95 (Reppond 285), this amendment was without a doubt a contributing factor to the current crisis that California experiences. Apart from issues already states, unemployment and a lack of affordable housing also increase the scale of problem experienced today. Another contributing factor is the negative effects politics have had on the housing scene in California over the years.

All the issues mentioned led to many problems, especially for individuals who spend most of their youth in these situations. As a coping mechanism for the harsh environment, many individuals resort to substance use to cope with their environments. Approximately 66-97% of YEH (youths experiencing homelessness) have engaged in alcohol, other drugs, or a mixture of several substances (Lightfoot 293). Thus, the issue of drug abuse among homeless youth is a severe problem that needs to be resolved.

First Failed Solution

The US government’s first solution was implementing a war on drugs in response to the situation (Brown 48). As a reaction, many homeless communities have had their rights violated in the name of arrests and searches. The wider public also launched stigmatizing campaigns in response to the collective view of individuals with substance use disorders. Law enforcement did not positively influence this matter, as witnessed by their treatment of these individuals by the public. Economically this has been a financial burden, too with US economy footing the bill for this failing enterprise. Despite such a mammoth investment, still, about 100 people die from opioid overdose every day.

Emphasizing the failure of this approach to the situation is that 2.3 million people in the United States suffer from OUD (Opioid use disorder) yet 60% of that population lack access to evidence-based strategies for treatment. Out of the 14,000 substance use treatment centers, most lack a medical professional within their ranks (Brown). This is an alarming statistic, given just how much is spent on this battle against substance use. Police and civilian relations have been stretched ever since, with the general population losing trust in law enforcement, hampering this approach even more. Of all the solutions, this is the most “famous” and most spectacular attempt to tackle substance use among the homeless youth.

Second Failed Solution

A more professional approach in the medical community was TDM (Therapeutic Drug Monitoring). This is a common approach used in many clinics to combat substance use disorder among various demographics. By definition, it is the measurement of drugs in the plasma to determine whether the client’s drug concentration is within the therapeutic range, neither toxic nor below the appropriate dosage (Johnson-Davis and Mcmillin 1). This is useful for ensuring that the plasma drug concentration is at an optimum level while minimizing toxicity levels in the patient’s system.

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TDM is, however, inflexible when treating patients with different levels of disorder. Consequently, this leads to cost-ineffectiveness for the state. All stages of treatment are tailored with the assumption that the institution will receive the same type of patient regarding the level of addiction or substance use. Medical resources that would have otherwise served others are hence wasted. The cost of treatment is also, at times, too much for a homeless individual to pay.

Suggested Solution

ATS is a more viable solution compared to the one discussed in the latter paragraph. Adaptive Treatment Strategies are medical courses of action based on the history of the patient’s previous treatments and their response to them. The tailoring variable(s) used may be single or more depending on the type of treatment required for the individual. This is the information concerning the patient utilized for treatment individualization. ATS strategies also produce similar results to TDM but at a lower cost per client.

This is a flexible approach as the number of medical resources released is directly proportional to the patient’s needs at a particular time. Basing treatment on time-varying data about the client’s system facilitates a system of decision rules that govern treatment. ATS may involve components that address the treatment of pharmacotherapy adherence, motivation for positive transformation, social coping skills, CBI (Combined Behavioral Intervention), and telephone disease management.

Implementation Area

These can be implemented in clinics that treat substance use disorders. Particularly in or near emergency housing units in California. Communities vulnerable to housing crises can be given priority over those nearer to quality healthcare. Youth programs should also promote the visitation of these clinics through their media outreach to encourage more interest in treatment in general. Churches play a big part in communities that end up homeless. Places of worship found in the worst stricken areas could be afforded a clinic with ATS within or nearby areas. This is especially plausible given how relatively cost-effective this strategy is compared to TDM (Inbal et al. 905). Schools in neighborhoods where the housing crisis is prevalent should also be equipped with such a facility to increase awareness among high-risk youths.

Hospitals are also great places to set up clinics with these methods, especially if they deal with a high number of substance use-related incidents. Nurses and doctors who interact with such patients should suggest substance use disorder (SUD) treatment to encourage individuals to steps forward and get help. In addition, a Social Awareness campaign in all the areas where ATS is implemented should be encouraged to challenge the views of homeless people in society.

Cost of Suggested Solution

Given the two previously failed solutions, Adaptive Therapeutic Strategies are a lot cheaper in relation. The average cost of ATS for a single client is less than $60.69. For every 1000 clients served, approximately $60,690 will be spent on fees (Inbal et al., 907). The cost can be further reduced to $50.36 per person if a mixed therapy session is organized. If the patient has willing family members to participate, the value is about $51.68 per recovering client. (Serje et al. 10). This indicates familial therapy sessions as the most cost-effective package for individuals and the state; however, it heavily relies on the cooperation of third parties and may not be as reliable.

Unlike TDM, a licensed medical practitioner is mandatory in an ATS setup to make informed, medically appropriate decisions, thus, increasing the relative cost. The average price of individual therapy for a physician is $124.49, while a professional psychologist is typically $203.18. Nurses cost an average of $67.26 for individuals in family therapy. The same service is higher for individuals in mixed treatment, with a nurse costing an average of $210.45. The higher costs observed in mixed therapy sessions indicate an attempt to remedy more severe cases by involving more people to increase the chances of better outcomes.

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Another reason for the variability in costs is that clients with different diagnoses require different types of treatment, positive merit of ATS compared to TDM in managing substance use disorder. In terms of recidivism, family therapy also has the lowest value of the three (8.9%), again justifying the high investment cost in relation to the other ones. The blood tests required for analysis will be included in the treatment packages. Accommodation won’t be provided as most clients are expected to be out-patients. Should admission be required, a hospital referral shall be conducted and the appropriate expenses channels to the relevant parties.

Short-Term Benefits

The amount of youth exposed to violence will undoubtedly reduce. With substance use disorder among the homeless highly correlated to crime, many youths in these situations are exposed to violence at a very early age. Cases of domestic violence are usually higher in lower-income individuals especially those in unstable housing situations. Treating them thoroughly and rehabilitating them on how to manage themselves as individuals and members of a collective will undoubtedly reduce cases of violent criminal activity among the youth and society in general.

Welfare programs will reduce funding in a bid to reduce dependence. This frees up resources that can be used to develop other areas of society, such as community centers for the youth and playgrounds for children. A sense of financial self-responsibility will also be instilled in the individual should they respond well to treatment and rehabilitation in the ways of current society. This increases their chances of living a fulfilled life independent from substance and welfare dependency. Also, reducing generational patterns that hinder progress at a personal family level.

Long-Term Benefits

Assisting the affected youth with tools to combat substance use is beneficial not only at the level of the individual but at the collective as well. Many positives can be drawn as effects of a positive campaign on this matter. Improved goal setting among the youth with this particular disorder is observed. Individuals who suffer from substance abuse disorder generally show a poor ability not only to set but a tendency to pursue them (Lightfoot et al.). Treating this condition significantly clarifies a youth’s state of mind, allowing one to fully appreciate their decision-making processes and the consequences. Undoubtedly this promotes a cheerful social fabric for all, homeless and housed.

Better decision-making also lowers crime rates among the youth with these disorders. Many are homeless, unemployed, and addicted to substances is a recipe for criminal behavior. Mainly to satisfy their drug urges, delinquency is picked up as a means to satisfy the demand their bodies chemically crave for these substances (Lightfoot et al. 289). Treating the root of the problem at a biological level and a psychological one will undoubtedly reduce the number of criminal acts by homeless youth. By also filling up their time with constructive activities correlating with treatment, one can learn how to use their time appropriately, hence better life planning capabilities both personally and socially.

Businesses will also report better-operating conditions as stereotypically homeless people are associated with “deviant” behaviors such as frightening others and public indecency (Reppond 295). This is synonymous with the stereotype content of apes correlated with individuals currently in low-income situations. Reducing the number of youths in a homeless situation will undoubtedly have a positive impact on the tourists and residents. A better rapport with business owners will also increase their chance of employment and making a livelihood.

Homelessness rates will also reduce as the treated youth are integrated into the ways of today’s world. With many former patients now reformed, the amount of financial resources these individuals once directed towards their habits reduces. This could potentially be a stepping stone to financial independence provided accurate guidance during the treatment phase. Undoubtedly this would be an economic positive for both the real estate agency and the workforce in general.

Given the state of mental health in California and globally, psychologically, the affected youth should be healthier than before treatment. Lower levels of depression will be observed as the patients let go of their attachment to these mood-altering substances. Mood independence will also be marked as the client won’t need any substance to regulate their moods; individuals should post better life satisfaction and more pleasant feeling.

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California is an economically significant state in the United States; a housing crisis is a serious problem that should not be ignored. Nationally it is associated with everything “gold”, still a precious mineral even a century later after its discovery. Home to Hollywood, the most economically significant area in the entertainment industry in the world. Yet with all these riches, a problem such as substance abuse among the homeless and young population has tainted a once-thriving city for all its residents. Now, especially the youth and homeless, suffer in the background of society’s psyche, an afterthought. With the strategies discussed in this paper, there is a chance that the situation can be saved. That many homeless youths can be rehabilitated and treated with the long-term in mind. ATS protocols are a viable tool for achieving this. Their flexibility and cost-effectiveness cement this position; also, they are equal to or surpass other methods of substance use disorder in positive outcomes for the patient.

Works Cited

Inbal, Nahum-Shani, et al. “A SMART Data Analysis Method for Constructing Adaptive Treatment Strategies for Substance Abuse Disorders.” Wiley Blackwell, vol. 112, no. 5, 2017, pp. 901-909. SAC Database, Web.

Reppond, Harmony, and Bullock, Heather E. “Framing Homeless Policy: Reducing Cash Aid as a Compassionate Solution.” Wiley Blackwell, vol. 18, no. 1, 2018, pp. 284-306. SAC Database, Web.

Johnson-Davis, Kamisha, and Gwendolyn Mcmillin. “Therapeutic Drug Monitoring.” ArupConsult, Web.

Lightfoot, Marguerita, et al. “Risk Factors for Substance Use among Youth Experiencing Homelessness.” Criminal Justice Abstracts with Full Text, vol. 27, no. 5/6, 2018, pp. 288-296. SAC Database, Web.

Serje, Juliana, et al. “Global Health Worker Salary Estimates: An Econometric Analysis of Global Earnings Data.” Medline, vol. 16, 2018, p.10. SAC Database, Web.

Brown, Teneille. “Treating Addiction in The Clinic, not the Courtroom: Using Neuroscience and Genetics the Failed War on Drugs.” Criminal Justice Abstracts with Full text, vol.54, no. 1, 2021, pp. 29-77. SAC Database, Web.

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