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Ewbank and many others point out that treatment programs expect people on waiting lists to respond quickly once slots become available. Most programs also require newcomers to be clean of whatever substance they're using.
"They could call you on a Friday," says Ewbank, "and say we want you here on Monday. That means you have to have maintained your sobriety, or have come out of detox at just the right time. That's impossible to plan."
There can be other obstacles as well.
Few programs accept patients suffering from both drug addiction and mental illness--a common occurrence among the homeless. Programs sometimes don't last long enough to get at the root of addictive behavior. And very few regimens have follow-up care to help prevent homeless addicts from returning to the same streets and circumstances that fed their habits.
As a result, treatment programs for homeless addicts tend to be revolving doors rather than final destinations. And some addicts become frequent fliers, riding programs for some clean time before falling back to life on the street.
Most agencies do little tracking once people leave their programs. However, drug counselors talk of long-term success rates--people who kick their habits and stay clean--in the range of 5 percent to 25 percent.
Why homeless addicts tend to relapse so frequently back to the drugs and street is a question that treatment experts debate. The answers, they say, can be as varied as the addicts.
Many homeless crack addicts--like all other addicts--tell you right off that everything's under control. They can take or leave the drug whenever they want. But when the conversation--often filled with the jumpy paranoia and deep rattling cough that afflicts people on crack--moves on to other areas of life, most of the 20 or so addicts interviewed for this story confide that the unbeatable pleasure they get from the crack smoke fills the canyon that lost jobs, friends, families and hopes have carved out of their souls.
The odyssey of Candy, a recovering crack addict, illustrates how the forces of homelessness and drug addiction can converge.
She once lived downtown. But in the past 10 years, she drifted west, working as a prostitute and using crack on Buckeye Road until she entered the Salvation Army's A.R.C. (Adult Rehabilitation Center) program in February.
At 42, she's a slight woman with a soft Texas twang and the hard-knock features of a longtime addict. Her face and skin have been splotched brown and white by years in the sun.
Sitting in the park behind the Phoenix Central Library, she talks quietly about a past filled with abuse.
She says she grew up in a troubled household in El Paso. Her mom and dad argued and fought constantly before her mom finally left him and moved to Houston.
"My dad was abusive to my mother and grandmother. He was sexually abusive to me and my sister. But before he died, when I got older, he was always there for me. I think in some ways he was a very sick man, a mean man, but there just weren't any resources to help him."
She ran away from home in her teens and was sent to a reformatory at 17. She became a prostitute at 19, when the man who fathered her son showed her how to work the streets. He also beat her. To get away from the beatings, she fled to Phoenix almost 20 years ago. She found jobs here, but continued working the streets, and lived with a succession of abusive men.
The abuse in Candy's life fits a pattern familiar to people who work with homeless drug addicts.
"We've started to notice that the problem of homeless addicts isn't just addiction," says Dr. Ed Gogek, the county homeless clinic's psychiatrist. "A lot of people in this country are addicted to drugs or alcohol, but they don't all end up homeless.
"Once we get beyond the addiction, we're finding that homeless people were often abused as kids. We're also finding that people who were abused as kids tend to come from homes with parents who had some form of addiction. Those two things are closely tied."
Gogek and other experts say that sort of baggage usually leaves homeless drug addicts with less incentive to escape the small comforts of their drugs. "Basically, these are people who have no self-esteem, no sense of belonging, or relationships. So a lot of the work being done now is focusing on how to motivate people--how to get them to the point where they want treatment and can succeed at it."
Candy says that her motivation was the hell she was living on the street, and a burgeoning desire to set things right with the family she could still reach. She had lost touch with her mother and sisters, and two of her four children--living somewhere in Alabama.
She says she had been trying to find a way out of prostitution and crack since the birth of a grandson in 1996.
"I didn't want to see him go through hell like my kids did," she says. "I had tried going to Narcotics Anonymous and Alcoholics Anonymous, and learned about how it takes one person to break that cycle. I knew that somebody had to stop it. So I made it up in my mind to be the one."
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