Alberta Model: Hope for Denver's homeless addicts?

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Craig Arfsten from Citizens for a Safe and Clean Denver believes the city is failing drug addicts.

He points to the explosion in homelessness, up 32% in Denver in 2022 versus the previous year, according to the Point in Time count. One only needs to look at homeless encampments in Denver to see open-air drug use, Arfsten says, noting it’s a problem that continues to get worse.

He asked newly elected Denver Mayor Mike Johnston earlier this month if he had heard of “The Alberta model” for addressing addiction and homelessness. He said he had not, and deferred to his homelessness czar, Cole Chandler. Chander said he never had heard of the Alberta model either, Arfsten said.

The Alberta model is a treatment-focused method of addressing addiction. The policy stems from recommendations made by a task force charged with creating a recovery-oriented housing model.

“With homelessness being the number one priority for the new mayor, I believe we owe it to the residents of Denver and the unhoused individuals living on the street to explore all options,” Arfsten wrote in an email to the mayor’s office. “I became aware of the Alberta model through our work with North America Recovers and was immediately impressed with the success of their efforts. I think the mayor can learn a lot from a conversation with Marshall Smith ... who is chief of staff to Alberta’s Premier Danielle Smith.”

Alberta task force suggests changes

The Alberta task force suggested:

Putting recovery supports into homeless shelters. “Emergency shelter agencies report having to reverse dozens of overdoses each month,” according to the report. “For instance, Alpha House Lethbridge reported 191 overdose reversals in February 2022 alone. Hope Mission in Edmonton reported 52 drug overdoses between April 1 and June 15, 2022, to which its staff have attended. The Calgary Drop-In Centre reports that staff responded to an average of four drug poisonings per day during the months of November 2021 through April 2022.”

Expanding addiction treatment at community health centers. “Community Health Centers integrate a range of services, including substance use and mental health services, as well as supporting a client’s social, emotional and spiritual well- being,” according to the report. “They are well-versed in trauma-informed and culturally appropriate practice. Moreover, they place importance on delivering their services with a view to reducing health inequities.”

Expanding addiction treatment center hours. “Crisis can and often does occur during evenings, overnights and weekends,” according to the report. “Enhancing services should include the availability of services on a 24/7 basis or at least an expansion of hours. Feedback from service providers is that a stepped approach would be ideal, starting with an expansion of hours, with consideration of going to 24/7 availability. Moreover, people can be ready to make a change in their lives at any time. As we’ve noted many times, that moment of readiness is crucial. Coordinated responses need to be ready to respond in that moment, whenever it arrives.”

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Hospitals and jails stop releasing people to the street. Case managers can coordinate so that people leaving these institutions are discharged to housing.

Housing is integrated with recovery-oriented supports. “Neither can be effective without the other,” according to the report. “In a coordinated response, it is not enough to provide an individual with a safe and secure housing option. That housing needs to be integrated with supports that put the individual on a path towards recovery. Those supports might sometimes be co-located with the housing, but they don’t necessarily need to be. But those supports must be integrated such that individuals are comprehensively assisted in an ongoing, effective way that makes sense for their circumstances.”

Readiness is treated like an emergency. “If a person attends an emergency room experiencing a heart attack or a stroke, the system doesn’t tell the person to fill out a form and wait a few weeks,” according to the report. “Instead, it responds at that moment because the moment is crucial. When a person experiencing homelessness presents with a substance use or mental health challenge and is ready in the moment to make a fundamental change in their life trajectory, that moment is likewise crucial. Missing the moment can result in loss of life. A coordinated response recognizes this and treats readiness as an emergency.”

Recovery-oriented care. “The word ‘recovery’ can have various meanings in various contexts,” according to the report. “For the purposes of an ideal coordinated response, it means helping individuals maintain forward momentum toward better wellness and fulfillment, across all dimensions of their life – physically, mentally, emotionally, spiritually, and culturally. This involves fits and starts. It happens faster in some aspects and slower in others. It is highly individualized since each individual is unique. It makes room for harm reduction as necessary, without slipping into harm acceptance. Overall, recovery-oriented care means every service and support is working to strengthen individuals’ protective factors and resiliency, with the aim of helping them become the best version of themselves they aspire to be.”

Warm hand-offs are a standard way of operating. “Individuals experiencing homelessness have different levels of capacity, yet they are all in relative states of vulnerability and disadvantage ,” according to the report. “Recognizing this, service providers use ‘warm hand-offs’ in a coordinated response, to help individuals access supports and assistance. This means the provider physically assisting or actively facilitating a consenting client in arriving at a service or support from another provider; in effect, the service provider performing the ‘warm hand-off’ takes responsibility for the client getting to the service required. It does not mean giving them a referral form, business card, or contact information, and expecting the person to access assistance or a service provider alone. Used as a standard way of operating, warm hand-offs help prevent individuals from falling through service gaps or becoming lost in the system. They also convey decency and respect human dignity.

Integration with community is a desired outcome. “Consistent with the concept of recovery-oriented care, a coordinated response aims to help individuals make new, healthier connections in their lives that promote integration with community,” according to the report. “These might take the form of employment, a volunteer position, hobbies and recreational pursuits, or other opportunities. In becoming more integrated with the community in healthier ways, individuals become less likely to slip back to the familiar chaos of homelessness, more likely to achieve housing stability, and far more likely to move towards better wellness and fulfillment.”

Alberta overdose deaths down overall

Despite beginning to institute these recommendations, Alberta in April had the most overdose deaths in its history, according to data provided by the city. Prior to April, overdoses were down about 17% from 2021 to 2022, according to the data. Overdose deaths by methamphetamines and alcohol have dropped significantly since the new policies have been implemented.

Narcan can reverse an opioid overdose.Photo byPharmacy ImagesonUnsplash

In May, overdose deaths declined again. "In Alberta, which is thoroughly rejecting the decriminalization and tax-funded handout of hard drugs and instead putting the money into recovery, we have seen, in the most recent data, a 30 per cent reduction in the number of overdose deaths," Pierre Poilievre told the House of Commons in May.

The Alberta model has been celebrated by conservative Canadian lawmakers. Alberta says on its website it had to try a new approach after harm reduction efforts had failed. “We are transforming Alberta’s health system to a new Alberta model of care that adopts a recovery-oriented approach for addiction and mental health. A recovery-oriented system of care is a coordinated network of personalized, community-based services for people at risk of or experiencing addiction and mental health challenges. It provides access to a full continuum of services and supports, from prevention and intervention to treatment and recovery.”

Could Denver learn from Alberta?

It's a new way of doing business, according to the website. “In the past, Alberta’s approach to addiction and mental health focused on acute interventions designed to manage the negative health effects of these chronic issues. While acute interventions are important and have saved lives, it has come at the expense of supporting the long-term wellness and recovery of individuals, families, and communities.

Alberta, Canada.Photo byAlex PuglieseonUnsplash

“Alberta’s government has embarked on a process of transformative change to dramatically shift the way mental health and addiction is managed. Transitioning towards a recovery-oriented system of care will improve outcomes for all Albertans.”

Arfsten believes such a system also would benefit Denver, which has embarked on a housing first and harm reduction approach to homelessness and addiction. He says the current system is failing everyone, with addicts left to die on the street without treatment and residents forced to deal with the filth of encampments.