HUD’s recent efforts to gut Housing First have sought to apply the logic from the addiction recovery industry to homelessness funding. Applying Housing First’s autonomy-centered logic to addiction recovery could be far more effective.
This article was first published in Shelterforce.
Every night before dinner, the residents of CRI-Help, a Medi-Cal-funded residential treatment facility in North Hollywood, file out onto the blacktop. The woman who holds that facility together walks into the center of the circle and introduces herself as a “mothafuckin’ dope fiend.”
New arrivals are called to the circle center and asked to give their names, how long they’re staying, and which drug they use. What happens next isn’t in any clinical manual: The people who’ve already stood in that circle answer back. Loudly. With recognition.
For someone who just hit rock bottom, that’s not nothing. That’s a reprieve from shame, delivered by a community that understands exactly where each newcomer is coming from because they’ve been there too. I know because I was one of those people. I spent 22 days in that facility. I’ve lived on Skid Row. I’ve also spent nearly two decades working in and around nonprofit systems meant to serve marginalized communities, including the American Civil Liberties Union, Equality California, and A Beautiful You, the harm reduction nonprofit I founded in Los Angeles.
That moment on the blacktop matters, and it is one of the clearest examples of what people inside recovery systems, often without resources or recognition, get right. But the industry surrounding that community is a different story, and that’s the subject of the rest of this piece. This isn’t a story about bad actors, though they appear in it. It’s a story about system design: what becomes structurally inevitable when the people being served—in recovery and in housing alike—are conditioned to remain silent and lack power to hold institutions accountable.
What the Recovery Industry Gets Wrong
In 12-step rooms, Step One asks participants to acknowledge that they are powerless over addiction. In peer-led settings, that’s an invitation to humility. But when institutions adopt that language, it can become something else: an operating condition.
The problem isn’t 12-step programs themselves. In many rooms, admitting powerlessness over substances serves as a path toward honesty and mutual support. The problem emerges when the concept of powerlessness is adopted by institutions that already possess formal authority over housing, treatment, benefits, and other care.
When an institution trains someone to distrust their own judgment, anything they say in protest can be dismissed as the disease talking rather than as an account of what happened. Philosopher Miranda Fricker calls this testimonial injustice: when prejudice causes a listener to give someone else’s account less credibility because of who they are, not what they’re saying.
This is what happened to me. I entered CRI-Help with a precancerous growth that my doctor had already identified and had an initial consult scheduled with my colorectal surgeon that had taken six months to get on the calendar. I went to the facility’s social services office three times to check on my paperwork. On the third visit, I was told to calm down—that they had it handled. They did not. I arrived at my appointment without the documentation they’d promised to send—and was turned away.
The social services clerk didn’t intend to harm me. Yet I was harmed. The harm resulted not from malice, but because of the constraints under which she was working. Sociologist Michael Lipsky described how a well-meaning caseworker becomes the cause for that kind of harm. Frontline workers with too many clients and too few resources ration, screen, and rubber-stamp, routinizing situations that need a human response because the system leaves them few alternatives.
Barriers to Treatment
Homelessness and drug use can be deeply intertwined. A survey of more than 3,200 unhoused adults in eight California counties published in 2025 in JAMA illustrated how deeply interconnected they can be: Among all participants, 41.6 percent began regularly using illicit drugs before they first experienced homelessness, while 23.2 percent began afterward.
As the most recent (2025) Substance Abuse and Mental Health Services Administration (SAMHSA) report documents relatively few people with substance-use disorders receive treatment. That report shows that among over 38 million adults with clinical criteria for a substance use disorder, only about 5.5 percent (about 2 million) report that they need treatment. Of those, less than one in 10 (187,000) receives it. Roughly 90 percent of the people who have already taken the difficult step of acknowledging they need help and recognizing that something needs to change, still don’t receive treatment.
Why? One reported reason has remained remarkably consistent for nearly two decades among people who perceived a need for treatment but didn’t receive it. Across multiple surveys going back decades, the National Survey on Drug Use and Health has consistently found a lack of readiness to stop or reduce substance use to be among the most frequently reported barriers; the most recent survey from 2025 finds that more than two in three cite “not being ready to stop or cut back on using alcohol or drugs” as a reason for not starting treatment. Often, people who are suffering from substance abuse are simply not ready to stop using altogether. Yet many programs still require participants to accept total abstinence.
Some people in recovery circles use the term “terminal uniqueness” to describe the idea that someone’s reluctance to enter treatment comes from believing their situation is so exceptional that ordinary approaches can’t help. It’s a tidy diagnosis. It also means the door never has to change, because the underlying assumption is that a person will eventually return after they hit rock bottom. But not everyone survives rock bottom.
Friedrich Engels used a term for that kind of failure in 1845: social murder. Engels argued that preventable death could be produced not only when someone deliberately caused death, but also through social arrangements that made harmful conditions predictable and then left them in place.
Public health researchers have used the concept to describe institutional harm in which no single person is responsible for the outcome, but the outcome remains foreseeable, preventable, and tolerated.
Lagging Indicators, Not Leading Ones
Many formal treatment programs treat abstinence as the primary outcome and relapse as the primary failure metric. These are lagging indicators. They measure what has already happened. They tell you the house burned down. They don’t tell you the wiring was faulty for years.
Leading indicators work differently. Repeated measures of emotional resilience, social support, and self-efficacy can track the factors that precede behavioral change, and research has linked such factors to recovery outcomes. Programs can overlook them not because they’re scientifically inferior, but because they’re harder to capture administratively.
A person whose resilience is improving and whose support network is strengthening, but who hasn’t yet achieved abstinence, looks like a failure under an abstinence-only framework. Within that system, relapse may not be read as a signal pointing to possible program shortcomings; rather, it’s read as proof the individual was never really ready.
Lack of Accountability
A framework that places the locus of failure permanently inside the person seeking help is unlikely to produce organized advocates. It produces people who are unlikely to file a complaint or retain an attorney, and who, even assuming they have a successful recovery, want nothing more than to leave and never come back. That’s a perfect accountability vacuum, one in which neglect, exploitation, and fraud by bad, often nonprofit, actors can flourish out of the spotlight.
In January 2026, the Los Angeles County District Attorney’s Office charged Alexander Soofer, CEO of Abundant Blessings, a youth homeless services nonprofit, with defrauding the Los Angeles Homeless Services Authority. Prosecutors allege more than $2 million went toward properties Soofer owned or was accounted for through fraudulent invoices. He has pleaded not guilty and the allegations have not been adjudicated, although he has agreed to pay $1.25 million to the L.A. Homeless Service Authority without admitting wrongdoing.
This isn’t unique to Los Angeles. Kentucky’s Addiction Recovery Care was once the state’s dominant provider—responsible at its 2024 peak for more than two-thirds of the state’s treatment beds—and praised by the U.S. Department of Health and Human Services as a model provider. Between 2018 and 2024, it billed the state $1.7 billion. ProPublica and the Lexington Herald-Leader reported on the case and the nonprofit’s alleged falsification of medical records. In July 2026, Addiction Recovery Care and its affiliates agreed to a $16.2 million settlement with the federal government in the eastern district of Kentucky.
A service provider generally holds more institutional power than any single person it serves. When an institution conditions the people who it serves to accept learned powerlessness and teaches them that resistance is a symptom, not a signal, the imbalance becomes extreme. Accountability weakens further when the people an institution serves have been taught not to trust their own perceptions.
The Same Logic, Scaled Up
The recovery industry didn’t invent the instinct to make people submit to institutional requirements before receiving help. It has often reinforced it. The U.S. Department of Housing and Urban Development (HUD) has tried to impose the same logic to federal homelessness funding at a scale that can’t be ignored.
In November 2025, HUD proposed overhauling the roughly $4 billion-a-year Continuum of Care (CoC) program, including a 30 percent cap on the amount of funding a grantee could spend on permanent housing. At the time, roughly 87 percent of CoC funding supported permanent supportive housing.
The language was different. The logic wasn’t. Housing First—an approach backed by more than two decades of bipartisan federal support and built on the premise that stability comes before compliance—was relabeled a failure. When HUD issued another funding notice in June 2026, Secretary Scott Turner called Housing First a failed experiment that had “warehoused the vulnerable without results.” That framing shifts attention from housing stability to individual compliance and behavioral change.
Federal courts blocked both efforts. On June 29, 2026, a federal court vacated HUD’s 2025 funding notice. On August 7, 2026, the court ordered HUD to vacate its issuance of the 2026 notice.
Restoring Agency
What does a healthy recovery system look like? The first step is structural: Stop requiring total abstinence as the price of accessing treatment, which is still the norm in many (90 percent, according to one estimate), although not all, programs. Two decades of SAMHSA data show that lack of readiness to stop or reduce use remains a commonly reported barrier to treatment. This isn’t a call to abandon clinical judgment. When someone is in acute withdrawal from alcohol or benzodiazepines, medical supervision isn’t bureaucracy; it’s survival. That distinction matters, and it’s worth stating plainly: Programs can impose clinically necessary safeguards without turning them into broader barriers to care. What they cannot do is disguise administrative gatekeeping as clinical necessity.
What does a healthy recovery system look like? The first step is structural: Stop requiring total abstinence as the price of accessing treatment …
The second step is measuring something different. At A Beautiful You, we’ve now logged 323 people who have participated across 64 sessions (as of July 2026), tracking their moods before and after every drop-in class. Those records show an average improvement in mood. They also suggest that participants who arrived in the greatest distress tended to report the largest changes—the very people many treatment programs might consider not ready to engage.
This is what leading indicators look like when you actually track them: resilience, perceived social support, and self-efficacy. These indicators are measured with tools like the Brief Resilience Scale, Multidimensional Scale of Perceived Social Support, and the Experiences Questionnaire and tracked over time rather than making a single abstinence milestone the sole test of success or failure.
The third step concerns method: how programs help people build resilience and connection, not just whether you decide to measure it. This is where arts-based and somatic practice earn their place—not as enrichment but as infrastructure. As I like to put it, the body receives regulation before the mind receives instruction.
Polyvagal theory contends that people need to feel physically safe before they can fully engage cognitively. This focus on tapping into the mind-body connection to effectively address addiction is gaining increased mainstream academic attention. A song may reach someone before a clinical intervention gets the chance to. A physical exercise can help participants recognize when connection feels welcome and when they need to set a personal limit, because embodied practice can make an idea felt, not merely explained.
In my practice, I find that the order matters: people need to feel safe and trust that their boundaries will be respected before they can engage with a curriculum. Before someone can engage with a curriculum, they need to feel safe enough for their body to stop scanning the room for threat. Before they can trust a facilitator, they need evidence that their consent and boundaries will be respected. Arts-based and somatic modalities work because they honor that sequence instead of skipping it, meeting people through creative expression and embodied practice before asking them to process new information.
None of this is exotic. It’s what the blacktop at CRI-Help got right without a formal curriculum. A person who had lived it delivered a truth that others felt safe enough to receive it. Many treatment systems have spent decades building programs that skip straight to compliance. The fix isn’t more sophisticated compliance. It’s fostering the conditions that make change possible.
Where the Evidence Stands
As noted above, the courts have blocked multiple attempts to roll back Housing First. By contrast, the recovery industry has not faced any comparable legal reckoning over its use of compliance as a condition of access to care.
We already know how often substance use issues and homelessness overlap … what if the work focused on addressing the conditions that make addiction more likely to take hold or harder to escape?
What’s promising is that the evidence keeps pointing in the same direction. Safety and belonging work. Coercive, nonclinical preconditions don’t. The question isn’t whether a different way is possible. It’s whether the people funding recovery and housing are willing to build systems around what the evidence already shows.
We already know how often substance use issues and homelessness overlap. What the systems have too often gotten wrong is how they’ve responded. Instead of forcing compliance, what if the work focused on addressing the conditions that make addiction more likely to take hold or harder to escape?
Go back to the people who recognize that they need help but still don’t receive treatment. The industry too often offers no honest answer for them, and it has commonly treated refusal as denial or resistance rather than as feedback. But this refusal may instead reflect a rational calculation about what treatment demands. That isn’t a failure of the person. That’s a verdict on what the system is offering.