Mar 11 • 1HR 9M

Maia Szalavitz On Drugs And Harm Reduction

She makes the case for more compassion and less coercion when it comes to drug addiction. But when does compassion become enabling?

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Appears in this episode

Andrew Sullivan
Unafraid conversations about anything

Maia is the author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, and her latest book, Undoing Drugs, which we cover in this episode. Much of her reporting and research on harm reduction is informed by her own history of drug addiction, including heroin, which we discuss in detail. She makes a strong case.

You can listen to the episode right away in the audio player embedded above, or right below it you can click “Listen in podcast app,” which will connect you to the Dishcast feed. For two clips of our convo — on how much to blame Big Pharma for opioid addiction, and to what extent harm reduction enables addicts — pop over to our YouTube page.

The episode with Maia Szalavitz is a good complement to our popular episode with Michael Shellenberger, which we just transcribed — read the whole conversation here. From one reader who enjoyed it:

Thank you for your continued attention to the issues of drug addiction and homelessness. These problems receive far too little reality-based coverage. The podcast with Shellenberger was excellent and I hope his message gains traction.

You asked why homeless men so often attack elderly Asian women, and Shellenberger said it was because they carry a lot of cash. That may be the motive of burglars, but does not explain the behavior of homeless men who attack passersby without stealing anything. Instead, I think there is a simpler explanation: These men target those who are unlikely to be able to fight back. And that means most victims are women and/or the elderly.

In many cities, homeless men have been allowed to dominate public spaces: sidewalks, parks, public transportation, and libraries. This makes these places unwelcoming and unsafe for the elderly, women, and children. If progressives want cities to be family friendly, they need to address this problem.

I think you and Shellenberger were too circumspect in describing the violent behavior of these men. He stated explicitly that he left out details because they were too horrible. I don’t think these details are distracting. I think they are clarifying. It is better to be matter of fact about exactly what is happening. Euphemistic discussion obscures the severity of these men’s sickness and the full toll their actions take on the community.

So let’s not pussyfoot around. For example, we can look at your hometown of DC. In December, a woman walking home from the gym with her 5-year-old daughter was attacked by a schizophrenic man. Her teeth were knocked out. A few weeks later, a homeless man in Capitol Hill threw a brick at an 11-month-old girl in a stroller, fracturing her eye socket and requiring 19 stitches. In 2019, a man with a history of homelessness and mental illness stabbed a 27-year-old woman to death while she was walking her dog. The previous year, a homeless man stabbed a 35-year-old woman to death while she was out for an evening jog.

Similar violent attacks are taking place in cities across the country. Below is just another small sampling. (I am making a particular effort not to use any sensationalist or dehumanizing language — that’s the most productive approach, in my opinion.) In New York City:

In San Francisco:

In Chicago:

  • A homeless man punched a 66-year-old woman at a train station, causing her to fall into the tracks. The victim suffered a broken eye socket, a concussion, and a dislocated wrist. This attack took place just one day after the same man was released for punching a 60-year-old woman in the face. The victim in that incident fell, hit her head, and was knocked unconscious.

  • A 31-year-old woman was stabbed to death by a homeless man while walking in the Loop neighborhood. The same man had recently attacked a 50-year-old woman and a 25-year-old woman. The first victim had a broken nose and required stitches on her head, and the second victim’s head injuries were so severe that first responders thought she had been shot.

You were right to point out that homeless men and their family and friends are the grievous victims of addiction and untreated mental illness. However, we should also prioritize the victims of these attacks and their families, some of whom face lifelong consequences from their wounds. Other residents who no longer feel safe in their neighborhoods are also important victims.

Thank you again for shining a light on this. You’ve now covered the topic from a variety of angles, and I think the only thing missing is hearing from a clinician or researcher who can speak to the potential for treatment and recovery.

Try our latest pod with Maia! If anyone else has a recommendation along those lines, please let us know: dish@andrewsullivan.com. Another reader provides a “quick update from Seattle regarding a shift in the voting public’s priorities”:

Our new mayor, Bruce Harrell, is a pro-police, anti-crime Democrat who defeated his leftist rival by historic margins. Even more surprising to me is the city attorney race, where a Republican, Ann Davison, defeated the pro-police abolition candidate Nicole Thomas-Kennedy. It should send a pretty clear message about the growing backlash when any Republican can win a political race in Seattle.

Another reader turns to Austin:

I enjoyed listening to your conversation with Shellenberger — both for the discussion of his new book and his views on nuclear energy. You could have added Austin to the conversation, as we were heading in the same direction as San Francisco and Seattle … but the people of Austin spoke last spring and approved a referendum reinstating a ban on public camping which had previously been eliminated by our city council. While enforcement of the ban has been half-hearted at best, it’s nonetheless progress.

The argument by our progressives and the homeless industrial complex has been the same as on the West Coast: the problem is lack of housing. And the solution is to build free housing on the most expensive ground in Texas … or California … or Washington. And, of course, you cannot expect homeless people who have suffered trauma to live in a communal shelter (even though large numbers live unsheltered in sweltering or freezing weather in what are effectively communal encampments).

In the meantime, one Austin leader, Allan Graham, is quietly demonstrating a solution. Community First Village, a planned community on the outskirts of the city, currently houses 200 formerly homeless people in tiny homes and RVs. It’s about to double in size. His book Welcome Homeless is an interesting read, and I’m sure you’d find a conversation with him fascinating.

Here’s Shellenberger on why San Francisco hasn’t built more shelters in the face of soaring homelessness:

Lastly, a reader zooms out to national politics:

Thank you for a great interview with Shellenberger. The segments on policing and homelessness, in particular, served to illustrate in stark terms the emerging problem with the Democratic Party (full disclosure: I am to the right of Attila the Hun and generally vote Republican): the Dems are increasingly becoming a party that caters only to the wealthy, educated, coastal elite.

That cohort is almost completely shielded from the consequences of the policies it advocates for. It is easy to call for the abolition of the police when you live in a gated community; for lockdowns when you can work remotely and lose no income; and for a massive influx of low-skilled immigrants when they won’t attend your children’s private schools or threaten the wages of your executive job. The harmful consequences are always borne by others, most often among the Party’s most loyal demographic groups.

If the Party continued to care primarily about its traditional hard-hat-and-lunchpail base, many people like me could vote for its candidate in national elections when the Republican opponent is a grossly unfit madman (as in the last two elections) or an ideologically blinded warmongering buffoon (as in 2000 and 2004). Far more importantly than the relatively small number who feel as I do, though, the Party seems to be going out of its way to drive away Latinos — who have always been more at home with the Democrats — by ignoring their legitimate concerns on issues related to education and immigration (as we recently saw in Virginia).

I expect this to continue until Democrats remember who they always used to fight for.

The latest polling on the Latino vote and the Republicans is pretty remarkable, I have to say:

By 9 percentage points, Hispanic voters in the new poll said they would back a Republican candidate for Congress over a Democrat. The two parties had been tied among Hispanic voters in the Journal’s survey in November.

Uh-oh.