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In July, President Donald Trump issued an executive order calling for an expansion of involuntary commitment—forcing people into treatment facilities—in response to the homelessness crisis. San Francisco has been attempting such an expansion for the past 19 months. What can the rest of the country learn from California?
This is the final episode in a three-part series from Radio Atlantic, No Easy Fix, about homelessness and addiction in San Francisco.
The following is a transcript of the episode:
Hanna Rosin: This is Radio Atlantic. I’m Hanna Rosin. Today, we have the third episode of our series about San Francisco and what it takes to escape homelessness and addiction.
Last week, we talked to San Francisco Mayor Daniel Lurie.
Daniel Lurie: We, as a city, just got to this point where we were like, If somebody wants to keep harming themselves and, really, killing themselves, that’s their right.
Rosin: And we followed Evan, who is trying to get off the streets, through a critical 48-hour period.
Evan: I don’t know where to go. And it’s raining, and I’m cold, and I’m hungry (Laughs.) And I’m over it. I’m so over it.
Rosin: This week, Evan is missing, and he badly needs medical care. We follow the search for Evan, and we look at a new experiment with involuntary treatment. Here’s reporter Ethan Brooks.
(Phone rings.)
Liz Breuilly: Hello?
Ethan Brooks: Hey.
Breuilly: How you doing?
Brooks: I’m doing all right. You know.
Brooks: It’s been a few weeks now since anyone’s seen Evan. The last time I saw him was late at night, in the Mission District. He needed urgent medical care for his leg, which was swollen and infected, and he planned to go to the hospital. And then he disappeared.
Breuilly: He could lose his leg, you know? That’s why, when we separated, I was really clear with him—that he understood that his leg was not gonna get better on its own.
Brooks: When Liz can’t find someone, usually at least someone out there, one of the many missing people Liz has found over the years, has seen that person around. But not this time.
Breuilly: No one’s seen him. I was like, Yeah, have you seen Evan around? They’re like, No, why? Is everything—I was like, I don’t know. He’s, like, missing, missing.
Brooks: Typically, when someone with an addiction like Evan’s disappears, it’s not some big mystery what they’re up to. Evan’s best friend, Joe, who lives out in Washington, has been through this more than once.
Joe Wynne: I was gonna have him get a tattoo with my phone number on it.
Brooks: (Laughs.) That’s a great idea.
Wynne: Yeah, yeah. (Laughs.) But he disappeared on me.
Brooks: But this time is different. When Liz called the hospitals, none of them had any records of Evan. She checked arrest records—no sign of him there either. The shelter where he’d been staying for the past few weeks, they also hadn’t seen him.
It’s one thing to not make it to the hospital or into treatment, but why would Evan stop sleeping at the shelter he’s been going to for weeks?
[Music]
Brooks: Are you worried?
Wynne: I mean, I expect Evan to die out there—100 percent, that’s how this ends: in the streets, in a bad way. As his best friend, I have seen no pieces of evidence that persisted beyond 72 hours of him heading in any other direction, and I’ve seen 10,000 pieces of evidence of him headed towards death: He’s been shot. He’s been run over. He’s been dead in the street and revived with Narcan, like, umpteen fucking times. Overdosing is, like, a weekend for Evan. So the question is like, What on the list of human experience is left to Evan that he hasn’t done?
Brooks: Recently, I’ve been thinking about something Evan told me the first time we met. When Liz asked him what he thought it would take to get clean, he said, “I can’t be trusted. I can’t have the privilege to do anything.” Liz put it more bluntly and said, “You need to be locked in a cell.”
At the time, this struck me as sort of tongue-in-cheek, something to acknowledge the seriousness of Evan’s addiction. But now that he was missing, and in urgent need of medical care, I was wondering if he actually meant it.
Not so long ago, there was a consensus in places like San Francisco that forceful confinement of drug-addicted people, of the type practiced at an astonishing scale during the War on Drugs, was not the path forward. But in the face of the crisis on the street, and the toll of that crisis on the city, San Francisco is expanding a system that would force people off the street and into involuntary treatment. And elsewhere, not so far away, a system of forced care is already in full effect.
From The Atlantic, this is No Easy Fix Episode 3, “A Golden Opportunity.”
[Music]
Sam Quinones: I didn’t really want to write about addiction or health or anything about that; I really just wanted to write about Mexican heroin traffickers.
Brooks: For someone who didn’t want to write about addiction, Sam Quinones has written about it a lot. He was one of the first journalists covering the rise of prescription pain pills and has been covering the opioid crisis in his books—and sometimes in The Atlantic—ever since.
In that time, Sam has seen a lot of money spent on solutions to this problem, a lot of ideas tried, and a lot of failure.
Quinones: I would say now, after 15 years of this and after watching so many people die, I’ve gotten to a point where I’m not gonna nod and smile at bullshit. And what we really need to be doing is rethinking how this is done.
Brooks: How recovery is done in America is not one cohesive thing. Some people are given the choice between rehab and jail, and choose rehab. Others have been referred from the hospital or pressured by family. You might be able to stay for a few months or just a month, depending on what you can afford and what Medicaid can pay for.
What unifies recovery in America are the results. Compared to Western Europe’s, our system is more expensive, has higher relapse rates and more overdoses.
The reason I called Sam is because now, in the face of such persistent failure, he’s part of a growing and surprising coalition of people calling for a different approach.
Quinones: I really believe that we have been wasting a magnificent golden opportunity for decades in jail because for so many people, the blessed day was the day they were arrested and they got off the street. A lot of people don’t wanna hear that, but in my opinion, that’s been a revelation.
Brooks: Sam knows, and I know, that for many people, calling jail for drug use “a magnificent golden opportunity” can be an unpopular position. For as many people as “the blessed day was the day they were arrested,” there are others for whom such an arrest led to nothing but pain and instability.
Historically, up to 75 percent of incarcerated people with opioid-use disorder will relapse within three months of release. Many of them do so having lost their tolerance, which sends the risk of overdose and death through the roof—which is one of the reasons why many people think this is not the way forward.
Quinones: That’s just nonsense. There’s a lot of people for whom it doesn’t work at certain times, but the idea that nobody ever found sobriety after being arrested and being forcibly removed from the streets—I mean, I can’t tell you how nonsensical that idea is—
Brooks: Not so much that nobody ever got sober, but, like, the question of what should be the dominant way that we deal with treatment and recovery.
Quinones: Well, I mean, it depends what drugs you’re talking about. Marijuana, maybe not. Alcohol, maybe not. With fentanyl, I have to say, I think it’s absolutely essential.
One of the effects of fentanyl is to turn people into folded people: So they are bent at the waist, their chins are almost touching their shoelaces, almost groveling before the drug, subservient. It is completely domineering and requires you to be taking it all day long.
Brooks: Sam’s argument is for involuntary treatment—in this case, jail-based recovery pods—not as a means to some other end, but as a tool for individual recovery.
Quinones: You just can’t get ready for treatment on the street in the time it takes for meth to drive you mad and fentanyl to kill you.
Brooks: Sam isn’t the only one calling for an expansion of involuntary treatment.
Archival (Fox News): President Trump signing an executive order to end homelessness that has taken over public streets. So let’s take a look at how he aims to do this.
Brooks: A few weeks ago, on July 24, President Trump signed an executive order called “Ending Crime and Disorder on America’s Streets.” The order makes it easier to clear homeless encampments; it blocks funding for safe-injection sites, predicates housing assistance on addiction treatment—and one other major change.
Archival (Fox News): It also supports involuntary treatment, which is crucial if you’re gonna get people off the streets who don’t wanna get off the streets and don’t wanna quit drugs.
Brooks: Involuntary treatment, or as the order puts it, quote, “shifting homeless individuals into long-term institutional settings,” end quote.
What the order calls for, in short, is an expansion of institutionalization, both for people with severe mental illness and for people with severe addiction, like Evan.
It’s the sort of thing that doesn’t sound very “San Francisco,” but on the subject of forcing people into long-term care, the city is actually way out ahead of Trump on this one—nearly two years ahead.
[Music]
Susan Eggman: When we closed the state hospitals, we didn't quite realize like, oh, they are serving a purpose. These people are being safely housed here. They have food, they have care, they have shelter, all these things.
Brooks: Susan Eggman is a former California State Senator, a Democrat, who served in the Senate from 2020 to 2024. And right out of the gate, Susan set out to make it easier to commit people against their will.
Eggman: We swing as a society, right? We were locking everybody up, throwing away the key, for their safety, for our safety. But now we’ve realized it was not bad to treat people; it’s bad to warehouse like we were doing. But there has to be someplace in between.
I mean, I tried for years—I couldn’t even get hearings in committees, right?
Brooks: Oh really?
Eggman: The judicial committee would be just like, (Laughs.) Get outta here, Eggman, right? I mean, I’m a huge ACLU lover, right, but they hate me when they see me coming (Laughs.) with this stuff.
Brooks: The reason the ACLU is so strongly opposed to changing the law is that it’s no small thing to rescind someone’s freedom when they haven’t committed any crime. America has a long and dark history with this. – a system of asylums and hospitals that would drug, shock, even lobotomize patients. The ACLU calls “conservatorship,” the present-day system of involuntary commitment in California, “the most extreme deprivation of civil liberties, aside from the death penalty.”
But after years of bargaining and pushing, Susan broke through. In October of 2023, Gavin Newsom signed Susan Eggman’s bill—it’s called S.B. 43—into law.
The law dramatically expanded the pool of people who qualify for involuntary treatment. Now people who can’t provide for their own personal safety, or necessary medical care, qualify. So do people with severe substance-use disorder.
Neglecting medical care, severe substance-use disorder—that sounds like Evan.
Two months after Susan’s bill became law, San Francisco put the new rules into effect, while just about every other county in California decided to wait.
So now, 19 months into this experiment, with Evan missing, I wanted to see how and if this system might work for him.
Brooks: Can you introduce yourself?
April Sloan: I’m April Sloan. I am the assistant deputy chief of the Community Paramedicine Division of the San Francisco Fire Department.
Brooks: In case you didn’t catch that, April Sloan is an assistant deputy chief in the San Francisco Fire Department—also a very fast talker.
April’s team, called EMS-6, is at the cutting edge of implementing this expanded involuntary system.
EMS-6 deals almost entirely in extremes: the most mentally ill, the most uncooperative, and the most severely drug addicted in San Francisco—in short, exactly the people that the city has in mind when expanding involuntary treatment.
April sees people who qualify for involuntary treatment all the time—among others, people with severe substance-use disorder and people with chronic medical neglect.
Sloan: We see a lot of people with wounds that they’re not getting treatment for.
Brooks: Yeah. A lot of amputations and stuff?
Sloan: I’ve never seen the amount of amputations like this. It’s crazy.
Brooks: The way the system is supposed to work is like a ladder: The bottom rung is the police or a clinician or a team like EMS-6. They make an evaluation and recommend that a patient be held for 72 hours and taken to an emergency room. I reached out to the San Francisco Police Department for this story and did not receive a response.
Eddy Bird, a captain on EMS-6, does plenty of this. He’s spent his whole career on an ambulance—which, before he worked at EMS-6, made Eddy a pretty popular guy.
Eddy Bird: When somebody’s collapsed and had a heart attack in front of their house, and they’re laying on the sidewalk, everybody’s real happy to see an ambulance rolling up. And the minute you put somebody in an ambulance, you drive away, everybody’s real happy to see you driving towards the hospital.
Brooks: When those types of patients arrive at the hospital, everyone knows what to do. But on EMS-6, it’s different.
Bird: Sometimes they’ve just got chronic needs, and we keep bringing them to the hospitals, and the staff now at the hospitals is like, Why do you keep bringing them here?
Brooks: EMS-6 is sending people to the emergency department for involuntary treatment; the hospitals are sending them right back out to the street. It’s possible that individual doctors aren’t buying into the new rules—simply don’t believe that severe substance-use disorder merits such an extreme deprivation of civil liberty. But it’s certain that the infrastructure required to pull off this expansion doesn’t yet exist.
In the long-term locked facilities meant for involuntary treatment, there is a desperate shortage of staff and beds. This isn’t just the case in San Francisco—cities across the country are scrambling to deal with a rise in psychiatric emergencies, including a spike in suicidality among young people. They are struggling to finance an effective response
This shortage funnels more and more people into the only place they can go: the emergency department.
Sloan: To be clear, EDs are not meant to treat people with psychiatric disorders or substance-use issues. Policy dictates that we have to take them to the hospital for a medical evaluation, so we do that. But then, they are discharged to the street.
Brooks: Which leaves Eddy and April and their team trying solutions that feel surreal.
April told me one story about a client of theirs that was suicidal—he told them as much. They kept getting 911 calls reporting that he had walked into traffic. EMS-6 would take him to the hospital, and the hospital would discharge him. This happened so many times that eventually one of the captains began to just follow this man around and just stop traffic when he stepped into the street.
With no way to keep this client out of oncoming traffic, EMS-6 kept traffic away from their client.
Bird: Every day, you go out to people that don’t wanna see you, to people that are calling that are angry because you’re not fixing the problems, because you don’t have the tools or the resources to fix these problems. So some people you’ve been friends with for a long time start being jerks to you, same thing with the hospitals.
Nobody wants to see you. They’re like, Oh, you’re not doing anything. You’re not fixing any problems. You don’t fucking do anything.
Brooks: Since the adoption of expanded involuntary treatment 19 months ago, the number of people placed into long-term involuntary care has hardly changed. The number of conservatorships initiated solely for severe substance-use disorder is zero.
So to the question of if this is a system that might have benefited Evan, the answer is a resounding no.
[Music]
Brooks: Before anyone can think about locking Evan away, and whether that would be compassionate or monstrous, there’s one thing that is not up for debate: You can’t lock up Evan if you can’t find him. And at the moment, no one knows where he is.
It’s early April now, and Evan has been missing for over a month. The last time they spoke, Liz told Evan that his leg would not improve on its own. She told him to get to a hospital immediately. Then he disappeared.
[Music]
Brooks: So Joe Wynne, Evan’s best friend, has flown to San Francisco to find him.
Wynne: Look, this is my “missing” poster for Evan.
Brooks: Joe is sitting in Liz’s car, showing off a template he’s downloaded onto his phone. The word MISSING is in all caps in white and red across the top.
Wynne: It’s classic, right? But I’m gonna swap out the picture of the cat, obviously.
All right, look, I wrote, “Evan: He’s friendly and handsome as fuck. Call me if you see him. His leg is fucked, and he needs medical.” It’s a fun flyer.
Breuilly: Evan’s gonna be like, Where’d you get that picture? Oh, Liz took it of me?
Brooks: The picture is not flattering. Evan does not look handsome or very friendly. His hair is in his face, and his skin is blotchy. He looks like someone who’s been living on the street for the last five years.
Liz took this photo originally with an eye towards the future, with the idea that she might show a clean, sober, housed Evan just how far he’d come, and that an image like this might ward him away from relapse. And now, Joe was about to show it to as many people as he could.
Wynne: So I have a photo of me and Evan side by side—that’s what I was gonna use.
Breuilly: I know, but that looks like him now. Your other one’s—he’s not happy like that.
Brooks: We spend the day driving and then walking around the Mission District and the Tenderloin, tracing wider and wider circles from where Evan was last seen.
Wynne: Hey, man, can I ask you a question? This is my brother Evan. I’m looking for him today. He’s got a really bum leg and a walker—
Brooks: Joe is handing out his flyers and offering a cash reward for whoever finds Evan—this is getting a lot of interest. Joe calls Evan his brother because he’s found that people are more likely to help that way.
Wynne: We’re trying to get him to the hospital ’cause he’s got an infection in his leg.
Brooks: Liz is going with her lighter-touch approach, asking friends and friends of friends if they’ve seen him. We see Evan’s last name spray-painted on a wall, which feels like a clue, but definitely isn’t.
As always, people living on the street in the Tenderloin are eager to help. One of them tells Joe, I’m sorry you’re going through this, without any irony that I could detect.
Operator: Operator.
Wynne: Hey, my name is Joe Wynne, and I’m trying to find out if my brother is a patient there.
Brooks: Twelve hours into this search, and Liz and Joe are getting a little desperate. We’ve been searching all day, Joe has handed out God knows how many flyers, and there’s still no sign of Evan.
Operator: No, I don’t see anyone by [that] name.
Wynne: Okay, thank you so much for checking.
Operator: No problem.
Wynne: There isn’t any way—(Phone hangs up.) Well, all right. Can I put, like, a call-back number?
Brooks: The hospitals don’t have any record of Evan. Liz and Joe are running out of ideas. And then Joe’s phone rings.
Wynne: Hello, this is Joe.
Anonymous: Are you looking for someone?
Wynne: Yeah, yeah, I’m looking for Evan.
Anonymous: Are you mobile right now or what?
Breuilly: Yeah.
Wynne: Oh yeah.
Anonymous: Yeah, he’s right here on Van Ness and Market, man, in front of the donut joint.
Brooks: We’re only a few minutes away from that intersection. And as we pull up, there’s Evan—wearing the same clothes Liz bought him over a month ago, standing on both legs. Joe pulls him into a hug.
Evan: Bring in the cavalry.
Wynne: (Laughs.) How are you, babe? Just so you know, about 400 people have flyers with your pictures on it.
Evan: I saw one of ’em—
Breuilly: (Laughs.)
Evan: —and I was like,What the fuck is that?
Wynne: (Laughs.)
Evan: I was like, That’s not real.
Breuilly: Full disclosure—
Brooks: That night, Joe and Evan stay in a hotel downtown. Forty-eight hours later, after a marathon wait in the emergency room, Evan is admitted to the hospital.
When I finally got to sit down with Evan, the first thing I wanted to know was where he’d been over the last month, why nobody had seen him.
In the month since I last saw Evan, he’d gone from being a thief who’d bring back and sell lots of stolen goods to looking through the trash—for some clothes or a half bottle of alcohol, anything he could sell for a dollar or two. For a while, he convinced a few restaurants to give him abandoned Doordash orders, which he would then barter for fentanyl. But eventually, that stopped working too.
He had disappeared not because he’d gone somewhere, but because he’d fallen so far as to be completely out of sight.
Two days ago, the day Liz and Joe were looking for him, Evan had decided to lie down. His feet had gone numb, so he wanted to rest—which, in his world, is a big decision: If you spend a full day lying down, you’re not making money, and you’re inching towards withdrawal.
Evan: So I had this tiny, little rice-sized piece of fentanyl, but I didn’t have a lighter, and so I kept using that as an excuse all day not to smoke it.
Brooks: He had decided to stay lying down, so instead of getting up, he called out, asking for a lighter. But no one helped. And then he had an idea.
Evan: Two nights before, I’d found this empty matchbox. And where I happened to lay down, there was two broken matches on the ground. And I went and sit inside my sleeping bag and put that little rice-grain piece of fentanyl on a piece of foil, and I took two hits with the match and then put it out, and then later, I did the same thing with the other match.
Brooks: Listening to Evan tell this story, there’s a bit of pride in his voice; you can hear that he’s smiling. He’s proud of having successfully MacGyvered a high out of two matches and a rice grain of fentanyl.
Brooks: How does this sound to your ear when you’re saying this stuff?
Evan: Yeah. (Laughs.) I just can’t believe that it would [be] me going through it. It’s like, How have you gotten so low, you know?
Brooks: Literally lying on the ground.
Evan: Using matches that I found in my sleeping bag to hit a piece of rice-grain fentanyl, because my legs are too swollen to get up to walk anywhere.
Brooks: Eventually, Evan got up. He hadn’t eaten anything all day, and it hurt to swallow. He made his way over to some people he knew and then found one of Joe’s flyers.
Evan: And then I was like, Oh yeah, that’s Joe’s making right there. I immediately was like, Facepalm. Like, No, no, no, no, no, no.
Brooks: Why “no”? If you had just had the day that you just described—
Evan: Well—
Brooks: —I feel like—
Evan: Yeah—
Brooks: —the answer could be, “Thank God.” (Laughs.)
Evan: No, just because of the embarrassment of, like, I never wanted to be this person on a flyer like that, just my picture all around town like that.
Brooks: When the cavalry arrived, in the shape of a best friend with the will and resources to save his life, Evan’s first thought was how it all looked. Even having lost everything else, until that moment, he still had a kind of privacy—no one there to see how bad things had really gotten.
In order to find him and to get him off the street, Joe had taken away that privacy; that’s what it took.
What it will take to keep Evan off the street, that’s after the break.
[Break]
Brooks: Since pulling Evan off the street a few days ago, Joe has come up with a new plan to save Evan. He’s standing at the foot of Evan’s hospital bed in San Francisco, delivering his pitch.
Wynne: From my perspective, we’re in a death-versus-something-else choice, right? I think death is really on the table for you. Between this, between that and your weight loss and your dehydration and just being out there, right, it’s really on the table. And I feel like Mexico’s the hammer. We swing that hammer (Punches one fist into his other palm.) You are gonna make it to 12 months.
Brooks: Joe is punching a fist into his palm and calling Mexico a “hammer” because what he’s proposing is force. Rather than finding his way into residential rehab in San Francisco, which Evan has tried and failed before, Joe is pushing for a more extreme option: Leave this waiting room right now, drive to the airport, and fly to Mexico. Joe found a rehab there called Twilight that does something that no rehab in America can do: Give Joe total control over Evan’s life.
Mexican law allows families to admit an addicted family member to rehab without their consent. If Evan gives the green light, Joe—and only Joe—can decide how long he stays in rehab. If he tries to leave, he’ll be stopped.
Wynne: And then after 12 months, you get to show up at my house, 12 months clean, and then we get to work out, eat good, work hard, be around the kids—there’s gonna be babies in the house. We’re gonna go to lacrosse games. I’m running the business; you can have a job working for me right out the gate.
Brooks: While Joe is delivering this rapid-fire vision of their glorious future, Evan is slouched down in his bed. I imagine this is sort of surreal. Forty-eight hours ago, he was on the street, and now he’s looking at spending the next year, or two years—it’s not up to him—in what is, in essence, a rehab jail.
Wynne: You’ll be in a very good world as soon as you get outta there, right? And you’d guaranteed get there—you will make 12 months if we send you to Mexico.
Brooks: Here was what sounded a lot like a version of recovery that people like Sam Quinones and Susan Eggman are saying people like Evan need. Twilight Recovery Center might give some insight into what works and what doesn’t when you approach addiction in this way, and Evan was getting closer to going.
Harrison Sidney: Welcome to Twilight Recovery Center. Please press 0 for assistance.
Brooks: Twilight Recovery Center is one of a constellation of Mexican rehab centers just south of San Diego catered towards American clientele.Harrison Sidney is the CEO.
Sidney: So in many states in the United States, people can do a conservatorship of people. I wish that they could do a conservatorship on people without going through the legal process but it is an impossibility to complete.
Brooks: Do you think about your work as conservatorship?
Sidney: Yes, I’m the guardian at the door. I’m the one that makes it happen.
Brooks: Recovery centers like Twilight fill a gap in the American system. In the States, as we’ve heard, the bar for conservatorship is high, and ultimately, the decision around involuntary treatment lies with a judge. At Twilight, all that control falls to Harrison.
Sidney: When a family member brings me their loved one, I give them the solution. Ultimately, my signature is gonna release their loved one, whether it’s a half an hour from the time that they arrive or a year from now.
Brooks: They’re handing you a really high degree of trust.
Sidney: Correct. That is correct.
Brooks: For patients, that can mean a lot of things. If the quality of care is high, that surrender of control can be beneficial. But if it’s not, the experience can be nightmarish.
In either case, it’s a gamble. It can mean a total stranger is in control of your future.
Brooks: Was that a hard decision for you to make, to sign away some autonomy?
Samantha: I’m not gonna lie: I really didn’t know that my parents would have full control over it.
Brooks: Samantha—and I’m just gonna use her first name—is a patient at Twilight. She’s from Pittsburgh and, by her count, has been to over 30 different rehabs all around the U.S.
She told me she didn’t really know that this rehab was different until she found out after her first month, which is when she would usually leave.
Samantha: That’s all I could think about, like, the first month I was here—was going home and getting high. I’m like, I’m so excited to go home and get high. I was just like, Yeah, I’m leaving in, like, a week, and he was like, No, the fuck you’re not. (Laughs.) I was like, Okay.
Brooks: Four months in, when I spoke with her, Samantha said she was still glad to be there, glad she didn’t go home after those first 30 days. Now she still thinks about getting high, but the feeling is fear—that she’ll relapse.
Samantha: In rehab in the States, when you’re in rehab, you can’t leave; you can’t do anything: You can’t have a phone. The nice thing about being here, though, is that we do go out and we do do normal things.And at this place, it’s kind of almost a step down from a rehab.
Brooks: Oh, that’s interesting—like it feels a bit more free, in a way?
Samantha: Yeah. Even though you have someone over you, yeah, you feel more free. They give you the idea that you’re free, but you’re not.
Brooks: At first, this struck me as a sort of trick Harrison was playing on patients like Samantha: cultivating this feeling in exchange for compliance. But it’s not far from principles you hear from people who advocate for a gentler approach to recovery. The key, they say, is to treat people with dignity. If you create an environment for someone like Samantha or Evan that doesn’t feel stigmatized or coercive, even if it is coercive, you might be more likely to recover.
[Music]
Brooks: Back in San Francisco, in Evan’s room at the hospital, it’s time to make a decision. The hospital’s addiction team has come by and thinks they can get him into a long-term residential rehab in San Francisco called Harbor Light. This is one of the best free facilities in the city, one where Evan could stay for up to two years.
Joe is pushing hard for Mexico. Evan has tried and failed to stay in rehab in San Francisco before, and Joe’s worried that if Evan fails, he won’t survive long enough to take another shot. Joe thinks it’s time to try something else, but Evan isn’t sure.
Evan: I don’t think I’m ready to do that. I could feel, like, in my head, I’m like, I’m gonna be successful this time. But I still have just, like—I’m still a little worried about having doubt—like, What if I don’t, though? And then all that time and money they spent is just wasted again, and it’s like …
Brooks: Mm-hmm.
Evan: I didn’t wanna do that.
Brooks: Evan, again, will try to get clean in San Francisco. He feels selfish asking Joe to pay for lockdown rehab in Mexico while San Francisco’s is free. So instead, Joe, in his salesman way, offers Evan a deal.
Wynne: So listen, what I’d like you to agree to—you don’t have to agree to it—is if you walk out of this place, the next time I see you, I just want you to get on the fucking plane to Mexico with me. Literally, like, Hey, good to see you; pop a methadone; we get on the plane. ’Cause we almost did that yesterday. You would be in Mexico now. And I get, like, this is the chance for you to do it nice, in a nicer facility, with more freedom, with better Medicare, for no money. I agree that if this works, it’s a better deal—if it works.
Evan: And it’s more, like, if I make it the year, it’s like—
Wynne: It’s more meaningful if you choose—
Evan: Yeah.
Wynne: —to do it every day than if we force you—if you make the right choice 365 days in a row, it’s more meaningful than if you make the choice to get on a plane with me once.
How do you feel about, if it doesn’t work, the next time I see you, we get on a plane—or you can pull the rip cord whenever. But really, the agreement is, eyeball to eyeball, that I wanna make: If it doesn’t work, we’re going to Mexico. Thoughts? Any reason to say no?
Evan: I don’t have any reason to say no.
Wynne: All right, so we agree on it? That’s your fucking left hand. That’s … (Laughs.) All right: Sober or Mexico.
Evan: Sober here in SF or Mexican sober jail.
Wynne: Uh-huh.
Evan: I like it.
Brooks: A few hours after this conversation in the hospital, Joe flew back to Washington. Before he left, he gave Evan a phone so we could all stay in touch. A group chat was started, along with Liz, called “Evan Party Chat,” which left Evan on his own again.
In a day or two, it’d be easy enough to walk out, take the bus back to the Mission, and pick up right where he left off: stealing Stanley cups, selling them for fentanyl money. There was nothing keeping Evan at the hospital.
A few days later, with the help of the hospital’s addiction team, Evan entered a long-term residential treatment program.
A month later, a text arrived, saying, “Hey. Thirty days clean.”
At day 72, we get an automated notification saying, “Evan left the conversation.”
A week later, Liz checked to see if he was still there. He was; he just wasn’t using his phone.
Evan is now past 120 days sober. It’s his longest period of sobriety in a very, very long time.
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Brooks: Back in January—at his inauguration—the mayor spoke about restoring San Francisco’s sense of decency and security. About putting a dent in this crisis that was all too visible.
To that end, Evan’s four months off of the street is a success. The cost of that success is tough to pin down. There were years of effort and care and failure from Liz and Joe. There’s the hospital bill, which was probably $10,000 and the cost of housing, feeding, and counseling Evan in residential rehab for up to two years.
In San Francisco, the homeless population is somewhere around 8,000. Many are dealing with addiction. Very few have a best friend or a volunteer detective working on their behalf.
Something like what it took to get Evan off the street for these four months will be required for thousands of others.
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Brooks: No Easy Fix is produced and reported by me, Ethan Brooks. Edited by Jocelyn Frank and Hanna Rosin. Engineering by Rob Smierciak. Fact-checking by Sam Fentress. Special thanks to Natalie Brennan and Nancy DeVille. Claudine Ebeid is the executive producer of Atlantic audio, and Andrea Valdez is our managing editor. Radio Atlantic will be back next week.
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