These programs exist, but they are underutilized to a significant degree.

From a partner who used to work in one, people:

- didn't trust the program and wouldn't sign up

- didn't actually want to quit using so they avoided it

- wanted to get the benefits from the program without changing anything (i.e. showed up to get free food etc)

- tried but didn't like it and went back to using

Very few people actually went all the way through compared to the population in the city that could have used it.

The real question is: how do you help people who do not want your help. Do you let them waste away and die on the sidewalk, or do you institutionalize them?

Yes, exactly, there's a reason the term is "continuum of care." There is no one-size-fits-all approach to solving addiction because, to quote Ted Lasso, all people are different people. Maybe some people do need to be involuntarily incarcerated, but many, many others would be able to recover with far less intrusive interventions.

Also we are chasing a lagging indicator by focusing exclusively on the homeless population. The vast majority of people who end up homeless because of addiction would have benefited from some far earlier, far milder form of intervention, or from the absence of something that actively drove them into addiction, e.g. some quack pushing oxycontin on them because Purdue Pharma promoted it as non-addictive. Or job loss because of offshoring pushing them into economic despair that then drives addiction, which they are unable to recover from because of the lack of affordable or accessible retraining or educational opportunities.

In many cases over the last 20-30 years, it was the combination of both job loss and careless opioid prescription that pushed people into an unrecoverable spiral, especially in the rust belt, where the opioid crisis hit the hardest. We may not have fixed the job loss side of the problem, but at least doctors aren't pushing pills the same way they were 10-20 years ago after Purdue's corporate downfall, so the number of people driven into addiction-mediated homelessness by that disaster should at least start tapering off soon. But if we don't help people before their lives fall apart with a continuum of support options that are accessible before they are in deep crisis, and are accessible to people who are beginning to spiral but don't yet appear to be in deep crisis, it will cost far more and be far more challenging to help them recover once they are on the street.

I'm not sure if you've had a drug addict in your life at any point, and if not that is a blessing.

Drug addiction is a dark place and it's very common that the availability of free support programs is entirely rejected by the user, and the only hope at a normal life requires forceful intervention by family and friends.

The only way to solve drugs on the street is to look at the cities that have solved them and copy what works. And, at least with what I'm familiar with, arresting people tends to work and alternatives tend to not.

At least in California, there are a lot of public support programs. I mean, a looooot of public support programs. A LOT. Like, to the point where the state is spending tens of thousands of dollars for each homeless person, and probably north of $100k per person per year for a subset. Talk to a firefighter or paramedic in a CA city sometime. They will tell you, there's "regulars" that they have to deal with every single week. The cops and firefighters know all of them by name.

We're paying hours a day in overtime to basically have the cops, firefighters, and EMTs deal with the same small population of mentally ill people on the same street corner every week, for years. These people cannot get better because they choose not to stay in the mental hospital or substance abuse programs offered to them. Someone is 5150'd, placed on a 3-day hold, and 72 hours later they walk out of the hospital and back to the same street corner, where they have a mental breakdown again the following week. You can offer support -- they will basically tell you the same thing, I'm not sick at all, there's nothing wrong with me, I am not a danger to myself or others, and you are shit out of luck.

At the same time, there are way more homeless people who are silently and cleanly living in their cars and showing up to work every day at a low wage job. Most people won't ever see them unless they look closely. Visit /r/urbancarliving sometime to get an idea of what that population looks like. Those people might get a 15 minute "knock" from the cops once a month.

The actually progressive option is to involuntarily incarcerate people who need it, while not criminalizing car/RV living, offering work placement services, housing assistance etc. The most realistic thing would probably be to build subsidized mobile homes and clean, low-rent central places to park an RV.

You correctly identified the biggest thing here though which is making housing affordable. Unfortunately, that will never happen.

Any meaningful public support program that actually keeps severely-mentally-ill visibly-homeless people from acting crazy in public will necessarily involve involuntarily incarcerating at least some of them, some of the time. A lot of very dysfunctional people genuinely do not want to cooperate with meaningful public support programs or are simply too out of it to meaningfully consent or not consent to participation in such.

I didn't create this "false dichotomy", nor did I say that those were the only two options. I'm just observing the fact that the current system that the major cities in the US seem to be employing is to treat homeless as a valid choice, even if much/most of it is a result of addiction and mental illness. The end result of that treating it that way is the death and suffering of people who actually need lots of help and who would be better served by more aggressive tactics.

Unfortunately, framing the problem as this kind of dichotomy is something people are inclined to do because then the problem can be reduced to the unwillingness of the opposing side to face reality.

Sometimes the dichotomy is correct, but the bias exists.

You should read a little book called Games People Play. Focus particular attention on the section on the game "Indigent."

This isn't a resource allocation problem, or rather, it isn't a resource allocation problem the way you seem to think it is.

Nothing?? What are you talking about? Go look up how much tax money the SF government spends trying to help the unhoused in their current budget. But no amount will fix the problem because if you ask a drug addict if they want help (and it’s not help getting drugs) they usually say “no thanks.” Many addicts are never ready to accept that kind of help. Sadly.