For more than 25 years, Dwight struggled with cocaine use. In 2013, after repeated offenses, a police officer referred him to Seattle’s Law Enforcement Assisted Diversion program, saying, “I have an amazing program that’s going to support you.”

LEAD is a unique coalition of law enforcement agencies, behavioral health providers, prosecutorial partners and community groups. In LEAD, Dwight decided he wanted to stop using. He was referred to a case manager at REACH, an arm of Evergreen Treatment Services. REACH’s team of social workers, nurses, chemical dependency specialists and case managers builds relationships with people experiencing homelessness.

Evergreen Treatment Services and REACH team members connect people with food, clothing, medical care, shelter, mental health services and substance treatment using an approach called harm reduction. Harm reduction focuses on keeping substance users alive and healthy without the requirement to stop using before offering health care, treatment and other life-changing services — and it may work so well that it’s garnering new support from the U.S. government.

Dwight stopped using drugs and alcohol and got a job with the city doing parks and recreation work. REACH got him into housing, where he began paying rent.

The harm reduction model

One in five people living outside has a serious mental illness, and one in five uses drugs and alcohol. In 2020, death by overdose increased by 40% in Washington state, and 2021 surpassed those record levels before the end of September. Nationally, around 105,000 overdoses occurred in the 12 months preceding October 2021 — a 40% increase compared to the previous year.

Evergreen Treatment Services relies on harm reduction. Harm reduction reduces the overdose deaths, life-threatening infections and chronic diseases that often occur from using alcohol or drugs. At the same time, harm reduction centers offer prevention, treatment and recovery services.

The approach is so promising that the Biden-Harris Administration is now incorporating harm reduction as an evidence-based approach toward substance use disorders. The U.S. Department of Health & Human Services’ first-ever Harm Reduction grant program will distribute $30 million in grant awards or $10 million per year over the next three years.

“Harm reduction saves lives; all-or-nothing models often lead to overdose. We need to meet people where they’re at and redefine what success looks like. Safe use is better than unsafe use,” says Tavia Rhodes, Evergreen Treatment Services’ philanthropy and communications director.

For example, to reduce the spread of sexually transmitted diseases, people who use substances may be given condoms, disease testing and treatment. To reduce overdose deaths and infectious diseases, treatment centers may provide users sterile syringes and overdose prevention medication Narcan. Fentanyl test strips help users determine whether a substance is laced with fentanyl, a powerful synthetic opioid responsible for many overdoses.

At three clinics in the Puget Sound region, Evergreen Treatment Services provides a federally accredited opioid treatment program. Opioid users visit the clinics to receive methadone or buprenorphine to stabilize the brain’s chemistry so users can begin the recovery process. The medication is supported with services that address the whole person, including regular counseling, visits with a medical provider and even acupuncture sessions.

According to ETS, research shows that people in treatment for opioid use disorder have the greatest likelihood of living successfully in recovery, with the risk of overdose death dropping by at least 60%. In addition, harm-reduction programs reduce crime, decrease hospital stays and use of emergency services and help people find housing and employment. For every $1 spent on treatment, a $4 to $5 return is realized, ETS says.

ETS participates in research through the NIDA Clinical Trials Network to advance knowledge about what works to save lives. And ETS’s model helped meet Dwight’s next challenge.


Supported recovery

When the COVID-19 pandemic arrived in 2020, Dwight’s doctor told him that the virus could impact his health conditions and suggested that Dwight quarantine. But isolation from work, people, and his community led to a new setback.

“Not having that structure caused him to use again for the first time in nearly eight years,” says Febben Fekadu, REACH housing director.

Dwight was cited for driving under the influence. As a result, he owed the city of Auburn $500 and missed work to meet court obligations. Dwight was in danger of falling into cycles of instability and drug use once again.

REACH staff offered supportive encouragement, providing Dwight with financial help as his case went through the court system. Dwight was committed to stop using drugs and alcohol, and REACH supported him in his goal. He’s been drug-free ever since.

Evergreen Treatment Services is a mission-driven nonprofit organization specializing in substance use treatment and homeless outreach services. ETS has been serving the Puget Sound region for nearly 50 years.