No Easy Fix | 3. A Golden Opportunity

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Speaker 3 this is radio atlantic i'm hannah rosen Today, we have the third episode of our series about San Francisco and what it takes to escape homelessness and addiction.

Speaker 3 Last week, we talked to San Francisco Mayor Daniel Lurie.

Speaker 5 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.

Speaker 3 And we followed Evan, who's trying to get off the streets through a critical 48-hour period.

Speaker 7 I don't know where to go. And it's raining.

Speaker 4 I'm cold. I'm hungry.

Speaker 7 And

Speaker 7 I'm over it.

Speaker 7 I'm so over it.

Speaker 3 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.

Speaker 3 Here's reporter Ethan Brooks.

Speaker 4 Hey.

Speaker 8 How you doing?

Speaker 9 Doing all right, you know.

Speaker 10 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.

Speaker 10 He needed urgent medical care for his leg, which was swollen and infected, and he planned to go to the hospital.

Speaker 10 And then he disappeared.

Speaker 11 He could lose his leg,

Speaker 11 you know?

Speaker 11 That's why when we separated, I was really clear with him that he understood that his leg was not going to get better on its own.

Speaker 10 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.

Speaker 10 But not this time.

Speaker 8 No one's seen him.

Speaker 8 I was like, yeah, have you seen Evan around? They're like, no, why?

Speaker 8 I was like, I don't know. He's like, missing, missing.

Speaker 10 Typically, when someone with an addiction like Evans disappears, it's not some big mystery what they're up to.

Speaker 10 Evan's best friend Joe, who lives out in Washington, has been through this more than once.

Speaker 6 I was going to have him get a tattoo with my phone number on it.

Speaker 10 That's a great idea.

Speaker 4 Yeah, yeah.

Speaker 4 But he disappeared on me.

Speaker 10 This time is different. When Liz called the hospitals, none of them had any record of Evan.
She checked arrest records, no sign of him there either.

Speaker 10 The shelter where he'd been staying for the past few weeks, they also hadn't seen him.

Speaker 10 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?

Speaker 4 Are you worried? I mean, it's, I expect Evan to die out there.

Speaker 6 100%, that's how this ends.

Speaker 7 In the streets, in a bad way.

Speaker 6 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.

Speaker 6 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.

Speaker 6 So the question is like, what on the list of human experience is left to Evan that he hasn't done?

Speaker 10 Recently, I've been thinking about something Evan told me the first time we met.

Speaker 10 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.

Speaker 10 Liz put it more bluntly and said, you need to be locked in a cell.

Speaker 10 At the time, this struck me as sort of tongue-in-cheek, something to acknowledge the seriousness of Evan's addiction.

Speaker 10 But now that he was missing and in urgent need of medical care, I was wondering if he actually meant it.

Speaker 10 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.

Speaker 10 But in the face of the crisis on the street 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.

Speaker 10 And elsewhere, not so far away, a system of forced care is already in full effect.

Speaker 10 From The Atlantic, this is No Easy Fix, Episode 3: A Golden Opportunity.

Speaker 12 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.

Speaker 10 For someone who didn't want to write about addiction, Sam Kinonis has written about it a lot.

Speaker 10 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.

Speaker 10 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.

Speaker 12 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 going to nod and smile at bullshit.

Speaker 12 when what we really need to be doing is rethinking how this is done.

Speaker 10 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.

Speaker 10 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.

Speaker 10 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.

Speaker 10 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.

Speaker 12 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.

Speaker 12 A lot of people don't want to hear that. But in my opinion, that's been a revelation.

Speaker 10 Sam knows, and I know, that for many people, calling jail for drug use a magnificent golden opportunity can be an unpopular position.

Speaker 10 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.

Speaker 10 Historically, up to 75% of incarcerated people with opioid use disorder will relapse within three months of release.

Speaker 10 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.

Speaker 12 That's just nonsense.

Speaker 12 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, that's, I mean, I can't tell you

Speaker 12 how nonsensical that idea is.

Speaker 10 I mean, 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.

Speaker 12 I mean, it depends what drugs you're talking about. Marijuana, maybe not.

Speaker 7 Alcohol, maybe not.

Speaker 12 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.

Speaker 12 Their chins are almost touching their shoelaces, almost groveling before the drug, subservient. It is

Speaker 12 completely domineering and requires you to be taking it all day long.

Speaker 10 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.

Speaker 12 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.

Speaker 10 Sam isn't the only one calling for an expansion of involuntary treatment.

Speaker 14 President Trump's signing an executive order to end homelessness that has taken over public streets.

Speaker 10 So let's take a look at how he a few weeks ago, on July 24th, President Trump signed an executive order called Ending Crime and Disorder on America's Streets.

Speaker 10 The order makes it easier to clear homeless encampments, it blocks funding for safe injection sites, predicates housing assistance on addiction treatment,

Speaker 10 and one other major change.

Speaker 14 It also supports involuntary treatment, which is crucial if you're going to get people off the streets who

Speaker 14 don't want to get off the streets and don't want to quit drugs.

Speaker 10 Involuntary treatment, or as the order puts it, quote, shifting homeless individuals into long-term institutional settings.

Speaker 10 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.

Speaker 10 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.

Speaker 15 When we closed the state hospitals, we didn't quite realize like, oh, but they are serving a purpose. Like these people are being safely housed here.

Speaker 15 They have food, they have care, they have shelter, all these things.

Speaker 10 Susan Eggman is a former California state senator, a Democrat who served in the Senate from 2020 to 2024.

Speaker 10 And right out of the gate, Susan set out to make it easier to commit people against their will.

Speaker 15 We swing as

Speaker 15 a society, right? We were locking everybody up, throwing away the key, you know, for their safety, for our safety. Now we've realized it's not bad to treat people.

Speaker 15 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? Oh, really?

Speaker 15 The judicial committee would just like,

Speaker 12 get out of here, Eggman.

Speaker 15 Right. I mean, mean, I'm a huge ACLU lover, right? But they hate me when they see me coming with this stuff.

Speaker 10 The reason the ACLU was 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.

Speaker 10 America has a long and dark history with this, a system of asylums and hospitals that would drug, shock, and even lobotomize patients.

Speaker 10 The ACLU calls conservatorship, that's the present-day system of involuntary commitment in California, quote, the most extreme extreme deprivation of civil liberties aside from the death penalty.

Speaker 10 But after years of bargaining and pushing, Susan broke through. In October of 2023, Gavin Newsom signed Susan Eggman's bill.
It's called SB 43, into law.

Speaker 10 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.

Speaker 10 So do people with severe substance use disorder. Neglecting medical care, severe substance use disorder, that sounds like Evan.

Speaker 10 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.

Speaker 10 So now, 19 months into this experiment, with Evan missing, I wanted to see how and if this system might work for him.

Speaker 10 Can you just introduce yourself?

Speaker 17 I am April Sloan. I am the Assistant Deputy Chief for the Community Paramedicine Division of the San Francisco Fire Department.

Speaker 10 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.

Speaker 10 April's team, called EMS6, is at the cutting edge of implementing this expanded involuntary system.

Speaker 10 EMS6 deals almost entirely in extremes, the most mentally ill, the most uncooperative, and the most severely drug addicted in San Francisco.

Speaker 10 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.

Speaker 10 Among others, people with severe substance use disorder and people with chronic medical neglect.

Speaker 17 We see a lot of people with wounds that they're not getting treatment for.

Speaker 17 A lot of amputations.

Speaker 17 I've never seen the amount of amputations like this. This is

Speaker 17 it's crazy.

Speaker 10 The way this system is supposed to work is like a ladder. The bottom rung is EMS6, or a clinician, or the police.

Speaker 10 I reached out to the San Francisco Police Department for the story and didn't get a response.

Speaker 10 If EMS6 thinks a patient requires involuntary treatment, they take the patient to the hospital. Eddie Bird, a captain on EMS-6, does plenty of this.

Speaker 10 He spent his whole career on ambulances, which before he worked on EMS6 made him a pretty popular guy.

Speaker 16 When somebody's collapsed, you know, 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.

Speaker 16 And the minute you put somebody in an ambulance, you drive away, everybody's real happy to see you driving towards the hospital.

Speaker 10 When those types of patients arrive at the hospital, everyone knows what to do. But on EMS6, it's different.

Speaker 16 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?

Speaker 10 EMS6 is sending people to the emergency department for involuntary treatment. The hospitals are sending them right back out to the street.

Speaker 10 It's possible that individual doctors aren't buying into the new rules, don't believe that severe substance use disorder merits such an extreme deprivation of civil liberty.

Speaker 10 But it's certain that the infrastructure required to make this expansion work doesn't yet exist.

Speaker 10 In the long-term lock facilities meant for involuntary treatment, there is a desperate shortage of staff in beds. This isn't just the case in San Francisco.

Speaker 10 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.

Speaker 10 This shortage funnels more and more people to the only place they can go, the emergency department.

Speaker 17 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.

Speaker 17 So we do that. But then they are discharged to the street.

Speaker 10 Which leaves Eddie and April and their team trying solutions that feel surreal.

Speaker 10 April told me one story about a client of theirs that was suicidal. He had told them as much.
They kept getting 911 calls reporting that he had walked into traffic.

Speaker 10 EMS6 would take him to the hospital and the hospital would discharge him.

Speaker 10 This happened so many times that eventually one of the captains began to just follow this man around and stop traffic when he stepped into the street.

Speaker 10 With no way to keep this client out of oncoming traffic, EMS6 kept traffic traffic away from their client.

Speaker 16 Every day you go out to people that don't want to see you, to people that are calling, that are angry because you're not fixing the problems, because you don't have the tools nor the resources to fix these problems.

Speaker 16 So, you know, 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.

Speaker 10 Since the adoption of this expanded system 19 months ago, The number of people placed into long-term involuntary care has hardly changed.

Speaker 10 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.

Speaker 10 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 Evan up if you can't find him.

Speaker 10 And at the moment, no one knows where he is.

Speaker 10 It's early April now, and Evan has been missing for over a month.

Speaker 10 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.

Speaker 18 So this is six in the tomahawk.

Speaker 6 Can we go for a walk?

Speaker 10 So Joe Wynne, Evan's best friend, has flown to San Francisco to to find him.

Speaker 6 Alright, let's look at this cat. Look, this is my missing poster for Evan.

Speaker 10 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.

Speaker 6 It's classic, right?

Speaker 6 But I'm going to swap out the picture of the cat.

Speaker 4 Obviously.

Speaker 6 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.

Speaker 4 That's a fun flyer.

Speaker 10 Evan's gonna be like, where'd you get that picture? Oh, Liz took it of me. The picture is not flattering.
Evan does not look handsome or very friendly. His hair is in his face and his skin is blotchy.

Speaker 10 He looks like someone who's been living on the street for the last five years.

Speaker 10 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.

Speaker 10 And now, Joe was about to show it to as many people as he could.

Speaker 6 So I have a photo of me and Evan side by side. That's what I I was going to use.

Speaker 18 I know, but that looks like him now.

Speaker 3 Your other one's.

Speaker 18 He's not happy like that.

Speaker 10 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.

Speaker 4 Hey man, can I ask you a question?

Speaker 6 This is my brother Evan. I'm looking for him today.
He's got a really bummed leg and a walker.

Speaker 4 We're trying to get him to the hospital.

Speaker 10 Joe is handing out his flyers and offering a cash reward for whoever finds Evan. This is getting a lot of interest.

Speaker 10 Joe calls Evan his brother because he's found that people are more likely to help that way.

Speaker 6 Well, yeah, thanks, man.

Speaker 4 If you see him, we'll be real.

Speaker 10 Liz is going with her lighter touch approach, asking friends and friends of friends if they've seen him.

Speaker 10 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.

Speaker 10 One of them tells Joe, I'm sorry you're going through this, without any irony that I could detect.

Speaker 6 Hey, my name is Joe Wynne and I'm trying to find out if my brother is a patient there.

Speaker 10 12 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.

Speaker 6 No, I don't say anyone by a name. Okay, thank you so much for checking.

Speaker 6 There isn't any way.

Speaker 4 Well, all right.

Speaker 6 Can I put like a callback number?

Speaker 10 The hospitals don't have any record of Evan. Liz and Joe are running out of ideas.
And then Joe's phone rings.

Speaker 6 Hello, this is Joe.

Speaker 19 Are you looking for someone?

Speaker 6 Yeah, yeah, I'm looking for Evan.

Speaker 20 Um, are you are you mobile right now or what?

Speaker 4 Oh, yeah.

Speaker 20 Yeah, he's right here on a bayonet market, man in front of the donut joint.

Speaker 10 We're only a few minutes away from that intersection. And as we pull up, there's Evan,

Speaker 10 wearing the same clothes Liz bought him over a month ago, standing on both legs. Joe pulls him into a hug.

Speaker 7 Bring in the cavalry.

Speaker 4 How are you, babe?

Speaker 6 Just so you know, about 400 people have flyers with your pictures on it.

Speaker 4 I saw one of them, and I was like, what the fuck is that?

Speaker 4 I was like, that's not real. Well, this is a sheriff.

Speaker 10 That night, Joe and Evan stay in a hotel downtown. 48 hours later, after a marathon wait in the emergency room, Evan is admitted to the hospital.

Speaker 10 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.

Speaker 10 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.

Speaker 10 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.

Speaker 10 He had disappeared not because he'd gone somewhere else, but because he'd fallen so far as to be completely out of sight.

Speaker 10 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.

Speaker 10 If you spend a full day lying down, you're not making money and you're inching towards withdrawal.

Speaker 7 So I had this tiny little, like, 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.

Speaker 10 He had decided to stay lying down, so instead of getting up, he called out, asking for a lighter, but no one helped. Then he had an idea.

Speaker 7 Two nights before I had found this empty match box

Speaker 7 and where I happened to lay down there was two broken matches on the ground. I went inside my sleeping bag and put that little rice grain piece of fentanyl on a piece of oil

Speaker 7 and I took two hits with the match

Speaker 7 and then put it out and then I and then later I did the same thing with the other match.

Speaker 10 Listening to Evan tell this story, there's a bit of pride in his voice. You can hear that he's smiling.

Speaker 10 He's proud of having successfully MacGyver to high out of two matches and a rice grain of fentanyl.

Speaker 10 How does this sound to your ear when you're saying this stuff?

Speaker 4 Yeah.

Speaker 7 I just can't believe that it would... me going through it.
It's like, how have you gotten so low, you know?

Speaker 10 Literally lying on the ground.

Speaker 7 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.

Speaker 10 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.

Speaker 7 And then I was like, oh yeah,

Speaker 7 that's Joe's making right there.

Speaker 7 I immediately was like, face palm, like, no, no, no, no, no, no.

Speaker 5 Why, why, no, if you had just had the day that you just described,

Speaker 4 I feel like

Speaker 6 the answer could be, thank God.

Speaker 7 Just because of like the embarrassment of like,

Speaker 7 I never wanted to be like this miss, like this person on the flyer like that, you know, like just my picture all around town like that.

Speaker 10 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.

Speaker 10 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.

Speaker 10 In order to find him and to get him off the street, Joe had taken away that privacy. That's what it took.

Speaker 10 What it will take to keep Evan off the street, that's after the break.

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Speaker 10 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.

Speaker 6 From my perspective, we're in like a death versus something else choice, right? I think death is really on the table for you.

Speaker 6 Between this, between that and your weight loss and your dehydration and like just being out there, right?

Speaker 6 It's really on the table. And I feel like Mexico is the hammer.
We swing that hammer, you're gonna make it to 12 months.

Speaker 10 Joe is punching a fist into his palm and calling Mexico a hammer because what he's proposing is force.

Speaker 10 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.

Speaker 10 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.

Speaker 10 Give Joe total control over Evan's life.

Speaker 10 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.

Speaker 10 If he tries to leave, he'll be stopped.

Speaker 6 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 going to be babies in the house.

Speaker 6 We're going to go to lacrosse games. I'm running the business.
You can have a job working for me right out the gate.

Speaker 10 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.

Speaker 10 48 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.

Speaker 6 You'll be in a very good world

Speaker 6 as soon as you get out of there. Right? And you guaranteed get there.
You will make 12 months if we send you to Mexico.

Speaker 10 Here was what sounded a lot like a version of recovery that people like Sam Kinones and Susan Eggman are saying people like Evan need.

Speaker 10 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.

Speaker 19 Welcome to Twilight Recovery Center. Please press zero for assistance.

Speaker 10 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.

Speaker 19 So in many, many states in in the United States, people can do a conservatorship on people.

Speaker 19 I wish that they could do a conservatorship on people without going through the legal process that it is an impossibility to complete.

Speaker 10 Do you think about your work as conservatorship?

Speaker 19 Yes,

Speaker 19 I'm the guardian at the door.

Speaker 19 I'm the one that makes it happen.

Speaker 10 Recovery centers like Twilight fill a gap in the American system.

Speaker 10 In the States, as we've heard, the bar for conservatorship is high, and ultimately the decision around involuntary treatment lies with the judge. At Twilight, all that control falls to Harrison.

Speaker 19 When a family member brings me their loved one,

Speaker 19 I give them the solution. Ultimately, my signature is going to release their loved one, whether it's a half an hour from the time that they arrive or a year from now.

Speaker 10 They're handing you a... a really high degree of trust.

Speaker 19 Correct. That is correct.

Speaker 10 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.

Speaker 10 In either case, it's a gamble. It can mean a total stranger is in control of your future.
Was that a hard decision for you to make to sign away some autonomy?

Speaker 22 You know, I'm not going to lie, I really didn't know that my parents would have full control over it.

Speaker 10 Samantha, and I'm just going to use her first name, is a patient at Twilight. She's from Pittsburgh, and by her count, has been to over over 30 different rehabs all around the U.S.

Speaker 10 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.

Speaker 23 That's all I could think about like the first month I was here was going home and getting high. Like I'm like, I'm so excited to go home and get high.

Speaker 23 I was just like, yeah, I'm leaving in like a week. And he's like, no, the fuck you're not.

Speaker 8 I was like, okay.

Speaker 10 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.

Speaker 10 Now she still thinks about getting high, but the feeling is fear that she'll relapse.

Speaker 22 In rehab in the States, you can't leave, you can't do anything, you can't have a phone.

Speaker 8 And

Speaker 22 the nice thing about being here is that we do go out and we do do normal things.

Speaker 8 At this place, it's kind of like almost like a step down from a rehab.

Speaker 10 Oh, that's interesting. Like it feels a bit more free in in a way.

Speaker 22 Yeah,

Speaker 22 even though you're a conservative, you have someone over you. Yeah, you feel more free.

Speaker 22 They give you the idea that you're free, but you're not.

Speaker 10 At first, this struck me as a sort of trick Harrison was playing on patients like Samantha, cultivating this feeling in exchange for compliance.

Speaker 10 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.

Speaker 10 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.

Speaker 10 Back in San Francisco, in Evan's room at the hospital, it's time to make a decision.

Speaker 10 The hospital's addiction team has come by and thinks they can get him into a long-term residential rehab in San Francisco called Harborlight.

Speaker 10 This is one of the best free facilities in the city, one where Evan could stay for up to two years.

Speaker 10 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.

Speaker 10 Joe thinks it's time to try something else, but Evan isn't sure.

Speaker 7 I don't think I'm ready to do that. I could feel like in my head, I'm like, I'm going to be successful this time, but like, I still have like,

Speaker 7 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 like wasted again.
And it's like,

Speaker 16 I didn't want to do that.

Speaker 10 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.

Speaker 10 So instead, Joe, in his salesman way, offers Evan a deal.

Speaker 6 So listen, but 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.

Speaker 6 Like literally, like, hey, good to see you. Pop a methadone.
We get on the plane. Because we almost did that yesterday.
You would be in Mexico now.

Speaker 6 And I get like this, this is a chance for you to do it nice, in a nicer facility, with more freedom, with better Medicare for no money. I agree that that if this works, it's a better deal.

Speaker 6 If it works, and it's more

Speaker 6 like if I feel like if I make it the year, it's like it's more meaningful if you choose to do it every day than if we force you.

Speaker 6 If you make the right choice 365 days in a row, it's more meaningful than if you make the choice to get on the plane with me once. How do you feel about it?

Speaker 6 If it doesn't work, the next time I see you, we get on a plane. Or if you can pull the rip cord whenever.
But really, the agreement, like eyeball to eyeball that I want to make,

Speaker 6 if it doesn't work, we're going to Mexico.

Speaker 6 Thoughts? Any reason to say no?

Speaker 16 I don't have any reason to say no.

Speaker 6 All right, so we agree on it?

Speaker 6 That's your fucking left hand.

Speaker 4 All right.

Speaker 6 Sober or Mexico?

Speaker 7 Sober here in ESF for Mexican sober Joe.

Speaker 4 Uh-huh.

Speaker 16 I like it.

Speaker 10 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.

Speaker 10 A group chat was started, along with Liz, called Evan Party Chat,

Speaker 10 which left Evan on his own again.

Speaker 10 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.

Speaker 10 There was nothing keeping Evan at the hospital.

Speaker 10 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, 30 days clean.

Speaker 10 At day 72, we get an automated notification saying, Evan left the conversation.

Speaker 10 A week later, Liz checked to see if he was still there. He was.
He just wasn't using his phone.

Speaker 10 Evan is now past 120 days sober. It's his longest period of sobriety in a very, very long time.

Speaker 10 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.

Speaker 10 To that end, Evan's four months off the street is a success. The cost of that success is a bit tough to pin down.
There were years of effort and care and failure from Liz and Joe.

Speaker 10 There's the hospital bill, which is probably $10,000. and the cost of housing, feeding, and counseling Evan in residential rehab for up to two years.

Speaker 10 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.

Speaker 10 Something like what it took to get Evan off the street for these four months will be required for thousands of others.

Speaker 10 No Easy Fix is produced and reported by me, Ethan Brooks, edited by Jocelyn Frank and Hannah Rosen. Engineering by Rob Smirciak, fact-checking by Sam Fentress.

Speaker 10 Special thanks to Natalie Brennan and Nancy Deville. Claudine Abade is the executive producer of Atlantic Audio, and Andrea Valdez is our managing editor.
Radio Atlantic will be back next week.

Speaker 24 They say, if you're the smartest person in the room, you're in the wrong room. My name is John Dick, and I'm never, ever in the wrong room.

Speaker 24 So I started a podcast to introduce you to some of the brilliant people I've encountered along the way.

Speaker 13 But we'll also keep it real.

Speaker 24 So we'll ask these incredibly successful people to share some of their most embarrassing stories, their dumbest mistakes.

Speaker 24 Mark and I talked about his inspiration and audacious goals for the business, how he's succeeding without spending a penny on marketing, and how he would fix our broken healthcare system if he had a magic wand.

Speaker 24 We also talked about how sports has changed since he walked away from the Mavs, what we're learning from our Gen Z kids, and why eggs are always better when dipped in ketchup.

Speaker 24 So, I hope you'll enjoy the latest quadrennial conversation with Mark Cuban and me, the dumbest guy in the room.