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Interview with Pat Townsley, Supervisor
Downtown Eastside Youth Alcohol and Drug Services

  Please describe the programs that reside in this building.

This building contains the DEYAS Street Youth Detox, the training program for the caregivers that work for this detox, and Nexus, an alcohol and drug counselling service.

What happens with the detox program is, rather than just providing a building where people go to detox, we have trained community caregivers so that kids go into a one-on-one situation in someone's home. They arewith contracted, level three caregivers who are trained in alcohol and drugs and other related issues for street youth.

"People have to be detoxed and deal with their drug issues where they're going to live. There's no sense in taking them out and putting them in an artificial environment."

We provide hands-on referrals, which means if you need a doctor or to get your status card or a bank account we'll send somebody with you to do that. What's good about the program is if you happen to be Latin-American or Oriental we can match the caregiver to you, rather than just having a staff here that's static. We can often meet the needs of transsexuals or of people with language barriers. We have ongoing training and caregivers coming through all the time.

The caregivers are from the community, and I think when you go to traditional detoxes that's often not the case. The reason that's important is that people have to be detoxed and deal with their drug issues where they're going to live. There's no sense in taking them out and putting them in an artificial environment.

We do hands-on referrals, we do housing, we do alcohol and drug education and counselling for downtown eastside youth and their families or partners. We have a youth food bank that operates weekly. For the people on social assistance, the night before the cheques come out there is a free dinner here, so people can come and have pizza. But they must also listen to some drug and alcohol education.

Who provides your funding?

ADS (Alcohol and Drug Services) provides the majority of our funding. We have also had funding from United Native Nations and the Youth Action Coalition, and we're very grateful for that money. Most recently the money we received through the Vancouver Action Plan has allowed us to double the number of bed days we can offer and to extend our services so that we're available 24 hours. I don't think there is any other detox anywhere that is doing 24 hour intake. Also, with this new funding we have money for an after-care worker to do transitional care.

How prevalent is the problem of drug use among street youth in Vancouver today?

More kids are becoming addicted to heroin. Drugs are being packaged in smaller and smaller kits, making them more available, whether it be heroin or coke. They're both really cheap now. In fact, it would be cheaper for a young person to get high on heroin than to go drinking. It would also be easier because they have to get someone to buy them alcohol, but they could just go buy their own heroin.

I think any drug can be damaging. People are presented with very little information about drugs. It's a continuum; I mean we have no use over here and full-blown problems over here and there's all this space in the middle. We know that people drink or use drugs to deal with stress, yet that is very rarely presented to people so they just fall into those habits. We certainly present role models for it on TV. Everywhere kids look people are having a good time while they're doing it, so really we create a social atmosphere that encourages drug use in our youth.

If somebody wants to leave the street, yes, we'll help them in any way we can; but if they don't we have to look at how we can make the street a safe place for young people to be.

Fatalities are definitely increasing because the drugs are becoming stronger and kids don't have the metabolism to process that much drug.

What services can you refer a youth to if he/she wishes to leave the streets?

A lot of what we do here is with third or fourth generation youth on the street. What we'd like is for the street to be a safe place to live, because if your mom lives down here and your brothers and your uncles you're not going to leave because this is what you know. It's sort of a different approach. If somebody wants to leave the street, yes, we'll help them in any way we can; but if they don't we have to look at how we can make the street a safe place for young people to be.

There's very few really supportive environments for young people. The after-care is where it all falls apart, but there isn't enough funding yet to really improve the situation. There's very few programs for youth, such as those available for adults who have recovery houses and treatment centres.

What types of programs or education do you believe would help prevent young kids from turning to drugs or alcohol?

Young people come to me all the time and they say, 'Hey, I'm sick. I've got this problem,' and I think to myself, 'Now, are they really sick or did they just learn what they were taught?' I think basically we're in a drug-using culture; we teach kids from very early ages that if you want to improve your mood or you don't like the way you feel you take a substance, whether that be aspirin or Children's Tylenol or beer or whatever. That is part of our learning process.

When you are giving someone treatment there's the underlying implication that they're flawed or sick in some way ... I don't think its a sickness. I think they've had a bad learning process.

You can talk about a dysfunctional family, but a dysfunctional family is only a conduit for the values learned in a dysfunctional society. Maybe we have to teach kids that something else is fun, because as long as they believe this is fun this is what they're going to do. We really don't do a lot of prevention.

I think there is a basic belief system in society that how we relax and enjoy ourselves is to have a couple of drinks. You add to that that most young people know if they start using drugs they can upset pretty well every adult they know, so it's a really good attention factor.

Most people focus on the type of drug rather than how the drug is being used, because, in fact, most of us use drugs, whether it's caffeine or cigarettes (and there are more of those people who end up in hospital beds). We only tell young people not to use them.

We don't say instead, if you are going to use drugs this might be something you need to think about, such as don't use them every day or don't use them to deal with stress, or if you're already angry don't start. We don't provide any of that information, so it is really difficult for people not to get in trouble when they do start using them.

Our society's approach is to use a treatment model. When you are giving someone treatment there's the underlying implication that they're flawed or sick in some way, whereas what I originally asked was, 'Are these people sick, or did they just learn what they were taught?' I don't think its a sickness. I think they've had a bad learning process.

I use the analogy with kids all the time. It's like, yes, I like chocolate cake a whole lot, but I don't eat it every day for every meal, because if I did there would be a health consequence.

That's the same attitude people should be taking with drugs and alcohol. If you like this or find that this works you have to remember that you can't do it all the time, because if you do there's going to be a health consequence, not to mention the financial and social consequences.

We try to focus on harm reduction. The harm reduction approach is where we're trying to make sure that if kids are using we put strategies in place so they can cope with the use.

What we found with young people was that they weren't interested in abstinence...We found that the best thing we could do for them was damage control.

Because you've had a lot of kids that just relapse instead of staying free?

With not a lot of after-care services, yes, relapse is really high. Re-admission is high. But it's not just that. Not every young person is interested in abstinence, so we try and work with young people where they are. That may seem strange because we normally think of alcohol and drugs services being aimed at abstinence. But what we found with young people was that they weren't interested in abstinence. I guess they're just too young. They haven't had enough bad things happen to them as a result of their use yet. We found that the best thing we could do for them was damage control.

You have two choices. You either exclude these people entirely from your help, or you help them where they're at. With many young people the idea of addiction is really inbred in them, so they feel they're out of control. Yet we can get them taking baby steps to begin to regain a sense of control. Sometimes if you take a giant step it's too big and you fail. That's not good for your self-image, and self-image and self-esteem are things that when low can cause you to use some more, so it becomes a circle. So if you try abstinence and you fail, you feel like shit, you drink some more, and it goes around and around.

What we say then is, ok, maybe you're not ready for abstinence, but maybe it wouldn't be a good idea for you to drink in this particular bar, because every time you go there seems to be a problem; it doesn't work for you and you seem to drink too much. Maybe we could look at just making a rule where you don't go out until 9:30 at night rather than going out at 6:00, and then by 11:00 you're not going to be as drunk. Or using strategies such as drinking every other day and not two days in a row, because when you drink two days in a row you just get too wired. Now if people can do those (and it's always them that has to make their rules or their guidelines) and they make it instead of fail, it's like 'Yes, I am in control! Hey, I said I wasn't going to use until 6:00 or until it was dark out, or whatever and I didn't for a whole week, I thought I was out of control and I thought the drug was controlling me, but it's not.'

'I've got some control here, so I'm going to take that little bit of control.' The choice is empowering. It's hard to say empowering when we talk about youth because we live in a culture where youth really don't have much power. But just to have a choice is empowering.

We take a more gradual approach than ever before because we don't talk in terms of addiction. Addiction is a weird word. What we're saying is, you have this problem, it's uncontrollable and now we're going to tell you how to control it. Once you've called someone an addict, you've already implied they can't control what you're now telling them how to control.

If all you want from me is to know where to get a clean needle then that's what I'm going to tell you, but if you want to know how to get in touch with a Twelve-Step group because you're looking for abstinence I'll tell you that. It's the individual that sets the goal, who decides what they want from this program, rather than us mandating, which we found just doesn't work for young people.

The program has been quite successful. We've had many, many young people come through and we've had a considerable amount of success in reducing the amount of harm they are experiencing as a result of their use. It's really damage control, and our drop-in centre makes it easy for us because the kids use it so much to act immediately instead of after the damage is already done.

For example, supposing you've had two or three weeks where you've been doing really well and then your aunt died. Without the drop-in we wouldn't know about that until you had already gone out and used and then come back in for detox. But because of the drop-in people usually come in right away and tell us, and so the intervention can happen before the actual damage has happened. The young people come in here for other day-to-day needs as well, such as food or telephone. We even have a washing machine now. We are pretty pleased about that. We got that with our money for Vancouver Action Plan.

What has struck me from talking with people is that there just hasn't been the funding that is needed to work with youth at risk, and especially street prostitution. It's child abuse when you see the ages of some of these kids, and yet nobody seems to be recognizing it.

It's always been kind of a mystery to me. I have some real problems with the treatment models on prostitution to start with. Think of being a young person who has run away from home. The average runaway has enough money for two days. You don't have a phone, you're probably under sixteen and you aren't allowed to work in our country until you are over sixteen. You are probably afraid to go to the Ministry of Social Services because they might send you back to where you are running away from. Usually kids run away from an abusive situation, so running away is actually a really adaptive response.

The buying of children is a social pathology. This is a social problem. We present children in the media as sexual objects and then we're surprised that people act on that information.

So then you end up working because there are no choices. People say it's the drugs that make people work. Sorry, you can't afford to get addicted to drugs until you start working. What usually happens is you are working and then the drugs follow because you can't deal with the experience. So now you are this young person out there working and doing the best you can to survive and you are arrested and sent for treatment. Well, before you can treat somebody there is the underlying implication that they are sick or morally flawed in some way, but they are not. I think that the people who are out there picking up 12 year old to 16-year old girls are sick and flawed and need treatment. But again the young person is viewed as the problem.

When you are picked up, rather than being supported you are taken away and treated as if it's an individual pathology. This isn't an individual pathology. The buying of children is a social pathology. This is a social problem. We present children in the media as sexual objects and then we're surprised that people act on that information.

This system is failing these kids all along, but rather than look at the system, we decide they need treatment. We just pretend there's nothing wrong with the North American family. We continually ostracize them and it allows us as a society to not look at the social factors that cause this. What are the social factors that cause men to buy women to start with, never mind young women. We create a lot of barriers for youth due to the social values and morality of adults which these youth already know is just a cover for something else. It's a way for people in our society not to look at any of the preventative things they can do.

For a number of years we excluded people who weren't interested in abstinence and we didn't allow them any help at all. Then we had AIDS and it just didn't work any more.

This area was surveyed and one of the things they said was they didn't want to have any programs that were aimed at abstinence. Maybe in a couple of years, but not right now. For a number of years we excluded people who weren't interested in abstinence and we didn't allow them any help at all. Then we had AIDS and it just didn't work any more.

The cogs in the wheel that are really missing is that there is almost no after-care to support the detox period and there isn't much in the way of education or prevention beforehand, so we've got kids getting in trouble with drugs. There was a young boy that died here a few months back, and he was twelve. He died of a heroin overdose. Nobody knew he was using, so they're pretty sure it was only a couple of times. But had he been able to pick up something in his school or a brochure that said 'We're not recommending the use of drugs, but if you are using drugs and you are not sure of your source,make sure you always cut what you're going to do in half,' he probably wouldn't be dead, because he would have known to do that.

People ask if telling a young person how to get a needle at an exchange isn't helping them use. Yes, but the consequence of not helping them is much greater. You have to look at what is going to have the most impact in terms of harm reduction. I think this is where you have to look for young people in approaches to drugs and alcohol.