Tribes of the Veterans who are Homeless


by Ken Smith


After founding and then running a shelter for veterans who were  homeless  for a number of years, I began to see patterns of pathology among the clients. These were guys who were once fully functioning human beings. They were trained to kill and then thrown into an environment of unimaginable stress. Then they were discharged from the military and asked to become normal healthy citizens overnight

Many vets were able to return home and lead productive lives. The guys who found their way to the vet shelter in Boston couldn’t make the transition. Without societal support, they fell victim to a wide variety of addictions and diseases. The struggle became too much and they dropped out of society to live on the streets, and in many cases the only crutch they had to get them from one day to the next was their addiction.

While at the shelter we gave every vet the respect they deserved and often received nowhere else. For me and my staff the emotional toll of dealing with these shattered men, once young and vital and considered our country’s finest and now reduced to homeless misery, was too much. We had to create some emotional distance and make sense of the chaos in our minds.

In response to what I was experiencing every day, I began to compartmentalize to myself each vet that entered the program. I would place them into one of a series of tribes that I had imagined in my mind. This sorting process made it possible for me to create appropriate responses to a wide variety of problems.

The Tribe of the Alcoholians, as I called them, was the largest tribe of homeless veterans. These tribe members had one thing in common: they drowned their pain in alcohol.

There was the Tribe of the Methadonians, and this tribe was comprised of former heroin addicts that had been weaned off of heroin and switched to the use of methadone. This tribe comprised the hardcore street homeless and there was a network and hierarchy of Methadonians that saw each other every day as they went to clinics to get their daily dose of methadone. This tribe was brutal. It was Methadonians who found the new fresh homeless out on the streets, veteran and non-veteran alike, and preyed on them either at shelters or on the street. Methadonians usually traveled in a pack and usually there was one who was the pack leader. Whenever I encountered them out on the streets they reminded me of a pack of snow wolves.

There was the tribe of the Neuroliptians and Psychotropians, and this tribe was comprised mostly of psych clients. They usually had glassy eyes and a bucket of pills given to them by the VA. The members of this tribe came in all shapes and sizes. Some took very good care of themselves and others would spend the night sleeping underneath a bridge because they would skip off of their meds and not remember where they were at or where they were going.

In addition to these tribes, there was a small group of vets who were newly homeless and typically they had been kicked out of the house by a wife or girlfriend. I came to see them as the tribe of the Virgins. On the streets of large cities the Methadonians sought out Virgins at train stations, bus stations, and late at night in parks and parking garages. Usually the fresh homeless were reluctant to admit their predicament, and many quickly fell prey to the street-savvy Methadonians.

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Some vets were members of more than one group, such as the Virgin vet who had been kicked out of his girlfriend’s apartment because he was an addict or she couldn’t handle his violent post-traumatic stress episodes.

There was a policy at the shelter that if you presented as intoxicated or if SAC (substance abuse counselors) had any suspicion that you were hooked on some drug, you were tested on the spot and given a choice: Detox or get out.

I speak about homelessness as a business and the detox side of homelessness was big business. Most alcohol-addicted vets took upwards of thirty days to wean themselves off of the dependency of alcohol. During this time they more often than not were in a detox facility that charged the insurance of the homeless (Medicaid), or if the vet were lucky enough to get into a VA detox, the same thing occurred you and I, with our taxes, paid for this service. What always amazed me, but shouldn’t have, was once the veteran was dried out, the detox facility usually sent them right back into the lion’s den, right back onto the streets with little to no follow up.

Let’s take a look at some math. If a detox program averages thirty days, and if the insurance paid $125 per day (I think it’s more), then the average detox stay for an Alcoholian was $3,750.00.

I know off the top of my head that vets we serviced sometime needed three, four, and maybe ten detoxes to get free of alcohol. You can see the investment.

Only those who have been touched by the effects of someone they love being an alcoholic can fully appreciate what I am telling you. It’s as if the veteran fell down Alice’s hole and what you thought you knew, you didn’t.

Ninety percent of all the vets who presented at intake at the vet shelter were drug or alcohol addicted.

Ninety percent of those were Alcoholians.

It would seem that if anyone wanted to get serious about making inroads with the homeless veteran, one of the first things they would want to do is to increase the capacity of detox beds nationwide. The larger the city or region, the more need for detox beds.

The second thing you would want to do is to ensure that upon discharge, the homeless veteran was placed in a program of some kind. Halfway house, sober house, something that allowed the veteran to continue on a path of recovery. It’s a huge gap in the treatment system and one that is as prevalent today as it was twenty years ago.

Homelessness is a business. Detox facilities get fed clients from the population of the homeless. I would venture to say that they get better than half of all their clients from this environment. Someone or some agency should study this issue, as I am sure that hundreds of millions of dollars are spent each year drying out a homeless Alcoholian and then a month later, he checks into another facility.

When someone leaves detox there needs to be better aftercare planning. It’s a waste of time and effort to work hard to dry someone out and then send them right back to the exact same environment that got them alcohol addicted in the first place.

When it comes to detoxing a heroin addict the price increases and the success rate drops. Weaning someone off hard core drugs takes patience and medical care. What perplexes me is that no one has come up with a better option than methadone.

I have first hand experience with the Methadonians. Each time a Methadonian goes and gets the dose of daily methadone, within an hour they are glassy eyed and most just want to nod off.

After seeing this at the shelter a number of times, I made a hard and fast rule: no sleeping during the day. This angered the tribe so much that one day they picketed the shelter. Most everyone who participated in this picket of the shelter were Methodonians, and it included tribe members from other shelters. There must have been sixty Methadonians who were walking in a formation like they were in a union picket line right outside of the shelter. All were chanting, “Hey, Hey, ho, ho, Ken Smith, has got to go.”

Mark Helberg, another founder said, “The media is on the way and we need a plan.”

From inside the shelter it was hard to look out to the front of the building, but I was alerted by security that a couple of TV trucks had just pulled up outside and a few print reporters were outside too.

I waited maybe ten minutes and walked right out the front door and approached the one Methadonian who I knew to be the “alpha” of the group. This guy (whom I will call Mike) was street savvy and I saw him talking to a TV reporter. A few of the group shouted “It’s him. It’s Ken Smith,” and that caused the TV reporter to turn to me and the camera man too.

I walked up to Mike the Methadonian and said, “It’s a little chilly out here today Mike, so I’ve instructed the mess sergeant of the kitchen to serve you guys hot black coffee while you’re picketing,” and then told the TV reporter that this group of former heroin addicts were picketing the shelter because we wouldn’t let them come in and sleep during the day.

The TV reporter, sniffing a story said, “Are you discriminating against former addicts?”

“Absolutely not,” I said. “Each of the veterans in the shelter fought for the right of these guys to picket us, and while we disagree that taking heroin is a lifestyle that is good, they are all still veterans out here and when they decide to stop nodding off after taking drugs we will let them back in.”

The group again started with “Hey, Hey, ho, ho, Ken Smith, has got to go.”

Just then the mess sergeant walked outside pushing a cart with a coffee urn and paper cups and said, “Hot coffee-getcha hot coffee here,” almost like he was at Fenway Park.

That night, all three of the major TV stations played the picket of the shelter on the news and within ten minutes of it playing the phones at the shelter lit up.

“Good for you guys, good for you standing up to those jerks,” was the most frequent response.

“I was a heroin addict once, and you’re right, they need to get off methadone,” said a few.

Mostly, the big picket line was a bust.

And then there were the pills.

After having the shelter open a month or two, it was obvious to me that the pills that were handed out at the VA like Chiclets were a commodity that was traded on the streets.

In response, we started a program where every single vet needed to turn in all of his medication to “sick bay,” and each of the vets then had a container supplied where the meds were stored. We didn’t allow anyone to have anything, Tylenol, aspirin, eye drops, nothing.

At first this was a huge pain in the ass. It meant that we were in charge of every homeless veteran’s meds and since no one took their pills at the same time, the sick bay was always busy. At the same time, some of these pills were related to legitimate pain management, and that worried me.

Mark came up with a great idea and had the medics rotated around in the sickbay and nobody knew until that day what medic job they would get.

At the same time, Mark (who is very good with numbers) had an audit done on all the pills and he did this on no set schedule. One day it was on a Monday, and a week later on a Tuesday and then two weeks later on a Saturday.

During the time that we were handling the pills of the vets, not one vet complained about having his medication stolen.

It was a few months later that an older vet came up alongside of me in the dinner line and said, “You have no idea, do you?”

“Idea about what?”

“You have no idea how great it is that I don’t have to fend off the nitwits who were always after me for my pills. I have cancer and cancer pain and the VA has given me a prescription that controls that pain and now, all I need to do is go to sick bay, sign out my dosage, and bingo, I am as right as rain.”

One tribe that didn’t like the new policy of handing over all your medication was the Neuroliptians and the Psychotropians. They were selling their pills out on the street and this policy put a dent on that quick.

At the same time, we saw an improvement in that tribe as nobody now had to remember to take their meds. There was a med call every evening at six o’clock and again at nine, and then the medic would do an audit to see who did and who didn’t come for their meds. We made a rule that if you missed med call twice, your privileges at the shelter were reduced. It had an impact.

“What we do to the homeless vets who have psych problems and are on the streets is borderline criminal.” That was true 20 years ago and it’s true now and someday, someone is going to formulate a better plan than handing a bucket of pills to someone who needs to take one a day, every day, whether they think they need it or not, because if they don’t, they rocket off to the dark side of the moon. No veteran should be in that position. What happens frequently is that they start feeling good, they don’t take the pill, and before they know it, they are baying at the very same moon the pill is helping to keep away.

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