Addict oppression: the (nonmedical) resource gap
Addicts are denied opportunities and positive assistance available to nonaddicts.
Previously in this series, I’ve discussed two common forms of addict oppression.
Next up is the resource gap: the systematic denial, in virtue of addict status, of opportunities, interventions, benefits, and various auxiliary forms of assistance granted to otherwise-similar nonaddicts. As I wrote this, it turned out to be way longer than even the intergenerational erasure entry. (Yeah, I know. I have a problem.) So I’ve divided it into two sections: non-medical (this entry) and medical (separate).
The resource gap
I won’t be able to enumerate every instantiation of the resource gap here. There are all kinds of ways to not get stuff that otherwise-similar people are getting. For instance, it can mean either having medication withheld from you (on the grounds that you might abuse it) or having the opportunity to get off medication withheld from you—both of these are manners in which the clinical standard of care can be denied. More so than the oppressions discussed thus far, this one works in a bunch of intuitively opposite ways. But the resource gap does not cover any and all ways in which addicts at large are treated differently than nonaddicts, or penalized in ways nonaddicts aren’t. Drug testing as a parole condition is a paradigm example of the resource gap, but disproportionate incarceration isn’t. That is because the absence of carceral-clinical interference is not (or is not generally construed to be) a privilege granted to nonaddicts but denied to addicts. The carceral-clinical seesaw involves people doing things to you, against your will, whereas the resource gap involves people failing to assist you when you request assistance.
Is there a real distinction between those two things? I don’t know or care. Whether there exists some meaty difference between action and inaction is irrelevant to my purposes here. The addict oppression schema I provide is gappy, gerrymandered. That is because mechanisms of oppression work in gappy and gerrymandered ways. I devised this four-part taxonomy in response to what I see as the realities of how addicts are oppressed. It’s socially contextual. Regardless of whether imprisoning people is different in a moral sense that denying them SNAP benefits—indeed, regardless of whether moral “rights” exist—these two mechanisms are levied in different ways, justified through different explanations, and associated with different consequences and experiences.
Finally: There are plenty of systematic mechanisms by which addicts are provided opportunities not provided to nonaddicts, but in ways that are predatory in light of their addict status. For instance: recruitment to exploitative clinical studies. While the resource gap is a grab bag, it’s not permissive enough to cover this sort of thing. I don’t mean “resource gap” to cover bidirectional asymmetries in the opportunities provided to addicts and nonaddicts. What entries under the resource gap heading have in common is that they worsen one’s material conditions in immediate and tangible ways. Meanwhile, the results of the provision of payment conditional on study participation are not as uniform. The reason it’s bad isn’t that it makes addicts, intrinsically and invariably, worse off. Sometimes it doesn’t! It’s bad for a different reason, which is that it is exploitative (as are the other forms of economic exploitation I’ll describe in the next post).
Moreover, the genesis of predatory offers is totally different from that of the resource gap. The resource gap—like the carceral-clinical seesaw and intergenerational erasure—encapsulates efforts to frustrate addicts’ participation in the human project. But, as I mentioned at the end of the last post, economic exploitation is somewhat disanalogous from the other three elements of my taxonomy. The functioning of each of these first three elements hinges on the desire to push addicts and our communities out of the way, usually in reaction to the sentiment that we, or the futures we might create, are dangerous. Economic exploitation operationalizes a totally different motivation: the desire to use addicts, to produce capital through us.
So anyway, I’ll now run through some examples of the resource gap, which will hopefully facilitate understanding of what I mean by it. This entry will cover access to material aid: shelter, welfare, income, and so forth. The next will consist of a discussion of medical inequities.
Conditions on shelter and welfare
Various public and private aid mechanisms exist to facilitate homeless and poor people’s access to housing, temporary shelter, and food and financial assistance. But homeless and poor addicts are often systematically excluded from such relief efforts. Homeless shelters drug-test and breathalyze potential residents; one Michigan shelter charges incoming people $3 per test. Zero-tolerance policies are increasingly common, as is having one’s possessions and person searched for drugs and other contraband. One story reports that at the only emergency shelter in Fitchburg, staff members check residents’ socks.
Low-barrier and sober shelters
Some homeless shelters are “low-barrier”: accepting clients who have recently used drugs (and in some cases permitting drug use on-premises). Others are “sober” or “dry” and turn away residents for drug use or addiction. The latter category often makes use of drug tests to determine resident admissibility, the legal status of which has long been under dispute. The political landscape for low-barrier versus dry shelters is an odd hodgepodge. Cities and polities have banned low-barrier shelters, often in response to uproars about crime and safety concerns for the housed population. But some state legislation limits or illegalizes shelters’ turning away residents for drug use or addiction. Such endeavors are ineffective (indeed, counterproductive) for several reasons. First, some shelters just test anyway, or use less explicit means to discern addict status. Second, the restrictions apply only to shelters that receive substantial funding from the government; privately funded shelters are unaffected. And finally, even among the publicly funded shelters, many close rather than comply with anti-testing policies. In response to a Connecticut Department of Housing policy that shelters receiving funding cannot drug-test clients, the Manchester Area Conference of Churches opted to shut down: “The organization lacks the staff and funding to supervise active alcohol- and drug-abusers overnight,” said director Beth Stafford.
Hence shelter deserts are created: no wet shelters exist within large radiuses, or the only ones that do cannot meet demand. A Los Angeles Times article from this February conveys the time-sensitivity with which residential coordinators of a Victorville homeless services program frantically shuffled residents who passed drug tests into their dry family shelter to free up beds at the other shelter in advance of the lethal oncoming storm. In such situations, homeless addicts are forced to compete with nonaddicts for limited shelter space. An article describing the large homeless population in Boston speculates that some homeless people “can’t stay at many of the emergency shelters around the state, because of rules requiring sobriety.” Homeless Illinois resident Demond Reeves explicitly draws this connection: the introduction of drug tests at the community shelter in Champaign “made my life a lot harder.”
The intra-community dispute justification
Competition between dry and low-barrier shelters manifests in further demonization of addicts. The varied interests of homeless addicts and homeless nonaddicts are played against each other to justify oppression. The aforementioned shelter that charges homeless people for drug tests appeals to the rationale that “having drug users around makes it more difficult for those trying to get clean.” (Another: “Mixing intoxicated and drug-addled clients with those who are seeking treatment and trying to change their lives would not work.”) Describing homeless addicts’ drug use as a threat to housed people sounds sensationalist. Characterizing it as a threat to the users themselves sounds insincere. But identifying the victimized group as other homeless addicts apparently justifies the policy. It frames the decision calculus as involving tradeoffs between the well-behaved and poorly-behaved subsets of the homeless population.
“Sober living clients should be put first in line for our public resources…But often unintentionally, they are put at the back of the line for help.”
-Washington State Representative Jim Walsh
The public perception of an intra-homeless conflict, sober-versus-using, both reinforces the notion that addicts are dangerous (in this case, to other homeless people) and facilitates a double bind. To be an active addict means being viewed as representative of homeless people at large. Successfully remitting makes you an inspiration—but the exception rather than the rule. And it allows tough-on-homelessness politicians to point at you as justification for stringent sobriety standards imposed upon your community. “See? They can get sober!”
The whole endeavor both relies upon and perpetuates the crabs-in-a-bucket narrative about the social mobility of marginalized people. On this view, the continued material hardships of oppressed groups are a result of their members’ unwillingness to see each other succeed. They’re tearing each other down. The call is coming from inside the house; privileged people are patiently waiting with open palms to uplift the poor, but sabotage by their own friends and family prevents such unfortunates from climbing out of the pit. These just-so stories are widespread: Black people are the ones who really want more policing. Disabled people are the community calling for access to euthanasia, and the disabled people who call MAiD genocide are harming other disabled people in so doing. Queer writers have been critical of the similar claim that homophobes are secretly gay, arguing that “the assumption that self-loathing is at the root of homophobic acts is…a convenient absolution for straight people.”
The intra-community dispute narrative says: Sure, there are some marginalized radicals. But the people who want moderate policy are also from the marginalized group, and isn’t the whole point of including them in the discussion about listening to them? These interpretations describe marginalized communities as succumbing to tumultuous infighting, too confused about what they want to be put in charge of policy about themselves. The (trivially obvious) claim that marginalized people as just as varied in opinion as anyone else does much more work here than it should: it implies they have no special standing in the debate. In order to, they’d have to be a monolith. (Of course, this is not a standard that non-marginalized people are held to when developing policy about themselves.)
Housing inequities
It’s hard enough to get access to a shelter as a homeless addict.1 Access to long-term housing is even tougher, as abstention from controlled substances is often a requirement for residence—common across lease agreements everywhere, but enforced to far greater degrees in interventions meant to house the homeless. Public housing programs are already subject to restrictions—applicants are screened for alcohol and drug use—and more are likely on the way.
In relief against this resource gap, the Housing First approach has revolutionized solutions to homelessness by doing exactly what its name says. From the National Alliance to End Homelessness website: “Housing First does not require people experiencing homelessness to address [their] behavioral health problems, or to graduate through a series of services programs…either before obtaining housing or in order to retain housing.”
But it’s under fire, and often a prime target for widespread sensationalist narratives about the trifecta of homelessness, Madness, and addiction in major U.S. cities. A federal legislative bill limiting the amount of funding to Housing First Services was just proposed by Andy Barr. Petitions and polemics abound demanding the restriction of such housing. One such article is Cicero Institute advisor Judge Glock’s 2022 piece on the awful wage of housing active addicts. This is a representative case of arguments against these policies, so I’ll discuss it in some detail.
If you don’t read closely, the piece looks like it cites evidence backing up its conclusions. But in fact it is—like such articles often are—filled with unreasonable interpretations and blatant falsehoods. I’ll start with the latter. Here’s how Glock describes the frequently-used VI-SPDAT tool for homeless care triage:
In a typical VI-SPDAT survey for single homeless adults, a homeless person can accumulate “points” toward free housing. He can get a point if he has “run drugs for someone” or “shared a needle.” He gets another point if his drug abuse got him evicted from an apartment. There’s another bonus point for taking medication other than “the way the doctor prescribed,” or selling the medication. For crime, the system awards a point if the homeless person has tried to harm someone in the last year, another for being the “alleged perpetrator of a crime,” and yet another for landing in a drunk tank, jail, or prison. If the person does enough drugs and commits enough crimes, he can get six total points. With enough time on the streets, he can get to the necessary eight points toward a free house, without showing any other issues, apart from criminal behavior and drug abuse.
This is untrue. Here’s the relevant section of the VI-SPDAT. (I’m not being selective or taking advantage of the fact that some assessments are different than others; VI-SPDAT is pretty ironclad and this is the version he links to.)
Being the “alleged perpetrator of a crime” and “landing in a drunk tank, jail, or prison” do not stack in the way Glock claims. If both these conditions are true of you, you can still get a maximum of one point toward the 8 for Housing First. You can’t get one point for being an alleged perpetrator and “yet another” for going to jail. The maximum number of points a person can accrue in the way Glock describes is 5, not 6—and that’s only if the “total number of interactions” with the carceral or clinical structures exceeds 4. I suppose it is theoretically possible that some guy out there deliberately decided to perpetrate 4 (four) crimes for the express purpose of getting one point towards Housing First. (But then, assuming he’s scheming in the perverse-incentive way Glock seems to think, wouldn’t he just call the suicide prevention hotline four times?) However, that is a much more tenuous connection between criminal activity and housing priority than what Glock describes.
I don’t mean to be pedantic about this. It makes a difference to the argument, for it’s not clear to me how Glock makes his imagined villain for Housing First on the basis of only crime and drug use. Being 60 or older is worth a point, as is more than 1 consecutive year or four episodes of homelessness, but that only takes the total to 7.2 These sorts of errors extend to the paragraph following the one I quoted, wherein Glock describes the family version of the VI-SPDAT.
For families—almost always, single mothers—the scoring system rewards both drug and child abuse. Beyond the usual substance-use points, mothers get a point if children are frequently truant. They get a bonus point if their child spends two or more hours per day without any responsible adult around. Incredibly, a mother can also get a bonus point if child protective services has removed one or more of her kids. Having “two or more planned activities each week,” such as going to the library or park, is a negative on their benefits score.
Here’s the family triage tool. Again, Glock’s claim that “child-abusing” parents get freebie points that make them more likely to qualify for housing, all else equal, is simply untrue. The way he says it, having “two or more planned activities” per week imposes a minus on your overall score. What is actually the case is that not having two planned activities gives you a point which can also be accessed through other means, with one maximal point for the section (similar to the setup of the individual checklist excerpt above). Having frequently unsupervised children (which he mentions as if it’s worth an additional point) is instead a way of getting this same point. As is elder children’s participation in younger children’s care. All of these correspond to the same single possible point, accessible through any of these means. His pile of bonus points comes out of nowhere! I guess the charitable explanation is that Glock doesn’t understand how the VI-SPDAT tool works.
In other respects, his rhetoric is more journalistically irresponsible than factually incorrect. For example, it is true that parents can get up to one point for a child’s CPS removal. (Again, this point can also be conferred by other mechanisms. For example, a homeless DV victim’s filing or intent to file against their abuser would qualify them. Victims of DV who haven’t lost custody are not penalized relative to those who have.) But homeless parents also get a point for getting their kids back! Or for any other change in who lives with you.
Basically, he’s reading way too much into how the VI-SPDAT assigns points. It’s just a list of things that might happen to homeless people, weighted and assorted in arcane ways. Are the criteria somewhat spurious? Yes. Welcome to bureaucracy. But it’s not accurate to say they benefit criminal addicts at the expense of law-abiding nonaddicts. Any point (or partial qualification toward a point) theoretically obtainable by alleged criminal activity is also attainable through criminal victimization. A person actually disadvantaged by this survey would have to be homeless but leading a life otherwise precisely resembling that of a housed person. That’s the tough-on-crime canard of the noble homeless, but it isn’t a kind of person that exists. The way homelessness works is that it makes you vulnerable. Hence the endeavor to get homeless people into housing.
Glock also cites studies in a misleading way—interprets them as backing up his conclusions when in fact he wildly cherry-picks the elements of the relevant studies to downplay and highlight—and appeals to rhetorically sensationalist strategies by presenting tautological facts as shocking. For instance, in service of the claim that Housing First programs “actively encourage drug abuse” and therefore directly cause overdoses, he cites a study by Rebecca Cherner and coauthors that he claims shows “the homeless placed in supportive housing are more likely to abuse drugs and alcohol than those left on the streets” (emphasis his).3 This implies that the housed addicts’ substance intake increased or at least didn’t decrease. But that’s not what the authors say! It’s rather that their intake rates reduced more slowly, as even a cursory look at the abstract of Cherner et al.’s paper reveals. They write that for alcohol, “both groups improved over time,” and that for non-alcohol drugs, “the comparison group had a greater decrease…by 24 months.” But they emphasize that the physical health and “community functioning” of the two groups were similar, and that the immediately-housed addicts were longer-housed and had less housing attrition. They conclude that “adults who are homeless with problematic substance use can successfully be housed using a Housing First approach,” and remind the reader that housing alone isn’t a panacea.
This is representative. Indeed, many studies on Housing First policies have found no significant differences between the substance use of populations housed only on condition of maintaining sobriety and those granted immediate housing. In one such study by Tsemberis et al., while “utilization of substance abuse treatment was significantly higher for the control group” (obviously), “no differences were found in substance use” Others find similar results, sometimes without differences in medical treatment sought. Shelter-based projects have found that homeless alcoholics fare excellently in terms of health and carceral outcomes when their consumption is reduced rather than forbidden. Even a study exhorting caution in implementing Housing First policies and appealing to some of the crabs-in-a-bucket justifications I described above—“clients who were required to maintain abstinence began abandoning the provided housing, complaining that their proximity to persons not required to remain abstinent…was detrimental to their recovery”—praises the organization of Tsemberis et al.’s study and concludes conservatively that further research on the efficacy of Housing First is required.
Before moving on to discussion of welfare more generally, I want to draw your attention to two salient features of Glock’s article. The first is this: The guy just hates us. In his discussion of harms reduction, he sneers at St. Ann’s Corner’s policy of employing addicts to counsel other addicts: “What a current drug abuser could tell another, besides how to score, [is] unclear.” (Umm…how to minimize interactions with law enforcement? How to mitigate withdrawal symptoms? Good God, the nons have absolutely no mental model of us. We’re like drug-seeking automata to these people.) He calls homeless addicts “incorrigible” and “damaged individuals,” adding that “the government is paying them to kill themselves and one another.” (That implication is common in other such pieces.) Every single one of the five times Glock mentions substance use disorder, it’s in quotation marks—he heavily implies it isn’t real, and bemoans that Congress accepted it as a disability “without any seeming debate.” Keep that in mind when you think about the second thing I want to point out, which is the following excerpt from the same article:
One resident [d]escribed what happened when he moved from a recovery house, which required sobriety, to a low-barrier supportive-housing unit: he quickly bumped into a neighbor on his floor who was smoking crack—and [he] relapsed.
This, again, is the classic tough-on-crime tack of pitting addicts in active use against addicts in remission. It draws attention to the apparent rights conflict between different members of the homeless addict community, and uses that as an excuse to make a tough call. But I want to concede that a lot of people who raise those arguments do mean well. Even I point out in one of my other posts that it’s tricky when some addicts want to use and some don’t. It’s easy to inadvertently play into the deployment of intra-community infighting as a mechanism to prevent change. That doesn’t mean the people who succumb to it don’t care about the well-being of those parties. Many do!
One of the things that happens to you very quickly when you learn you are an addict is you develop the ability to distinguish between the people who deploy rights-conflicts narratives like this innocently and those who deploy them cynically. People who work in sober shelters are usually in the former category, while people who push this competing-objectives story in order to criticize Housing First generally fall into the latter. They think nonaddicts are good and active addicts are bad, all else equal. Addicts in remission are okay if they stay remitted, which should be easy because all you have to do is not use drugs. So, come on. As soon as the man in this story relapsed, he sustained a category shift and stepped outside the scope of concern of someone like Glock. If addiction is a choice, as Glock says, then relapse is a choice. I don’t generally use the phrase “concern trolling,” but this is it if I’ve ever seen it.
So what I need you to understand is this. If you genuinely think Judge Glock cares whether the relapsed crack addict whose story he uses to push his agenda lives or dies, you are being had.
Welfare and benefits
A 2011 New York Times article reported that at the time, 20 U.S. states refused unemployment for people whose job loss was a result of drug use, and close to that number forbid drug felons from accessing welfare. That year, lawmakers in 36 states introduced legislation facilitating drug-testing as a precondition for various forms of government benefits: housing (as we’ve seen), welfare, unemployment, job training, and more. The most stringent of these was Florida’s, requiring potential recipients of aid to pay for their own tests. (It passed, and provoked an ACLU lawsuit. The ACLU won, but the adjudication was drawn out for years.) Originally practiced only in the U.S. and New Zealand, pilot programs have been implemented in Australia and considered in Canada and the UK. Similar endeavors are under consideration all over the world. (Many U.S. states have also proposed drug testing as a condition for SNAP.)
Meanwhile, 15 U.S. states have implemented policies instantiating some variant of testing as a requirement, and others have found creative loopholes to avoid doing so outright. Pennsylvania introduced a program of randomly testing recent drug felons and people on probation in 2012. Other states make use of drug tests only when applicants self-report substance use in response to formulaic questionnaires—almost every state includes such questions in welfare applications—despite evidence that such reports are not actually predictive of positive drug tests. Unfortunately, whatever the states are doing is working: the questionnaire model produces addict attrition from applying in the first place. A study by Pollack and Reuter found that the proportion of low-income substance-using mothers receiving welfare assistance decreased by 16% from 1996 to 2001, while the decrease in the proportion of otherwise-similar nonusers accessing welfare in the same time period was only 6%.
It is unequivocally true that states spend far more on drug testing than they save. (In 2017, U.S. states spent over $490,000 drug-testing around 2,500 applicants to the Temporary Assistance for Needy Families (TANF) program (finding only 300 positive tests). Utah spent $30,000 in testing in 2012 but found a positive rate far below the national proportion. Arizona and Oklahoma have been criticized on similar grounds.) But appeal to the cost-benefit analysis as the primary reason not to implement wide-scale testing policies is unwise and will backfire. It cedes the extremely important claim that if states that tested all welfare applicants and withheld aid from those with positive tests were in the black, then their doing so would be unproblematic—which is absurd. The problem is not, at its heart, pragmatic. It’s with the concept that being an addict or drug user bears in any relevant (negative) capacity on whether one should receive aid. To complain about the costs does not challenge the concept that addiction theoretically should disqualify poor people from government financial assistance (but that most of the time that’s not an issue for those people because privacy laws forbid states from testing for it). It critiques the ways in which states are currently operationalizing the mandate to vigilantly sniff out whether poor people are addicts. It leaves unquestioned that addicts will use their benefits to pay for drugs, that allowing addicts access to welfare will incentivize drug use, and that those two things are indisputably terrible. In fact, even well-meaning liberals reveal their opinion when they say things like “All this does is perpetuate the stereotype that low-income people are lazy, shiftless drug addicts.” That indicates that drug addicts are lazy and shiftless, and that the reason the states shouldn’t test is that it won’t turn up positives.
Anyway, in most U.S. states you can’t drug-test welfare recipients without cause, but forms still require drug use disclosure, which is just a legal way of getting across to addicts that they will not be provided assistance. Something similar is true for social security (SSDI or SSI). Not only does addiction not qualify as a disability for the purposes of social security, but it disqualifies otherwise-qualifying candidates. Technically, applications to SSDI or SSI cannot be denied on the basis of substance use alone. The Social Security Administration (SSA) can, however, deny benefit claims for disability it determines to be downstream of substance use. This works in particular against addicts whose medical records contain an SUD diagnosis: the examiners must “assess whether drug or alcohol dependency is, in Social Security parlance, ‘material’ to determining whether you are disabled.” (Notably, it treats alcohol and illegal drugs differently from prescribed controlled substances for this purpose.) Even addicts whose addiction status is totally irrelevant to their disability suffer discrimination under the current SSI/SSDI rules. To be an addict at all (as determined by the SSA) in many cases means that a “representative payee” must be assigned—the applicant does not receive the money directly.
Drug testing and employment
Addiction status also plays a central role in employment, again through the ubiquity of drug testing. Both Carolinas, Tennessee, Nebraska, Mississippi, Maryland, Alaska, Utah, and Louisiana, among other states, place no or almost no restrictions on drug testing job applicants. Testing employees is also legal in many states, often not subject to many conditions. The ACLU has challenged the suspicionless drug testing of public sector employees (and sometimes won—for example, Florida governor Rick Scott’s 2011 executive order requiring random drug testing for over 80,000 employees didn’t stick). They’re very good about this, but the problem persists. Drug testing prospective hires is still widely done (I’ve had to drug test several times in order to volunteer at a data entry job in a hospital). The 2022 CCG Employer Drug Testing Survey found that 87% of the employers surveyed carry out some form of lab-based urine testing (for 42%, instant urine testing) and 75% make use of some form of alcohol testing. Several major hospitals have only recently reversed course on random drug-testing employees, but continue testing “during the hiring process, for reasonable cause, and following any accidents or incidents that may occur within their facilities.”
Pre-employment screenings are generally not considered problematic because failing them is thought to have no consequences. That’s not true! In Kansas City, failing a pre-employment drug test carries a five-year ban from applying to any other city job (Local 955 is fighting this at the bargaining table). This is a paradigm example of what I mean by “resource gap.” Addicts aren’t only less likely to be hired than nonaddicts; often, they are prohibited from applying in the first place!
There are ongoing mass panics about the degree of substance use among first responders and teachers. The Quest Diagnostics lab analyzed over 6 million tests last year, among which marijuana positivity was 4.3%, over a quarter million, and a 25-year high. It’s a fireable offense at many companies even in the states where cannabis is legal. (Medical cannabis cards have not helped fired workers.) And those 6.3 million tests excluded those of the workers federally mandated to take drug tests for performance-safety reasons…
Performance, safety, and smoking gun justifications
…which is not to say that drug-testing pilots or mail truck drivers is therefore unproblematic. As I keep saying in this post series, there are always facially sympathetic justifications in play—children’s best interests, the welfare of sober homeless people—that are not the real motivation for implementing the policies whose architects appeal to them. In this case, the just-so story is, “It’s important to drug-test people for workplace safety reasons.” People operating high-risk machinery. People who’ve recently been in workplace accidents. Those whose behavior seems suspicious. But let’s look at how those policies are actually implemented.
Earlier this year, the American Postal Workers Union exposed that the USPS testing contractor (Concentra) required drivers (workers in a dangerous occupation, for the purpose of drug-testing legislation) to submit a medical record release form! Those who refused were “denied the opportunity to take the drug and alcohol test.” That’s counted as a positive test; it’s reported to the database and results in suspension. The release form read:
I give Concentra authorization to release to my employer, insurance company, and their representatives…any medical information, including any psychotherapy notes, psychiatric information, sexually transmitted diseases, alcohol and drug abuse and/or HIV/AIDS status, which is obtained as part of the evaluation and/or treatment for this work-related injury/illness or employment-related examination.
This indicates, of course, that what the employer really cares about extends far beyond positivity on a drug test as conducive to work performance. Absent a nuanced understanding of the inflation of the “addict” category as conveying HIV risk, STDs, and “psychiatric information” (and often to compel militant concern for pregnancy), we would be less able to make sense of why employers would be interested in this information.
Well, what about testing after workplace injuries? Shouldn’t the company check for intoxication, to protect the health not only of other workers but of the injured parties themselves? No. The reason that companies carry out post-incident drug tests isn’t worker safety. It’s to dampen reporting and create liability excuses. A 2009 AFL-CIO-affiliated study found that 70% of the workers surveyed “reported that their workplaces had mandatory drug or alcohol testing following a workplace injury”; 60% of such policies produced a chilling effect on injury reporting. Workers’ compensation attorneys link mandatory post-incident drug testing to state laws that provide employers with a defense against compensation claims if they can demonstrate intoxication. But I didn’t even need to provide a link for that one. Obviously that’s the reason employers conduct post-accident drug tests!
Take the Crest Hill plant of the Rich Products Corporation, a site storied for its recent deluge of workplace deaths (and, after the death of Adewale Ogunyemi, one of a small number of companies to be tagged for OSHA’s Severe Violator Enforcement Program). Last year, another processing plant worker was badly injured when her arm was pulled into a machine. The site safety manager took her to an “urgent care facility,” where—rather than being immediately treated for her mauled arm—she was asked to take a drug test. The worker demanded to be taken to the hospital instead. She was, but the next day she was fired, her refusal of the drug test given as a reason. Similarly, a Vegas casino worker who suffered an injury and was subjected to a drug test for it was fired when the test came up positive for marijuana—even though he was not high at the time of the injury and cannabis is legal in Nevada. The Nevada State Supreme Court found in the employer’s favor in 2022. (Its reasoning was that cannabis is federally illegal; this is a common justification.)
OSHA used to be on the worker’s side here. In 2016, they ruled that employers must “demonstrate a reasonable possibility that employee drug use could have contributed to the reported injury or illness before conducting post-accident drug testing.” That went on the chopping block two years later: “The Department believes that many employers who…conduct post-incident drug testing do so to promote workplace safety and health.” Don’t be fooled by the radical-sounding policies in the likes of California and elsewhere against pre-employment cannabis screening; they don’t make a dent in the perverse incentive to drug test after accidents. The deck is already rigged, and some states are in the process of making addicts’ access to redress even harder. A current Iowa bill proposes to change the standard of evidence in the employer’s favor in the review of drug-test-related lawsuits.
Meanwhile, the safety-sensitivity exclusion incentivizes companies to redescribe jobs as dangerous without modifying the actual job parameters, in order to legitimize drug testing their workers. A class action lawsuit against Amazon’s pre-employment drug screening policies was thrown out in NYC on the grounds that exemptions for marijuana-positive tests did not carry over to occupations involving heavy machinery operation. But the tested applicants maintain that that wasn’t the job description for which they’d applied. (And, nonsensically, Amazon later reversed course and changed its policies, stopping testing for this role.)
Opacity around drug tests for those working in dangerous jobs fosters a climate of one-stop, dogmatic reaction verging on absurdity. Last year, one American Airlines pilot’s badly botched routine random drug test made the news. According to Forbes, the personnel conducting the test asked for someone by the name of David. When the pilot truthfully said that wasn’t his name and walked away, she marked him as having refused the drug test. American Airlines immediately suspended and later fired him. (The courts sided with the pilot.) A manufacturing plant violated federal law by suspending a remitted opioid addict until he stopped MAT—despite the fact that medication-assisted treatment like Suboxone is totally compatible with carrying out the responsibilities of a dangerous job. When a bus administrator sought recourse after being fired for a positive test attributable to prescribed amphetamine use, his company allegedly leaked his drug test results to the news. I’ve said it before and I’ll say it again: These companies aren’t individual bad actors, perniciously scheming against the grain of a society generally geared towards workers’ interests. These are just the institutions that have been caught doing this sort of thing. The way legislation is set up—in particular, the fact that addicts are uniquely excluded from the scope of much worker protection legislation—incentivizes the vigilant drug testing. Companies that take the honorable route are at a comparative disadvantage.
I want to briefly add that drug test positives are often spurious. (Roadside and prison drug tests are well-known to be inaccurate, and absurdly, you can in fact test positive for opioids if you’ve eaten a poppyseed bagel, especially when tests render positives for extremely low thresholds.) But I won’t dwell on that. I don’t want to play into the narrative, sympathetic to nonaddicts, on which the rationale for stopping drug-testing is that it’s ineffective and wrongfully harms nonaddicts. Media articles about the pilot I mentioned above emphasize that, once contacted by the airline, he immediately took a drug test which came up negative. The bus driver was using a prescription medication as directed. “These people aren’t addicts! The mechanism for preventing addicts from having jobs wasn’t working correctly! We need to change it!” Nobody advocates full-chestedly for addicts’ rights. They criticize drug testing by drawing attention to situations in which nonaddicts are caught up in it.
No. I am against penalizing addicts, which is what employment-related drug tests are supposed to do when they work correctly. If you still feel like invoking exclusion clauses—“but what about school bus drivers?”—I implore you to keep in mind that the purpose of drug-testing safety-sensitive workers is not to prevent accidents. The use of such legislation to license drug testing of non-safety-sensitive workers by changing the job description (as in the Amazon case above) makes that clear. It’s to prevent drug users in general, and addicts specifically, from having jobs.
One final excerpt I want to bring your attention to—again, from an author ostensibly sympathetic to the interests of homeless people and addicts—is this, from a Yale Law Journal monograph describing inequitable hiring practices towards homeless candidates.
If employers are concerned that homeless people are more prone to substance abuse, they can refrain from asking for addresses and employ less discriminatory approaches such as testing all applicants for alcohol and illegal drug use, as long as procedural and legal requirements are met. A number of employers—including Target, Sears, and Kohl’s—already note in their applications that prospective employees may be compelled to submit to drug screening as a condition of employment. Indeed, fifty-seven percent of private employers in 2011 reported administering drug tests to all potential employees. Plaintiffs who have been denied jobs because they are homeless should have little difficulty in proving that employers might employ less discriminatory measures to ensure that their workplaces are drug-free and that employees are stable and reliable.
I think this is just, like, really transparent. “Change the practice of spurious drug testing so that it’s not obviously illegal, holding constant the desired results.” After all, this is supposed to assuage employers’ concerns that homeless people are disproportionately addicts! The thrust of its appeal is that it’ll eliminate that same group of undesirable hiring candidates. It will merely do so without stepping afoul of the law.
There’s a well-known story about quippy philosopher Sydney Morgenbesser that goes as follows. Morgenbesser was advocating for Columbia students during their 1960s Vietnam War protests, and the cops showed up and clubbed him—and a bunch of other protesters—over the head. Later, Morgenbesser was asked whether he’d been treated unfairly or unjustly by the police. He responded that his treatment was “unjust” (they’d clubbed him on the head) but “not unfair” (they clubbed everyone else too).4 The approach described in the above excerpt strikes me doing the same, but sincerely. “Not fair! You ought to hit everyone else, not just me!” As Morgenbesser slyly pointed out, that’s obviously misguided. Clubbing people over the head remains wrong even if universally applied.
I think this exhortation to balloon oppression out—we shouldn’t be drug-testing just homeless people—is a classic example of what happens when we don’t conceptualize addict oppression. It’s a reductive view on which the only way in which systemic oppression can happen is profiling, not entrapment. On this view, being subjected without cause to a drug test is oppressive; the systemic use of equitably applied drug tests for the express purpose of getting rid of homeless people and addicts isn’t.
I imagine it must be hard to hold this sort of stance and consider oneself progressive. Your whole argument is immediately kneecapped by any evidence that marginalized people are disproportionately doing the thing you’re trying to test for: drug use, criminality, whatever. It seems to commit you to saying, “If police didn’t profile and target poor Black people in particular, they wouldn’t be overrepresented in prisons and jails.” That’s not true. The systemic oppression of poor Black communities is way more involved than such a view suggests. It involves subjection to double binds that facilitate doing illegal things, and historically has relied upon post hoc criminalization of behaviors precisely because Black people were doing them (the crack panic comes to mind). Besides, the canonical justification for why policing should be geared towards poor Black communities in particular draws from the view that such people are disproportionately criminals. You can’t stop the input at one side of a self-reinforcing mechanism and think the oppression it creates will resolve.
As with Glock’s view of the Christlike homeless, this “we should only oppress homeless people by subjecting them to mechanisms housed people will also face” solution makes only the poor racialized addicts who otherwise resemble affluent white nonaddicts deserve liberation. That’s a very small group. The reason it’s a small group is very simple: being a member of these categories makes your life difficult. My theory of oppression is much more robust against that uncritical argument.
Grab bag
This is already too long and I need to turn to medical stuff, so, briefly, some other instantiations of the resource gap. Many involve drug-testing: Addicts who are court-ordered to take drug tests often have to pay for the tests on their own dime. Drug-testing is often a parole or probation condition. It’s also required for obtaining a U.S. green card. Also, addicts are deprived of access to non-drug-containing safety mechanisms: for example, fentanyl test strips are illegal in Texas and Kansas, among other places. (This strikes me as very difficult to attribute to any sensibility besides “I hope those opioid addicts just die.”) The rationale, often explicitly, is that such aids incentivize drug use. (Again, these tough-on-crime nons just have no mental model of addicts. “Yay, just found a fentanyl test strip! I had managed to kick it, but now I’ll contact my dealer.”)
All right, I’m done. Click below for the medical resource gap—a behemoth in its own right.
Homelessness is often considered both a cause and an effect of addiction, although I don’t know how I feel about those kinds of conclusions given my general opinions about shibboleths of oppression. What is indisputably true, I think, is that homeless people who may have already been subject to marginalization for atypical use patterns when housed are, once homeless, immediately more vulnerable to mechanisms precipitating and punishing their use.
You get an additional point for frequently sleeping outside, but I imagine even he’d agree that’s sort of a default point—especially since he’s so concerned about low-barrier housing being offputting to homeless nonaddicts!
First off, nobody was ever disputing this; obviously, if homeless addicts are housed and their access to housing made non-conditional on their use, then they aren’t going to either immediately stop using or else drop out (which, of course, is a problem with the representativeness when research underemphasizes the attrition rate in housing studies where abstinence is a requirement).