“Why don’t they just quit?”
It’s a question that comes up often, especially as the crisis on our streets becomes more visible and more severe. But it assumes something that is no longer true, that people are operating with the same capacity to choose, recover, and stabilize as they might have in the past.
Over the past few years, the drug supply has changed in ways that are difficult to overstate. It is no longer just unpredictable, it is profoundly toxic. The health consequences we are witnessing may not be fully reversible.
People are experiencing repeated episodes of oxygen deprivation to their brains and often do not recognize it as overdose because naloxone was not required. But sedation is not safety.
If you have ever had surgery and gone under anesthesia, think about recovery. You do not wake up sharp and clear. There is fog, disorientation, physiological strain.
Now imagine experiencing something similar, not once, but sometimes daily.
The unregulated supply is contaminated with sedatives and tranquilizers that suppress respiratory drive, lower heart rate and blood pressure, and leave people vulnerable to assault, theft, and further trauma. The damage is cumulative, and it changes how people think, respond, and function.
So when we ask, “why don’t they just quit,” we are asking the wrong question.
Consider something in your own life that you have tried to change. Exercising consistently. Cutting back on alcohol. Spending less time on your phone. How many attempts did it take? What support did you have? What did you believe about your ability to succeed?
Now imagine attempting profound life change while unhoused, physiologically dependent, sleep deprived, stigmatized, and operating from a baseline of severely diminished self-worth.
Among many of the people I work with, the barrier is not laziness or indifference. It is rock bottom self-worth. Some mask it well. But when you peel back the layers, you often find people who have internalized the belief that change is not for them.
For some, the idea of a different life has never been modeled in a tangible way. Change is not simply difficult, it is abstract. It feels unattainable.
For some, it goes even further. Recovery is not something they are choosing against, it is something that has never felt like an option. There are people who have grown up through generations of poverty and substance use, where survival, not long term change, is the focus. When you have never seen what stability looks like, when no one has shown you that there is life on the other side, it is not just hard to get there, it is hard to even picture it.
Recovery is hard because change is hard. Survival mode is hard too, but it is familiar.
Recovery requires facing trauma and pain without the substance that has muted it for years. And before distancing ourselves too quickly from that reality, it is worth acknowledging that we all rely on coping mechanisms. Some are more socially acceptable than others. Few of us are without them.
What is most difficult is not that recovery is rare. It is that deterioration can be visible and relentless. It is watching someone decline in real time and knowing that even with skill, compassion, and effort, you cannot manufacture readiness.
It is absolutely gutting to watch people deteriorate and to know that the question was never “why don’t they just quit,” but whether they have ever truly had a chance to begin.
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