Between the Lines of Care

We often talk about the choices people make.

We talk about the choice to use drugs. The choice to live on the streets. The choice to refuse treatment. The choice to leave housing.

Rarely do we talk about the experiences that shaped those choices.

After years of working on the front lines, I have learned that what we call a choice is often the final chapter of a story we have never taken the time to read. There is almost always more to the story than we can see.

People often wonder why someone would “choose” to live on the streets.

Sometimes what looks like a choice from the outside is actually someone trying to survive in the only environment where they have ever felt accepted. For some people, the streets become the first place where they truly feel like they belong.

I have seen people who never felt they had a purpose find one amongst their peers. I have watched people step up to help someone who is struggling, help an organization clean up a mess left behind from the night before, or sit beside a friend while they sleep to make sure they are safe.

I have watched countless clients delay or even give up opportunities for recovery because they are worried about what will happen to their “friends” if they leave. From the outside, this can be difficult to understand. Why would someone stay in a situation that is clearly harming them?

This is not everyone’s story. I have met many families who continue to love, support, and show up for someone despite years of heartbreak, and I have seen how incredibly difficult that can be. I have also met families who have had to set boundaries to protect their own wellbeing while never giving up hope that their loved one will find their way.

Addiction is complicated. As someone’s life begins to revolve around substance use, they often become surrounded by others whose lives revolve around it too. Those relationships can provide a sense of acceptance, understanding, and belonging that feels difficult to find anywhere else. They can also reinforce the addiction because the people around them often understand, normalize, or even encourage the very behaviours they are trying to overcome.

That does not mean these relationships are not real. I have witnessed incredible acts of kindness, loyalty, and compassion within this community. But it does help explain why leaving is often about much more than simply walking away from drugs. For some people, it also means walking away from the people they spend every day with, the people who understand their struggles, and the only community where they truly feel they belong.

I have also attended countless funerals, memorials, and celebrations of life over the years. Grief in this community is complicated. Sometimes the people who were closest to someone while they were alive are not the ones who show up when it is time to say goodbye. Sometimes the loss of a peer becomes another trauma layered onto everything else someone is already carrying and, unfortunately, some people cope with that pain by using more substances.

What has always struck me, though, is how difficult it can be for people to recognize that they too are at risk.

A long-time client said to me recently, while we were sharing stories about someone who had passed away, “I don’t understand these people. Why don’t they just test it with a small amount first?”

That mindset is likely one of the reasons this client has survived more than 40 years of substance use. But I pointed out that over the past few years, we have lost many long-time users who also lived by that same rule.

The reality is that the current drug supply is unpredictable and contaminated with substances people are not expecting. Someone may believe they are using a substance they know well and still be exposed to something completely different. Different substances or batches may become mixed together, sometimes unintentionally, and someone who believes they are only using methamphetamine may unexpectedly experience an opioid overdose.

This is one of the reasons why the current drug supply is so dangerous. It has taken away many of the strategies that helped people survive in the past.

People who have never struggled with addiction will sometimes say that people “deserve” to overdose or die because they chose to use despite knowing the risks. I understand where that perspective comes from. I also understand how difficult it can be to comprehend a reality you have never experienced yourself.

The truth is, we often make assumptions about people’s choices without understanding the experiences that shaped them.

Many years ago, I worked with a client who refused to shower. They had experienced something incredibly traumatic earlier in life that contributed to this behaviour. I use the word “choice” carefully because this was not something they consciously decided every day. It was a trauma response. It was the way their brain had learned to protect them.

As you can imagine, this eventually led to significant health concerns and other consequences. We live in a society where behaviours like this are often met with judgment. We tell people they need to shower or change their clothes before they can access certain services. We make people feel shame for things that are often connected to experiences they never asked for and may never have had the support to process.

I often wonder how different this person’s story might have been if someone had wrapped around them earlier and helped them work through that pain. Instead, they survived the only way they knew how by building a wall around themselves.

I see this often. People working on the front lines are supporting individuals with incredibly complex histories, yet not everyone providing services has been given the training, support, or understanding required to navigate these situations. Sometimes people unintentionally cause harm by approaching behaviours through the lens of what they believe someone should be doing instead of trying to understand why that behaviour exists.

This does not mean that health, safety, or expectations do not matter. They absolutely do. Understanding why a behaviour exists does not remove responsibility for changing it. It simply gives us a better starting point for helping someone do so.

For example, a staff member working in housing may observe a behaviour that seems completely unacceptable at first glance. The immediate reaction may be frustration or judgment. But what if that person grew up without running water or access to basic sanitation, and this was simply what they had always known?

That does not mean the behaviour should continue, but it does change how we approach it. Instead of shame, it becomes a teaching moment. Instead of making someone feel like they are wrong or broken, we help them understand the health and safety concerns while supporting them to learn something new.

There is a difference between accountability and shame. Although they are often confused, they lead to very different outcomes.

Accountability says, “This behaviour is causing harm, and we can work together to find a better way.”

Shame says, “There is something wrong with you.”

The people we serve do not need us to lower expectations for them. They need us to understand where they are starting from.

I have also seen people make remarkable changes once they finally felt understood instead of judged. Change is rarely quick and it is rarely linear, but understanding creates opportunities that judgment often closes.

When someone has spent their entire life being told they are less than, our job is not to reinforce that belief. Our job is to show them that they are worthy of support, dignity, and the opportunity to do something different.

Understanding someone’s story does not mean excusing every behaviour. It means recognizing that people are more than the choices we see in front of us. Every behaviour has a story behind it. Sometimes that story helps explain what we are seeing and sometimes it doesn’t, but taking the time to understand where someone started gives us a much better chance of helping them get somewhere different.

If we want better outcomes, we have to become just as interested in people’s stories as we are in their choices.