The homeless desperately need treatment for alcoholism, drug addiction and mental illness -- and they aren't getting it, experts agreed yesterday at the University of Maryland at Baltimore.
But such agreement was rare as the authors of a controversial book tangled with Baltimore advocates for the homeless in a lunch-hour forum before a packed auditorium.
Authors Alice S. Baum and Donald W. Burnes, whose book "A Nation in Denial: The Truth About Homelessness" sparked the debate, said that homelessness should be treated as a medical problem.
Up to 85 percent of homeless people suffer from alcoholism, drug addiction, mental illness or some combination of the three, the authors argued. Unless society treats those problems, they said, the extensive network of shelters in the United States will be just a revolving door.
But Jeff Singer, community affairs director of Health Care for the Homeless, and John R. Belcher, a University of Maryland social work professor, contended that homelessness is fundamentally an economic problem.
Unless government helps create industrial jobs that pay wages sufficient to support a family and provides housing that workers can afford, homelessness won't disappear, they said. It was sometimes a chicken-or-egg argument: Does a person become homeless because he is an alcoholic or drug addict, or does he become a substance abuser because he is homeless?
The authors said that substance abuse generally precedes homelessness, launching the person into a downward spiral from which only treatment can rescue him.
"The system of thousands of soup kitchens, emergency shelters and transitional programs address immediate needs, but does nothing to break the twin cycles of addiction and homelessness," Ms. Baum said.
The advocates argued that homelessness often precedes alcoholism or addiction -- and that both are bred by poverty and despair.
"Homelessness is simply a symptom of what's wrong in our society," Dr. Belcher said. "We need more than substance abuse and mental health treatment. We need a better industrial base and a better economy."
Mr. Singer said that, by defining homelessness as a medical problem, the authors take the pressure off government to fight poverty. The authors responded that poverty and homelessness both are serious problems -- but separate ones requiring different solutions.
Gary Dickens, 39, a homeless man who has lived at a South Baltimore shelter for three months, found something to like on both sides.
Mr. Dickens agreed with the advocates that government has done too little to remedy the causes of homelessness or to treat its symptoms.
But, as a man who has battled drug habits -- most recently, crack cocaine -- for two decades, he agreed with the authors that addiction often drives a person into homelessness.
"You can put somebody in a new house, but they will still have their old habits," he said.
"We should do more for ourselves. I think communities have to get involved."