Charlotte’s Moore Place is pioneering a new response to substance use  

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Gregg died of a massive heart attack three years ago. His longtime companions – cocaine, pills, and alcohol – weren’t with him in the last moments, but their presence could be felt. His skin, leathered from working in the sun and living on the streets, didn’t belong on the body of a man who was only 52 years old.  

Gregg was my mom’s older brother and only sibling. He was my uncle. 

Robert Nesbit with uncle Gregg

We all have problems. Gregg’s problems were easy to see and he never had the chance to receive substance abuse services without committing to lifelong abstinence. Most treatment programs are based on this idea, that total abstinence is the only acceptable goal for a person having problems with drug or alcohol use. These programs have helped millions of people, including my uncle at points along the way. But because of stringent program guidelines, whenever Gregg drank or used – when he was most in need of compassion – he lost his housing and support network.  

Harm reduction, an alternative to traditional substance abuse treatment, seeks to reduce the harmful consequences of substance use and other risky behaviors without requiring abstinence as the end goal. As program coordinator for Urban Ministry Center’s Moore Place, an 85-unit apartment building for men and women who were homeless for many years, I’ve seen how harm reduction can transform, even save lives. 

We don’t require residents to be abstinent to maintain housing. Instead, our counselors and social workers build collaborative relationships and work on the goals that are important to them. Residents who have difficulty with substance use not only maintain housing but make meaningful life changes, often reducing or stopping their use altogether. 

But there aren’t accessible harm reduction services in Charlotte. In fact, when compared to abstinence-based programs, harm reduction is an underutilized approach across the country. At Moore Place, we hope to change that by creating a support group based on these principles that’s open to the community. When I think about Gregg, I can’t help but wonder how his life might have been different if harm reduction services had been available to him.

A life

If it’s possible to trace the challenges of a person’s life to a single event, Gregg’s seemed to begin in 1976 when he was 16. 

It was the typical Saturday night for a teenager in a small community outside of Charlotte. Gregg was drinking with his cousin in an empty parking lot. Being the more sober of the two, Gregg drove home. He lost control of the car and it careened into an embankment off a country road. Gregg wasn’t injured, but his cousin was paralyzed from the waist down. 

Gregg never was the same after that. He dropped out of school and struggled to find work. The years went by in a blur of treatment programs, AA meetings, and factory jobs. He got arrested for drug possession and more than a few DWIs. In 1991 his mom died from leukemia, and three years later his dad died from a brain tumor. His main sources of support were gone.

Gregg-and-family

After their parents died, my mom and Gregg sold their childhood home. Gregg spent his half of the money on landscaping equipment with the hope of starting his own business. But he wasn’t an entrepreneur and after that dream crumbled he lost his home. He lived with different friends until he wore out his welcome. Then, as part of a probation requirement, he joined a faith-based drug and alcohol treatment program. Six months later, he was kicked out when his urine tested positive for cocaine. 

This is only one example of many when Gregg was discharged from a treatment program following a relapse. When he needed help the most, he found himself homeless. Alone on the streets, and then in a concrete room, full of cots with other people who were just as alone. This cycle – treatment, relapse, homelessness – is familiar for countless men and women ensnared by poverty and addiction.

My parents tried to support Gregg as best they could, but no family ever knows what to do. They took him to job interviews and probation appointments. When he was approved for disability benefits, he was able to afford a cheap apartment in Winston-Salem. He died a year later, but he was housed. 

Harm reduction and housing first

At Moore Place, we believe housing is a basic human right, a philosophy known as Housing First. We house people first, and then help them with their problems. We ask only that residents be good neighbors and pay rent if they have income. The success of Moore Place has been well-documented. The program has saved our community millions of dollars

Harm reduction is an important part of our success. The origins of the approach can be traced to the UK and Netherlands during the early 1980s with needle-exchange programs to reduce the spread of HIV transmission caused by intravenous drug use. 

Harm reduction recognizes that, for better or worse, substance use is part of society. And complete abstinence, while a fine goal for many people, is not likely for everyone. Harm reduction focuses instead on helping people reduce the harmful consequences of substance use. For example, if a person has problems related to drinking, they can find ways to live a healthier life even if they choose not to quit. Among other ways, this could be done by reducing how much they drink or drinking only in safe places with people they trust. 

Most importantly, people don’t have to live in fear of losing housing if they are dealing with a substance use problem. At Moore Place we know that, for some, change happens gradually and we affirm any positive changes that are made. The outcomes speak for themselves: over 80% of our residents remain housed each year. 

I could share countless stories, but one in particular comes to mind. Brad* dealt with homelessness for over 30 years. While living on the streets, he’d suffered from malnutrition, experienced many head traumas, and was arrested for numerous “quality of crimes” (victimless misdemeanors that are a result of homelessness such as second degree trespassing, public urination, and open container violations).

After moving to Moore Place, he worked closely with his social worker and became engaged in art classes and an affordable housing advocacy group. While he didn’t quit drinking, these activities, and the bedrock of housing, helped him reduce his alcohol use and the problems associated with it. His health improved and he was able to reconnect with family.

Because of the successes we’ve seen, we want to expand harm reduction in Charlotte. My colleague, Emily Lupsor, and I have begun hosting a weekly harm reduction support group on Monday afternoons from 4 p.m. to 5 p.m. The group is free of charge and open to anyone in our community having challenges with substance use. We hope to provide a non-judgmental space for individuals to talk about their experiences without having to pledge to abstinence. At the moment, ours is the only group of its kind in Charlotte and one of only a few programs across the country.

A matter of priorities 

When I reflect on Gregg’s life, what first comes to mind isn’t the person who dealt with addiction. I remember the man who would pick me up from elementary school in his rusted Honda Accord and take me to the local 7-Eleven. He would talk with me about my day and buy me Slim Jims or gas station hot dogs. As I got older, he’d call me every few months to see how I was doing. In November 2012, Gregg left me a voicemail. It was his usual message. “Hey Robert. This is your Uncle Gregg. Call me back when you can. I love you.” 

Robert Nesbitt with Uncle Gregg and sister Rachel

It would have taken me three minutes to call him back, but Gregg was dead before I found the time. I could have prioritized my relationship with Gregg, but I didn’t. As a city, we have the opportunity to do something different: We can prioritize helping people dealing with substance use issues by creating harm reduction services. 

People struggling to change. People we all know. People like us.

__________________________________________

*This individual’s name and personal details have been changed to protect their identity.

 Anyone who is interested in attending the Harm Reduction Drop-In group can come to Moore Place (2435 Lucena St.) on any Monday afternoon from 4 p.m. to 5pm. 

Cover image courtesy of the Moore Place Facebook page

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