Nobody wants to become addicted to drugs, but once they have, quitting and the symptoms of withdrawal can become even harsher and more severe than the symptoms of drug use. Fentanyl withdrawal for example can lead to involuntary leg movements, bone pain, muscle pain, diarrhea, vomiting, and more. In the case of alcoholism, withdrawal can lead to death.

It’s said, sometimes with sympathy and other times with cruelty, “People won’t go to shelters because they want to keep doing drugs.” Oftentimes, homeless shelters turn away people who are active substance users. People who have never been homeless, who have never struggled with substance abuse disorder, can easily dismiss how hard it is to get sober. It’s easy to sit back and think that if somebody wanted a spot in a shelter so badly, if they wanted recovery so badly, they would do it. 

As the opioid crisis treads on, Fentanyl has surpassed car accidents as the leading killer of millennials this year. There’s a severe shortage of affordable housing, and home interest rates are at unattainable highs. In Portland, homes and apartments are dwindling in supply, let alone affordable homes and apartments.

Milestone Recovery is a shelter in Portland that takes in clients other shelters are more likely to turn away. They accept people who may be active substance users, or experiencing mental illness, regardless of their ability to pay.I spoke with the Director of Homelessness Services at Milestone, Joseph McNally. Joseph has been with Milestone for fifteen years and has served in a variety of roles. Among other responsibilities, Joseph supervises the Housing Navigator programs at the shelter and represents Milestone for the City of Portland, Preble Street, Mercy Hospital, and several other agencies.Milestone Recovery, in the words of Joseph, aims “to meet people where they are.” 

What, in your words, does Milestone recovery aim to accomplish on a daily basis?

Milestone has a wide variety of programming, all are designed to meet people where they are. We operate a 36 [bed] substance use shelter, a 16 bed medical withdrawal unit, an outreach program and a long-term treatment program. All of these programs are highly used by the community. Our goal is to support people regardless of where they are at in the recovery process, whether that is active use or sobriety. We base ourselves in motivational interviewing and harm reduction.

How valuable is this service?

Our programs are extremely valuable and can be life saving. 

How does someone get into your recovery program?

Depends on the program. For shelter our clients just need to present at our India Street location. For detox and our long term facility clients must do a phone screening prior to admission.

Is there a cost? Is there a payment plan?

Milestone bills insurance, including MaineCare, when possible. Milestone does not directly charge clients, we are the only detox in Portland that accepts clients regardless of their ability to pay.

What does recovery, at Milestone, look like?

At Milestone we believe recovery looks different to everyone. For some recovery involves 12 step meetings for others recovery means harm reduction approaches or Suboxone treatment. Milestone honors the individual’s choice of recovery. 

Where do you employ from?

Lots of our staff have lived experience. We try to employ people that are compassionate and caring.

How is Milestone funded?

Milestone receives a wide variety of funding including a grant from the state to take uninsured individuals. We supplement the rest of our budget with other grants and bill to insurance when possible.

Do you have many returning patients/clients?

Yes most of our programs see clients more than once.

How many Milestone locations are there?

We have a location at 65 India St in Portland and another in Old Orchard Beach.

If you’re willing, could you share a story from Milestone that’s stuck with you? 

There are many stories but the best is when past clients come back and apply to work here. We have people on staff that were clients at one point.

What’s something that the public gets wrong about homelessness and substance abuse?

The public often makes substance use and homelessness a moral issue or an issue of someone not being motivated to change. Both are harmful and wrong. No one dreams of being a substance user or homeless. The public often thinks there are lots of resources available but that’s not the case. Lots of programs have long waitlists and we have a severe affordable housing shortage. 

The coming winter has made the ongoing conversation on homelessness even more urgent for anyone who spends time in Portland. Locals are growing concerned for the safety of those without homes in the frigid months to come. A proposal to allow unhoused people to continue camping on public property in Portland was rejected last week. A woman was so outraged she climbed onto the mayor and city counselor’s desk.

It isn’t as common to see the same sort of passion when discussing how to get people back on their feet, or how to prevent people from becoming homeless in the first place. Portland City Council can pack to the brim as citizens debate whether or not to allow people to sleep on the streets. Yet, we hardly ever discuss how to get people valuable assistance. The city manages the homelessness crisis with only temporary fixes. The result is hoards of unhoused people forced to move from place to place with no resources in place to enable them to change.

Shelters like Milestone, who provide resources to help the unhoused help themselves, are infinitely valuable.