Compiled by Christopher Battin with a lot of help from AI
A PDF File of this Document is available here.
Executive Summary
This document addresses the urgent need for a more compassionate and effective approach to the addiction crisis, specifically regarding involuntary commitment. It highlights the human cost of the current system's failures, emphasizing the importance of quality, trauma-informed care and exploring alternatives to coercion. The document argues for a shift towards prioritizing care, respect, and evidence-based practices to foster genuine and sustainable recovery. It calls for a system that empowers individuals, reduces stigma, and ultimately saves lives.
Table of Contents
Chapter 1: A Crisis of Compassion: Understanding the Human Cost and the Urgency for Change
Chapter 2: The Contentious Question of Involuntary Commitment: Examining the Arguments For and Against
Chapter 3: The Critical Importance of Quality Care and Addressing Underlying Trauma: A Foundation for Effective Treatment
Chapter 4: Exploring Alternatives to Involuntary Commitment: Empowering Choice and Fostering Engagement
Chapter 5: Re-evaluating "Imminent Danger": A More Holistic Approach to Crisis Intervention
Chapter 6: Building a System of Seamless Care: From Crisis to Long-Term Recovery
Chapter 7: Addressing Systemic Barriers: Funding, Stigma, and Policy Reform
Chapter 8: Charting a Path Forward: Prioritizing Care, Respect, and Evidence Over Coercion
Chapter 1: A Crisis of Compassion: Understanding the Human Cost and the Urgency for Change
The opioid and broader substance use crisis continues to devastate communities across the nation, leaving a trail of broken lives, shattered families, and a profound sense of loss. For those on the periphery, it can be easy to view statistics and news reports as abstract concepts, failing to grasp the raw human suffering at the heart of this epidemic. However, as one individual, Chris, poignantly shared, the loss of a dear friend to an overdose is not an abstract statistic; it is a deeply personal tragedy that compels a closer examination of the systems and societal responses to addiction.
Chris's reflection highlighted a critical failure point within the current healthcare paradigm: the recurring experience of individuals seeking help for their substance use disorder only to be met with judgment, exhaustion, and ultimately, dismissal. The all-too-common scenario of intake personnel, overwhelmed by repeated attempts at seeking care, delivering the devastating ultimatum, "This is your last time," underscores a profound lack of understanding of the disease of addiction. For individuals already grappling with feelings of alienation and worthlessness, such statements can be interpreted as a confirmation of their deepest fears – that they do not belong and are not worthy of healing.
The neurobiological reality of substance use disorder, as we have discussed, involves a fundamental rewiring of the brain's reward and motivation systems. This hijacking of normal brain function compels individuals to prioritize drug seeking above all else, often overriding their own desire for health and recovery. The repeated attempts to seek help, even when followed by premature departures from care, are not acts of defiance but rather manifestations of a brain in conflict – a desperate yearning for sobriety battling against the powerful grip of addiction.
The tragic outcome Chris experienced – the preventable death of a loved one – serves as a stark reminder of the urgency for a more compassionate and effective approach. The current system, often characterized by fragmented care, inadequate resources, and a lack of consistent empathy, is failing some of the most vulnerable members of our community. This failure compels us to explore alternative strategies, even those that challenge conventional thinking, to better support individuals on their difficult journey toward recovery.
One such area of exploration is the potential role of involuntary commitment, often referred to as a "302" in Pennsylvania, for individuals with severe substance use disorder who pose a danger to themselves. While traditionally reserved for individuals experiencing acute mental health crises, the question arises whether a similar framework could be ethically and effectively applied to those whose severe addiction presents an equally imminent risk of death or serious harm. This exploration, however, must be undertaken with careful consideration of individual rights, the potential for coercion, and the fundamental need for a system of care that prioritizes dignity, respect, and evidence-based treatment.
As we delve deeper into this complex issue, it is crucial to remember the human being at the center of the crisis – someone's child, parent, friend, or loved one deserving of compassion and support. The search for solutions must be guided by a commitment to saving lives and fostering genuine, sustainable recovery.
Chapter 2: The Contentious Question of Involuntary Commitment: Examining the Arguments For and Against
The concept of involuntarily committing individuals with severe substance use disorder, akin to the "302" process used in mental health crises, is fraught with ethical complexities and practical challenges. Proponents of expanding involuntary commitment argue that it offers a necessary intervention in situations where an individual's addiction has reached a critical point, rendering them incapable of making rational decisions about their own life and safety.
One of the primary arguments in favor of this approach centers on the imminent risk of harm. As we discussed, the dangers associated with severe, untreated substance use – including overdose, life-threatening medical complications, and an inability to care for basic needs – can be as immediate and potentially fatal as those faced by someone expressing suicidal intent. From this perspective, the state has a moral and legal obligation to intervene to preserve life, even if it means temporarily overriding individual autonomy. The analogy is often drawn to the involuntary commitment of someone in the midst of a psychotic episode who poses a danger to themselves or others.
Furthermore, proponents point to the potential for medical stabilization and initiation of treatment during an involuntary hold. A period of mandated detoxification and initial therapy could, in theory, break the cycle of acute use and provide a foundation for future recovery efforts. The argument is that once the individual is no longer in the throes of active withdrawal and their cognitive function begins to improve, they may be more receptive to the idea of long-term treatment.
The visible crisis in communities like Kensington, with its open-air drug markets and associated public health and safety concerns, also fuels the argument for involuntary measures. Some believe that it offers a way to compel individuals into care who might otherwise remain in a dangerous environment, both for themselves and the surrounding community.
However, the expansion of involuntary commitment for substance use disorder faces significant opposition rooted in concerns about individual liberty and the right to self-determination. Opponents argue that forcing someone into treatment against their will is a violation of their fundamental rights and can be a traumatizing experience, potentially leading to increased resistance to future treatment attempts. The focus on coercion, they contend, undermines the trust and intrinsic motivation that are crucial for long-term recovery.
A significant concern also revolves around the efficacy of forced treatment. Research suggests that the success of addiction treatment is strongly correlated with the individual's internal desire for change. Coerced treatment may lead to superficial compliance during the mandated period but often fails to produce lasting behavioral change once the individual is released. Without addressing the underlying psychological, social, and economic factors contributing to the addiction, the likelihood of relapse remains high.
Moreover, there are practical challenges associated with implementing widespread involuntary commitment. This would place an enormous strain on already limited resources, including hospital beds, detox facilities, and qualified staff. Ensuring that individuals are placed in facilities that provide high-quality, evidence-based, and compassionate care is paramount, and the current disparities in funding and quality between Medicaid and private facilities raise serious concerns about equitable access to effective treatment under an involuntary system.
The very definition of "imminent danger" in the context of substance use disorder also presents a complex legal and ethical hurdle. While the risks are undeniable, establishing a clear and present danger that warrants the deprivation of liberty can be more nuanced than in cases of explicit suicidal intent.
Ultimately, the debate over involuntary commitment for substance use disorder highlights a fundamental tension between the desire to save lives and the commitment to individual autonomy. Finding a balance that protects vulnerable individuals while upholding their rights and promoting effective, long-term recovery requires careful consideration of all perspectives and a commitment to evidence-based solutions.
Chapter 3: The Critical Importance of Quality Care and Addressing Underlying Trauma: A Foundation for Effective Treatment
Our examination of the arguments surrounding involuntary commitment for substance use disorder reveals a fundamental truth: the efficacy and ethical justification of any intervention are inextricably linked to the quality and nature of the care provided. As we discussed earlier, the experiences of individuals within the current treatment system often fall far short of providing the compassionate and effective support needed for genuine recovery. Addressing these systemic shortcomings is not merely a moral imperative; it is a crucial prerequisite for any meaningful discussion about interventions, voluntary or involuntary.
One of the most significant barriers to successful treatment engagement and retention is the inadequacy of comfort care, particularly in under-resourced facilities. The often-agonizing physical and psychological symptoms of withdrawal can drive individuals to leave treatment prematurely, seeking immediate relief in the familiar embrace of their drug of choice. If the medical and supportive care provided does not effectively manage these symptoms with dignity and respect, the perceived benefits of continuing treatment are severely undermined. Robust comfort care protocols, tailored to the individual's needs and delivered with empathy, are essential to create a stable and tolerable environment in the initial stages of recovery.
Furthermore, our conversation highlighted the profound connection between substance use disorder and underlying trauma. For many individuals, substance use begins as a coping mechanism to manage the intense emotional pain stemming from past experiences of abuse, neglect, or other significant traumas. As individuals begin to achieve sobriety, even within a treatment setting, the clarity of mind can bring these long-suppressed traumas to the surface. Without immediate and appropriate support from trauma-informed staff, these overwhelming emotions can trigger a powerful urge to return to the numbing effects of drugs.
The need for trauma-informed care at every level of substance use disorder treatment cannot be overstated. This includes training all staff – medical, nursing, and support personnel – to recognize the signs and symptoms of trauma, create a safe and validating environment, and provide basic grounding and de-escalation techniques. Integrating mental health professionals into the early stages of treatment is also crucial to address emerging emotional issues proactively and provide timely therapeutic support.
The provision of dignity and respect is another cornerstone of effective care. Individuals struggling with addiction often face significant societal stigma and internal shame. Being treated with judgment or disdain by healthcare professionals can further erode their self-worth and undermine their motivation for recovery. A person-centered approach that values each individual's inherent worth, actively listens to their concerns, and involves them in their care decisions is essential to build trust and foster a collaborative therapeutic relationship.
In contrast to a system focused solely on compelling individuals into treatment, prioritizing high-quality, compassionate, and trauma-informed care addresses the very reasons why many individuals are hesitant to seek or remain in treatment voluntarily. When the physical discomfort of withdrawal is effectively managed, and the emotional pain is met with understanding and support, the intrinsic motivation for recovery is more likely to emerge and be sustained.
Investing in such a system requires a fundamental shift in resource allocation and a commitment to training and supporting the workforce that serves this vulnerable population. By creating a treatment experience that is humane, effective, and responsive to the complex needs of individuals with substance use disorder, we can build a foundation for genuine and lasting recovery, potentially reducing the perceived need for coercive measures and ultimately saving more lives.
Chapter 4: Exploring Alternatives to Involuntary Commitment: Empowering Choice and Fostering Engagement
Given the ethical concerns and questions surrounding the long-term efficacy of involuntary commitment, it is crucial to thoroughly explore and prioritize alternative approaches that empower individual choice and foster genuine engagement in the recovery process. Building a system of care that individuals willingly seek and remain in holds greater promise for sustainable change and aligns more closely with principles of autonomy and respect.
One key alternative lies in significantly expanding and improving access to voluntary treatment options. This includes ensuring a comprehensive continuum of care, from medically managed detoxification to long-term residential programs and outpatient services. Reducing waiting lists, streamlining the intake process, and offering a diverse range of treatment modalities that cater to individual needs and preferences are essential. This also necessitates addressing the funding disparities that often limit access to high-quality care for individuals with Medicaid or no insurance.
Harm reduction strategies represent another vital component of an alternative approach. By focusing on minimizing the negative consequences associated with drug use, harm reduction aims to keep individuals alive and engaged with services, even if they are not yet ready or able to abstain completely. Examples include needle exchange programs, safe consumption sites, and the distribution of naloxone, an opioid overdose reversal medication. These strategies build trust, reduce stigma, and provide opportunities for connection with healthcare professionals who can offer information about treatment and recovery.
Assertive outreach and engagement programs can play a crucial role in connecting with individuals who may be hesitant or unwilling to seek traditional treatment. These programs involve dedicated teams proactively reaching out to individuals in the community, building rapport, and offering support and resources. By meeting people where they are and addressing their immediate needs (such as housing, food, and medical care), outreach workers can build trust and gradually guide individuals toward considering treatment options.
The development of robust community-based support systems is also paramount. This includes expanding access to peer support groups, recovery community centers, and mutual aid organizations. These resources provide a sense of belonging, shared experience, and ongoing support for individuals in all stages of recovery. Peer support, in particular, can be incredibly powerful as it offers guidance and encouragement from individuals who have lived experience with addiction and recovery.
Furthermore, addressing the social determinants of health that often contribute to addiction is crucial for long-term prevention and recovery. This includes tackling issues such as poverty, lack of affordable housing, unemployment, and systemic discrimination. By creating healthier and more equitable communities, we can reduce the vulnerability to addiction and provide a stronger foundation for recovery.
Drawing lessons from models like Portugal, which prioritizes a public health approach centered on decriminalization, treatment, and harm reduction, offers valuable insights. While direct replication may not be feasible, the underlying principles of destigmatizing drug use, expanding access to comprehensive care, and focusing on social reintegration can inform the development of more effective and humane strategies in Philadelphia.
By prioritizing these alternatives -- expanding voluntary treatment, implementing harm reduction strategies, utilizing assertive outreach, strengthening community-based support, and addressing social determinants of health -- we can build a system of care that empowers individuals to make informed choices about their recovery journey and fosters genuine, long-term engagement. This approach not only respects individual autonomy but also holds the potential for more sustainable and meaningful outcomes than a system reliant on coercion.
Chapter 5: Re-evaluating "Imminent Danger": A More Holistic Approach to Crisis Intervention
Our discussion has highlighted the complexities of defining "imminent danger" in the context of severe substance use disorder. While the traditional framework often focuses on explicit threats of self-harm, the reality is that the trajectory of severe addiction can present an equally immediate and life-threatening risk, albeit one that manifests differently. This chapter aims to explore a more holistic and nuanced approach to crisis intervention that acknowledges the potential for imminent danger in severe SUD while prioritizing voluntary engagement and the least restrictive means of intervention.
Instead of solely relying on a legal framework designed primarily for acute mental health crises, we need to develop a more comprehensive understanding of what constitutes a critical juncture in severe substance use disorder. This might involve considering a constellation of factors, including:
History of Overdose: Individuals with a history of recent or repeated overdoses are at a significantly elevated risk of future life-threatening events.
Co-occurring Medical Conditions: Severe addiction often exacerbates or leads to serious medical conditions (e.g., endocarditis, sepsis, organ failure) that pose an immediate threat to life.
Acute Intoxication Leading to Severe Impairment: Instances where an individual is so severely intoxicated that they are unable to care for their basic needs, are at high risk of accidents, or are experiencing life-threatening physiological symptoms.
Withdrawal Complications: Severe and unmanaged withdrawal can lead to life-threatening complications such as seizures or delirium tremens.
Environmental Risks: Situations where an individual's living conditions or immediate environment (e.g., exposure to highly toxic substances, extreme weather without shelter) pose an imminent threat to their survival.
Adopting a more holistic assessment of imminent danger requires a multidisciplinary approach involving medical professionals, addiction specialists, mental health providers, and social workers. This team would be better equipped to evaluate the totality of an individual's circumstances and determine the most appropriate course of action.
Crucially, even when a situation is deemed to represent imminent danger, the initial response should prioritize voluntary engagement and the least restrictive means of intervention. This could involve:
Mobile Crisis Teams: Deploying specialized teams that can respond to individuals in the community, assess their needs, and offer immediate on-site support and connection to services.
Crisis Stabilization Units: Providing short-term, voluntary residential settings where individuals in acute crisis can receive medical stabilization, mental health support, and connection to longer-term treatment options. These units should prioritize a welcoming and therapeutic environment.
Enhanced Peer Support: Utilizing individuals with lived experience in crisis intervention to build rapport and offer hope and guidance.
Transportation and Logistical Support: Removing practical barriers to accessing voluntary treatment by providing transportation, childcare assistance, or help with navigating bureaucratic processes.
In situations where voluntary engagement is not immediately possible or the level of imminent danger is exceptionally high, a carefully considered and legally sound framework for short-term involuntary stabilization might be a necessary last resort. However, such a framework must include robust due process protections, strict criteria for initiation, and a clear focus on immediate medical stabilization and connection to voluntary treatment pathways as soon as the individual is able to engage. The emphasis should always be on transitioning individuals to voluntary care and addressing the underlying issues driving their addiction.
By shifting towards a more holistic understanding of imminent danger and prioritizing voluntary, less restrictive interventions, we can create a more humane and effective system of crisis response that respects individual autonomy while still providing necessary support and protection when lives are at risk. This approach recognizes the complexity of severe substance use disorder and moves away from a one-size-fits-all solution rooted primarily in the legal framework for acute mental health crises.
Chapter 6: Building a System of Seamless Care: From Crisis to Long-Term Recovery
The journey from active substance use to sustained recovery is rarely linear. It requires a comprehensive and interconnected system of care that seamlessly supports individuals through every stage, from initial crisis intervention to long-term aftercare. Addressing the fragmented nature of the current system is crucial to improving outcomes and reducing the likelihood of relapse and repeated crises.
One of the first steps in building a seamless system is to improve coordination and communication between different service providers. Individuals often interact with various entities -- emergency medical services, hospitals, detox facilities, mental health centers, social service agencies -- with little continuity of care or information sharing. Creating integrated care teams and utilizing shared electronic health records (while respecting privacy) can help ensure that all providers are aware of an individual's history, current needs, and treatment plan.
Accessible and timely entry points into the system are also essential. Barriers such as long waiting lists, complex intake procedures, and a lack of transportation can deter individuals who are ready to seek help. Streamlining these processes and offering multiple points of access, including mobile outreach teams and walk-in centers, can increase engagement.
The continuum of care must extend beyond initial detoxification. Individuals need access to a range of treatment options tailored to their specific needs, including:
Medication-Assisted Treatment (MAT): Utilizing medications like buprenorphine, naltrexone, and methadone, in combination with counseling and behavioral therapies, has been proven highly effective in treating opioid use disorder and alcohol use disorder. Expanding access to MAT and destigmatizing its use are critical.
Residential Treatment: Providing structured living environments for individuals needing more intensive support and a break from their usual surroundings. Programs should vary in length and intensity to meet diverse needs.
Outpatient Therapy and Counseling: Offering individual, group, and family therapy to address the underlying psychological and emotional issues contributing to addiction and to develop coping skills and relapse prevention strategies.
Peer Support Services: Integrating individuals with lived experience into the care team to provide mentorship, guidance, and a sense of hope.
Case Management: Providing individualized support to help individuals navigate the complexities of the healthcare system, access social services (e.g., housing, employment assistance), and address practical barriers to recovery.
Long-term aftercare and relapse prevention planning are crucial for sustained sobriety. This includes ongoing therapy, support groups, and access to resources that promote healthy living and social reintegration. Recognizing that relapse is a possibility and providing accessible support without judgment is essential.
Finally, a data-driven approach is necessary to continuously evaluate the effectiveness of different interventions and identify areas for improvement within the system. Collecting and analyzing data on treatment outcomes, retention rates, and the impact of different strategies can inform policy decisions and resource allocation.
By building a system of seamless and integrated care, we can create a more supportive and effective environment for individuals seeking recovery from substance use disorder. This approach prioritizes accessibility, individualized treatment, and long-term support, ultimately empowering individuals to achieve sustained sobriety and live fulfilling lives. When individuals feel consistently supported and connected throughout their journey, the need for coercive measures becomes less compelling, and the focus shifts towards fostering genuine and lasting recovery.
Chapter 7: Addressing Systemic Barriers: Funding, Stigma, and Policy Reform
Building a truly effective and compassionate system of care for substance use disorder requires not only a focus on individual treatment but also a concerted effort to address the significant systemic barriers that hinder progress. These barriers include inadequate funding, pervasive societal stigma, and outdated or ineffective policies. Overcoming these challenges is essential to creating a landscape where recovery is accessible and achievable for all.
Inadequate and inequitable funding is a major obstacle. As we discussed earlier, the vast disparities in reimbursement rates between private insurance and Medicaid create a two-tiered system of care. Facilities serving primarily low-income individuals often struggle with limited resources, leading to understaffing, less comprehensive services, and a diminished capacity to provide the high-quality, trauma-informed care that is so critical. Increasing Medicaid reimbursement rates and allocating more public funding towards substance use disorder treatment are essential steps to ensure equitable access to quality care for all who need it.
Pervasive societal stigma surrounding addiction continues to be a significant barrier. This stigma manifests in negative attitudes, discriminatory practices, and a lack of understanding of the neurobiological basis of substance use disorder. It can prevent individuals from seeking help, lead to feelings of shame and isolation, and hinder the implementation of evidence-based policies and programs. Public health campaigns aimed at destigmatizing addiction, promoting understanding, and highlighting the possibility of recovery are crucial to changing public perception and fostering a more supportive environment.
Outdated or ineffective policies at the local, state, and federal levels also impede progress. This can include restrictive regulations on medication-assisted treatment, barriers to harm reduction strategies, and a continued emphasis on criminal justice approaches over public health interventions. Advocating for evidence-based policy reforms is essential to creating a system that prioritizes treatment, prevention, and harm reduction. This may involve legislative changes, shifts in funding priorities, and the implementation of innovative approaches like those seen in Portugal.
Addressing these systemic barriers requires a multi-pronged approach involving advocacy, education, and policy reform. Healthcare professionals, individuals with lived experience, families, and community leaders all have a role to play in raising awareness, challenging stigma, and advocating for change.
Collaboration across sectors is also crucial. Breaking down silos between healthcare, social services, criminal justice, and housing agencies is essential to creating a truly integrated and supportive system. This requires fostering communication, coordination, and shared goals.
Ultimately, creating a system that prioritizes voluntary engagement and reduces the perceived need for coercive measures like expanded involuntary commitment requires a fundamental shift in how we as a society view and respond to substance use disorder. By addressing the systemic barriers of inadequate funding, pervasive stigma, and outdated policies, we can create a landscape where high-quality, compassionate, and evidence-based care is accessible to all, empowering individuals to choose recovery and live fulfilling lives.
Chapter 8: Charting a Path Forward: Prioritizing Care, Respect, and Evidence Over Coercion
Our extensive exploration of the complexities surrounding severe substance use disorder and the potential role of involuntary commitment has revealed a critical need for a paradigm shift in how Philadelphia, and indeed society as a whole, approaches this multifaceted crisis. While the desire to intervene in life-threatening situations is rooted in compassion, our analysis suggests that prioritizing a system built on high-quality, accessible, and respectful voluntary care, coupled with addressing systemic barriers, offers a more ethical and ultimately more effective path forward than a reliance on expanded involuntary measures.
The arguments for expanding the "302" involuntary commitment framework to include severe substance use disorder often center on the immediate dangers faced by individuals in the throes of addiction and the potential for forced intervention to interrupt the cycle of use and initiate treatment. However, these arguments are tempered by significant ethical concerns regarding individual liberty, questions about the long-term efficacy of coerced treatment, and the very real potential for re-traumatization and alienation from the healthcare system.
Our examination of the current landscape reveals critical shortcomings in the existing system, particularly the disparities in the quality of care, the lack of adequate comfort measures during withdrawal, and the insufficient integration of trauma-informed practices. These systemic failures often contribute to individuals leaving treatment against medical advice, highlighting the urgent need to prioritize and invest in creating a more humane and supportive treatment experience.
The exploration of alternatives to involuntary commitment offers a compelling vision for a more effective approach. By expanding access to a comprehensive continuum of voluntary treatment options, implementing evidence-based harm reduction strategies, utilizing assertive outreach to engage individuals where they are, and strengthening community-based support systems, we can empower individuals to make informed choices about their recovery journey and foster genuine, long-term engagement.
Learning from the experience of Portugal, a nation that shifted its drug policy to prioritize public health over criminal justice, provides a powerful example of a different paradigm. By decriminalizing personal use, focusing on treatment and harm reduction, and addressing the social determinants of health, Portugal has achieved significant improvements in public health outcomes and a more humane approach to individuals struggling with addiction. While direct replication may not be feasible, the core principles of this model offer valuable lessons for Philadelphia.
Ultimately, the path forward lies in building a system of seamless and integrated care that supports individuals through every stage of their journey, from crisis intervention to long-term recovery. This requires a commitment to:
Prioritizing High-Quality, Compassionate, and Trauma-Informed Care: Ensuring that all individuals have access to treatment that effectively manages withdrawal, addresses underlying trauma, and is delivered with dignity and respect.
Expanding Access to Voluntary Treatment Options: Creating a comprehensive and accessible continuum of care that meets diverse individual needs.
Implementing Evidence-Based Harm Reduction Strategies: Reducing the negative consequences of drug use and providing pathways to care.
Addressing Systemic Barriers: Advocating for equitable funding, challenging stigma, and reforming outdated policies.
Adopting a Holistic Approach to "Imminent Danger": Developing a nuanced understanding of crisis intervention that prioritizes voluntary engagement and the least restrictive means.
While the desire to utilize involuntary commitment as a tool to combat the devastating effects of addiction is understandable, the evidence and ethical considerations suggest that a more sustainable and humane solution lies in building a system that individuals willingly choose to engage with. By prioritizing care, respect, and evidence-based practices, Philadelphia can chart a path towards a future where recovery is accessible, stigma is reduced, and the tragic loss of life to addiction is minimized. The focus must shift from coercion to empowerment, fostering an environment where individuals are supported and inspired to reclaim their lives.
