Mayor London Breed Announces New Initiative to Require Screening and Treatment for Substance Use Disorder in Order to Receive County-Funded Cash Assistance

The Mayor’s proposed treatment initiative aims to incentivize individuals with substance use disorder to get the help they need to recover
September 26, 2023

San Francisco, CA — Mayor London N. Breed joined Supervisor Matt Dorsey and the San Francisco Human Services Agency (SFHSA) today to announce a new initiative that would require individuals with substance use disorder who want to access county-funded cash assistance to be enrolled in treatment and services.  

Under the proposed legislation, those who apply for or receive benefits from the County Adult Assistance Programs (CAAP) would undergo screening for substance use disorder and participate in a substance abuse treatment program when the screening reveals that they may have a substance abuse dependency. The legislation must be approved by the Board of Supervisors.  

“San Francisco is a city of compassion, but also a city that demands accountability,” said Mayor London Breed. “We fund a wide range of services, and we want to help people get the care they need but under current state law, local government lack tools to compel people into treatment. This initiative aims to create more accountability and help get people to accept the treatment and services they need.”   

Under the new proposal, as a condition of eligibility to receive CAAP, individuals with suspected substance use disorder would be required to participate in substance abuse screenings or treatment programs funded by SFHSA. These treatment programs would include a range of interventions from residential treatment, medical detox, medically-assisted treatment, outpatient options, and abstinence-based treatment, among others based on the needs of the client. Individuals who refuse or do not successfully engage in treatment would not be eligible to receive CAAP cash assistance and their application would be denied, or they would be discontinued from receiving cash assistance.   

“In our pursuit to address the opioid crisis, let our message be clear: the City isn’t going to give you money to buy drugs. If you are ready for help, we are ready to help you,” said Supervisor Catherine Stefani. “I believe that requiring individuals with addiction issues to be in a treatment program to receive county monetary assistance is not just a policy but a compassionate pathway towards recovery and stability.” 

“In recent years, San Francisco has earned a reputation as a destination for people who use the most toxic drugs to come, and eventually die,” said Supervisor Rafael Mandelman. “I support this effort to make San Francisco the City where people are able to get sober and build a better life.” 

“I strongly support Mayor Breed’s initiative, which will better incentivize treatment and recovery for a population that’s at wildly disproportionate risk for drug addiction and overdose fatalities,” said Supervisor Matt Dorsey. “We’re facing an unprecedented loss of life in San Francisco, and we know coercive interventions can work. This approach reflects a key principle from the National Institute on Drug Abuse that treatment doesn’t need to be voluntary to be effective, and that sanctions and incentives ‘can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.” 

According to SFHSA, from 2018 to 2020, approximately 20 percent of CAAP recipients self-disclosed in an initial interview with SFHSA staff that they have substance abuse issues. The incidence of substance use disorder among CAAP recipients who are experiencing homelessness is likely higher than the CAAP population as a whole. 

In 2022, the San Francisco Homeless Count and Survey released by the Department of Homelessness and Supportive Housing found that 52 percent of individuals experiencing homelessness reported their drug or alcohol use as a disabling health condition, representing a 10 percent increase from 2019. In its Accidental Drug Overdose Reports for 2020 through 2022, the Office of the Chief Medical Examiner has determined that at least 25 percent of drug overdose decedents have no fixed address. 

“The incidence of substance use disorders among San Francisco’s CAAP population is significantly higher than among the citywide population generally, especially among our recipients who are experiencing homelessness,” said Trent Rhorer, SFHSA Executive Director. “This initiative aims to support our clients who have substance use disorders by motivating them to get the help they need, which we hope will lead to ending their drug abuse and their homelessness.”  

State law requires all 58 counties to provide aid and support in the form of cash and other services to very low-income adults without dependents through locally funded "General Assistance" Programs. In San Francisco, the state mandated General Assistance is part of the San SFHSA's County Adult Assistance Programs.   

The initiative is part of Mayor Breed’s commitment to prioritizing treatment, offering support to people with substance use disorder in crisis, and holding them accountable when they refuse help.