The new mayor, Dan Sullivan, a Republican, has created a staff position and a task force devoted to addressing homelessness. The police recently gained the authority to dismantle homeless encampments with just 12 hours’ notice. Citizen groups are patrolling parks where homeless camps have been the site of rapes and other violence. But in perhaps the biggest and most controversial break from how the city has handled the problem in the past, a Salvation Army detoxification and alcohol abuse treatment center has begun accepting chronic inebriates who have been taken there essentially by force.

With $1.2 million in new state financing pushed through by one of Alaska’s more liberal Democrats, State Senator Johnny Ellis of Anchorage, the facility, the Clitheroe Center, is accepting people committed under a state law, Title 47. Under the law, a judge can order people into secure treatment for 30 days, and potentially for months, if the police, a doctor or family members convince the judge that the person’s abuse of alcohol has made them a threat to themselves and others. The person does not need to have committed a crime.

“Ten years ago, there would have been a community outcry that Johnny Ellis is locking up people with the disease of addiction,” Mr. Ellis said. “ ‘How can he do that and say he’s still a progressive?’ ”

Now, Mr. Ellis said, the problem has increased so much “that for various motivations people are saying let’s try something new.” He added, “The people dropping dead during the summertime really got this community paying attention.”

One homeless person drowned. Another was hit by a car. One died from hypothermia. Most had been drinking, and several had four or even five times the blood-alcohol level above which a person is considered too drunk to drive. Experts say the problem of public drunkenness is part of a larger homeless problem that disproportionately affects Native Alaskans, particularly men who have moved in from rural parts of Alaska and lost their way in the city. The recession has also played a role.
Involuntary commitment of homeless alcoholics has been used elsewhere in the country. Some homeless advocates say it infringes on civil rights, and they question its effectiveness. Here in Anchorage, several longtime advocates said the severity of the situation had made them open to giving it a chance.

• First, I'm skeptical of slippery slope arguments. Sometimes the slippery slope is the right place to be.
• The ethics of this seem to rest on questions of free will in addiction. If one believes the addict is not free, coercive interventions make sense. (More here, here, here, here, here, here and here.)
  
• Adopting this positive view of liberty opens the door to potential abuses by the state. Coercion should be a last resort.
• Attraction is preferable. This problem is not just a problem of individuals with a disease. It's likely a symptom of a system failure. Does a recovery-oriented system exist? One that encompasses the complete continuum from harm reduction to long term drug free treatment and recovery support? What if we added Project SAFE style recovery coaches engaged in aggressive outreach? Help support a vibrant recovering community that was capable of transmitting infectious hope and continuous peer support? How many could we attract voluntarily?
• That an alternative to palliative care and coercion exists, means that those would be justifiable only if voluntary attraction into recovery failed, or as a stopgap while implementing a voluntary system.
  
• This approach would require investing in more than just the squeaky wheels. It would mean investing in the well-being and recovery of all addicts.

• A brief history of scholastic inebriation (Too bad they missed Robert Smith whose U of M fraternity brothers called his father to fetch him because his drinking was out of hand.)
  
• Claims injection site dropped Downtown Eastside crime 'very much exaggerated,' say cops
• Battling Addiction With Those Who Know It Best
• New UK study suggests minimal relationship between cannabis and schizophrenia or psychosis
• Cocaine exposure during pregnancy leads to impulsivity in male, not female, monkeys

A study that will appear in the December issue of the American Journal of Public Health tracked the ways in which party affiliation related to people's responses to identical information on diabetes.

Participants in the study read a mock news article on the American Diabetes Association lobbying Congress for greater attention to Type 2 diabetes, the sixth-leading cause of death in the United States. Some people read a straight news report, with minimal mention of what causes diabetes. Others read one of three versions of the story: one that pegged the disease primarily to genetic factors; one that emphasized personal choices; and one that focused on social and environmental factors, such as access to safe places to exercise and affordable, healthy food.

The study's authors, University of Pennsylvania researcher Sarah E. Gollust, along with the University of Michigan's Paula M. Lantz and Peter A. Ubel, were most interested in how people responded to the notion that "social determinants" -- how easy it is to buy fresh vegetables or exercise, among other things -- are underlying causes of disease. Public health advocates have been promoting the importance of these factors, believing that the more people know about these circumstances, the more likely they are to want to help.

But that assumption doesn't hold up. When people who identified themselves as Democrats read specifically about the social factors that can lead to Type 2 diabetes, they expressed greater backing for public health policies aimed at addressing those factors; Republicans, by contrast, registered much lower levels of support.

"The take-home message is that people can walk away from the same information with different attitudes," Gollust says.

Project Prevention makes sense to me. Although a few thousand IUDs might not make a dent in the problem, the bluntness of the gesture turns up the volume.

And it brings drug-using moms in on the dialogue. Thank you for helping me do the first responsible thing I've ever done with my addiction, one mother wrote in a letter to Harris, who solicits a life story from every client.

"They're not bad women," Harris told me. "They don't set out to have babies that are taken away. They feel regret about what they've done."

She's right. Demonizing the mothers doesn't help. They need counseling, not just contraception. Many were victims of childhood trauma and are prisoners of addiction now.

Some hope giving birth will redeem and stabilize their lives. "It's one of the few things they can do that they have control over," said retired social worker Glynis Morrow. "Then the realities of parenting hit. And they feel like failures. And that pain drives them back to drugs."

And we're right back where we started from.

So we can talk about women's rights or about the privilege of procreation. However we cast the conversation, there is one truth we can't avoid: We are helping mothers heal when we keep unwanted children from being born.