After 17 years as an addict, hooked on crack cocaine, Orlando Ward had hit bottom. The former Stanford basketball player, who grew up in Orange County, was sitting on a cardboard box in front of St. Vincent's Cardinal Manning Center at 231 Winston Street, arguably the epicenter of Los Angeles' skid row. Leaning against the white tile wall, with a bottle of cheap wine by his side, he looked up into the evening sky and spoke to God.

"I thanked him for all that he had shown me: graduating from Stanford, good jobs at Fortune 500 companies, travel to Europe and my family," he recalled last week from behind a cluttered desk at the Midnight Mission, where he is director of public affairs. "People would give their right arm to have just a tip of the things that I've had.

"I remember resolutely declaring that I'm going to die here on these streets, addicted to cocaine and forgotten. And in that instance, I was absolutely OK. There was no more fighting, struggle. No more dreams about, 'I'm going to pull it together.' It was like, 'I'm done and I accept what I am.'

"That was the moment that my heart could opened up and surrendered to something else," he confided. "I was able to admit to myself that, you know, this life I'm leading down here on skid row isn't worth living."

A few months later, on April 18, 1999, then-39-year-old Ward entered the recovery program at The Midnight Mission, his second time at the skid row institution as well as 10 other programs. Only this time things were different after the sidewalk epiphany that he was powerless over cocaine.

Going through the 12 steps of AA (Alcoholics Anonymous) again, for the first time he didn't try to intellectualize his downward spiral. Over the next nine months, he accepted responsibility for a failed marriage, lost jobs, separation from his parents and winding up on skid row.

But he stayed at the open-ended recovery program for another 15 months, slowly getting his life back together. He worked various jobs at the mission, socking away 70 percent of his earnings in a bank account and started paying off debts like child support and back taxes. He took care of outstanding warrants for shoplifting and other crimes. He got a driver's license and bought a car. And he made amends to family members and friends he had hurt during almost two decades of addiction.

"I think the difference this time --- no, I know the difference after a dozen other tries --- was the flexibility to meet me on my own terms was more evident in The Midnight Mission than any other program that I've been in," the now-46-year-old man explained. "Plus there was this huge practical component, forcing me to address things that I never addressed. So it wasn't the 12 steps alone. And, in fact, the difference was that practical piece."

Returning to his Catholic roots was another crucial component of his recovery. A renewed spiritual longing was met by going back to Transfiguration Church in South Los Angeles. And when he gradually came to a new view of "where I sit in God's world," his life just took off. Remarried, he and his wife, Kathy, have a three-year-old son named Xavier Michael and live in Carona.

"The long and short of it, I probably have the best job in the world," Ward said with a smile. "It's more satisfying than anything I did at Xerox or anywhere else I worked, because I represent something that, obviously, I believe. And I've got evidence that it can work."

Depression, dependency and disability
But Ward's recovery story is atypical, unfortunately. Why is it so hard for most of the 5,000 to 10,000 individuals living in emergency mission shelters or long-term recovery programs, SRO (Single Room Occupancy) hotels, cars and vans, and on the streets in encampments to get off skid row?

The two factors one hears over and over again from social workers, homeless advocates, researchers, police officers and down-and-outers themselves are addiction and mental illness, which are often combined in a hellish cycle of depression, dependency and disability.

Estimates of drug and alcohol addiction on the row range from a low of 9 percent, the result of a 2005 self-reporting survey, to as high as 85 percent from service providers' reports. In fact, more drug arrests are made every year in the some 50 blocks of skid row than any other part of Los Angeles. Last year the LAPD's Central Division made almost 6,000 drug busts there, 20 percent of the city's total.

"Untreated addictive disorders do contribute to homelessness," says a recent report by the National Coalition for the Homeless. "For those with below-living wage incomes and just one-step away from homelessness, the onset or exacerbation of an addictive disorder may provide the catalyst to plunge them into residential instability. And for people who are addicted and homeless, the health condition may be prolonged by the very life circumstances in which she/he finds her/himself."

Mental illness figures are harder to come by. Estimates usually fall in the 40 to 50 percent bracket. In the "2005 Los Angeles Homeless Count" by the Los Angeles Homeless Services Authority, 44 percent of skid row respondents said they had a mental disability, with nearly 11 percent reporting that mental health issues were the primary reason for their current homelessness.

The National Coalition for the Homeless says, "A new wave of deinstitutionalization and the denial of services or premature and unplanned discharge brought about by managed care arrangements may be contributing to the continual presence of seriously mentally ill persons within the homeless population."

When the two factors are combined, the result is often chronic homelessness.

'A whole subculture'
Los Angeles Police Captain Andrew Smith commands the Central Division that encompasses skid row. Recently, the parishioner at American Martyrs Church in Manhattan Beach told the Los Angeles Times, "With all the narcotics sales in skid row, it strikes me as nearly impossible to get clean."

Richard Rawson, associate director of UCLA's Integrated Substance Abuse Programs, agrees with that off-the-cuff assessment, but with a couple of exceptions. The researcher points out that some reformed alcoholics still visit their favorite bars for the camaraderie. In addition, many recovery programs on skid row employ former addicts like Orlando Ward, who after not using for a period of time can work in that climate.

But those individuals are definitely in the minority.

"The availability of drugs is a big factor in people's ability to recover," Rawson told The Tidings. "If you're surrounded by drugs, it makes it extremely difficult. It's not impossible. It's not likely, though."

He talked about "drug craving," which is not the same as deciding whether to have a late night cup of coffee. Being a physical longing, it's not a voluntary response. The desire is much more powerful and even irrational.

"It gets triggered by certain cues and environmental stimuli that have been associated with drug use," he explained. "And one of the most powerful cues is the drug itself. So if you're surrounded with drugs and people offering you drugs and knowing that drugs are right outside your tent or whatever you've living in, it makes it extraordinarily difficult for anybody to get sober."

Rawson believes that for stimulants like cocaine and methamphetamine a good public policy would be to break up the concentration of shelters, missions and treatment centers on skid row, spreading them throughout Los Angeles and the county. For heroin addicts, however, having methadone clinics nearby in the area could do a "tremendous amount" to reduce heroin use.

"At some point, the city has to respond by doing something for skid row," he said. "And the drug problem is a huge part of the problem."

A lot of Dr. C. Scott Saunders' patients at the Veteran Administration Hospital in West Los Angeles wind up living on the street. Saunders, codirector of the VA's schizophrenic treatment program and director of trauma psychiatric service at UCLA, reports that he has run across them while walking his dogs in Santa Monica.

Still, the psychiatrist notes that numbers and percentages about mental illness for chronically homeless individuals are difficult to come by.

"It's very hard to make that determination," he said. "But a substantial number have psychiatric illnesses that are very debilitating. And I would imagine if you were to gather 100 people living on skid row and do interviews, you would find that the most common psychiatric diagnosis would be schizophrenia."

Saunders points out that most schizophrenics are probably living on some type of disability income, which might come to $800 a month. "You just can't do very well in Los Angeles for eight hundred bucks a month," he said.

Some of his patients are treated and choose to live on the street. He has had cases where he's placed someone in a hospital and under medication the person does very well. But then when the patient moves on to a board-and-care facility, he or she wanders away and gravitates back to skid row.

"What is it?" he mused. "Drugs? The companionship? The familiarity? I'm not sure. But I've seen it many times. And a large percentage of the schizophrenic population that I'm talking about are drug users, too. All you have to do is walk around down there and you can see what the population is. A substantial number are crazy. I'm sorry to be so unscientific about it, but a substantial number are nuts."

He says schizophrenia can be treated if the patient commits to a regimen of regular medications. But the problem with schizophrenics is they often stop taking the prescribed drugs once they start feeling better. So long-lasting life changes are few and far between.

"The reality is that in this city the climate is relatively gentle and there are lots of resources around," Saunders observed. "And for these guys, it becomes a way of life. They know where to go for food; they know where to go for shelter. It's like a whole subculture."

Small successes
Joan Sotiros, director of St. Vincent's Cardinal Manning Center, has been a social worker for more than 30 years, the last dozen on L.A.'s skid row. She estimates that over half the folks living there have severe mental health or addiction issues.

"It's precious few people you find down here who are not either addicted or have mental problems --- very, very few," she said, during an interview in her office.

Assistant director Chuck Happold nodded. "The two go hand in hand."

"If you could get rid of the addiction, if you could work with the mentally ill ---which I personally think you can do, but it's awfully hard --- then you could get at the problem of underemployment because of under-education and all the other problems," pointed out Sotiros.

But temptation is literally right outside St. Vincent's door, especially when the Latino shopkeepers close up their toy and knickknack stalls. Almost instantaneously, dealers are out selling balloons of crack and heroin, while addicts light up their pipes.

Against this anything-goes environment, a dozen staff members plus social work graduate students and Vincentian volunteers work in the remodeled two-story white tile and stucco building, which was a creamery. They run a daytime drop-in center, short-term shelter for 58 men, much smaller shelter for homeless women and children, and a six-month extended program for men. Case management and group sessions are offered for both sexes along with one-on-one counseling and referrals.

To enter the extended program, men must have a job and not be using drugs. They are also expected to participate in the group meetings. "The real important part of the extended program is emancipating from here and getting their own apartment, which is going to take a couple thousand dollars at least," said Happold. "That's why we ask that 70 percent of one's income is saved. The goal is for them to be able to function on their own."

But in a steadily gentrifying Los Angeles, where apartment buildings practically all around skid row are being turned into lofts and condominiums, that is no easy task. It's not unusual for men to return to St. Vincent's when they just can't make it financially, often on nearly minimum-wage security guard salaries.

And these low-paid, dead-end jobs can bring on a new debilitating problem ---depression.

"It's that whole depression you create within the human being when he has no place to go," Sotiros said. "He knows he's making minimum wage, and 20 years from now he's still going to be making minimum wage, whatever that is. It really depresses them."

"We try to encourage the men to pursue other opportunities through schooling that can help them attain a better job," added Happold, "But that can be a difficult sell for a number of reasons."

St. Vincent's director believes that a significant number of skid row residents, in fact, have development disabilities that keep them from pursuing any job that requires abstract reasoning and on-the-spot decision-making. Her assistant has seen clients who are just not able to navigate the complexities of life, with skid row becoming their haven of last resorts.

But there are positives, too.

"A success is a guy from here who became a security guard at a construction site first and then got a better guard job at a hotel," Sotiros reported. "He and a buddy from the extended program, who was good with computers, rented an apartment together, so he's functioning independently for the first time in his life. Before, he'd always lived with his mother until she went into a nursing home.

"So," she added, "that's a success that keeps you going."

Crack, the dragon
Cornelius Kincy was having a good day.

Just this Friday morning, the 55-year-old man got a diploma from an accelerated MTA training class, qualifying him for an interview as a bus driver. And now, standing by his bed and dresser in St. Vincent's Cardinal Manning Center, he was in a hurry --- brushing his closely cropped hair and straightening his gray-black tie, getting ready to find out if his SRO (Single Room Occupancy) apartment was ready.

"I'm trying to better myself," he said with a smile. "There's more money and more security being a bus driver. They start you at $13.65 an hour. My head's still spinning."

Kincy is at the tail end of his second six months in the extended program at St. Vincent's. Two years ago, he went through a troubling divorce and his wife "got everything," he says. He stayed with his mother for awhile, but needed a more permanent place when somebody told him about the shelter on Winston Street.

After going through the half-year program, he was working as a security guard, had his own apartment and was getting by even though paying child support made it tough. But then his California guard card and driver's license got pulled because he owned $1,500 in late child support he was unaware of. The result was he missed two weeks of work, couldn't pay his rent and got evicted.

So he came back to St. Vincent's about six months ago, completed the extended program again and is staying there until an apartment opens up.

The soft-spoken, articulate man says he has not used drugs since he went through a two-year recovery program at the Union Rescue Mission, finishing it in 2002. His drug of choice was crack, which he's convinced is the number one reason most people wind up and stay on skid row.

"That crack cocaine is a dragon, and it's never full," he stressed, shaking his head. "It takes people and changes their mental attitude towards things. It warps you and tosses you up. It changes the chemicals in your brain. The brain loves crack cocaine.

"Drugs are the major reason why people are out on the street," he said. "Years ago it used to be alcohol. Skid row was the place where alcoholics came. But crack cocaine pushed those alcoholics out."

His best guess is that at least four out of five folks on skid row today are there because they want to be. They're willing to live on the street because there are no restrictions, he says, and they can do what they want to do, when they want.

About his own fate, Cornelius Kincy is pretty sure he is going to make it this time. The only possible hitch is the $400 child support he has to pay every month from his $1,000 take-home pay.

"Yeah, I'm looking forward to having my own place," he said. "There's a lot of things going on for me right now, things anybody can accomplish if you put your mind to it and don't get distracted.

"Of course, it's difficult living in a shelter on skid row," he admitted. "I hate it down here. And the thing of it is, is to keep your dignity. That's what I tell myself."