> Junkies shooting up in public, homeless people shitting on the sidewalk, etc, etc is a problem confined to a handful of cities on the west coast.
This just isn't true. At all. This is a problem in cities all over the country. Some cities hide it away, but homelessness and the other problems that come with drug addiction exist all across this country.
I live in Portland so I'm well aware of the effects from a large homeless population, but I try to travel as often as I can and I make it a point to get out of tourist areas as much as possible, usually to concerts or something. I can tell you first hand, within the last 2 years Philadelphia seems to have the same issues, DC definitely has the same problems, Boston, NY, Chicago, Austin, and Denver all have visible homeless.
What I find strange is how every city tends to believe their city is unique with homeless, like they don't realize this is a problem across the entire country. Go to any of those city's subreddits and search "homeless" and you'll see how they've all deluded themselves into believing their city is somehow unique and magically the only place in the country with a homeless problem. It's bonkers. This is a massive problem across the entire country. I suspect small towns across the rust belt probably have their own problems, especially considering how their meth and opiate addictions on a per capita level are significantly higher than even major cities.
I've lived and worked in Boston and DC. You see the occasional person panhandling in certain places. There's some homeless on the public transit systems. Never once have I had to step over shit. Never once have I seen a homeless person bother anyone else. Never once have I had to step over feces. I didn't say these cities were special. I just said the west coast has it far worse. I have been to SF. The scale and nature of the homelessness is categorically different.
The substance abusers don't want less of it, thats why they do it to begin with.
Address the causes that lead people into homelessness and addiction and you end up with less of it. That isn't conjecture, its fact, proven by dozens of disparate cultures and countries adopting or rescinding preventative measures with statistically traceable results proving positive correlation.
Where did I say anything about what substance abusers want? For what it's worth many of them want to get clean but can't pull it off because that's how addiction works.
My point was that substance abuse is (relatively) evenly distributed geographically and pretty much every city and state has more of it than they'd like. Homelessness to the point where it is a significant impact on the day to day lives of the non-homeless is a west coast problem (I've never had to step over human feces in DC, NY or Boston). I'm not saying anything about causes, effects or correlations.
You said "what we want" and one of the important things to remember when having a discussion about macrosocial policy like reducing drug abuse or homelessness is that it is exceedingly rare for everyone to be in agreement.
When confronting homelessness, remember that landlords, aristocrats, and even upper middle income working class all don't want to actually improve the homeless situation. To them its a cost center, and they save more money exporting their homeless by force than trying to actually get them housed and healthy. The policies currently in place out west and across the country, in relation to not just homelessness but all "problems" in society are all intentional. Its key to remember that, because recognizing the hostile actors in resistance to societal improvement is often half the battle in knowing how to make meaningful change.
Homelessness and drug abuse are both symptomatic of livelihood instability, as can be proven by how European nations demonstrated marked reductions in both as more policies are enacted to keep people from falling into extreme poverty. But neither is simple enough to distill to being the consequence of one decision or policy - the frequency of homelessness is influenced by many factors, including... 1) The livability of the area exposed to the elements (homeless in Seattle and Boston are often lower not because of good social policy but because its life threatening in the winter). 2) Local policy relating to the homeless. Mostly due to the age of many of the cities there are more well established non-profits, charities, and churches operating to assist the homeless in the East than the West. 3) Housing prices, obviously, are a huge factor. Its much easier to be livelihood insecure when your rent is a larger and larger chunk of your income. This is why, despite often rampant poverty in the South, homelessness isn't nearly as endemic because property is much cheaper in Nowhere Kentucky than it is in the Bay Area.
Junkies shooting up in public, homeless people shitting on the sidewalk, etc, etc is a problem confined to a handful of cities on the west coast.