Those efforts ultimately proved unsuccessful. On Dec. 17, Carter died of alcohol intoxication at Howard University Hospital after being found unresponsive at a Dupont Circle McDonald’s. Last month, the well-known fixture on D.C. streets became the face of a city auditor’s report that warned the District is doing too little to help those struggling with chronic addiction.
“We hope that by understanding how Carter came to drink herself to death on a freezing D.C. sidewalk just shy of her 36th birthday after hundreds of professionals tried to help her with housing, medical care, and legal support, we might help others who struggle as she did,” D.C. Auditor Kathleen Patterson wrote in a letter accompanying the report.
The report, prepared for the auditor by the nonprofit Council for Court Excellence, found the city did not provide consistent addiction care to most people in its criminal justice system between 2015 and 2018. About 1 percent of those incarcerated with likely substance-abuse disorders received treatment before, during and after their time behind bars, the report said, and inmates waited for treatment an average of 33 days upon release.
Meanwhile, the report found, the D.C. Department of Behavioral Health — the city agency tasked with responding to the opioid epidemic — had limited success in reaching those who would later die of overdoses. Almost 8 in 10 lethal overdose victims had no contact with the agency before their deaths, the report found.
The audit offered a number of recommendations, including expanding drug treatment programs at the D.C. jail and using court diversion programs to keep people from being incarcerated in the first place. But — rare for an auditor’s report — it also came with a main character: Carter, whose turbulent life was explored in excruciating detail in an accompanying case study.
Patterson, a former D.C. Council member and reporter for the Kansas City Star, said her office sought to attach a name and face to its findings.
“It just occurred to me that, if we could do a much fuller look at her life, it would be a way to put a human face on the complicated policy issues,” she said. “It’s a difficult story. It’s got a lot of pieces to it. I think that’s what makes it compelling.”
As put forth in the case study completed by Street Sense, a D.C. homeless outreach organization and publisher of a newspaper for which Carter sometimes wrote, her life was infused with tragedy.
She was born in Maryland before her family moved to Ohio. Her parents divorced when her father was convicted of rape; they remarried after his release, then divorced again.
Carter, bullied because she was transgender, began using drugs as a teenager. She had a child with a girlfriend and survived a suicide attempt at 19 before joining a religious group that led her to Detroit and, eventually, to the D.C. area. She became a Whitman-Walker Clinic patient in 2006, when she tested positive for HIV.
Carter turned to sex work to survive, the report said, and the final decade of her life was a swirl of diagnoses, erratic behavior, hospitalizations, arrests for mostly minor crimes and failed interventions by an alphabet soup of District agencies. She was arrested in 2010, for example, after she jabbed a broken beer bottle at a man in Scott Circle, was sentenced to drug treatment, didn’t comply and ended up in jail.
Occasionally, there was hope. In 2015, she secured an apartment with a housing voucher — a hard-to-reach first step to stability for many homeless people. But after a few months of relative calm, Carter was arrested again after she spat on a Metrobus driver. Her apartment was beset by squatters and, after further arrests, she lost her voucher in 2018. Though she found housing with another social service agency the next year, she died after more arrests, jail time and an involuntary psychiatric commitment.
Julie Turner, a social worker who tried to help Carter, said she met her in 2012 in Dupont Circle “passed out at a light post, half dressed with the remains of a needle in her arm.” Turner said Carter would periodically get sober, but the city’s outreach systems weren’t equipped to keep her alive.
“I want to believe that in a perfect world [with] long-term access to psychiatric treatment for psychiatric and substance abuse, Alice would have been able to transition in a healthy way,” she wrote in an email. “A week’s stay or a month in a hospital does not even put a dent in anti-social behaviors or the emotional turmoil and pain Alice felt.”
In a statement, D.C. Department of Behavioral Health Director Barbara Bazron and D.C. Department of Corrections Director Quincy Booth expressed sympathy to Carter’s family and wrote that the agencies “are dedicated to providing high-quality care and support to individuals in custody who need treatment for substance use disorders.”
The city’s corrections department works with Unity Health Care, the statement said, which refers residents in treatment programs to providers in the community. Meanwhile, behavioral health officials contact inmates 30 days before their release to make them aware of mental health and substance treatment opportunities, according to the statement.
Brian Carome, chief executive of Street Sense, said in an email that he hoped the study and city auditor’s report would lead “to a focused and sustained conversation about our systems of care, especially for persons struggling with substance use disorder and mental illness.”
Foundry United Methodist Church, where Carter attended services, held a memorial for her in February. Speaking to an audience of about 100 people, including Carter’s mother, the Rev. Ben Roberts recalled her as unpredictable. Once, when he wasn’t in the mood to give a sermon, she cheered him up by presenting him with a “Where’s Waldo?” book.
“She gave us a chance to be compassionate,” he said. “We are less than complete without her voice.”
Deborah Smith, Carter’s mother, said her daughter struggled her entire life — with attention-deficit disorder, with substance abuse, with her gender identity. Ultimately, Smith said, “she did what she wanted to do, and you couldn’t do any different.”
Still, she said some of the revelations in the public case study came as a shock.
“I so wish I could have helped her more, but I didn’t know how she was out of control,” she said.
Smith had one request for anyone telling the story of her daughter’s life.
“Just please say she was loved,” she said.