Bluto: My advice to you is to start drinking heavily.
December 19, 2005 3:10 PM Subscribe
75 hard-core alcoholics to be offered apartments. Seventy-five alcoholics... are about to get an invitation to move into a new apartment building all their own on the edge of downtown Seattle. At tax payer's expense. What's different about this homeless shelter? The residents will be allowed to drink alcohol, provided they do it in their rooms. [.PDF]
"As much as we want it to work, the idea of asking a hard-core population of chronic alcoholics, for example, to put down the bottle before they get a set of apartment keys is unrealistic and impractical." Predictably, the project was not without opposition. [bugme]
"As much as we want it to work, the idea of asking a hard-core population of chronic alcoholics, for example, to put down the bottle before they get a set of apartment keys is unrealistic and impractical." Predictably, the project was not without opposition. [bugme]
Excellent... I'm glad the pilot program in Moscow worked out.
posted by rolypolyman at 3:24 PM on December 19, 2005
posted by rolypolyman at 3:24 PM on December 19, 2005
do the apartments come with bar fridges?
posted by MiltonRandKalman at 3:25 PM on December 19, 2005
posted by MiltonRandKalman at 3:25 PM on December 19, 2005
Hmmm, I have doubts, but hey, experimentation is how you learn. Glad it isn't my tax money funding this experiment.
posted by caddis at 3:27 PM on December 19, 2005
posted by caddis at 3:27 PM on December 19, 2005
This should be very interesting.
...will have been addicted to alcohol for at least 15 years and failed at alcohol treatment at least six times.
Tenants are being picked from a list of those identified by King County as draining the most emergency and criminal-justice resources...
I hope that along with the medical staff they hire some pretty serious security. I'm uncomfortable with the idea of warehousing terminal alcoholics in ghetto filled with the drunkest of the drunk who, not by coincidence, use the most "criminal-justice" resources.
I would really like to know how they intend to manage a population of mentally ill (nobody fails treatment six times and drinks in this fashion for fifteen years without having, or acquiring, some sort of mental illness) recidivists. The rules are all well and good but in my experience people in the end stages of alcoholism are not particularly prone to follow instructions and have never been known for showing good judgement.
There is also the simple fact that putting them in such an environment pretty much removes any chance of them getting sober -- even those with an honest desire are being set up for failure.
Park an ambulance out back. Your going to need it.
posted by cedar at 3:34 PM on December 19, 2005
...will have been addicted to alcohol for at least 15 years and failed at alcohol treatment at least six times.
Tenants are being picked from a list of those identified by King County as draining the most emergency and criminal-justice resources...
I hope that along with the medical staff they hire some pretty serious security. I'm uncomfortable with the idea of warehousing terminal alcoholics in ghetto filled with the drunkest of the drunk who, not by coincidence, use the most "criminal-justice" resources.
I would really like to know how they intend to manage a population of mentally ill (nobody fails treatment six times and drinks in this fashion for fifteen years without having, or acquiring, some sort of mental illness) recidivists. The rules are all well and good but in my experience people in the end stages of alcoholism are not particularly prone to follow instructions and have never been known for showing good judgement.
There is also the simple fact that putting them in such an environment pretty much removes any chance of them getting sober -- even those with an honest desire are being set up for failure.
Park an ambulance out back. Your going to need it.
posted by cedar at 3:34 PM on December 19, 2005
Apparently they're all washed-up grunge musicians.
posted by brain_drain at 3:36 PM on December 19, 2005
posted by brain_drain at 3:36 PM on December 19, 2005
King County seems to have an open mind in terms of drug policy.
posted by Gyan at 3:42 PM on December 19, 2005
posted by Gyan at 3:42 PM on December 19, 2005
This is called the "housing first" approach, and it is in fact the most cutting edge (and effective) new way to held the "hardcore" addicted and/or mentally ill homeless get off the streets. It starts with the simple premise that the problem with homeless people is that they don't have a home. Give them a place to live with no questions asked, and the rest will (may) follow. The problem the old approaches, which conditioned housing on compliance with taking medication, staying sober, etc., is that it basically set them up for failure and did not foster stability.
Pathways to Housing in New York (founded by Sam Tsemberis, the guy interviewed in my first link) is one of the pioneers in "housing first," and other organizations have followed its example. Pathways found that their clients were just as successful in getting into treatment as were clients in other programs where housing was conditioned on sobriety/medication.
posted by footnote at 3:44 PM on December 19, 2005
Pathways to Housing in New York (founded by Sam Tsemberis, the guy interviewed in my first link) is one of the pioneers in "housing first," and other organizations have followed its example. Pathways found that their clients were just as successful in getting into treatment as were clients in other programs where housing was conditioned on sobriety/medication.
posted by footnote at 3:44 PM on December 19, 2005
I'm glad to see the "out of sight, out of mind" Rockefeller policies are still alive and kicking.
posted by ChasFile at 3:45 PM on December 19, 2005
posted by ChasFile at 3:45 PM on December 19, 2005
1st para line -3 should read "the problem with the old approaches."
posted by footnote at 3:46 PM on December 19, 2005
posted by footnote at 3:46 PM on December 19, 2005
The cost is $11 million, or $147,000 per tenant.
To get the program started? or annually?
posted by martinX's bellbottoms at 3:53 PM on December 19, 2005
To get the program started? or annually?
posted by martinX's bellbottoms at 3:53 PM on December 19, 2005
Per casket.
posted by It's Raining Florence Henderson at 3:55 PM on December 19, 2005
posted by It's Raining Florence Henderson at 3:55 PM on December 19, 2005
Tangentially related to MartinX's comment, housing first has the potential to end up being less expensive than what we have for the chronic homeless now: an endless cycle of jail-streets-hospital-streets-jail...
posted by footnote at 3:55 PM on December 19, 2005
posted by footnote at 3:55 PM on December 19, 2005
As footnote says, this isn't new; there's a similar housing project, about a half-mile from my home in south Minneapolis, that's been running for a number of years now. The residents are, as noted, people who'd been signally unresponsive to other efforts to bring them to sobriety; they drink, they keep drinking, they show no likelihood of quitting. Given that fact, I'd far rather they continue to do their drinking in a warm, safe place, rather than passing out and freezing to death behind a snowbank along Hiawatha Ave.
posted by Kat Allison at 3:56 PM on December 19, 2005
posted by Kat Allison at 3:56 PM on December 19, 2005
How exactly is the new cycle of jail-assisted living-hospital-assisted living-jail supposed to be cheaper?
posted by It's Raining Florence Henderson at 3:58 PM on December 19, 2005
posted by It's Raining Florence Henderson at 3:58 PM on December 19, 2005
I welcome new approaches to homelessness. These residents certainly won't be in any more danger than they were on the street, and they'll almost certainly be less of a nuisance.
The idea of solving homelessness by giving people a place to live does have quite a bit of appeal to common sense....
posted by mr_roboto at 3:58 PM on December 19, 2005
The idea of solving homelessness by giving people a place to live does have quite a bit of appeal to common sense....
posted by mr_roboto at 3:58 PM on December 19, 2005
How exactly is the new cycle of jail-assisted living-hospital-assisted living-jail supposed to be cheaper?
posted by It's Raining Florence Henderson at 3:58 PM PST on December 19 [!]
Because it's not "assisted living" that's being provided, exactly. Instead, they're getting a stable place to live and much less of a chance of ending up back on the streets. The idea is to end the cycle.
"Housing first, combined with a harm reduction approach to mental health and substance abuse problems virtually eliminates the barriers of access to housing for people with dual diagnosis and reduces the likelihood of their relapse into homelessness."
posted by footnote at 4:04 PM on December 19, 2005
posted by It's Raining Florence Henderson at 3:58 PM PST on December 19 [!]
Because it's not "assisted living" that's being provided, exactly. Instead, they're getting a stable place to live and much less of a chance of ending up back on the streets. The idea is to end the cycle.
"Housing first, combined with a harm reduction approach to mental health and substance abuse problems virtually eliminates the barriers of access to housing for people with dual diagnosis and reduces the likelihood of their relapse into homelessness."
posted by footnote at 4:04 PM on December 19, 2005
I realized I could answer you a little more directly, IRFH.
The underlying philosophy here is to stop treating homelessness like an emergency (shelters, jails, hospitals, temporary supportive housing, etc) and to start moving people into permanent solutions. Fostering this stability ends up being a better way to end homelessness...and cheaper for the taxpayers because emergency services always end up being more expensive.
posted by footnote at 4:10 PM on December 19, 2005
The underlying philosophy here is to stop treating homelessness like an emergency (shelters, jails, hospitals, temporary supportive housing, etc) and to start moving people into permanent solutions. Fostering this stability ends up being a better way to end homelessness...and cheaper for the taxpayers because emergency services always end up being more expensive.
posted by footnote at 4:10 PM on December 19, 2005
I wish I was a hardcore drunk. So I could get a free place to live and a check to buy "food".
Given that fact, I'd far rather they continue to do their drinking in a warm, safe place, rather than passing out and freezing to death behind a snowbank along Hiawatha Ave.
Is there really a compelling reason to keep these alive? Seriously. What joy can there be in perpetually waking up to some hungover Groundhog Day? And what joy can there be for the wage slaves who will have to clean up the common areas?
What's the problem with this scenario: one group of people get room, board and a stipend to drink themselves to death. Another group gets $5.15 an hour to clean up after group one and none of the perks that group one gets.
posted by Mayor Curley at 4:21 PM on December 19, 2005
Given that fact, I'd far rather they continue to do their drinking in a warm, safe place, rather than passing out and freezing to death behind a snowbank along Hiawatha Ave.
Is there really a compelling reason to keep these alive? Seriously. What joy can there be in perpetually waking up to some hungover Groundhog Day? And what joy can there be for the wage slaves who will have to clean up the common areas?
What's the problem with this scenario: one group of people get room, board and a stipend to drink themselves to death. Another group gets $5.15 an hour to clean up after group one and none of the perks that group one gets.
posted by Mayor Curley at 4:21 PM on December 19, 2005
I'm not arguing that giving them a place to stay won't keep them off the streets. I'm questioning where any of these studies have yet provided evidence for the claim that it will lower criminal care and health costs associated with the long-term, non-responsive alcoholic. If not, paying for housing is an added expense.
This question is completely unrelated to whether or not it is a good idea, from a humanitarian standpoint, to do this. I just didn't see any actual evidence in any of the links for the claim that it would be less expensive.
On preview: I did read your links, and I understand the basic idea. It may even be the right thing to do, although I'm not at all convinced yet that this is the case (or that it's not, either - it's a complicated dynamic). I'm just not convinced that it will really be cheaper, without seeing some real numbers first.
posted by It's Raining Florence Henderson at 4:21 PM on December 19, 2005
This question is completely unrelated to whether or not it is a good idea, from a humanitarian standpoint, to do this. I just didn't see any actual evidence in any of the links for the claim that it would be less expensive.
On preview: I did read your links, and I understand the basic idea. It may even be the right thing to do, although I'm not at all convinced yet that this is the case (or that it's not, either - it's a complicated dynamic). I'm just not convinced that it will really be cheaper, without seeing some real numbers first.
posted by It's Raining Florence Henderson at 4:21 PM on December 19, 2005
So the homeless who *aren't* drunks, and *aren't* criminals, they get what?
posted by beth at 4:23 PM on December 19, 2005
posted by beth at 4:23 PM on December 19, 2005
beth writes "So the homeless who *aren't* drunks, and *aren't* criminals, they get what?"
Here is a listing of some resources available in King County, including emergency shelters, transitional housing arrangements, and affordable housing programs for permanent housing. The City of Seattle also makes resources available, including shelter, food, and transportation.
posted by mr_roboto at 4:27 PM on December 19, 2005
Here is a listing of some resources available in King County, including emergency shelters, transitional housing arrangements, and affordable housing programs for permanent housing. The City of Seattle also makes resources available, including shelter, food, and transportation.
posted by mr_roboto at 4:27 PM on December 19, 2005
There is a tremendous problem in Seattle with homelessness. If this program gets more bums off the buses and out of the gutter, then I'm all for it. As for using taxpayer dollars, are you serious? Can you think of a better thing for public money than to clean up the downtown and give people a comfortable place to die? Because that's what this place, really. A hospice.
Having said that, this would be a terrible place to work. Wow.
posted by _sirmissalot_ at 4:32 PM on December 19, 2005
Having said that, this would be a terrible place to work. Wow.
posted by _sirmissalot_ at 4:32 PM on December 19, 2005
It starts with the simple premise that the problem with homeless people is that they don't have a home.
Alternatively, a case could be made that they are homeless because they are addicts and/or mentally ill.
There is a huge difference between becoming homeless due to circumstances beyond ones control and becoming homeless due to ones actions. The former can be easily managed by providing housing while the later cannot be handled without addressing the root causes.
These are people who have failed in treatment a minimum of six times. They have had housing.
The problem the old approaches, which conditioned housing on compliance with taking medication, staying sober, etc., is that it basically set them up for failure and did not foster stability.
Not when done properly. Most current treatment models for alcoholism include a long term component. This often includes halfway houses and then a move to transitional housing (what this sounds like, minus the booze part).
I'm having a difficult time seeing the advantage here. They still need medical care when an esophagus explodes, they are still going to be arrested when they stab the guy next door because he won't share and they are still going to commit foolish crimes to feed their addictions.
As powerful a disease as alcoholism is there is a proven method of treatment (only one) and nobody, but nobody, is hopeless. It's a tragedy that the best we can do for a terminally ill population is make it easier for them to kill themselves. Whether it's in a snowbank or a comfy taxpayer funded apartment, the end result for a late stage drunk who continues drinking is a pine box.
I expect about the only people who benefit are the police who now have them in a single convenient location and the liquor store on the corner. There are probably a few contractors pretty pleased also.
posted by cedar at 4:39 PM on December 19, 2005
Alternatively, a case could be made that they are homeless because they are addicts and/or mentally ill.
There is a huge difference between becoming homeless due to circumstances beyond ones control and becoming homeless due to ones actions. The former can be easily managed by providing housing while the later cannot be handled without addressing the root causes.
These are people who have failed in treatment a minimum of six times. They have had housing.
The problem the old approaches, which conditioned housing on compliance with taking medication, staying sober, etc., is that it basically set them up for failure and did not foster stability.
Not when done properly. Most current treatment models for alcoholism include a long term component. This often includes halfway houses and then a move to transitional housing (what this sounds like, minus the booze part).
I'm having a difficult time seeing the advantage here. They still need medical care when an esophagus explodes, they are still going to be arrested when they stab the guy next door because he won't share and they are still going to commit foolish crimes to feed their addictions.
As powerful a disease as alcoholism is there is a proven method of treatment (only one) and nobody, but nobody, is hopeless. It's a tragedy that the best we can do for a terminally ill population is make it easier for them to kill themselves. Whether it's in a snowbank or a comfy taxpayer funded apartment, the end result for a late stage drunk who continues drinking is a pine box.
I expect about the only people who benefit are the police who now have them in a single convenient location and the liquor store on the corner. There are probably a few contractors pretty pleased also.
posted by cedar at 4:39 PM on December 19, 2005
I wish I was a hardcore drunk. So I could get a free place to live and a check to buy "food".
You're obviously not trying hard enough. It isn't a difficult thing to accomplish. Just start drinking the moment you wake up, and stop going to work.
Eventually, the rest will surely follow. Trust me on this.
Is there really a compelling reason to keep these alive? Seriously.
Sure there is. Everybody changes to some degree or other. We're just not very good at reliably identifying the levers that produce those changes -- but there are certain things that we do know, and one of those things is that the greater one's sense of self-efficacy, the more likely people are to be able to affect those changes.
When you're homeless, jobless and have been living on the streets for twelve years, I'm pretty sure that you're sense of having any power at all to effect change would be minimal. In that situation, why wouldn't you drink? You've got nothing at all to lose by it.
True fact: the most effective substance misuse facility in the world -- and the only one that has almost 100% success rate is a facility that exclusively treats doctors.
Why should this be? Is it that doctors are any less severely dependent than anybody else? That they have been dependent for shorter periods?
Of course not. The reasons why almost 100% of doctors manage to get and stay clean after a single treatment episode are two fold:
First, because they have huge resources of social and emotional support to draw upon. Friends, family, professional organizations, a job with status and meaning, etc. etc.
Second, because they have so much to lose by their failure to do so. Financially, there's that big fat doctor's income. But again, there's that sense of status, of having something of real value that most people really don't want to lose.
Of course, you might still not see this as a compelling reason to keep other people alive. I do come across people with this attitude from time to time, but you know what? Whenever such people find themselves or a family member in this situation, they also tend to be the people who should longest and hardest about what they should be entitled to in this situation. I guess it's borne out of a certain sense of self-entitlement that they aren't inclined to extend to others.
posted by PeterMcDermott at 4:49 PM on December 19, 2005
You're obviously not trying hard enough. It isn't a difficult thing to accomplish. Just start drinking the moment you wake up, and stop going to work.
Eventually, the rest will surely follow. Trust me on this.
Is there really a compelling reason to keep these alive? Seriously.
Sure there is. Everybody changes to some degree or other. We're just not very good at reliably identifying the levers that produce those changes -- but there are certain things that we do know, and one of those things is that the greater one's sense of self-efficacy, the more likely people are to be able to affect those changes.
When you're homeless, jobless and have been living on the streets for twelve years, I'm pretty sure that you're sense of having any power at all to effect change would be minimal. In that situation, why wouldn't you drink? You've got nothing at all to lose by it.
True fact: the most effective substance misuse facility in the world -- and the only one that has almost 100% success rate is a facility that exclusively treats doctors.
Why should this be? Is it that doctors are any less severely dependent than anybody else? That they have been dependent for shorter periods?
Of course not. The reasons why almost 100% of doctors manage to get and stay clean after a single treatment episode are two fold:
First, because they have huge resources of social and emotional support to draw upon. Friends, family, professional organizations, a job with status and meaning, etc. etc.
Second, because they have so much to lose by their failure to do so. Financially, there's that big fat doctor's income. But again, there's that sense of status, of having something of real value that most people really don't want to lose.
Of course, you might still not see this as a compelling reason to keep other people alive. I do come across people with this attitude from time to time, but you know what? Whenever such people find themselves or a family member in this situation, they also tend to be the people who should longest and hardest about what they should be entitled to in this situation. I guess it's borne out of a certain sense of self-entitlement that they aren't inclined to extend to others.
posted by PeterMcDermott at 4:49 PM on December 19, 2005
PeterMcDermott : "When you're homeless, jobless and have been living on the streets for twelve years, I'm pretty sure that you're sense of having any power at all to effect change would be minimal. In that situation, why wouldn't you drink? You've got nothing at all to lose by it."
This is what gives me some skepticism about drug legalization. Sure, addiction among working middle-class & above may be contained & managed with sensible regulation (taxes, advertising, social oppobrium) but legal & easily available methamphetamine among those who are stuck in poverty with not much to lose? Of course, there's the argument that alcohol is already available legally & many drugs as well, and that legalization will promote substitution & some multiple use rather than envelope the sober among the poor.
posted by Gyan at 5:01 PM on December 19, 2005
This is what gives me some skepticism about drug legalization. Sure, addiction among working middle-class & above may be contained & managed with sensible regulation (taxes, advertising, social oppobrium) but legal & easily available methamphetamine among those who are stuck in poverty with not much to lose? Of course, there's the argument that alcohol is already available legally & many drugs as well, and that legalization will promote substitution & some multiple use rather than envelope the sober among the poor.
posted by Gyan at 5:01 PM on December 19, 2005
It's wrong not to care about drunk people. Imagine a world where George W. Bush *had* in fact drunk himself to death in his 30's...
Well never mind I'm just undermining my own point now.
posted by clevershark at 5:01 PM on December 19, 2005
Well never mind I'm just undermining my own point now.
posted by clevershark at 5:01 PM on December 19, 2005
This is like Old School II - the Later Years.
Being a resident of this over-priced and over-rated "world-class" city I find this just another slap in the face of the working Seattleite.
We got no real transit system, draconian liquor and "civility" laws, and idiotic millionaires (Paul Allen) who get any obscene pet project they want (Stadiums, Sci-fi Museum, etc) underwritten by middle class schlubbs like me who work our asses off to just survive in this town.
Meanwhile my 2BR 1200 square foot leaking shack is supposedly worth $380,000? Oh. Yippee. I can sell that and move to...where? Boise? Kentucky?
A 40 of Old English 800 sounds nice right now.
posted by tkchrist at 5:04 PM on December 19, 2005
Being a resident of this over-priced and over-rated "world-class" city I find this just another slap in the face of the working Seattleite.
We got no real transit system, draconian liquor and "civility" laws, and idiotic millionaires (Paul Allen) who get any obscene pet project they want (Stadiums, Sci-fi Museum, etc) underwritten by middle class schlubbs like me who work our asses off to just survive in this town.
Meanwhile my 2BR 1200 square foot leaking shack is supposedly worth $380,000? Oh. Yippee. I can sell that and move to...where? Boise? Kentucky?
A 40 of Old English 800 sounds nice right now.
posted by tkchrist at 5:04 PM on December 19, 2005
Sure, addiction among working middle-class & above may be contained & managed with sensible regulation (taxes, advertising, social oppobrium) but legal & easily available methamphetamine among those who are stuck in poverty with not much to lose?
That's a silly point to make. People in the lowest echelons of society never have the least bit of problem obtaining illegal drugs now. You want coke anywhere now? Look for the seedy, cheap hooker-ridden part of your town, that's where you can get some.
posted by clevershark at 5:05 PM on December 19, 2005
That's a silly point to make. People in the lowest echelons of society never have the least bit of problem obtaining illegal drugs now. You want coke anywhere now? Look for the seedy, cheap hooker-ridden part of your town, that's where you can get some.
posted by clevershark at 5:05 PM on December 19, 2005
Get a god damn job Al!
posted by lemonfridge at 5:08 PM on December 19, 2005
posted by lemonfridge at 5:08 PM on December 19, 2005
Look for the seedy, cheap hooker-ridden part of your town, that's where you can get some.
Crack yes. Coke? No. For coke you wanna go to the semi-burbs or upscale enclaves and look for the meat markets filled with young hipsters bump'n and grinding.
posted by tkchrist at 5:10 PM on December 19, 2005
Crack yes. Coke? No. For coke you wanna go to the semi-burbs or upscale enclaves and look for the meat markets filled with young hipsters bump'n and grinding.
posted by tkchrist at 5:10 PM on December 19, 2005
As a native here, I think this is a great idea.
There was a call in segment on the local NPR station here in Seattle with similar sentiments expressed as here. I would point out it's far cheaper than dealing with chronic street alcoholics via using a private ambulance on contract with the city to transport them to an emergency room and often the often times subsequent hospitalization. Which is what happens when they are passed on the sidewalk, or when they get beat up by gutter punks or each other or when they fall down and injure themselves when on a binge.
I have seen what they do when a drunk is passed in a bus stop or left beat up on a sidewalk. The fire department is called. The standard procedure is the fire department shows up with an aid car and a fire truck. The Fire Department EMT's talk to the drunk if possible, suss the situation out and then call a private ambulance on contract to the city. The drunk is then transported to a hospital emergency room. If they are injured or ill, they are often put in a bed in a hospital. All of this is on the taxpayer's dime--Fire department salaries and equipment, private ambulance charges, not to mention those for emergency room visits and hospital stays. Using the fire department as social workers and hospitals as detox centers runs well into four figures person per trip and stay.
The rules for the apartment building is they can only drink in their rooms and not public areas. They can't party. The facility is located across the freeway from my neighborhood in the Cascade district. It is not a ghetto but rather a refurbished apartment building in neighborhood near downtown that is in transition from warehouses and low income apartments to trendy downtown condos and office buildings. Providing housing for them is far cheaper than shuttling them through the hospital-as-drunk-tank approach. And it gets them off the streets. Which is far more humane than the ignoring them until an ambulance has to be called approach.
posted by y2karl at 5:16 PM on December 19, 2005
There was a call in segment on the local NPR station here in Seattle with similar sentiments expressed as here. I would point out it's far cheaper than dealing with chronic street alcoholics via using a private ambulance on contract with the city to transport them to an emergency room and often the often times subsequent hospitalization. Which is what happens when they are passed on the sidewalk, or when they get beat up by gutter punks or each other or when they fall down and injure themselves when on a binge.
I have seen what they do when a drunk is passed in a bus stop or left beat up on a sidewalk. The fire department is called. The standard procedure is the fire department shows up with an aid car and a fire truck. The Fire Department EMT's talk to the drunk if possible, suss the situation out and then call a private ambulance on contract to the city. The drunk is then transported to a hospital emergency room. If they are injured or ill, they are often put in a bed in a hospital. All of this is on the taxpayer's dime--Fire department salaries and equipment, private ambulance charges, not to mention those for emergency room visits and hospital stays. Using the fire department as social workers and hospitals as detox centers runs well into four figures person per trip and stay.
The rules for the apartment building is they can only drink in their rooms and not public areas. They can't party. The facility is located across the freeway from my neighborhood in the Cascade district. It is not a ghetto but rather a refurbished apartment building in neighborhood near downtown that is in transition from warehouses and low income apartments to trendy downtown condos and office buildings. Providing housing for them is far cheaper than shuttling them through the hospital-as-drunk-tank approach. And it gets them off the streets. Which is far more humane than the ignoring them until an ambulance has to be called approach.
posted by y2karl at 5:16 PM on December 19, 2005
As powerful a disease as alcoholism is there is a proven method of treatment (only one)
This isn't true. The idea that there is only a single proven method of treatment for alcoholism is a ideologically-driven myth perpetuated by a quasi-religious cult.
Now, if I were suffering from severe, chronic alcoholism, I may very well sign up to that cult myself. You get good peer and social support, contact with people who genuinely understand what it's like to go through what you're going through, and some aspects of the philosophy -- particularly the emphasis on focusing outside yourself and on other's needs is very helpful for those people who may be narcissistically self-obsessed with their own moods and feelings.
But when it comes to making truth-statements about our knowledge of addiction and addiction treatment, I've long learned to be extremely sceptical about claims from that quarter. There are mountains of evidence now for the effectiveness of things like brief interventions, controlled drinking, spontaneous recovery, but these inconvenient data points all get conveniently discarded by arguments like 'well, those people obviously weren't really addicted/aren't really in recovery'.
And a great many of those who sign up for the 'one true way' may also fail repeatedly. I'd be willing to bet that every one of the people who end up in this facility will have been through some form of twelve-step programme during their drinking career, and most will have done so numerous times.
and nobody, but nobody, is hopeless.
This is true though.
I have a friend, Tanya, who is probably one of the most chaotic and severely dependent people I've ever known -- and I've known more than my fair share.
A black woman whose mother was a prostitute, she grew up in a family of eight children to eight different fathers. Of course, there was some sexual abuse in her childhood, and Tanya became expert at fighting for her survival.
When Tanya took up crack cocaine in her early twenties, she was determined that she wasn't going to be a victim in the same way that her peers were. And so rather than turning to prostitution along with her sisters and friends, Tanya became a 'clipper'. She would work the local stroll, touting for customers, and after they negotiated a price, she'd take them to a dark isolated place and then beat them and rob them. Even at her most severely crack dependent, Tanya was a match for any man.
But her life was in ruins. She had several children, all of whom were removed into the care of the local authority for child neglect, and all of those services that were paid to work with Tanya and other women like her had long since given up on her.
Every few years, her crimes would catch up with her, and she'd spend a period in prison, where she would do very well, training, staying clean, but severely mourning the loss of her children.
After her last sentence, she decided that rather than going back home on her release, she wanted to go to a rehab. A friend was enable to secure the funding to send her to a rehab aimed specifically at working with women of colour, and so over twenty years into a crack habit, Tanya finally made a real emotional commitment to getting and staying clean.
Now, she's been discharged from that rehab for over three years. She works in the BBC canteen at Shephards Bush, and recently had a major role in a drama series shown on BBC Three. This year, she got married, and has another child on the way. As you'd expect, she's had more than her fair share of scrutiny from social services, but as things stand at the moment, they have agreed that mother and baby will be discharged from hospital together, back to the mother's flat in South London.
But pretty well every professional that worked with Tanya had written her off, and if it hadn't been for one woman -- a friend of mine who established one of the first projects for sex workers in the UK, who had formed a strong bond with her early in her working life and who had maintained that contact despite no longer living or working in the area, the chances are, Tanya would still be smoking rock, clipping for a living, and spending her life in and out of prison.
Is there a compelling reason to keep people like Tanya alive? I believe that there is, not just for their own sake, but also for the powerful example of how change is possible for everybody, regardless of the severity or duration of your dependence.
posted by PeterMcDermott at 5:25 PM on December 19, 2005 [1 favorite]
This isn't true. The idea that there is only a single proven method of treatment for alcoholism is a ideologically-driven myth perpetuated by a quasi-religious cult.
Now, if I were suffering from severe, chronic alcoholism, I may very well sign up to that cult myself. You get good peer and social support, contact with people who genuinely understand what it's like to go through what you're going through, and some aspects of the philosophy -- particularly the emphasis on focusing outside yourself and on other's needs is very helpful for those people who may be narcissistically self-obsessed with their own moods and feelings.
But when it comes to making truth-statements about our knowledge of addiction and addiction treatment, I've long learned to be extremely sceptical about claims from that quarter. There are mountains of evidence now for the effectiveness of things like brief interventions, controlled drinking, spontaneous recovery, but these inconvenient data points all get conveniently discarded by arguments like 'well, those people obviously weren't really addicted/aren't really in recovery'.
And a great many of those who sign up for the 'one true way' may also fail repeatedly. I'd be willing to bet that every one of the people who end up in this facility will have been through some form of twelve-step programme during their drinking career, and most will have done so numerous times.
and nobody, but nobody, is hopeless.
This is true though.
I have a friend, Tanya, who is probably one of the most chaotic and severely dependent people I've ever known -- and I've known more than my fair share.
A black woman whose mother was a prostitute, she grew up in a family of eight children to eight different fathers. Of course, there was some sexual abuse in her childhood, and Tanya became expert at fighting for her survival.
When Tanya took up crack cocaine in her early twenties, she was determined that she wasn't going to be a victim in the same way that her peers were. And so rather than turning to prostitution along with her sisters and friends, Tanya became a 'clipper'. She would work the local stroll, touting for customers, and after they negotiated a price, she'd take them to a dark isolated place and then beat them and rob them. Even at her most severely crack dependent, Tanya was a match for any man.
But her life was in ruins. She had several children, all of whom were removed into the care of the local authority for child neglect, and all of those services that were paid to work with Tanya and other women like her had long since given up on her.
Every few years, her crimes would catch up with her, and she'd spend a period in prison, where she would do very well, training, staying clean, but severely mourning the loss of her children.
After her last sentence, she decided that rather than going back home on her release, she wanted to go to a rehab. A friend was enable to secure the funding to send her to a rehab aimed specifically at working with women of colour, and so over twenty years into a crack habit, Tanya finally made a real emotional commitment to getting and staying clean.
Now, she's been discharged from that rehab for over three years. She works in the BBC canteen at Shephards Bush, and recently had a major role in a drama series shown on BBC Three. This year, she got married, and has another child on the way. As you'd expect, she's had more than her fair share of scrutiny from social services, but as things stand at the moment, they have agreed that mother and baby will be discharged from hospital together, back to the mother's flat in South London.
But pretty well every professional that worked with Tanya had written her off, and if it hadn't been for one woman -- a friend of mine who established one of the first projects for sex workers in the UK, who had formed a strong bond with her early in her working life and who had maintained that contact despite no longer living or working in the area, the chances are, Tanya would still be smoking rock, clipping for a living, and spending her life in and out of prison.
Is there a compelling reason to keep people like Tanya alive? I believe that there is, not just for their own sake, but also for the powerful example of how change is possible for everybody, regardless of the severity or duration of your dependence.
posted by PeterMcDermott at 5:25 PM on December 19, 2005 [1 favorite]
When you're homeless, jobless and have been living on the streets for twelve years, I'm pretty sure that you're sense of having any power at all to effect change would be minimal. In that situation, why wouldn't you drink? You've got nothing at all to lose by it.
If your living on the streets for twelve years I think your lack of ability to effect change is a given.
As far as losing more goes, hell, you can always lose more. You can lose control over your bowels, you can lose your mind, you can lose your vision and you can lose the use of your liver. Trust me on this, as long as your alive, there is another bottom.
What is being missed throughout this discussion is that while the recovery rate for drunks in this demographic is pretty damn low, the fact remains that each and every day these men make a conscious decision to drink and sometimes they make a conscious not to drink. I know which choice I want to reward.
I fear that programs of this nature will have a placebo effect on the community and take resources away from detoxification centers, education, crisis centers and residential treatment facilities.
It's a harsh reality but anyone who has been in treatment six times and still drinks simply does not want to stop. I'll be damned if I'll pay for people to drink. I'll pay for their treatment, I'll pay for their hospital stays and I'll pay for their jail cells. What I won't do is pay for them to commit suicide on the installment plan.
Yeah, it's a selfish program.
posted by cedar at 5:26 PM on December 19, 2005
If your living on the streets for twelve years I think your lack of ability to effect change is a given.
As far as losing more goes, hell, you can always lose more. You can lose control over your bowels, you can lose your mind, you can lose your vision and you can lose the use of your liver. Trust me on this, as long as your alive, there is another bottom.
What is being missed throughout this discussion is that while the recovery rate for drunks in this demographic is pretty damn low, the fact remains that each and every day these men make a conscious decision to drink and sometimes they make a conscious not to drink. I know which choice I want to reward.
I fear that programs of this nature will have a placebo effect on the community and take resources away from detoxification centers, education, crisis centers and residential treatment facilities.
It's a harsh reality but anyone who has been in treatment six times and still drinks simply does not want to stop. I'll be damned if I'll pay for people to drink. I'll pay for their treatment, I'll pay for their hospital stays and I'll pay for their jail cells. What I won't do is pay for them to commit suicide on the installment plan.
Yeah, it's a selfish program.
posted by cedar at 5:26 PM on December 19, 2005
This isn't true. The idea that there is only a single proven method of treatment for alcoholism is a ideologically-driven myth perpetuated by a quasi-religious cult.
Uh... the proven method I mentioned was, at the risk of stating the obvious, not drinking. What path one takes to achieve that goal I'm happy to leave to the individual.
posted by cedar at 5:28 PM on December 19, 2005
Uh... the proven method I mentioned was, at the risk of stating the obvious, not drinking. What path one takes to achieve that goal I'm happy to leave to the individual.
posted by cedar at 5:28 PM on December 19, 2005
Not all homeless alcoholics want housing, like this guy.
posted by shoesietart at 5:31 PM on December 19, 2005
posted by shoesietart at 5:31 PM on December 19, 2005
I'd like to believe. I just have trouble seeing how any of the problems you've described go away just because they now have a permanent residence to crash at (when they can make it home). They're not going out? They're no longer going to be drunk in public? They're not going to require hospitalization anymore?
Again - not arguing this isn't a humane thing to do. I'm just sceptical that this will solve anything more than maybe opening up more beds at other shelters. I have no problem paying for the experiment - I just need to see some statistics showing that these residents improve their long-term health and/or decrease recidivism before I'm ready to call it more than just that - another shelter.
posted by It's Raining Florence Henderson at 5:35 PM on December 19, 2005
Again - not arguing this isn't a humane thing to do. I'm just sceptical that this will solve anything more than maybe opening up more beds at other shelters. I have no problem paying for the experiment - I just need to see some statistics showing that these residents improve their long-term health and/or decrease recidivism before I'm ready to call it more than just that - another shelter.
posted by It's Raining Florence Henderson at 5:35 PM on December 19, 2005
I think this is great. People need a place to live, and adults in this country are allowed by law to drink alcohol. If every place were as good as Seattle, there might be less alcoholism in general.
posted by nervousfritz at 5:45 PM on December 19, 2005
posted by nervousfritz at 5:45 PM on December 19, 2005
A friend was enable to secure the funding to send her to a rehab aimed specifically at working with women of colour, and so over twenty years into a crack habit, Tanya finally made a real emotional commitment to getting and staying clean.
How do you think Tanya would have done if instead of rehab she had been sent a nice new free apartment full of active crackheads?
posted by cedar at 5:46 PM on December 19, 2005
How do you think Tanya would have done if instead of rehab she had been sent a nice new free apartment full of active crackheads?
posted by cedar at 5:46 PM on December 19, 2005
cedar writes "Uh... the proven method I mentioned was, at the risk of stating the obvious, not drinking. What path one takes to achieve that goal I'm happy to leave to the individual."
Well, this program aims to be the path that one takes to that goal. The process of quitting drinking isn't often done at once, without events leading up to it. If an addict can be brought into a stable setting, there is a much greater chance for that person to make wiser decisions about their life and how to change it for the better. Above all, there is the humane aspect to this. If someone has a chronic addiction to alcohol, that doesn't necessarily mean it's acceptable to let that person die of exposure. Even Andy Griffith's Mayberry had a town drunk, Otis Campbell, who regularly used the lock-up as a second home. At the least, they had compassion for the man. Yes, it's fiction, but it illustrates a segment of popular opinion at the time, and a conservative one at that.
posted by krinklyfig at 5:49 PM on December 19, 2005
Well, this program aims to be the path that one takes to that goal. The process of quitting drinking isn't often done at once, without events leading up to it. If an addict can be brought into a stable setting, there is a much greater chance for that person to make wiser decisions about their life and how to change it for the better. Above all, there is the humane aspect to this. If someone has a chronic addiction to alcohol, that doesn't necessarily mean it's acceptable to let that person die of exposure. Even Andy Griffith's Mayberry had a town drunk, Otis Campbell, who regularly used the lock-up as a second home. At the least, they had compassion for the man. Yes, it's fiction, but it illustrates a segment of popular opinion at the time, and a conservative one at that.
posted by krinklyfig at 5:49 PM on December 19, 2005
I'm willing to support this and hope that it works out.
It's got to be better than what we've had in Seattle until now, because what they did in the past wasn't working.
posted by spinifex23 at 5:49 PM on December 19, 2005
It's got to be better than what we've had in Seattle until now, because what they did in the past wasn't working.
posted by spinifex23 at 5:49 PM on December 19, 2005
I guess even if you're still waking up hung over and addicted, it has to be better to wake up in your own home than on the street or in a shelter. And that makes your day a little better, and that in turn might give you that little extra bit of clarity or hope it takes to get you to clean up.
Seems worth a try. The price of low-income housing seems a lot less than a few trips to the emergency room.
OP: but cedar, it seems unlikely that Tanya would have any shortage of "active crackheads" in her environment in either case.
posted by freebird at 5:50 PM on December 19, 2005
Seems worth a try. The price of low-income housing seems a lot less than a few trips to the emergency room.
OP: but cedar, it seems unlikely that Tanya would have any shortage of "active crackheads" in her environment in either case.
posted by freebird at 5:50 PM on December 19, 2005
This is what gives me some skepticism about drug legalization.
I'm a long-term supporter of legalization, Gyan. For a couple of reasons, but the biggest reason for me is that my own experience is that a conviction for drug offenses tends to make it much harder for people to avoid getting more deeply involved with the drug subculture and the criminal elements that currently organize the trade.
That said, I don't support a free market in all drugs. My personal prescription for drug policy would be decriminalized possession of all drugs, fairly liberal arrangements for the purchase and sale of cannabis (as per the Dutch model), and controlled medical availability of opioids and amphetamines (as a crack/cocaine substitute) for those suffering from opioid dependence who aren't ready or have no desire to achieve abstinence.
I'd leave the dealing prohibitions pretty much in place, because of the inherent tendency that heroin and cocaine dealers have to create dependent populations of consumers, and because I don't think drugs like MDMA would make it through any kind of FDA safety assessment. And I think we need to be consistent about things like the safety of products we allow people to sell on the open market.
However, I do think that the sentences imposed for drug dealing in some countries -- the USA in particular -- are out of all proportion to the crime. Sell a willing consumer a product that they want and you get 25 to life. Rob, beat, rape and terrorize women or communities and you won't expect to get anything like that long in jail.
Says something about our priorities that I don't think we should be saying.
So to go back to your core point -- the idea that legalization will make things worse for the poor -- while I'm inclined to agree with you, I've got two friends, both experts in various aspects of drug policy, who have opinions that differ.
They make the argument that the reason that poor people continue to take cocaine for as long as they do is because they can never afford to buy enough to become so satiated that they reject the drug as the horrible, unpleasant experience that it eventually turns out to be. Rather than lapsing into horrible cocaine paranoia and swearing off the stuff for life, they're only able to buy small quantities, and so they get intermittent reinforcement from the occasional pleasure such amounts still bring them.
I'm not sure that I buy this argument, but the background of the aforementioned two friends is very different. One is a Dutch academic who lives and works in Amsterdam and has an international reputation for his research into cocaine use. The other is an ex-cocaine dealer who stopped after getting busted with two kilos which left her facing fifteen to life under NYC's Rockefeller Laws. So even though I'm not sure that I agree with them, I'm inclined to take their arguments seriously because of the very different approaches that led them to reach the same conclusions.
posted by PeterMcDermott at 5:53 PM on December 19, 2005
I'm a long-term supporter of legalization, Gyan. For a couple of reasons, but the biggest reason for me is that my own experience is that a conviction for drug offenses tends to make it much harder for people to avoid getting more deeply involved with the drug subculture and the criminal elements that currently organize the trade.
That said, I don't support a free market in all drugs. My personal prescription for drug policy would be decriminalized possession of all drugs, fairly liberal arrangements for the purchase and sale of cannabis (as per the Dutch model), and controlled medical availability of opioids and amphetamines (as a crack/cocaine substitute) for those suffering from opioid dependence who aren't ready or have no desire to achieve abstinence.
I'd leave the dealing prohibitions pretty much in place, because of the inherent tendency that heroin and cocaine dealers have to create dependent populations of consumers, and because I don't think drugs like MDMA would make it through any kind of FDA safety assessment. And I think we need to be consistent about things like the safety of products we allow people to sell on the open market.
However, I do think that the sentences imposed for drug dealing in some countries -- the USA in particular -- are out of all proportion to the crime. Sell a willing consumer a product that they want and you get 25 to life. Rob, beat, rape and terrorize women or communities and you won't expect to get anything like that long in jail.
Says something about our priorities that I don't think we should be saying.
So to go back to your core point -- the idea that legalization will make things worse for the poor -- while I'm inclined to agree with you, I've got two friends, both experts in various aspects of drug policy, who have opinions that differ.
They make the argument that the reason that poor people continue to take cocaine for as long as they do is because they can never afford to buy enough to become so satiated that they reject the drug as the horrible, unpleasant experience that it eventually turns out to be. Rather than lapsing into horrible cocaine paranoia and swearing off the stuff for life, they're only able to buy small quantities, and so they get intermittent reinforcement from the occasional pleasure such amounts still bring them.
I'm not sure that I buy this argument, but the background of the aforementioned two friends is very different. One is a Dutch academic who lives and works in Amsterdam and has an international reputation for his research into cocaine use. The other is an ex-cocaine dealer who stopped after getting busted with two kilos which left her facing fifteen to life under NYC's Rockefeller Laws. So even though I'm not sure that I agree with them, I'm inclined to take their arguments seriously because of the very different approaches that led them to reach the same conclusions.
posted by PeterMcDermott at 5:53 PM on December 19, 2005
How do you think Tanya would have done if instead of rehab she had been sent a nice new free apartment full of active crackheads?
Exactly.
It's got to be better than what we've had in Seattle until now, because what they did in the past wasn't working.
They did essentially "nothing" before, so yeah.
We should come back to this in two years and see how the program has come along. Sadly, I predict almost certain total failure. Unless the goal is to give these folks some where warm to die. Then.. SUCCESS!
posted by tkchrist at 6:02 PM on December 19, 2005
Exactly.
It's got to be better than what we've had in Seattle until now, because what they did in the past wasn't working.
They did essentially "nothing" before, so yeah.
We should come back to this in two years and see how the program has come along. Sadly, I predict almost certain total failure. Unless the goal is to give these folks some where warm to die. Then.. SUCCESS!
posted by tkchrist at 6:02 PM on December 19, 2005
Sadly, I predict almost certain total failure. Unless the goal is to give these folks some where warm to die. Then.. SUCCESS!
I'm OK with that.
Far more humane for them to die in their own warm bed, than among rotting trash under a highway overpass.
posted by spinifex23 at 6:04 PM on December 19, 2005
I'm OK with that.
Far more humane for them to die in their own warm bed, than among rotting trash under a highway overpass.
posted by spinifex23 at 6:04 PM on December 19, 2005
How do you think Tanya would have done if instead of rehab she had been sent a nice new free apartment full of active crackheads?
I think you're mixing up cause and effect. At any point in the previous twenty years, Tanya could have been sent to the same rehab and would have done whatever it took to find crack.
Once she'd made that decision that she wanted to stop, of course it's obvious that you want her to be in a place where you minimize the risks. However, I've worked in and around this field since the early eighties, and I've yet to come across any method of reliably persuading people to change their desires before they reach that conclusion for themselves. However, all of the facilities of this sort that I've ever been aware of (and we've had them in the UK forever now, though not many) provide people with the sort of contact such that when they do reach such a stage in their drug/drink career, they have somebody there who can help them get redirected to an appropriate facility when they are looking to make those sorts of changes.
It's all about flexibility, and providing them with the services that are most appropriate to their needs at any given time, rather than trying to insist on a one-model-fits-all, which allows those people whose needs aren't met by that model to fall through the cracks.
Finally, the area that Tanya lives in now (Peckham, for those who know London) is a crack heavy area. She doesn't appear to be tempted by the proximity of the drug, because it isn't where she used. She tells me that when she walks through the streets and sees the local crackheads, she feels repelled and wonders how she could ever have done it for so many years.
However, whenever she comes back home to Liverpool, she still feels a little shakey because the cues, the people and the situations that she used in are all still here.
posted by PeterMcDermott at 6:06 PM on December 19, 2005
I think you're mixing up cause and effect. At any point in the previous twenty years, Tanya could have been sent to the same rehab and would have done whatever it took to find crack.
Once she'd made that decision that she wanted to stop, of course it's obvious that you want her to be in a place where you minimize the risks. However, I've worked in and around this field since the early eighties, and I've yet to come across any method of reliably persuading people to change their desires before they reach that conclusion for themselves. However, all of the facilities of this sort that I've ever been aware of (and we've had them in the UK forever now, though not many) provide people with the sort of contact such that when they do reach such a stage in their drug/drink career, they have somebody there who can help them get redirected to an appropriate facility when they are looking to make those sorts of changes.
It's all about flexibility, and providing them with the services that are most appropriate to their needs at any given time, rather than trying to insist on a one-model-fits-all, which allows those people whose needs aren't met by that model to fall through the cracks.
Finally, the area that Tanya lives in now (Peckham, for those who know London) is a crack heavy area. She doesn't appear to be tempted by the proximity of the drug, because it isn't where she used. She tells me that when she walks through the streets and sees the local crackheads, she feels repelled and wonders how she could ever have done it for so many years.
However, whenever she comes back home to Liverpool, she still feels a little shakey because the cues, the people and the situations that she used in are all still here.
posted by PeterMcDermott at 6:06 PM on December 19, 2005
I'm in training for this. I hope to qualify some day.
posted by psmealey at 6:08 PM on December 19, 2005
posted by psmealey at 6:08 PM on December 19, 2005
Well, this program aims to be the path that one takes to that goal. The process of quitting drinking isn't often done at once, without events leading up to it.
But this isn't a stable setting except in the sense of having a roof over ones head. They can still drink, they still have to go out and buy booze, they can still go to bars and pretty much do whatever they want. All that has changed is they can now do it with a little less risk and in the company of 74 other like-minded folks.
If an addict can be brought into a stable setting, there is a much greater chance for that person to make wiser decisions about their life and how to change it for the better.
Unfortunately, addiction doesn't work like that. An alcoholic or addict is, by definition, unable to manage their life. Alcoholics stop drinking they when they reach a point in their lives that the consequences of continuing are too dire and the pain is too strong -- then they get sober or commit suicide. This kind of housing only enables the drunk and prolongs the process.
posted by cedar at 6:09 PM on December 19, 2005
But this isn't a stable setting except in the sense of having a roof over ones head. They can still drink, they still have to go out and buy booze, they can still go to bars and pretty much do whatever they want. All that has changed is they can now do it with a little less risk and in the company of 74 other like-minded folks.
If an addict can be brought into a stable setting, there is a much greater chance for that person to make wiser decisions about their life and how to change it for the better.
Unfortunately, addiction doesn't work like that. An alcoholic or addict is, by definition, unable to manage their life. Alcoholics stop drinking they when they reach a point in their lives that the consequences of continuing are too dire and the pain is too strong -- then they get sober or commit suicide. This kind of housing only enables the drunk and prolongs the process.
posted by cedar at 6:09 PM on December 19, 2005
It's all about flexibility, and providing them with the services that are most appropriate to their needs at any given time, rather than trying to insist on a one-model-fits-all, which allows those people whose needs aren't met by that model to fall through the cracks.
This is where we will have to agree to disagree.
While I agree on the need for flexibility I do not believe that providing public housing with 'chronic alcoholism' and 'frequent arrests' as the sole criteria is viable.
Unless they plan on installing an open-bar in the lobby these people are still going to need drinking money. They are going to continue to use the heath care system, probably more than ever as one more barrier to the Holy Grail of a bottomless vodka fountain is removed. They are going to continue to get arrested because, well, because they're drunk and drunk people do stupid stuff and get arrested.
I agree that all the babble in the world isn't going to help anyone until they are ready to change, but removing incentives for change doesn't strike me productive. Hell, they might stay drunk out of fear of losing their home to someone in worse shape.
posted by cedar at 6:27 PM on December 19, 2005
This is where we will have to agree to disagree.
While I agree on the need for flexibility I do not believe that providing public housing with 'chronic alcoholism' and 'frequent arrests' as the sole criteria is viable.
Unless they plan on installing an open-bar in the lobby these people are still going to need drinking money. They are going to continue to use the heath care system, probably more than ever as one more barrier to the Holy Grail of a bottomless vodka fountain is removed. They are going to continue to get arrested because, well, because they're drunk and drunk people do stupid stuff and get arrested.
I agree that all the babble in the world isn't going to help anyone until they are ready to change, but removing incentives for change doesn't strike me productive. Hell, they might stay drunk out of fear of losing their home to someone in worse shape.
posted by cedar at 6:27 PM on December 19, 2005
An alcoholic or addict is, by definition, unable to manage their life. Alcoholics stop drinking they when they reach a point in their lives that the consequences of continuing are too dire and the pain is too strong -- then they get sober or commit suicide.
This quaint piece of 19th century temperance theology is the model most commonly promoted via television news. However, a survey of research comparing various treatment programs conducted by the American Psychological Association suggests that the most cost effective treatments are brief interventions and motivational interviewing between capable therapists and clients with no moral voodoo about the alcoholic having to reach a state of utter degradation in order to stop drinking involved. From the evidence, people not going through any treatment program whatsoever have similar or better results compared to those entering twelve step programs. People drink all sorts of different ways and quit in all sorts of different ways.
Here are some excerpts from Stanton Peele: Ten Radical Things NIAAA Research Shows About Alcoholism
...(5) American twelve-step treatment is of limited usefulness. Any documented success of twelve-step treatment would reflect well on American alcoholism treatment, since Roman and Blum in their National Treatment Center Study, found that 93 percent of drug and alcohol programs follow the twelve-step program. Margaret Mattson a principal NIAAA MATCH coordinator, declared: "The results indicate that the Twelve Step model, . . . the most widely practiced . . . in the US, is beneficial." But this conclusion is not consistent with a meta-analysis of all available controlled alcoholism treatment studies reported by Miller et al. Unlike MATCH, Miller et al. found that alcoholism treatments were clearly differentiated in terms of their demonstrated effectiveness, with brief interventions ranked first, followed by social skills training and motivational enhancement. Ranked at the low end were confrontation and general alcoholism therapy. The two tests of AA found it inferior to other treatments or even no treatment but were not sufficient to rank AA reliably...
...(7) The most cost-effective therapy for any severity alcohol problem is brief interventions/motivational interviewing—that is, short-term, nondirective treatment. In both brief interventions and motivational interviewing, therapies found most effective by Miller et al., patients and counselors jointly discuss the patient's drinking habits and consequences in a nonjudgmental way that focuses the patient on the value of reducing or quitting drinking. Meanwhile, Motivational Enhancement Therapy would be the recommended treatment based on MATCH because it produced equal results at far lower cost. TSF and CBT were designed to be 12 weekly sessions while MET was designed to be only four sessions. However, MATCH patients on average attended only two-thirds of their sessions, so that MET in MATCH approached brief interventions. That the briefest treatment in MATCH worked as well as more extensive treatments challenges conventional wisdom that brief interventions are inappropriate for alcohol-dependent patients.
...(8) Elaborate alcoholism treatment is not necessary for recovery; most alcoholics in the United States recover without treatment. MATCH indicated that people who seek to overcome alcoholism and have a supportive social environment can well do so with brief therapeutic interactions that focus their motivation and resources on improving their lives. The NLAES analysis of untreated alcoholics shows (a) that most alcoholics do not seek treatment and (b) that most of these stop abusing alcohol (Dawson, 1996).
...(9) Nonabstinent remission is standard for American alcoholics. Not only do most alcoholics improve significantly without treatment, but they typically do so without quitting drinking. According to NLAES, from five years following a...
We need to put a stake through the heart of all this you have to hit rock bottom theology. Science just does not support it.
posted by y2karl at 6:55 PM on December 19, 2005
This quaint piece of 19th century temperance theology is the model most commonly promoted via television news. However, a survey of research comparing various treatment programs conducted by the American Psychological Association suggests that the most cost effective treatments are brief interventions and motivational interviewing between capable therapists and clients with no moral voodoo about the alcoholic having to reach a state of utter degradation in order to stop drinking involved. From the evidence, people not going through any treatment program whatsoever have similar or better results compared to those entering twelve step programs. People drink all sorts of different ways and quit in all sorts of different ways.
Here are some excerpts from Stanton Peele: Ten Radical Things NIAAA Research Shows About Alcoholism
...(5) American twelve-step treatment is of limited usefulness. Any documented success of twelve-step treatment would reflect well on American alcoholism treatment, since Roman and Blum in their National Treatment Center Study, found that 93 percent of drug and alcohol programs follow the twelve-step program. Margaret Mattson a principal NIAAA MATCH coordinator, declared: "The results indicate that the Twelve Step model, . . . the most widely practiced . . . in the US, is beneficial." But this conclusion is not consistent with a meta-analysis of all available controlled alcoholism treatment studies reported by Miller et al. Unlike MATCH, Miller et al. found that alcoholism treatments were clearly differentiated in terms of their demonstrated effectiveness, with brief interventions ranked first, followed by social skills training and motivational enhancement. Ranked at the low end were confrontation and general alcoholism therapy. The two tests of AA found it inferior to other treatments or even no treatment but were not sufficient to rank AA reliably...
...(7) The most cost-effective therapy for any severity alcohol problem is brief interventions/motivational interviewing—that is, short-term, nondirective treatment. In both brief interventions and motivational interviewing, therapies found most effective by Miller et al., patients and counselors jointly discuss the patient's drinking habits and consequences in a nonjudgmental way that focuses the patient on the value of reducing or quitting drinking. Meanwhile, Motivational Enhancement Therapy would be the recommended treatment based on MATCH because it produced equal results at far lower cost. TSF and CBT were designed to be 12 weekly sessions while MET was designed to be only four sessions. However, MATCH patients on average attended only two-thirds of their sessions, so that MET in MATCH approached brief interventions. That the briefest treatment in MATCH worked as well as more extensive treatments challenges conventional wisdom that brief interventions are inappropriate for alcohol-dependent patients.
...(8) Elaborate alcoholism treatment is not necessary for recovery; most alcoholics in the United States recover without treatment. MATCH indicated that people who seek to overcome alcoholism and have a supportive social environment can well do so with brief therapeutic interactions that focus their motivation and resources on improving their lives. The NLAES analysis of untreated alcoholics shows (a) that most alcoholics do not seek treatment and (b) that most of these stop abusing alcohol (Dawson, 1996).
...(9) Nonabstinent remission is standard for American alcoholics. Not only do most alcoholics improve significantly without treatment, but they typically do so without quitting drinking. According to NLAES, from five years following a...
We need to put a stake through the heart of all this you have to hit rock bottom theology. Science just does not support it.
posted by y2karl at 6:55 PM on December 19, 2005
cedar : "An alcoholic or addict is, by definition, unable to manage their life. "
Of course not. An addict is someone who is psychologically and/or physically dependent on something. They may be functional or not.
PeterMcDermott : "because I don't think drugs like MDMA would make it through any kind of FDA safety assessment"
Well there is some FDA-approved research happening with MDMA. But in any case, alcohol wouldn't pass any FDA assessment either.
PeterMcDermott : "They make the argument that the reason that poor people continue to take cocaine for as long as they do is because they can never afford to buy enough to become so satiated that they reject the drug as the horrible, unpleasant experience that it eventually turns out to be."
Isn't that good? If they ingest higher amounts, there's a mortal risk. (Is your friend Peter Cohen?)
posted by Gyan at 7:04 PM on December 19, 2005
Of course not. An addict is someone who is psychologically and/or physically dependent on something. They may be functional or not.
PeterMcDermott : "because I don't think drugs like MDMA would make it through any kind of FDA safety assessment"
Well there is some FDA-approved research happening with MDMA. But in any case, alcohol wouldn't pass any FDA assessment either.
PeterMcDermott : "They make the argument that the reason that poor people continue to take cocaine for as long as they do is because they can never afford to buy enough to become so satiated that they reject the drug as the horrible, unpleasant experience that it eventually turns out to be."
Isn't that good? If they ingest higher amounts, there's a mortal risk. (Is your friend Peter Cohen?)
posted by Gyan at 7:04 PM on December 19, 2005
tkchrist: Quit your bitching. Please. As a fellow Seattleite who has lived in 7 different large cities across the country and the world you can rest assured that despite the transportation issues and, ahem, urban planning issues Seattle has, you (we) live in one of the most pleasant cities in the world.
Seriously.
posted by ryanhealy at 7:06 PM on December 19, 2005
Seriously.
posted by ryanhealy at 7:06 PM on December 19, 2005
How do you raise an alcoholic's bottom? Cut off his legs.
This program is a good start at speeding up that process. A huge reason I left the field was the lack of creative thinking in terms of treatment alternatives. Having been trained in the "Minnesota Model" at Hazelden, it was pretty much 12 steps, god, and a cloud of dust. Something like this would never have been pulled off 10-15 years ago. Talking about alternative programs to my patients would have insured I didn't last longer than I did. So all axe-grinding aside, I welcome this. Sure, on paper, this looks like bunk and further enabling of the process of self-destruction however the alternatives are much less pretty. We can give it a chance an see where it leads us.
posted by KevinSkomsvold at 7:08 PM on December 19, 2005
This program is a good start at speeding up that process. A huge reason I left the field was the lack of creative thinking in terms of treatment alternatives. Having been trained in the "Minnesota Model" at Hazelden, it was pretty much 12 steps, god, and a cloud of dust. Something like this would never have been pulled off 10-15 years ago. Talking about alternative programs to my patients would have insured I didn't last longer than I did. So all axe-grinding aside, I welcome this. Sure, on paper, this looks like bunk and further enabling of the process of self-destruction however the alternatives are much less pretty. We can give it a chance an see where it leads us.
posted by KevinSkomsvold at 7:08 PM on December 19, 2005
This is what gives me some skepticism about drug legalization. Sure, addiction among working middle-class & above may be contained & managed with sensible regulation (taxes, advertising, social oppobrium) but legal & easily available methamphetamine among those who are stuck in poverty with not much to lose? Of course, there's the argument that alcohol is already available legally & many drugs as well, and that legalization will promote substitution & some multiple use rather than envelope the sober among the poor.
That's a good point. If it were up to me as a benevolent dictator, access to drugs would require being a productive member of society. Stop being productive, stop getting drugs. The truly addicted would then be willing to work and be productive just to get their fix.
There would also be health requirements, so no shooting meth until you need 24/7 care.
Being a resident of this over-priced and over-rated "world-class" city I find this just another slap in the face of the working Seattleite.
If the program saves money, you win. Would you rather spend money just to make these people suffer?
---
And in any event, I simply cannot believe that it would be easier to quit drinking if you lived out in the gutter then if you lived in your own apartment. For one thing, living on the streets is simply physically uncomfortable (I would imagine), and being drunk would make it much more bearable. I would imagine if there were fewer stresses in your life there would be less desire to be intoxicated.
I asked about this (in MeTa, rather then Ask, actually) just the other day. So far no one has come up with any scientific evidence (other then anecdotal evidence) that withholding support from someone until they quit drinking hastens their recovery.
posted by delmoi at 7:20 PM on December 19, 2005
That's a good point. If it were up to me as a benevolent dictator, access to drugs would require being a productive member of society. Stop being productive, stop getting drugs. The truly addicted would then be willing to work and be productive just to get their fix.
There would also be health requirements, so no shooting meth until you need 24/7 care.
Being a resident of this over-priced and over-rated "world-class" city I find this just another slap in the face of the working Seattleite.
If the program saves money, you win. Would you rather spend money just to make these people suffer?
---
And in any event, I simply cannot believe that it would be easier to quit drinking if you lived out in the gutter then if you lived in your own apartment. For one thing, living on the streets is simply physically uncomfortable (I would imagine), and being drunk would make it much more bearable. I would imagine if there were fewer stresses in your life there would be less desire to be intoxicated.
I asked about this (in MeTa, rather then Ask, actually) just the other day. So far no one has come up with any scientific evidence (other then anecdotal evidence) that withholding support from someone until they quit drinking hastens their recovery.
posted by delmoi at 7:20 PM on December 19, 2005
I understand in abstract what the program is trying to accomplish but I am glad I don't live next to that building. When I first moved to Seattle I lived on the edge of First Hill and had quite enough of being followed and harassed by drunks. This has the potential to infuse a relatively peaceful block with exactly the same problems.
They say that people will be kicked out of the program if they mess with the neighbors, but I wonder just how well that will be enforced in practice. If it's anything like the apartment complex I lived in that mixed regular and "transitional" housing, someone will have to be caught red-handed in the act of muder in order to be kicked out of the program. As much as I want to look at this from a humanitarian perspective, if I lived in that neighborhood I'd be worried about my safety.
It would be interesting to see a year from now if this program improves the health and stability of its residents and if it has a negative effect on the rest of the neighborhood.
posted by rhiannon at 7:22 PM on December 19, 2005
They say that people will be kicked out of the program if they mess with the neighbors, but I wonder just how well that will be enforced in practice. If it's anything like the apartment complex I lived in that mixed regular and "transitional" housing, someone will have to be caught red-handed in the act of muder in order to be kicked out of the program. As much as I want to look at this from a humanitarian perspective, if I lived in that neighborhood I'd be worried about my safety.
It would be interesting to see a year from now if this program improves the health and stability of its residents and if it has a negative effect on the rest of the neighborhood.
posted by rhiannon at 7:22 PM on December 19, 2005
This isn't true. The idea that there is only a single proven method of treatment for alcoholism is a ideologically-driven myth perpetuated by a quasi-religious cult.
1) admitted we were powerless over kneejerking, that our kneejerking had become unmanageable.
posted by quonsar at 7:24 PM on December 19, 2005
1) admitted we were powerless over kneejerking, that our kneejerking had become unmanageable.
posted by quonsar at 7:24 PM on December 19, 2005
I agree that all the babble in the world isn't going to help anyone until they are ready to change, but removing incentives for change doesn't strike me productive. Hell, they might stay drunk out of fear of losing their home to someone in worse shape.
Right except you're also removing incentives for getting drunk, like avoiding the physical discomfort of sleeping on the ground in the freezing cold.
If there is any evidence that what you say is true (by evidence I mean published, scientific studies) I have never seen any of it.
posted by delmoi at 7:26 PM on December 19, 2005
Right except you're also removing incentives for getting drunk, like avoiding the physical discomfort of sleeping on the ground in the freezing cold.
If there is any evidence that what you say is true (by evidence I mean published, scientific studies) I have never seen any of it.
posted by delmoi at 7:26 PM on December 19, 2005
PeterMcDermott : "They make the argument that the reason that poor people continue to take cocaine for as long as they do is because they can never afford to buy enough to become so satiated that they reject the drug as the horrible, unpleasant experience that it eventually turns out to be."
Which would also mean that the drug isn't really hurting them, no?
posted by delmoi at 7:32 PM on December 19, 2005
Which would also mean that the drug isn't really hurting them, no?
posted by delmoi at 7:32 PM on December 19, 2005
The Cultural Context of Psychological Approaches to Alcoholism
Social scientists have traditionally been concerned with cultural recipes that distinguish between socially disruptive and socially integrated drinking. Moderate drinking is notable in ethnic and cultural groups such as the Chinese, the Greeks, the Jews and the Italians, where such drinking is modeled for the young and maintained by social custom and peer groups. Children are gradually introduced to alcohol in the family setting; drinking is not presented as a rite of passage into adulthood and is not associated with masculinity and social power. Adult drinking is controlled by group attitudes both toward the proper amount of drinking and proper behavior when drinking. Strong disapproval is expressed when an individual violates these standards and acts in an antisocial manner.
The American experience with alcohol parallels the results of such cross-cultural findings. In colonial America, drunkenness was accepted as a natural consequence of drinking, and habitual drunkenness was not considered to be an uncontrollable disease. Despite higher per capita consumption, alcoholism was not a serious social problem, and problem drinking was less evident than it is today. Drinking was a universally accepted social activity that took place within a tightly knit social fabric; families drank and ate together in the neighborhood tavern. Between 1790 and 1830, due to expanding frontiers and other social changes, the male-oriented saloon became the typical setting for drinking. Here alcohol was consumed in isolation from the family (the only women likely to be present were prostitutes), and drinking came to symbolize masculine independence, high-spiritedness, and violence. Alcoholism rates rose dramatically.
The temperance movement arose in response to the explosion of alcohol problems in 19th century America. It propagated the view that habitual inebriates were unable to control their drinking, the early version of the disease theory that originated with physician Benjamin Rush. Large numbers of Americans came to view alcohol as "demon rum" and regarded drinking as frequently—or inevitably—leading to uncontrolled drunkenness. The solution they proposed was national abstinence. There were regional, social class, religious, sex, and ethnic variations in these views and in the composition of the wet and dry forces that battled throughout the century. In 1920—at a point when, paradoxically, drinking patterns had moderated substantially— national prohibition was enacted. When prohibition was repealed in 1933, the goal of universal abstinence died with it. The disease theory became transmuted at this time to the view that chronic drunkenness was not an inescapable property of alcohol but was rather a characteristic of a small group of people with an inbred susceptibility to alcoholism.
This was the modern disease theory, and it was spread effectively by the Alcoholics Anonymous (AA) self-help movement. AA had many commonalities with 19th century temperance brotherhoods, such as the Washingtonians, an organization in which reformed drunkards took the vow of abstinence. Like members of the Washingtonians, AA members gathered in a highly charged, revival-type atmosphere to relate their struggles with alcohol and to support each other's continued abstinence (as well as to convince others to join them). There are peculiarly American features of AA that made its resounding success in the United States unique. AA's emphasis on public confession, contrition, and salvation through God has its roots in Southern and Midwestern evangelical Protestantism. In no other Western country have AA and the recovering alcoholic attained such a central role in the formulation of alcoholism policy and alcoholism treatment as in the United States ...
posted by y2karl at 7:38 PM on December 19, 2005
Social scientists have traditionally been concerned with cultural recipes that distinguish between socially disruptive and socially integrated drinking. Moderate drinking is notable in ethnic and cultural groups such as the Chinese, the Greeks, the Jews and the Italians, where such drinking is modeled for the young and maintained by social custom and peer groups. Children are gradually introduced to alcohol in the family setting; drinking is not presented as a rite of passage into adulthood and is not associated with masculinity and social power. Adult drinking is controlled by group attitudes both toward the proper amount of drinking and proper behavior when drinking. Strong disapproval is expressed when an individual violates these standards and acts in an antisocial manner.
The American experience with alcohol parallels the results of such cross-cultural findings. In colonial America, drunkenness was accepted as a natural consequence of drinking, and habitual drunkenness was not considered to be an uncontrollable disease. Despite higher per capita consumption, alcoholism was not a serious social problem, and problem drinking was less evident than it is today. Drinking was a universally accepted social activity that took place within a tightly knit social fabric; families drank and ate together in the neighborhood tavern. Between 1790 and 1830, due to expanding frontiers and other social changes, the male-oriented saloon became the typical setting for drinking. Here alcohol was consumed in isolation from the family (the only women likely to be present were prostitutes), and drinking came to symbolize masculine independence, high-spiritedness, and violence. Alcoholism rates rose dramatically.
The temperance movement arose in response to the explosion of alcohol problems in 19th century America. It propagated the view that habitual inebriates were unable to control their drinking, the early version of the disease theory that originated with physician Benjamin Rush. Large numbers of Americans came to view alcohol as "demon rum" and regarded drinking as frequently—or inevitably—leading to uncontrolled drunkenness. The solution they proposed was national abstinence. There were regional, social class, religious, sex, and ethnic variations in these views and in the composition of the wet and dry forces that battled throughout the century. In 1920—at a point when, paradoxically, drinking patterns had moderated substantially— national prohibition was enacted. When prohibition was repealed in 1933, the goal of universal abstinence died with it. The disease theory became transmuted at this time to the view that chronic drunkenness was not an inescapable property of alcohol but was rather a characteristic of a small group of people with an inbred susceptibility to alcoholism.
This was the modern disease theory, and it was spread effectively by the Alcoholics Anonymous (AA) self-help movement. AA had many commonalities with 19th century temperance brotherhoods, such as the Washingtonians, an organization in which reformed drunkards took the vow of abstinence. Like members of the Washingtonians, AA members gathered in a highly charged, revival-type atmosphere to relate their struggles with alcohol and to support each other's continued abstinence (as well as to convince others to join them). There are peculiarly American features of AA that made its resounding success in the United States unique. AA's emphasis on public confession, contrition, and salvation through God has its roots in Southern and Midwestern evangelical Protestantism. In no other Western country have AA and the recovering alcoholic attained such a central role in the formulation of alcoholism policy and alcoholism treatment as in the United States ...
posted by y2karl at 7:38 PM on December 19, 2005
mr_roboto : "The idea of solving homelessness by giving people a place to live does have quite a bit of appeal to common sense...."
I guess I just wanted to repeat this down here to hammer this specific point a little deeper into the thread. It looks like an amazing application of the KISS principle.
Also, since I am here already, I would like to add a big flashing (I spare you) ME TOO to everything PeterMcDermott said above (and probably below).
And finally point out that there is another angle worth taking into consideration in the legalization debate: legalization makes the lives of poorer people better by lowering the crime rate they usually have to cope with. Once having/using drugs ceases to be a crime, a large portion of the population effectively ceases to be criminals and ceases to be imprisoned, lose their jobs, their families, their parents. Strange as it seems, such a paradigm shift alone may do wonders for some communities.
posted by nkyad at 7:49 PM on December 19, 2005
I guess I just wanted to repeat this down here to hammer this specific point a little deeper into the thread. It looks like an amazing application of the KISS principle.
Also, since I am here already, I would like to add a big flashing (I spare you) ME TOO to everything PeterMcDermott said above (and probably below).
And finally point out that there is another angle worth taking into consideration in the legalization debate: legalization makes the lives of poorer people better by lowering the crime rate they usually have to cope with. Once having/using drugs ceases to be a crime, a large portion of the population effectively ceases to be criminals and ceases to be imprisoned, lose their jobs, their families, their parents. Strange as it seems, such a paradigm shift alone may do wonders for some communities.
posted by nkyad at 7:49 PM on December 19, 2005
Pardon me.
Here is a site worth a gander:
Social and Cultural Aspects of Drinking
Of interest there are
Key findings
and
Culture, chemistry and consequences
[McAndrew's and Edgerton's] Drunken Comportment remains, however, the only global-scale, systematic analysis of empirical evidence relating specifically to drunken behaviour. Although individual studies and ethnographies have contributed further examples of variation in alcohol’s effects on human behaviour, descriptions of drunken behaviour are often incidental to the main focus or argument of the work, and therefore may not provide a reliable indication of the predominant behaviours associated with drunkenness in a particular culture... Despite this caveat, the cross-cultural evidence of wide variation in drunken behaviour is extensive, and must cast doubt on any purely biochemical explanations. The problem-oriented approach of recent years has led to a disproportionate focus on just two of the many possible behavioural outcomes of drinking, aggression and sexual promiscuity, at the expense of what the Aztecs might call ‘the other 398 rabbits’.
Some people, in some societies, may indeed behave in an aggressive or promiscuous manner when drunk, but the range of behavioural outcomes also includes calmness, joviality, passivity, indolence, affability, tolerance, sociability, generosity, volubility, confidence, loquaciousness, sentimentality, gaiety, euphoria, animation, tenderness, tranquillity, boastfulness, jocularity, silliness, laziness, effusiveness, vivacity, cheerfulness, relaxation, drowsiness, peacefulness, etc. In global terms, the most frequently emphasised outcomes are relaxation and sociability.
...The notion that the behavioural outcomes of drinking are determined by cultural norms had already been proposed in a seminal paper by Mandelbaum :
'When a man lifts a cup, it is not only the kind of drink that is in it, the amount he is likely to take and the circumstances under which he will do the drinking that are specified in advance for him, but also whether the contents of the cup will cheer or stupefy; whether they will induce affection or aggression, quiet or unalloyed pleasure. These and many other cultural definitions attach to the drink even before it reaches his lips'
MacAndrew and Edgerton, and subsequent researchers, have provided overwhelming evidence to support Mandelbaum’s statement, and to illustrate the learning process summarised in Drunken Comportment:
'Over the course of socialisation, people learn about drunkenness what their society ‘knows’ about drunkenness; and, accepting and acting upon the understandings thus imparted to them, they become the living confirmation of their society’s teachings.'
The anthropological literature shows how central aspects of culture can radically shape the ways in which people learn to drink and the patterns of behaviour which are associated with alcohol consumption. It is also clear that the process of ‘acculturation’, whether induced by colonial domination, tourism or economic and cultural ‘convergence’ such as that currently occurring in parts of Europe, can introduce styles of drinking with which previously existing cultural frameworks are unable to cope.
To understand why, in some societies, drinking leads to problematic behaviours, we therefore need to be concerned with aspects of culture and cultural change, rather than with the pharmacology of alcohol. The different patterns of learning fostered by different cultures, and the novel modes of learning that acculturation can present, do not only provide models of appropriate and inappropriate drinking habits, they also create sets of expectancies regarding the behavioural effects of alcohol. Reviews of both ethnographic and psychological literature show that the behavioural consequences of drinking are always in accord with what people in a given culture expect to happen, and that individuals internalise such expectations during the learning process of socialisation.
In short, how we drink is learned behavior that varies culture by culture. Very few cultures appear to have the drinking problems we seem to have cosntucted for ourselves. That fact itself should give people pause for thought.
posted by y2karl at 7:58 PM on December 19, 2005
Here is a site worth a gander:
Social and Cultural Aspects of Drinking
Of interest there are
Key findings
and
Culture, chemistry and consequences
[McAndrew's and Edgerton's] Drunken Comportment remains, however, the only global-scale, systematic analysis of empirical evidence relating specifically to drunken behaviour. Although individual studies and ethnographies have contributed further examples of variation in alcohol’s effects on human behaviour, descriptions of drunken behaviour are often incidental to the main focus or argument of the work, and therefore may not provide a reliable indication of the predominant behaviours associated with drunkenness in a particular culture... Despite this caveat, the cross-cultural evidence of wide variation in drunken behaviour is extensive, and must cast doubt on any purely biochemical explanations. The problem-oriented approach of recent years has led to a disproportionate focus on just two of the many possible behavioural outcomes of drinking, aggression and sexual promiscuity, at the expense of what the Aztecs might call ‘the other 398 rabbits’.
Some people, in some societies, may indeed behave in an aggressive or promiscuous manner when drunk, but the range of behavioural outcomes also includes calmness, joviality, passivity, indolence, affability, tolerance, sociability, generosity, volubility, confidence, loquaciousness, sentimentality, gaiety, euphoria, animation, tenderness, tranquillity, boastfulness, jocularity, silliness, laziness, effusiveness, vivacity, cheerfulness, relaxation, drowsiness, peacefulness, etc. In global terms, the most frequently emphasised outcomes are relaxation and sociability.
...The notion that the behavioural outcomes of drinking are determined by cultural norms had already been proposed in a seminal paper by Mandelbaum :
'When a man lifts a cup, it is not only the kind of drink that is in it, the amount he is likely to take and the circumstances under which he will do the drinking that are specified in advance for him, but also whether the contents of the cup will cheer or stupefy; whether they will induce affection or aggression, quiet or unalloyed pleasure. These and many other cultural definitions attach to the drink even before it reaches his lips'
MacAndrew and Edgerton, and subsequent researchers, have provided overwhelming evidence to support Mandelbaum’s statement, and to illustrate the learning process summarised in Drunken Comportment:
'Over the course of socialisation, people learn about drunkenness what their society ‘knows’ about drunkenness; and, accepting and acting upon the understandings thus imparted to them, they become the living confirmation of their society’s teachings.'
The anthropological literature shows how central aspects of culture can radically shape the ways in which people learn to drink and the patterns of behaviour which are associated with alcohol consumption. It is also clear that the process of ‘acculturation’, whether induced by colonial domination, tourism or economic and cultural ‘convergence’ such as that currently occurring in parts of Europe, can introduce styles of drinking with which previously existing cultural frameworks are unable to cope.
To understand why, in some societies, drinking leads to problematic behaviours, we therefore need to be concerned with aspects of culture and cultural change, rather than with the pharmacology of alcohol. The different patterns of learning fostered by different cultures, and the novel modes of learning that acculturation can present, do not only provide models of appropriate and inappropriate drinking habits, they also create sets of expectancies regarding the behavioural effects of alcohol. Reviews of both ethnographic and psychological literature show that the behavioural consequences of drinking are always in accord with what people in a given culture expect to happen, and that individuals internalise such expectations during the learning process of socialisation.
In short, how we drink is learned behavior that varies culture by culture. Very few cultures appear to have the drinking problems we seem to have cosntucted for ourselves. That fact itself should give people pause for thought.
posted by y2karl at 7:58 PM on December 19, 2005
for crying out loud y2karl, you are screwing up "My Comments" with your failure to close the small tag.
posted by caddis at 8:00 PM on December 19, 2005
posted by caddis at 8:00 PM on December 19, 2005
I want to run cedar's "liquor store on the corner" near this place.
In fact, they could make up some of the funding by putting a liquor store in the basement, whose proceeds (from tenants and walk-in customers) go back into the organization...
posted by anthill at 8:16 PM on December 19, 2005
In fact, they could make up some of the funding by putting a liquor store in the basement, whose proceeds (from tenants and walk-in customers) go back into the organization...
posted by anthill at 8:16 PM on December 19, 2005
for crying out loud y2karl, you are screwing up "My Comments" with your failure to close the small tag.
I don't know what is causing your problem, caddis. I closed the tags both times. Click on View Source and see for yourself.
posted by y2karl at 8:51 PM on December 19, 2005
I don't know what is causing your problem, caddis. I closed the tags both times. Click on View Source and see for yourself.
posted by y2karl at 8:51 PM on December 19, 2005
I find that it's better to use <sub> or <sup> rather then <small> because the line spacing isn't as disproportionate to the text size.
posted by delmoi at 8:55 PM on December 19, 2005
posted by delmoi at 8:55 PM on December 19, 2005
y2karl : "I don't know what is causing your problem, caddis. I closed the tags both times. Click on View Source and see for yourself."
May I suggest that the elder and the (vision) impaired among us would be much more pleased if you returned to the ancient tradition of using italics for citations? I grow tired of zooming in and out so I hardly read your fancy but very small text.
posted by nkyad at 9:00 PM on December 19, 2005
May I suggest that the elder and the (vision) impaired among us would be much more pleased if you returned to the ancient tradition of using italics for citations? I grow tired of zooming in and out so I hardly read your fancy but very small text.
posted by nkyad at 9:00 PM on December 19, 2005
First, they said the top 20 had cost a cool million in public resources.
Second, Kat Allison, I'm in love!! Marry me?
posted by FredsinPa at 12:07 AM on December 20, 2005
Second, Kat Allison, I'm in love!! Marry me?
posted by FredsinPa at 12:07 AM on December 20, 2005
Far more humane for them to die in their own warm bed, than among rotting trash under a highway overpass. - spinifex23
Certainly. But not everyone cares about humane. Some would prefer that "those kind of people" are allowed to rot like trash wherever they end up, "as long as it's not on my lawn". I find it sad, but expected that many people are very upset to learn that some of their money might help alleviate someone else's suffering. It's the "I could have bought another Starbucks coffee with those tax dollars" mentality.
posted by raedyn at 12:44 AM on December 20, 2005
Certainly. But not everyone cares about humane. Some would prefer that "those kind of people" are allowed to rot like trash wherever they end up, "as long as it's not on my lawn". I find it sad, but expected that many people are very upset to learn that some of their money might help alleviate someone else's suffering. It's the "I could have bought another Starbucks coffee with those tax dollars" mentality.
posted by raedyn at 12:44 AM on December 20, 2005
In the last comment you opened two small tags yet closed one. Oh well, someone has opened a MeTa thread about this. The real solution is to code the My Comments page like the rest of the site so that a silly mistake like forgetting to close a tag doesn't affect the rest of th page. We have all been guilty of that.
posted by caddis at 2:48 AM on December 20, 2005
posted by caddis at 2:48 AM on December 20, 2005
May I suggest that the elder and the (vision) impaired among us would be much more pleased if you returned to the ancient tradition of using italics for citations?
I am not fond of the italics. But then I am not crazy about the small text either, so I will try delmoi's suggestion above or use blockquotes as much as possible.
posted by y2karl at 2:56 AM on December 20, 2005
I am not fond of the italics. But then I am not crazy about the small text either, so I will try delmoi's suggestion above or use blockquotes as much as possible.
posted by y2karl at 2:56 AM on December 20, 2005
I am not fond of the italics. But then I am not crazy about the small text either, so I will try delmoi's suggestion above or use blockquotes as much as possible.
Will wonders never fucking cease?
posted by stavrosthewonderchicken at 4:14 AM on December 20, 2005
Will wonders never fucking cease?
posted by stavrosthewonderchicken at 4:14 AM on December 20, 2005
This would be better if they were sent to rural Kansas or another place that needs the money, is losing population, and has much, much, much lower rents. Every farmer could board an alcoholic outsider and pick up a government check, and maybe there would be less encouragement to drink and more encouragement to stay sober out in the middle of nowhere.
posted by pracowity at 7:13 AM on December 20, 2005
posted by pracowity at 7:13 AM on December 20, 2005
Sorry to be responding so late, IRFH, but I did want to add some links to rigorous social science studies of these kinds of programs. The studies show that the housing first model increases housing stability (1, 2), is just as effective in dealing with addiction and mental illness (3), and reduces costs (4, 5). (The New York City program in link 5 isn't precisely the housing first model, because it doesn't seem to incorporate harm reduction -- e.g., active users will probably get kicked out -- but it's definitely following along the same lines of putting housing first and treatment second.)
I think it's really important to point out that the idea is not to give up on treating these people -- the facilities still provide access to mental health and addiction services. The idea is that stable housing is a vital component of their treatment, and that accordingly it is counter-therepeutic to use housing as a bargaining chip to force people into treatment.
Of course, providing free housing to the chronic homeless exposes the shortcomings of the US social welfare system, since we don't provide guaranteed housing for anyone else. The heart of the matter is that as a society we're just not willing to just let these people die in the streets -- we'll always scoop them up at the last minute and send them to a mental institution, or a hospital, or an emergency shelter, or to jail. Once we face up to the fact that we do indeed have a safety net, then we can start structuring it in a more logical, humane (and fiscally conservative) way.
posted by footnote at 10:30 AM on December 20, 2005
I think it's really important to point out that the idea is not to give up on treating these people -- the facilities still provide access to mental health and addiction services. The idea is that stable housing is a vital component of their treatment, and that accordingly it is counter-therepeutic to use housing as a bargaining chip to force people into treatment.
Of course, providing free housing to the chronic homeless exposes the shortcomings of the US social welfare system, since we don't provide guaranteed housing for anyone else. The heart of the matter is that as a society we're just not willing to just let these people die in the streets -- we'll always scoop them up at the last minute and send them to a mental institution, or a hospital, or an emergency shelter, or to jail. Once we face up to the fact that we do indeed have a safety net, then we can start structuring it in a more logical, humane (and fiscally conservative) way.
posted by footnote at 10:30 AM on December 20, 2005
Thank you very much, footnote! Your links provided exactly the information I was looking for. As a partial remedy for the issue of homelessness of chronic alcoholics, this was a tempting program to get behind. But I wasn't ready to simply assume that the financial benefits were also as stated without seeing some numbers first. (Although I hope I also made it clear that the cost was not of particular concern to me - I just wanted more info to support the claims.) But you have made your case.
I do still worry about some of the logistics, particularly surrounding security/safety of the residents of the facilities, but that's more a question of proper implementation than of the intrinsic potential value of the program. I guess we'll just have to wait and see how well Seattle manages to put this into practice.
Thanks again!
posted by It's Raining Florence Henderson at 10:58 AM on December 20, 2005
I do still worry about some of the logistics, particularly surrounding security/safety of the residents of the facilities, but that's more a question of proper implementation than of the intrinsic potential value of the program. I guess we'll just have to wait and see how well Seattle manages to put this into practice.
Thanks again!
posted by It's Raining Florence Henderson at 10:58 AM on December 20, 2005
You're welcome! I was sorry to leave this discussion behind last night, since I have connectivity problems at home and knew I wouldn't be able to follow up.
posted by footnote at 11:21 AM on December 20, 2005
posted by footnote at 11:21 AM on December 20, 2005
No problem. I actually had to post and run last night, too, so I wouldn't have seen it then, anyway.
Cheers!
posted by It's Raining Florence Henderson at 11:28 AM on December 20, 2005
Cheers!
posted by It's Raining Florence Henderson at 11:28 AM on December 20, 2005
I find it sad, but expected that many people are very upset to learn that some of their money might help alleviate someone else's suffering.
That is a completely insulting strawman.
You never entertained the notion that maybe we're upset because we believe it WON'T alleviate anyones suffering. If fact we may believe it will increase suffering.
Obviously anybody that disagrees with you is a cold unfeeling scrooge, right?. None of us has ever worked probono for homeless shelters or given money to homeless charities every year for over ten years. Nope.
Like I said - let's revisit this in a couple of years and see who was right. But by then you'll have forgotten all about it and millions will have been wasted that actually COULD have helped people.
posted by tkchrist at 5:14 PM on December 20, 2005
That is a completely insulting strawman.
You never entertained the notion that maybe we're upset because we believe it WON'T alleviate anyones suffering. If fact we may believe it will increase suffering.
Obviously anybody that disagrees with you is a cold unfeeling scrooge, right?. None of us has ever worked probono for homeless shelters or given money to homeless charities every year for over ten years. Nope.
Like I said - let's revisit this in a couple of years and see who was right. But by then you'll have forgotten all about it and millions will have been wasted that actually COULD have helped people.
posted by tkchrist at 5:14 PM on December 20, 2005
I wasn't accusing anyone in this thread of wanting to keep their money more than they wanted to help these people. I'm sorry that I wasn't more clear in my post, tkchrist.
I don't know enough to have an opinion on this project. I think it's an interesting approach, but I don't pretend to know if it will actually help or the people it's aimed at or not.
I was only intending to remind spinifex23 that not everyone has the same values and priorities. That there actually are some people who would rather have people die far away than have them "leach off me"*. My comment wasn't intended as a back handed suggestion that the people in this thread questioning this approach were those people. I'm sorry I didn't make that clearer.
* this is not my opinion, but it's an opinion I've heard repeated many times by others
posted by raedyn at 7:44 AM on December 21, 2005
I don't know enough to have an opinion on this project. I think it's an interesting approach, but I don't pretend to know if it will actually help or the people it's aimed at or not.
I was only intending to remind spinifex23 that not everyone has the same values and priorities. That there actually are some people who would rather have people die far away than have them "leach off me"*. My comment wasn't intended as a back handed suggestion that the people in this thread questioning this approach were those people. I'm sorry I didn't make that clearer.
* this is not my opinion, but it's an opinion I've heard repeated many times by others
posted by raedyn at 7:44 AM on December 21, 2005
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posted by fenriq at 3:19 PM on December 19, 2005