The shelter that gives wine to alcoholics
April 27, 2016 6:20 AM Subscribe
I am often pessimistic about the basic income movement, but an upshot seems to be a growing recognition that if people need something desperately enough to start turning to illegal or unorthodox sources, it's cheaper for the public good to just give them that thing.
If something's taken over your life to the extent it's now on the bottom of your own personal Maslow's hierarchy, then a supportive environment isn't much help, morality be damned.
posted by solarion at 6:40 AM on April 27, 2016 [18 favorites]
If something's taken over your life to the extent it's now on the bottom of your own personal Maslow's hierarchy, then a supportive environment isn't much help, morality be damned.
posted by solarion at 6:40 AM on April 27, 2016 [18 favorites]
My mum is a mental health nurse who works primarily with drug users. Many (if not most) of her clients are non-functioning alcoholics who have been referred either from various parts of the NHS or homelessness charities. Part of the treatment offered to these clients is a routine alcohol allowance (both because alcohol withdrawal is very very serious and because many of them are more stable on the booze than off it).
A couple of years ago the trust my mum works for got their funding cut by the government, so they had to start weaning people off the alcohol because they could no longer afford to pay for it. The nurses were told to "get them clean in 6 weeks or less" (or words to that effect) because if they were still in the system after that, there would be no place for them to go. My mum was very upset by this because she was seeing so many people who were getting better with this allowance, who just needed the smallest amount of hand-holding to live their lives with a minimum of harm, and all of them were being left in the cold.
posted by fight or flight at 6:41 AM on April 27, 2016 [53 favorites]
A couple of years ago the trust my mum works for got their funding cut by the government, so they had to start weaning people off the alcohol because they could no longer afford to pay for it. The nurses were told to "get them clean in 6 weeks or less" (or words to that effect) because if they were still in the system after that, there would be no place for them to go. My mum was very upset by this because she was seeing so many people who were getting better with this allowance, who just needed the smallest amount of hand-holding to live their lives with a minimum of harm, and all of them were being left in the cold.
posted by fight or flight at 6:41 AM on April 27, 2016 [53 favorites]
A couple of years ago the trust my mum works for got their funding cut by the government, so they had to start weaning people off the alcohol because they could no longer afford to pay for it.
And that's when you build a still in a disused janitor's closet.
posted by Faint of Butt at 6:45 AM on April 27, 2016 [5 favorites]
And that's when you build a still in a disused janitor's closet.
posted by Faint of Butt at 6:45 AM on April 27, 2016 [5 favorites]
Reminds me of a remark I heard about the campaign to raise the price of alcohol: 'So you think if someone's alcoholic the best thing to do is ensure they're also bankrupt?'.
posted by Segundus at 6:46 AM on April 27, 2016 [7 favorites]
posted by Segundus at 6:46 AM on April 27, 2016 [7 favorites]
I've seen several articles describing newly-opened wet shelters (so-called), such as the one in the previous link, but no stories following up on how the programs are faring after operating for a few years. I'd really like to see that!
posted by thelonius at 7:01 AM on April 27, 2016 [4 favorites]
posted by thelonius at 7:01 AM on April 27, 2016 [4 favorites]
a friend and i used to make bags for homeless people in our town - they included something like chili (thing that could be made in batches, cheaply, that didn't seem 'weird'), plastic silverware, a little bit of candy, and a couple bucks. some people who saw our plan got mad - 'they're only going to spend it on alcohol and drugs!' - and i mean, that's what we were going to do with the money too, so....also we figured if for 45 minutes or so we could give someone the gift of a full belly and not having to worry about where that night's drink was coming from, why wouldn't we? i was surprised that we got so much resistance from our friend group which was filled with functioning alcoholics.
posted by nadawi at 7:05 AM on April 27, 2016 [61 favorites]
posted by nadawi at 7:05 AM on April 27, 2016 [61 favorites]
This is basically "Junco Partner," right?
(The lyrics vary from performer to performer. In Professor Longhair's version the listener is instructed to give the junco whiskey when he gets dry, water when he gets thirsty, attention when he gets sickly, and a graveyard when he dies. The Dr. John version goes like this:
"Give me whisky
When I get a little frisky
Cus it's-a mighty good drink
When you get a little dry
Give me tobacco-o-o
When I get a little sickly
But give me heroin
Before I die.")
posted by octobersurprise at 7:07 AM on April 27, 2016 [3 favorites]
(The lyrics vary from performer to performer. In Professor Longhair's version the listener is instructed to give the junco whiskey when he gets dry, water when he gets thirsty, attention when he gets sickly, and a graveyard when he dies. The Dr. John version goes like this:
"Give me whisky
When I get a little frisky
Cus it's-a mighty good drink
When you get a little dry
Give me tobacco-o-o
When I get a little sickly
But give me heroin
Before I die.")
posted by octobersurprise at 7:07 AM on April 27, 2016 [3 favorites]
It seems like keeping politics and morality away from public health issues generally results in better outcomes. Who would have though it? Whatever next?
posted by pipeski at 7:08 AM on April 27, 2016 [40 favorites]
posted by pipeski at 7:08 AM on April 27, 2016 [40 favorites]
The only thing that sounds crazy is that this sounds crazy to anyone.
posted by enn at 7:08 AM on April 27, 2016 [22 favorites]
posted by enn at 7:08 AM on April 27, 2016 [22 favorites]
This is harm reduction at it's most practical. Brilliant job. Needle exchange and methadone programs work. Harm reduction for crystal meth users works. We need more doctors like Turnbull in charge.
posted by Sophie1 at 7:13 AM on April 27, 2016 [41 favorites]
posted by Sophie1 at 7:13 AM on April 27, 2016 [41 favorites]
It seems like it's specifically designed so that if you need alcohol to function, you can get it there - but if you try and go above and beyond that and use alcohol to get drunk, they're not going to help you.
But they'll give you more chances -- it's not a once and you're out. And the "don't let drunk people come in" was actually requested by the alcoholics, not imposed from above.
It's a great story, I hope to see more shelters like this.
posted by jeather at 7:17 AM on April 27, 2016 [10 favorites]
But they'll give you more chances -- it's not a once and you're out. And the "don't let drunk people come in" was actually requested by the alcoholics, not imposed from above.
It's a great story, I hope to see more shelters like this.
posted by jeather at 7:17 AM on April 27, 2016 [10 favorites]
Mod note: Comment and a few replies removed; let's skip the hyperbolic one-liner "yeah but what if" takes.
posted by cortex (staff) at 7:19 AM on April 27, 2016 [7 favorites]
posted by cortex (staff) at 7:19 AM on April 27, 2016 [7 favorites]
A couple of years ago the trust my mum works for got their funding cut by the government, so they had to start weaning people off the alcohol because they could no longer afford to pay for it.
That's what scares/frustrates me most about these harm reduction programs - no matter how well researchers and healthcare professionals can establish that they're successful, they're unpopular politically and don't really make sense to those who haven't taken the time to learn about addiction. And I worry that that's a really hard popular opinion to change. So no matter how effective the programs are, they'll be the first ones to go when the money is slashed (or the money for the programs will be slashed specifically for that).
I mean, look how many people still argue against providing free condoms in schools (arguably harm reduction as well). And that one doesn't require too much imagination to make sense of.
posted by R a c h e l at 7:22 AM on April 27, 2016 [7 favorites]
That's what scares/frustrates me most about these harm reduction programs - no matter how well researchers and healthcare professionals can establish that they're successful, they're unpopular politically and don't really make sense to those who haven't taken the time to learn about addiction. And I worry that that's a really hard popular opinion to change. So no matter how effective the programs are, they'll be the first ones to go when the money is slashed (or the money for the programs will be slashed specifically for that).
I mean, look how many people still argue against providing free condoms in schools (arguably harm reduction as well). And that one doesn't require too much imagination to make sense of.
posted by R a c h e l at 7:22 AM on April 27, 2016 [7 favorites]
People tend to get clean when they are ready to. Some people do it with the help of a 12-step program, some go cold turkey, and some use other methods.
Some never do, regardless of the approach.
Would you rather have those people drunk (or high) in the gutter, or someplace safe where they can be monitored?
posted by TheWhiteSkull at 7:28 AM on April 27, 2016 [4 favorites]
Some never do, regardless of the approach.
Would you rather have those people drunk (or high) in the gutter, or someplace safe where they can be monitored?
posted by TheWhiteSkull at 7:28 AM on April 27, 2016 [4 favorites]
Some people do it with the help of a 12-step program, some go cold turkey, and some use other methods.
It's bizarre how many people actually believe that 12-step programs are the only way to get sober (putting aside that they tend to define "sobriety" as ongoing particiapation in these progams...). Do they actually think, say, that no one could quit drinking before the 1930s?
posted by thelonius at 7:37 AM on April 27, 2016 [11 favorites]
It's bizarre how many people actually believe that 12-step programs are the only way to get sober (putting aside that they tend to define "sobriety" as ongoing particiapation in these progams...). Do they actually think, say, that no one could quit drinking before the 1930s?
posted by thelonius at 7:37 AM on April 27, 2016 [11 favorites]
So no matter how effective the programs are, they'll be the first ones to go when the money is slashed (or the money for the programs will be slashed specifically for that).
A significant part of the funding for this program -- and many long-term shelter programs in Canada -- is the standard welfare/disability benefits that residents are already receiving. It makes it a whole lot harder to directly cut the funding for the shelter because you'd have to cut social programs in general to do it, and that affects more than the shelter.
They also keep a pretty low profile. I'm vaguely aware that Seaton House in Toronto exists because I used to know someone who worked there. I would hazard to guess that 90%+ of Toronto's population has either never heard of Seaton House at all or doesn't know it's not a dry shelter. That helps keep the programs from becoming a political football.
posted by jacquilynne at 7:42 AM on April 27, 2016 [6 favorites]
A significant part of the funding for this program -- and many long-term shelter programs in Canada -- is the standard welfare/disability benefits that residents are already receiving. It makes it a whole lot harder to directly cut the funding for the shelter because you'd have to cut social programs in general to do it, and that affects more than the shelter.
They also keep a pretty low profile. I'm vaguely aware that Seaton House in Toronto exists because I used to know someone who worked there. I would hazard to guess that 90%+ of Toronto's population has either never heard of Seaton House at all or doesn't know it's not a dry shelter. That helps keep the programs from becoming a political football.
posted by jacquilynne at 7:42 AM on April 27, 2016 [6 favorites]
"The only thing that sounds crazy is that this sounds crazy to anyone."
I don't think a lot of people understand that alcohol addiction becomes physical. If I remember correctly, if you're physically addicted and quit cold turkey then you could die whereas opiate addiction, while bad, doesn't kill you when you go cold turkey.
posted by I-baLL at 7:45 AM on April 27, 2016 [5 favorites]
I don't think a lot of people understand that alcohol addiction becomes physical. If I remember correctly, if you're physically addicted and quit cold turkey then you could die whereas opiate addiction, while bad, doesn't kill you when you go cold turkey.
posted by I-baLL at 7:45 AM on April 27, 2016 [5 favorites]
Yeah, most people recover on their own and there's no evidence treatment programs are anymore effective than just giving people time and support to work through their problems.
posted by saulgoodman at 7:48 AM on April 27, 2016 [3 favorites]
posted by saulgoodman at 7:48 AM on April 27, 2016 [3 favorites]
They also keep a pretty low profile.
"Don't mention the war." - Basil Fawlty
posted by fairmettle at 7:50 AM on April 27, 2016 [1 favorite]
"Don't mention the war." - Basil Fawlty
posted by fairmettle at 7:50 AM on April 27, 2016 [1 favorite]
I'm personally not a fan of these places but I find them interesting and the people involved are doing good work with great compassion. I also would like to see follow up studies a few years down the road about how the program and people are doing and if it's a workable system. I've tried to get more information on the St. Anthony Residence from that previous post and there isn't much that I can find. I also called Catholic Charities who operates it but they said they couldn't tell me anything except that it's still operating
It's bizarre how many people actually believe that 12-step programs are the only way to get sober
Yes it is and I never understand why some people are so averse to alternatives.
putting aside that they tend to define "sobriety" as ongoing particiapation in these progams
I've been involved in several 12-step groups and I've never heard this. I have heard people say that participation is important and will worry if people stop showing up, but that's not the measure of sobriety.
posted by Clinging to the Wreckage at 7:51 AM on April 27, 2016 [3 favorites]
It's bizarre how many people actually believe that 12-step programs are the only way to get sober
Yes it is and I never understand why some people are so averse to alternatives.
putting aside that they tend to define "sobriety" as ongoing particiapation in these progams
I've been involved in several 12-step groups and I've never heard this. I have heard people say that participation is important and will worry if people stop showing up, but that's not the measure of sobriety.
posted by Clinging to the Wreckage at 7:51 AM on April 27, 2016 [3 favorites]
Give strong drink to the one who is perishing, and wine to those in bitter distress; let them drink and forget their poverty and remember their misery no more.
Proverbs 31:6-7
posted by Apocryphon at 7:57 AM on April 27, 2016 [25 favorites]
Proverbs 31:6-7
posted by Apocryphon at 7:57 AM on April 27, 2016 [25 favorites]
"A recent Lancet Commission on public health and international drug policy implores the world to move away from a war on drugs and to put health at the centre of revolutionizing drug policy [2]. Over the past decade, harm reduction has been proven time and again, across varying countries, regions, social and cultural settings, to be a highly effective HIV prevention measure, a cost-effective set of interventions, and an approach promoting the human rights and dignity of a marginalized and criminalized community.
Its adoption in policy and practice has slowly but steadily increased. Today, the majority of the 158 countries with documented injecting drug use have adopted harm reduction measures to some degree in domestic policy and practice: 91 countries allow for harm reduction in national policy documents, 90 have at least one needle-syringe programme (NSP) and 80 countries provide opioid substitution therapy (OST) -- an increase of 17 since this monitoring began [3].
Where harm reduction programmes have had adequate financing and the legal and policy space to flourish, the impact has been dramatic. This has been observed among early harm reduction pioneers, as well as in countries to more recently adopt harm reduction."
Cook C et al. Journal of the International AIDS Society 2016, 19:21129
posted by Sophie1 at 8:03 AM on April 27, 2016 [7 favorites]
Its adoption in policy and practice has slowly but steadily increased. Today, the majority of the 158 countries with documented injecting drug use have adopted harm reduction measures to some degree in domestic policy and practice: 91 countries allow for harm reduction in national policy documents, 90 have at least one needle-syringe programme (NSP) and 80 countries provide opioid substitution therapy (OST) -- an increase of 17 since this monitoring began [3].
Where harm reduction programmes have had adequate financing and the legal and policy space to flourish, the impact has been dramatic. This has been observed among early harm reduction pioneers, as well as in countries to more recently adopt harm reduction."
Cook C et al. Journal of the International AIDS Society 2016, 19:21129
posted by Sophie1 at 8:03 AM on April 27, 2016 [7 favorites]
putting aside that they tend to define "sobriety" as ongoing particiapation in these progams
I've been involved in several 12-step groups and I've never heard this. I have heard people say that participation is important and will worry if people stop showing up, but that's not the measure of sobriety.
I've heard versions of this. I find other groups that are less "One of us! One of us!" when that happens.
posted by Etrigan at 8:04 AM on April 27, 2016 [2 favorites]
I've been involved in several 12-step groups and I've never heard this. I have heard people say that participation is important and will worry if people stop showing up, but that's not the measure of sobriety.
I've heard versions of this. I find other groups that are less "One of us! One of us!" when that happens.
posted by Etrigan at 8:04 AM on April 27, 2016 [2 favorites]
They also keep a pretty low profile.
Yeah this is super important just because the moment a politically active group that doesn't believe in harm reduction finds out about you, your harm reduction program is in jeopardy.
In my neighborhood there were a bunch of protests recently because a homeless shelter was opening up, which a certain part of the community did not care for. Arguing for the shelter on Facebook someone said "it's not like it's a methadone clinic or something." There is a methadone clinic a few blocks from where they were opening the homeless shelter, but you'd never know it because they've been very good about keeping it subtle. I assume if the people who were protesting the homeless shelter found out (or if someone decided to make a stink) they'd be out in the streets trying to get that closed down too.
posted by griphus at 8:12 AM on April 27, 2016 [13 favorites]
Yeah this is super important just because the moment a politically active group that doesn't believe in harm reduction finds out about you, your harm reduction program is in jeopardy.
In my neighborhood there were a bunch of protests recently because a homeless shelter was opening up, which a certain part of the community did not care for. Arguing for the shelter on Facebook someone said "it's not like it's a methadone clinic or something." There is a methadone clinic a few blocks from where they were opening the homeless shelter, but you'd never know it because they've been very good about keeping it subtle. I assume if the people who were protesting the homeless shelter found out (or if someone decided to make a stink) they'd be out in the streets trying to get that closed down too.
posted by griphus at 8:12 AM on April 27, 2016 [13 favorites]
saulgoodman, the site that you link to is really pretty bad. Here's a quote from that page: "23.8% of those who were never treated are still dependent – yet 28.4% of those who have been treated are still dependent. This means your chance of resolving your substance use problem may be better if you simply avoid treatment!" Does he really mean to say that seeking treatment actually increases an addict's chances of relapse? Just a thought here--maybe the people who seek treatment have a worse problem to begin with than the ones that don't? Oh, hey, check out this bit from his "About" page: "I am not a doctor, counselor, or any sort of PhD. Besides a few college level courses in psychology and psychiatry, I do not have the formal education and credentials most people expect from someone who speaks on this topic." Well.
In terms of the FPP, as someone who has benefited greatly from AA, I have no real problem with this harm reduction approach. I mean, I encourage people to give AA a try, of course, and part of the program is to give people hope that they can live better lives without alcohol, even and especially when they've come to believe that they can't do that. But even AA notes that there are some people who seem to be incapable of working the program (see, for example, the beginning of Chapter 5 of Alcoholics Anonymous, aka the Big Book, "How It Works", which is read at the beginning of every meeting). I don't want these people to suffer.
posted by Halloween Jack at 8:14 AM on April 27, 2016 [4 favorites]
In terms of the FPP, as someone who has benefited greatly from AA, I have no real problem with this harm reduction approach. I mean, I encourage people to give AA a try, of course, and part of the program is to give people hope that they can live better lives without alcohol, even and especially when they've come to believe that they can't do that. But even AA notes that there are some people who seem to be incapable of working the program (see, for example, the beginning of Chapter 5 of Alcoholics Anonymous, aka the Big Book, "How It Works", which is read at the beginning of every meeting). I don't want these people to suffer.
posted by Halloween Jack at 8:14 AM on April 27, 2016 [4 favorites]
This pragmatic approach is desperately needed for American polices regarding drugs, poverty, homelessness, etc. Arguments concerning morality and personal responsibility -while applicable to individuals- are irrelevant to public policy.
Should people become homeless and engage in chronic alcoholism? No, of course not. But it's happening. Finger waving has not and will never solve the problem.
Should tax dollars be spent giving alcohol to to the homeless? Ideally no. But it seems to be far cheaper to give homeless chronic alcoholics a little booze and a place to stay than pay the costs of arrests, emergency room visits, and whatever else.
This hearing about senior hunger is a great example of how the government can smartly spend tax dollars to ultimately save tax dollars. If you want to skip ahead, go to 2:55 for Al Franken's question about whether spending money to feed seniors and keep them in their homes will save the government money. Then stick around for Rand Paul's brilliant comment.
posted by blairsyprofane at 8:28 AM on April 27, 2016 [3 favorites]
Should people become homeless and engage in chronic alcoholism? No, of course not. But it's happening. Finger waving has not and will never solve the problem.
Should tax dollars be spent giving alcohol to to the homeless? Ideally no. But it seems to be far cheaper to give homeless chronic alcoholics a little booze and a place to stay than pay the costs of arrests, emergency room visits, and whatever else.
This hearing about senior hunger is a great example of how the government can smartly spend tax dollars to ultimately save tax dollars. If you want to skip ahead, go to 2:55 for Al Franken's question about whether spending money to feed seniors and keep them in their homes will save the government money. Then stick around for Rand Paul's brilliant comment.
posted by blairsyprofane at 8:28 AM on April 27, 2016 [3 favorites]
let them drink and forget their poverty and remember their misery no more.
The thing is, that is not what happens.
posted by thelonius at 8:37 AM on April 27, 2016 [2 favorites]
The thing is, that is not what happens.
posted by thelonius at 8:37 AM on April 27, 2016 [2 favorites]
The 'wet house' in Saint Paul is still there. Oddly, there's a couple of microbreweries nearby now, one of which is also a pub.
posted by ZeusHumms at 8:48 AM on April 27, 2016 [1 favorite]
posted by ZeusHumms at 8:48 AM on April 27, 2016 [1 favorite]
I think I remember seeing like this on TV. And, I also believe I remember them saying that many of the people in the program actually wound up getting sober. Which kinda makes sense, once your whole isn't built around getting you next fix, you can actually think about getting your shit together.
posted by jonmc at 8:55 AM on April 27, 2016 [3 favorites]
posted by jonmc at 8:55 AM on April 27, 2016 [3 favorites]
That site may have been a bad source, as I grabbed it quickly, but there are a number of reliable studies showing that long term recovery rates between people who go into treatment programs are basically identical to the outcomes for people who don't. And most treatment programs are run on really outdated science.
Other than nicotine, I've only had one, honest to goodness physical substance addiction and what helped me kick it most was friends and family being supportive and forcing me to confront it.
My mom was actually stuck in a long term treatment program for heroin addiction in Germany when my grandparents here in the US kidnapped me, and that triggered a relapse for her that cost her another year of her life, so it's obviously a combination of factors that contribute to long term success. If you suddenly take away a person's reasons for wanting to recover, no treatment program is likely to paper over that.
posted by saulgoodman at 8:56 AM on April 27, 2016 [3 favorites]
Other than nicotine, I've only had one, honest to goodness physical substance addiction and what helped me kick it most was friends and family being supportive and forcing me to confront it.
My mom was actually stuck in a long term treatment program for heroin addiction in Germany when my grandparents here in the US kidnapped me, and that triggered a relapse for her that cost her another year of her life, so it's obviously a combination of factors that contribute to long term success. If you suddenly take away a person's reasons for wanting to recover, no treatment program is likely to paper over that.
posted by saulgoodman at 8:56 AM on April 27, 2016 [3 favorites]
One of my first memories was riding the El in Chicago headed downtown with my father to go some museum or other. An obvious homeless, alcoholic man came through the car with a paper bag asking for money. My father gave him a few dollars. After they man left, my father turned to me and asked, "If someone is asking for money and you know they'll just spend it on alcohol, would you give them money?" Of course this question was really complex for my 6 year old mind. After maybe managing an "I don't know" but more likely after just sitting there baffled for a while, like I often did in response to my dad's questions, he said something along the lines of "You never know what will help someone or what someone needs to be okay. Don't assume that what you see as their problem is not their solution."
posted by milarepa at 8:59 AM on April 27, 2016 [27 favorites]
posted by milarepa at 8:59 AM on April 27, 2016 [27 favorites]
The actual AA meeting model of 12-step programs is not really the problem. The two big problems are a) AA's marketing was so good that people (as in, society, not people with a drinking problem) believe it's The Only Way, and b) evil entrepreneurs have turned that into a massive Medicare- and insurance-sucking industry of "inpatient rehab" that accomplish nothing except expose patients to fraud, abuse, gross malpractice, death, and almost-guaranteed relapse for recurring revenue.
Legitimate medical-based addiction treatment is more successful and safer than those places, but a lot of people believe that doesn't "count" and have exhausted their financial and insurance resources on the scam programs anyway.
posted by Lyn Never at 9:00 AM on April 27, 2016 [10 favorites]
Legitimate medical-based addiction treatment is more successful and safer than those places, but a lot of people believe that doesn't "count" and have exhausted their financial and insurance resources on the scam programs anyway.
posted by Lyn Never at 9:00 AM on April 27, 2016 [10 favorites]
I used to be a needle exchange volunteer for several years. It was startling to me at first (and is not even slightly startling to me now with some more years of wisdom and getting my head out of my own ass under my belt) how much more receptive people are to medical care, reducing their usage, using more safely, etc. when you come in with a baseline harm reduction assumption of "meeting you wherever you're at, helping you be at that place more safely, not being judgmental, and making other resources available to you when/if you want them." This seems like a good harm reduction program and I wish it, and its clients, well.
(And on the alcohol-specific front, I'll just note that SMART Recovery is an alternative to AA that has been really helpful to several people in my life. Might be worth checking out, people who are interested in alternatives.)
posted by Stacey at 9:08 AM on April 27, 2016 [15 favorites]
(And on the alcohol-specific front, I'll just note that SMART Recovery is an alternative to AA that has been really helpful to several people in my life. Might be worth checking out, people who are interested in alternatives.)
posted by Stacey at 9:08 AM on April 27, 2016 [15 favorites]
I am generally in support of harm-reduction programs, but I would be interested to learn how programs like this handle what you might call collateral problems. People exhibit a wide range of undesirable and antisocial behaviors when they're drunk. The program accepts, as it must, that some people in the residence are going to get drunk, and it sounds as if most of these residents in particular have had their social norms worn down by rough living for quite some time before they arrive. How do you manage those behaviors so that the place doesn't become intolerable to live in? Obviously this program has done it for some time; I'd just like to know what they do. It's basically the problem of any service provider which serves distressed groups: concentrate a bunch of people with severe social problems in one place and there are going to be some undesirable behaviors acted out in the vicinity. In order to make harm reduction more politically palatable, I think it would be helpful if it could be made clear how those behaviors will be handled. Otherwise people think their neighborhoods are going to turn into that Penn Station-area White Castle with the methadone clinics nearby.
posted by praemunire at 9:25 AM on April 27, 2016 [1 favorite]
posted by praemunire at 9:25 AM on April 27, 2016 [1 favorite]
Obviously this program has done it for some time; I'd just like to know what they do.
It's in the article: maximum seven ounces at 7.30am for the first pour of the day, and five ounces each hour after that. Last call is 9.30pm.
The pour is calculated for each resident to be just enough to stave off the shakes and sweats of detox, which for alcohol is particularly unpleasant – seizures from alcohol deprivation can be fatal. The pour is strictly regulated: Young cuts off anyone who comes in intoxicated. They won’t be given another drink until they sober up.
They're being given maintenance doses - hourly, so they have also eradicated the anxiety about where the next fix will come from. Five ounces of wine (one bar glass of wine) isn't enough to get an alcoholic drunk, at that rate it'd be enough for a medium-framed social drinker to maintain a little buzz and then need a real good nap about 2pm. But it is enough to stave off the DTs, which are also really incredibly disruptive. It's also enough to prevent kindling from having long enforced dry periods interspersed with binge-drinking.
posted by Lyn Never at 9:38 AM on April 27, 2016 [11 favorites]
It's in the article: maximum seven ounces at 7.30am for the first pour of the day, and five ounces each hour after that. Last call is 9.30pm.
The pour is calculated for each resident to be just enough to stave off the shakes and sweats of detox, which for alcohol is particularly unpleasant – seizures from alcohol deprivation can be fatal. The pour is strictly regulated: Young cuts off anyone who comes in intoxicated. They won’t be given another drink until they sober up.
They're being given maintenance doses - hourly, so they have also eradicated the anxiety about where the next fix will come from. Five ounces of wine (one bar glass of wine) isn't enough to get an alcoholic drunk, at that rate it'd be enough for a medium-framed social drinker to maintain a little buzz and then need a real good nap about 2pm. But it is enough to stave off the DTs, which are also really incredibly disruptive. It's also enough to prevent kindling from having long enforced dry periods interspersed with binge-drinking.
posted by Lyn Never at 9:38 AM on April 27, 2016 [11 favorites]
> I've seen several articles describing newly-opened wet shelters (so-called), such as the one in the previous link, but no stories following up on how the programs are faring after operating for a few years. I'd really like to see that!
The article describes in detail a program that opened fifteen years ago. And it includes a link to the 2006 peer-reviewed research. Or are you asking for something else here?
posted by gingerbeer at 9:48 AM on April 27, 2016 [1 favorite]
The article describes in detail a program that opened fifteen years ago. And it includes a link to the 2006 peer-reviewed research. Or are you asking for something else here?
posted by gingerbeer at 9:48 AM on April 27, 2016 [1 favorite]
Someone always says: “My dad was an alcoholic and he quit. Why don’t these people quit?” said Bartolo.
My dad was an alcoholic and he didn't quit, he died. So I'm super-keen on harm reduction.
posted by alasdair at 10:01 AM on April 27, 2016 [9 favorites]
My dad was an alcoholic and he didn't quit, he died. So I'm super-keen on harm reduction.
posted by alasdair at 10:01 AM on April 27, 2016 [9 favorites]
It's basically the problem of any service provider which serves distressed groups: concentrate a bunch of people with severe social problems in one place and there are going to be some undesirable be haviors acted out in the vicinity. In order to make harm reduction more politically palatable, I think it would be helpful if it could be made clear how those behaviors will be handled.
Lyn Never answered really well, but there's a bit further on in the article that explains that they have to be sober (ish) to get their hourly dose, and that they have to check in 30 minutes before wine o'clock to get it. They can leave and get drunk but it's discouraged, and they lose the free stuff if they do.
posted by jrochest at 10:07 AM on April 27, 2016 [1 favorite]
Lyn Never answered really well, but there's a bit further on in the article that explains that they have to be sober (ish) to get their hourly dose, and that they have to check in 30 minutes before wine o'clock to get it. They can leave and get drunk but it's discouraged, and they lose the free stuff if they do.
posted by jrochest at 10:07 AM on April 27, 2016 [1 favorite]
Interesting! I live in this neighbourhood in Ottawa, and the Oaks is at the end of my street. I am surprised to read about it in a UK publication. For what it's worth, I am more apprehensive of some of my home-owning neighbours' behavior than the residents of this facility.
posted by maggiemae at 10:14 AM on April 27, 2016 [5 favorites]
posted by maggiemae at 10:14 AM on April 27, 2016 [5 favorites]
Another interesting publication specifically about alcohol and harm reduction: Int. J. Environ. Res. Public Health 2015, 12(11)
Specifically:
2. The Need to Overcome the Dichotomy “Harm Reduction” vs. “Comprehensive Treatment”, Plus the Advantages of a Philosophy of Intervention that Refrains from Aiming at Immediate Disengagement from Alcohol
Among the various dichotomies that limit an effective approach to the problem of addiction, one of the most prominent is “integrated treatment versus harm reduction”. For years, these two strategies have been considered opposite poles of different philosophies of intervention. One is bound to the search for methods that lead the subject to complete abstinence, the other assigns top priority to a fall in substance use, with maximum reduction in the damage done correlated with the extent of the fall in use [7].
Supporters of harm reduction argue that this approach is desirable in any case, because it promotes each patient’s opportunity to improve his/her health while reducing the risk of practices of abuse. Critics argue that this approach is useless, as it does not intervene in the pathophysiology of the disease, maintaining the positive reinforcement of the intake of the drug and course of disease.
Etc.
posted by Sophie1 at 10:29 AM on April 27, 2016
Specifically:
2. The Need to Overcome the Dichotomy “Harm Reduction” vs. “Comprehensive Treatment”, Plus the Advantages of a Philosophy of Intervention that Refrains from Aiming at Immediate Disengagement from Alcohol
Among the various dichotomies that limit an effective approach to the problem of addiction, one of the most prominent is “integrated treatment versus harm reduction”. For years, these two strategies have been considered opposite poles of different philosophies of intervention. One is bound to the search for methods that lead the subject to complete abstinence, the other assigns top priority to a fall in substance use, with maximum reduction in the damage done correlated with the extent of the fall in use [7].
Supporters of harm reduction argue that this approach is desirable in any case, because it promotes each patient’s opportunity to improve his/her health while reducing the risk of practices of abuse. Critics argue that this approach is useless, as it does not intervene in the pathophysiology of the disease, maintaining the positive reinforcement of the intake of the drug and course of disease.
Etc.
posted by Sophie1 at 10:29 AM on April 27, 2016
If you're interested in alcohol addiction alternatives, take a look at Baclofen - a drug which, though usually prescribed for spasticity, has shown a remarkable ability to quell cravings in cases of long-term heavy (20+ drinks/day) alcoholism. (previously)
Baclofen is a generic drug, and at the dosage levels commonly shown effective (200+ mg daily), the cost is roughly $5/day.
Here's a study that reviewed data from a clinic prescribing Baclofen as a treatment for alcoholism (click on the chart for a quick overview of results). Lower down on the page, you can read individual case studies, such as this:
Patient-3 (Pt3) is 59-year-old woman referred for an intractable alcoholism (4 bottles of white wine per day) associated with a fronto-temporal dementia. The dementia was labeled idiopathic by her neurologist, independent of the alcoholism. She is treated by clomipramine and donepezil. Baclofen was considered by the family as a last-resort attempt. Increasing baclofen doses proved to be extremely difficult due to the massive memory problems of the patient and to insufficient surveillance of treatment administration by the (very busy) family. It took 2 years to reach the dose of 400 mg/day (thanks to an ancillary worker who was hired by the family to accompany the patient and control her treatment observance). At that dose, the patient suddenly stopped drinking, showing a total indifference toward alcohol. Two years later, she is still sober (ritually filling at dinner time a glass of wine, which she does not finish), and has recovered fairly good memory capacities (the diagnosis of idiopathic dementia has been abandoned).
If you're interested for personal reasons, have read enough to satisfy your safety and efficacy concerns, but are unable to find a doctor willing to prescribe Baclofen for alcoholism, you should know that there are online pharmacies operating in Europe that are willing to "prescribe" online, and ship to the US. A close friend recently ordered (and received) a month's supply of Baclofen (from this site, MIOREL TABL 50x10MG was the cheapest option), as a last resort for a family member struggling with severe alcoholism. Shipping took a few weeks. They've not had to resort to using it, as the family member is in treatment.
Disclaimer: I don't have any affiliation with the website, and no personal experience with the drug. From what I've read, it sounds like a very promising option for people in a terrible situation.
posted by cavedweller at 10:46 AM on April 27, 2016 [7 favorites]
Baclofen is a generic drug, and at the dosage levels commonly shown effective (200+ mg daily), the cost is roughly $5/day.
Here's a study that reviewed data from a clinic prescribing Baclofen as a treatment for alcoholism (click on the chart for a quick overview of results). Lower down on the page, you can read individual case studies, such as this:
Patient-3 (Pt3) is 59-year-old woman referred for an intractable alcoholism (4 bottles of white wine per day) associated with a fronto-temporal dementia. The dementia was labeled idiopathic by her neurologist, independent of the alcoholism. She is treated by clomipramine and donepezil. Baclofen was considered by the family as a last-resort attempt. Increasing baclofen doses proved to be extremely difficult due to the massive memory problems of the patient and to insufficient surveillance of treatment administration by the (very busy) family. It took 2 years to reach the dose of 400 mg/day (thanks to an ancillary worker who was hired by the family to accompany the patient and control her treatment observance). At that dose, the patient suddenly stopped drinking, showing a total indifference toward alcohol. Two years later, she is still sober (ritually filling at dinner time a glass of wine, which she does not finish), and has recovered fairly good memory capacities (the diagnosis of idiopathic dementia has been abandoned).
If you're interested for personal reasons, have read enough to satisfy your safety and efficacy concerns, but are unable to find a doctor willing to prescribe Baclofen for alcoholism, you should know that there are online pharmacies operating in Europe that are willing to "prescribe" online, and ship to the US. A close friend recently ordered (and received) a month's supply of Baclofen (from this site, MIOREL TABL 50x10MG was the cheapest option), as a last resort for a family member struggling with severe alcoholism. Shipping took a few weeks. They've not had to resort to using it, as the family member is in treatment.
Disclaimer: I don't have any affiliation with the website, and no personal experience with the drug. From what I've read, it sounds like a very promising option for people in a terrible situation.
posted by cavedweller at 10:46 AM on April 27, 2016 [7 favorites]
It's in the article...at that rate it'd be enough for a medium-framed social drinker to maintain a little buzz and then need a real good nap about 2pm
The article also states that some of the participants go out and get more alcohol on their own, and indeed specifically describes one of the individuals profiled as having done so, to the point of blacking out. It is clearly and unescapably a fact that unless you use very repressive (hence undesirable and probably unworkable in the long run) measures you are going to have some of the alcoholics in your care getting drunk, with the resulting problems. There's a passing reference in the article to one participant having been aggressive over the weekend, but I would like a better understanding of the strategy for handling it, especially if alcoholism is co-morbid with more severe mental illness. You cannot just hand-wave the collateral problems away, especially if you want people who still think addiction is a choice to support your programs. I'm interested to learn how they can be successfully managed, which it seems like so far this program is doing.
posted by praemunire at 10:56 AM on April 27, 2016 [1 favorite]
The article also states that some of the participants go out and get more alcohol on their own, and indeed specifically describes one of the individuals profiled as having done so, to the point of blacking out. It is clearly and unescapably a fact that unless you use very repressive (hence undesirable and probably unworkable in the long run) measures you are going to have some of the alcoholics in your care getting drunk, with the resulting problems. There's a passing reference in the article to one participant having been aggressive over the weekend, but I would like a better understanding of the strategy for handling it, especially if alcoholism is co-morbid with more severe mental illness. You cannot just hand-wave the collateral problems away, especially if you want people who still think addiction is a choice to support your programs. I'm interested to learn how they can be successfully managed, which it seems like so far this program is doing.
posted by praemunire at 10:56 AM on April 27, 2016 [1 favorite]
A building I worked at for a year was housing for chronic inebriates. University of Washington has (last I checked) ongoing studies there. They found that it not only saves the city millions of dollars, it is also proven to decrease drinking. Tldr; 4 million and 35% less.
There was about 5 to 10% of the residents who had managed to get and stay sober, and around double that percentage that openly struggled with trying to get sober. I also unfortunately recall that, on average, someone would pass away every other month.
posted by P.o.B. at 11:14 AM on April 27, 2016 [4 favorites]
There was about 5 to 10% of the residents who had managed to get and stay sober, and around double that percentage that openly struggled with trying to get sober. I also unfortunately recall that, on average, someone would pass away every other month.
posted by P.o.B. at 11:14 AM on April 27, 2016 [4 favorites]
They've done (are doing?) something similar in Amsterdam. Paying alcoholics to clean a park for wages and beer. I haven't heard a followup, but at the time people were reporting on it it seemed to be helping.
posted by antinomia at 12:44 PM on April 27, 2016
posted by antinomia at 12:44 PM on April 27, 2016
I love AA, and I wish programs like this were everywhere. AA doesn't work for most people with drinking issues, and it especially doesn't work for people who don't actually want to stop drinking entirely. Unfortunately, the only place you'll find more moralistic disapproval of heavy drinking and "enabling" of same than in AA is everywhere outside of AA.
...AA's marketing was so good...
It seems weird to refer to AA's PR as "marketing" when participation in AA is free, always and everywhere. If it's not free, it's not AA.
posted by generalist at 1:50 PM on April 27, 2016 [3 favorites]
...AA's marketing was so good...
It seems weird to refer to AA's PR as "marketing" when participation in AA is free, always and everywhere. If it's not free, it's not AA.
posted by generalist at 1:50 PM on April 27, 2016 [3 favorites]
Yeah, I'm trying not to get grar-y about that "marketing" thing, since a) this thread is not really about AA, and b) saying that something is "not really AA" is not only your basic No True Scotsmanning, but also ignores what some particular branches or offshoots of AA may be doing. I will say, pertinent to the current discussion, that a couple of big reasons why AA may be promoted by others over alternative recovery programs or systems (such as SMART, which I've heard good things about), is that a) its emphasis on a spiritual aspect to recovery and on abstinence appeals to a lot of particular religions and belief systems, especially a couple of large American-based denominations that require their members to be abstinent, and b) it's free and open to anyone who has a sincere desire to stop drinking, which means that it may be one of the few requirements for a legally-mandated treatment program--say, for a DUI--that don't actually cost the patient/offender anything. This gets a lot of butts into the bleachers, but contrary to the general goal of any marketing program, may give the program a worse name in the long run, since so many of the people who are exposed to it are at a low point in their lives and don't really want to be there.
posted by Halloween Jack at 2:47 PM on April 27, 2016 [2 favorites]
posted by Halloween Jack at 2:47 PM on April 27, 2016 [2 favorites]
I'm a huge supporter of harm reduction, and this article just emphasized to me everything that makes it important.
In the late 1990s, a tiny group of people was responsible for absorbing a huge proportion of Ottawa’s healthcare budget.
It would be one thing if harm reduction helped some people but at a huge cost. I'd probably still argue for it, but it would be a hard sell. But again and again, these kinds of programs make so much financial sense that it is ridiculous. It is similar to the programs in a few cities in the US that provide outreach and direct services to the tiny number of people with the most ER visits -- a relatively small outlay pays itself back many times over. The resistance to these programs is strange to me, since to me they seem so self-evidently worthwhile.
posted by Dip Flash at 6:38 PM on April 27, 2016 [2 favorites]
In the late 1990s, a tiny group of people was responsible for absorbing a huge proportion of Ottawa’s healthcare budget.
It would be one thing if harm reduction helped some people but at a huge cost. I'd probably still argue for it, but it would be a hard sell. But again and again, these kinds of programs make so much financial sense that it is ridiculous. It is similar to the programs in a few cities in the US that provide outreach and direct services to the tiny number of people with the most ER visits -- a relatively small outlay pays itself back many times over. The resistance to these programs is strange to me, since to me they seem so self-evidently worthwhile.
posted by Dip Flash at 6:38 PM on April 27, 2016 [2 favorites]
Sometimes it makes sense to provide people with what they need, regardless of judgement or opinions. Good article, thanks for posting.
posted by HuronBob at 9:10 PM on April 27, 2016 [1 favorite]
posted by HuronBob at 9:10 PM on April 27, 2016 [1 favorite]
« Older the marketing team jokingly referred to as a... | New short story from Paolo Bacigalupi Newer »
This thread has been archived and is closed to new comments
posted by k5.user at 6:33 AM on April 27, 2016