
At St. Paul 'wet house,' liquor can be their life - and death - michaelfairley
http://www.twincities.com/ci_16774107?nclick_check=1
======
iamelgringo
My first job in a hospital (I'm an ER nurse ) in 1993 was as an ER tech at
Hennepin County Medical Center in Minneapolis.

After welfare checks came out at the beginning of the months, we would have
literally dozens of homeless alcoholics lining the hallways of the ER,
sometimes stacked in gurneys along the wall, three deep.

The beginning of the month, people would drink hard liquor. Middle of the
month, cheap grain alcohol and towards the end of the month, when Walgreens
sold 1 liter bottles of Listerine for $2, "List" became the drink of choice.

At the time, it was illegal to be publicly intoxicated in Minneapolis, so the
police would pick up the drunks and bring them to the ER for medical
clearance, but never take them to jail when they were sober. So, the drunks
would marinate all night in the ER until they could blow less than 0.1 on a
breathalyser and then they could walk out.

ER overcrowding with drunks became such a huge problem, that the hospital
opened up a "drunk tank" or a dedicated hospital unit to let these guys sleep
and sober up. It was a 25 bed unit, and you weren't eligible to stay on that
unit unless your alcohol level was over 0.3. I routinely saw people at 0.4 and
occasionally 0.5. (Legally drunk in California is 0.08 these days.)

On top of that, the ER built a dedicated holding unit for the alcoholics who
blew between 0.1 and 0.3 on the breathalyser. It was an 8 room locked holding
unit. staffed by 2 nurses, 2 security guards and 2 ER techs. One night, I
remember holding over 26 patients in there.

One night, two police officers (understandably) who were quite fed up with the
situation brought in 3 patients soaked in urine and feces in to the ER in
their patrol car. They could only fit 1 in the back seat of their car, so they
brought the other two.... in the trunk of the cop car. Bad plan.

Someone called the press, the cops were suspended. The two alcoholics pressed
a lawsuit against the city of Minneapolis, and were awarded $4 Million in
damages.

Hennepin County Medical Center, the ER where the alcoholics were brought to
knew these two men well. They had had over 200 ER visits and/or
hospitalizations in the previous 2 years. So, Hennepin County immediately
pursued payment for these two men's ER bills (over $2 Million each), and got a
lien on the lawsuit money.

A month after the suit was settled and these men received the payment for the
county, and paid off their hospital bill, they started frequenting the ER
where I worked yet again--passed out, covered in feces and soaked in urine.

I'm not trying to make judgments. It's a terrible situation all around.
Alcoholism is a terrible disease. And, when it's terminal... I think hospice
might be the smarter choice.

At least via the hospice model, the alcoholics can die with a few shreds of
dignity instead of passing out drunk in a snow bank when it's -20F in the
Minnesota winters and having toes and then feet amputated because of frost
bite. Also, in the hospice model, the health care system can take care of
people who can best use their services.

Good article. It brought back a lot of interesting memories. :)

~~~
vdm
Great story; thanks.

------
Groxx
Interesting. I can see how it would be appealing to long-time alcoholics (the
"endless optimism" _would_ get pretty sickening).

Not entirely sure what my stance is on it, though - it's essentially long-term
non-profit euthanasia. It's what they want, but it's also what they want
because they're addicted and it's re-wired their brain so drastically they'll
do just about anything to keep feeding it.

On the flip side, rehabilitating someone who doesn't _want_ to be
rehabilitated to some degree is essentially throwing enormous sums of money
down the drain, and drags that time of their life far lower than it was
before. Instead, this offers them companionship and fewer insults (and keeps
them in line) until they die, and that seems to be what many people want -
what they have for shorter instead of something else which may or may not be
better for longer.

If nothing else, it has jogged my thinker; I'll probably debate with myself
for a while on this :)

~~~
joe_the_user
Even as something of a liberal, this makes me feel conflicted. It doesn't
quite feel like harm reduction - just cost-reduction for the agencies. It's
very bleak.

~~~
Groxx
But if you can't really reduce the harm (or not much), but you can
significantly reduce the cost... is bleak bad?

America is on a _huge_ "everyone should be happy" kick - smile all the time,
buck up and be cheerful, if you're not happy take this pill - but that has its
own problems, and masks problems like these people are having, making them
worse. It also trivializes pain / unhappiness - everyone can have it! Why
don't you? Try this pill, go to a meeting, look everyone can do it! - and
given the amount of depression occurring can it even be said to be working?
For some, sure - there are outliers in any system of people..

There's also that it can cause things to get even worse - if everyone really
can / should be happy, and I can't, clearly something's wrong with me. You'll
find a _lot_ of depressed people in that line of thinking, and it crops up in
suicides pretty often too.

Not really disagreeing, just debating with myself / you / the Internets.

~~~
jacques_chester
Oh hey, someone who mocks the use of antidepressants. I suffer from congenital
depression. Zoloft helps me to be a functioning, productive member of society.
It has prevented many deaths from suicide. People like you prevent people from
seeking help because they buy into the "just harden up" bullshit.

Should people with diabetes just kick the insulin habit? Please.

~~~
Groxx
Where the _hell_ are you getting that from? Read what's written, not what you
want to see. I said America is on a happy kick, not that such drugs don't work
or that they're unnecessary. There's an obsession with _appearing_ happy that
hides and / or causes a lot of problems, including depression.

~~~
jacques_chester
I've applied a simple stereotype. Everyone I've ever seen saying "America /
society / the world are on a mandatory happy kick" usually segues into a rant
about the pharmaceuticals themselves, written in a disparaging tone.

You fit the profile, and it's a profile I find repugnant and dangerous to the
mental health of depressed people everywhere.

There is an important difference between unhappiness due to life events and
clinical depression. One may trigger the other; but the fact is that
depression is a neurochemical disorder that is, in most cases, directly and
immediately treatable with cheap, safe, effective pharmaceuticals with a
minimum of fuss.

I've had the deep dark nights of despair. The black nights of the soul. I
spent years trying to stare down the black dog. It is exhausting and I gained
_nothing_ by it. It has borne me no fruit whatsoever.

~~~
Groxx
If that's your standard response to such an apparently-vague profile, without
them actually stating such things, you're going to be jumping the gun a _lot_
and probably win more enemies than successes. Do you also leap at people who
think we're over-medicating?

~~~
jacques_chester
You're right that I jumped the gun. I'd apologise, but it would be
disingenuous as I still can't shake you out of the profile I put you in at
first.

It's not fair, and it's not rational, but if there's anything I've learnt from
taking zoloft it's that dualism is rubbish. We are illusions of ourselves,
running on a largely hacked-together substrate made of meat.

I used to put the position that the drugs are over-prescribed, that it's a
societal problem etc. But I don't feel that way any more, because thinking
like that was another reason that I did not seek treatment. I basically lost
my 20s to this disease, I don't want others to suffer as I did.

If that means erroneously attacking a few false positives on HN, so be it.

~~~
Groxx
Would anecdotes help? My sister is bipolar, and medication has helped her
immensely. My wife had a pretty bad bout of anxiety / depression that pretty
much tanked two years until I convinced her to try some medication - a year of
it helped get her over the edge, and she's off and doing much better.

Now I'll proceed to shoot somewhere near my foot, maybe hitting it :) I'd
rather be understood and disagreed with than misunderstood and have fake
happiness. And I would honestly be curious what your take is on this, I
obviously haven't experienced everything there is in the world. There's no
hard feelings here, I've seen that stance before, and I hate it too. It does
indeed prevent people from getting help.

My main view with anything that tweaks your brain is that your brain is
enormously flexible. Barring issues where you're not making enough / too much
of a certain chemical (ie, largely genetic), you quite literally did this to
yourself (as bad as that sounds). Your life habits have caused you to get
stuck in the loop of depression / anxiety, and it builds on itself, pretty
frequently until it controls you unless you are lucky enough to find a way to
break out before then. Or someone drags you out. Drugs help get you out of
that loop, but if your habits don't change you'll train your brain to go back
to where it was in spite of the drugs (and this _happens_ , it's not just
dualism / zomg-natural-only. That's part of what causes psychological
addictions, and depression is highly addictive). Again, unless there's a more
permanent biological problem - then you're using drugs to reach normalcy,
which is where your body / brain wants to be anyway. But enforced normalcy
while you keep pulling yourself away from it is doomed to failure and high
costs.

There are plenty of cases of, say, insufficient dopamine production due to
genetics. And cases where depression / anxiety have caused chemical imbalances
(ie: nearly all, especially severe cases). And the existence of medications to
help that is utterly _wonderful_. But using drugs to ignore a problem isn't a
solution. To _solve_ a problem, yes, but that's not how many (possibly most)
people use them, in part because of how quickly these medications are leapt
at. Can't focus? Try hyperactivity drugs. Can't sleep? Try sleep aids. Can't
be happy? Try antidepressants. Therapy, on the other hand, gets nowhere near
as much medical support, despite similar success rates and often longer-term
solutions. It has plenty of failures as well, everyone's different and there
are plenty of bad therapists out there; I'm merely saying that it gets _far_
less _support_ than drugs do.

~~~
jacques_chester
OK, we're getting dangerously nuanced now, which breaks all the rules of the
Internet.

I think you're conflating the illusion of consciousness with the brain itself.
It is possible to take actions to intervene in my own neurochemistry -- I am a
self-observing system. I can avoid situations that upset me, I can spend more
time with friends and family, and so on.

But my personal experience of depression is that it _removes the will to be
cured_. Yes, you can seek therapy, spend time with friends, take up meditation
and these will help. But when you are depressed even the _thought_ of getting
help is ... exhausting. A cause for dismay, even. It is a particularly
invidious disease.

Each of us has different systemic set points for our internal processes --
dynamic equilibria which our systems drift to over time. Most of these are
necessary and useful, they keep us alive. But some of us have set points with
unpleasant side-effects. Some people have trouble regulating blood sugar, and
they use exogenous insulin to do it manually. I have trouble regulating
serotonin, and I use sertraline hydrochloride to influence it manually.

High doses broke the back of a depressive episode that lasted 5 years. Low
doses have kept me functioning since then.

Is it perfect? No. I could do without the side-effects, but I expect that as
time goes on these drugs will become more specific and effective. Or someone
will come up with a gene therapy. Who knows?

I do not regard what I experience as fake happiness. It is as real as anybody
else's.

~~~
Groxx
I like breaking rules :)

I'm not claiming it's fake happiness. You've clearly made it work for you. I'm
merely saying that _many_ people expect drug X to solve all their problems,
because it makes them feel better, and do nothing to solve the root problems
(which will come back in time). Maybe not most, but even a small percentage
means hundreds of thousands of people, and _tons_ of kids who have no choice
in the matter.

> _it removes the will to be cured_

Absolutely, that's why it's such a hard thing to fix. And drugs are a
fantastic way to crack your way out of it, to break that relentless loop. And
our current culture sneers at anyone (particularly men) seeking help to solve
personal problems. _That_ needs to change. It is, slightly, thankfully, but
there's a _very_ long way to go.

I take no issue with medicating. Only over-medicating. And neurochemical-
manipulating drugs have been _crammed_ down America's collective throat for a
while now, without long-term trials, frequently with barely-detectable
improvements over sugar pills (and later studies showing none or _worse_ ),
and without really understanding what they're doing or their ramifications.

Not that I think that's surprising. It's a powerful, successful-enough new
line of treatment that's helping a lot of people, and exposing a lot of
existing problems that are now getting treated. Of course such a thing would
be used before long-term trials were run. People would take it voluntarily -
the immediate almost always out-weighs the long-term in any creature, but it's
entirely founded when the immediate threatens your life.

The problem I find with the current everyone- _must_ -be-happy trend (as nice
as it would be to achieve) is that a) it adds _more_ weight against those who
are unhappy to conceal their problems rather than publicly seek help, as
everyone else is clearly happy (ignoring the truth) and they don't want to
cause unhappiness, and b) it has lead to over-prescribing short-term (in that
they work quickly, not that they don't continue to work - that's debatable and
essentially unknown currently) solutions, when the _causes_ are the real
demons that must be exorcised. It is _masking_ the problems because people
quit dealing with them because a fast way out is a doctor's visit and a
complaint away. Which is their fault for being lazy, but that's human (and
efficient), and it shouldn't be _that_ readily handed out or advertised as a
magic bullet.

It also doesn't help that hyperactivity drugs have been pushed by _elementary
schools_ (or individual teachers) for unruly kids when it's far more likely
that they are bored or weren't raised properly. But that's a rant about our
education system, which (especially at elementary levels) I feel is
fundamentally, _enormously_ flawed and contributing to a lot of problems. I
won't go further on that.

What needs to be done is to treat the imminent danger, and then _immediately_
work with people to solve the causes. But that's cross-discipline - medication
and (essentially) psychotherapy - thus rare in a single person, and because
the initial danger is gone _people quit trying_. It _appears_ to be a
solution, without actually being one, and long-term / long-term-use side-
effects are very real and very dangerous, and largely unknown. One of which I
do feel is that it teaches people to medicate their problems instead of
dealing with them directly. It's encouraging people to take fast exits.

\---

Anecdote time! I had a couple years of depression a while back, and didn't
take anything for it. I was lucky enough to find a way out of it before I got
wholly stuck, and I'm incredibly aware of how close I was to getting stuck and
how powerful the loop is - that realization is what shocked me out of it. I'm
a minority in that, and I know I was _lucky_ , not strong-willed or somehow
better.

Once I got out of the loop, I knew it was just a matter of time before I was
back to normal, so I just kept doing what was working. Drugs could likely have
shortened it, but I'm leery of drugging my brain after trying various sleeping
aids left me hung over and brain-dead for good chunks of that year. It's not
entirely rational, and I fully admit it, but I think I made the right choice
for me. The process of fixing it _has_ improved me, as I work at fixing things
much sooner now.

And if that's rambly, apologies! I'm sort of rambly-feeling right now, and
this touches on a lot of areas so it's hard to make cohesive.

------
RevRal
My step brother's uncle was an alcoholic for ~25 years (off and on for 25
years? I don't know how this works). He joined the native American church,
where he presumably used peyote, and the alcoholism eventually went away and
he is now happy.

I am by no means read on the subject, just some first hand experience seeing
someone crawl out of a pit of despair. It's unfortunate that this avenue isn't
researched or condoned much.

~~~
Alex3917
"It's unfortunate that this avenue isn't researched or condoned much."

Right now MAPS.org is doing an observational study of Pangaea Biomedics, one
of the more famous ibogaine clinics in Mexico. Claire Wilkins (who runs it)
gave a pretty amazing talk at Horizons this year, which you can watch here:

<http://www.youtube.com/watch?v=L0tt3mgT8gA>

------
teyc
This is the equivalent of heroin injection galleries that has been trialled in
various parts of the world. The basic idea is that these people are at less
risk of overdosing, or sharing needles. Basic medical care is readily
available should these people need it.

I just haven't heard it being done for chronic alcoholics. But the hospice
analogy is correct.

It is the equivalent of palliative care for cancer patients who have given up
(or their doctors have given up) further treatment.

------
verysimple
I don't think I have a problem with it yet, because I'm rationalizing. It
somehow makes sense. I'm not sure I would feel the same if someone I cared for
decided this would be the solution to their problem though.

I suspect many people will feel similarly. If my suspicions are correct, I
wonder if we're witnessing a paradigm shift about problems such as alcoholism,
drugs and homelessness. Are we as a society beginning to accept that some
people are beyond redemption and should just be considered a "loss"? How far
can we take this?

~~~
cosmicray
Try thinking of it like this ...

Every life has a beginning, a middle, and an end. Some lives are very short, a
few are very long, and most somewhere in the middle of the curve (something
the insurance companies call the actuarial).

Everyone wants to live as long as possible, but how you get from beginning to
end varies widely. What works for me, may not work for you. Trying to impress
one social groups idea of 'proper lifestyle' is what causes most of the
problems in America (possibly elsewhere) today.

There are times, when a little bit of the problem, is a better cure than all
the societal enforced behavioral change. For the most part, we really are
smart people.

------
patrickgzill
I wonder how much of the $18K per resident cost is defrayed by taxes on the
liquor they are drinking (though Listerine as mentioned in the article as
something some drink, would only have sales tax on it).

Note that one of the men has a 20-mile bike route for collecting cans - be
interesting to know, despite his alcoholism, what kind of physical shape he is
in. Surely he burns off some of the bad effects of drinking via exercise?

~~~
ars
Alcohol is already quite good for the heart and circulatory system.

It the liver that is the problem, and exercise won't help there.

------
6ren
I don't like to think anyone is hopeless. That's because to be truly hopeless
requires mathematical certainty, which usually isn't possible in the real
world. In the real world, we don't know everything; there are always unknowns.
Where there are unknowns, there is a chance; there is hope.

Giving love and care and respect to these alcoholics... I would expect that
that might help some of them to recover. The article doesn't mention it, but I
wonder if some do recover.

It certainly seems economically justifiable. Which doesn't necessarily make it
right, since an economic analysis doesn't take into account all the factors. A
society that starts to classify some people as hopeless and give up on them,
may gradually widen its definition of _hopeless_. Whereas some of the greatest
benefits and victories for society seem to come from goals that seemed
impossible, aka _hopeless_.

If we undermine that, we will be the worse for it.

~~~
Daishiman
If the money saved on treatment for these people can be better spent in
improving policy and other aspects in society, then it appears to be money
well spent.

Transplant patients are prioritized, among other things, on the chance that
they will be able to recover from their illnesses. Alcoholics are never given
transplants for that reason.

At some point you have to take into account what works best statistically,
otherwise you are being unfair to those who have not wasted their chances.

------
seertaak
It seems pretty logical that St. Anthony's -- in certain cases -- is
preferrable to the AA model.

What bothers me is that my understanding is that a large percentage of long-
time alcoholics and homeless have mental health issues. These issues would
perhaps best be addressed by forcably interning them in mental health
institutions (which, again according to my limited understanding, have gotten
somewhat of an unfairly bad reputation in the last fifty years). Perhaps using
the the correct pharmaceuticals and treatment would be better than the "drink
yourself to death" approach. However, this would involve removing the freedom
of the homeless person to decide for himself. It's a tough choice, but all in
all I applaud rational systems that are subject to a-posteriori measurements
of efficacy.

------
Pahalial
The MeFi thread on this a few days ago had some good content, including the
abstract from a study on just how drastically housing the homeless and/or
alcoholic reduces overall costs to society

[http://www.metafilter.com/100658/Everyone-is-going-to-
keep-d...](http://www.metafilter.com/100658/Everyone-is-going-to-keep-
drinking-its-probably-going-to-kill-them-and-no-ones-going-to-talk-them-out-
of-it)

I still don't know how I feel about it, though. Just sad rather than strongly
for or against.

------
vannevar
I find the rationalization that this is a cheaper alternative to be morally
abhorrent. Why not make it even cheaper and euthanize them at the door?

~~~
vannevar
Wow, someone downvoted that. Could you elaborate on why you think reducing
social cost is a valid argument for promoting suicide? Note that I'm not
saying there aren't valid arguments supporting the St Paul's approach, I'm
only suggesting that "because it's cheaper" is an incredibly callous and
cynical one.

~~~
stjohn
I didn't downvote you, but to answer your question, first, no one is promoting
suicide. This system allows people to lead a life you don't consider
worthwhile, but they are still living, and the life they are living seems to
be objectively better than the one they would be living otherwise. In
addition, it's cheaper. So win-win.

If it wasn't cheaper, their would still be an argument to be made in favor of
wethouses because it seems to be far more humane than allowing people to rot
away on the streets. But then the debate would be whether or not society
should have to bear the cost of their poor decisions. In fact, they will have
a cost to society no matter what. It just so happens that the best thing for
them is also the cheapest thing for society, so there is no possible
objection. So the argument goes.

No one is saying, "Do it because it's cheaper." They're saying, "Don't not do
it because it's more expensive, because it isn't -- it's cheaper."

~~~
vannevar
The tag line of the article reads "It's a place where the most hopeless of
alcoholics can drink away their final days at less risk and cost to the
public." That sounds like a place where they are invited to come and commit
suicide, albeit slowly. I certainly agree that the alternative of turning them
out on the streets is less humane. But what about the alternative of
committing them to an institution where they have a chance of being cured of
their addiction? What about the alternative of a life where they're sober?

The article implies that all of these men are incorrigible, but many might
simply be people with families who don't have the resources to get treatment,
or that simply don't care enough to get it. There is a great danger that
because it's cheaper, we'll rationalize away the moral argument in much the
same way you do, by pretending that there is no alternative but putting them
on the street.

------
neworbit
I'm torn. At what point do we say "these people are not competent to make
decisions for themselves, this is just suicide"?

------
originalgeek
State sponsored homicide on the installment plan.

~~~
ars
Suicide maybe, but not homicide - they have to get their own alcohol, the
center does not provide it.

------
reeses
Why precisely is this Hacker News material?

~~~
ekoontz
Seriously though, I found it interesting and am glad it was on Hacker News.
Social engineering is engineering, and engineering is Hacker News. You are
minimizing the harm and cost in a society by providing a place where people
can safely use alcohol. It's far better and cheaper than leaving them to do it
on the streets.

~~~
reeses
How are you measuring the minimization of the harm and cost? Where is the
methodology? What hypothesis were they testing when they conducted this
"experiment?" What are the second order effects on public infrastructure?

And social engineering is not engineering, unless anything involved in
influencing the universe through action is engineering. Your analogies are
based on logical fallacies.

~~~
Daishiman
The effects of this clinic can be easily compared to those of other
institutions if proper statistics are kept. Judging from the article, they
most likely are.

Aside from that, bioethical issues, while using quantified information as
tools to measure effectiveness, need an equal or greater amount of thought to
the basic philosophy of the clinic, and ultimately require human judgement
where we determine what is "better" and what we want as a society.

So, yeah, wrong on all counts.

------
AndrewVos
"They have peed on their last couch"

Hilarious

~~~
smcl
Nope, alcoholism is not hilarious. It's pretty sad.

