US shelter uses alcohol to combat alcoholism {video report at link}

[xchrom]

http://www.aljazeera.com/video/americas/2012/02/20122211512821931.html

A controversial project treating alcoholic homeless people in the US has yielded some surprising results.

The programme in the city of Seattle has been allowing homeless shelter residents to use alcohol in order to reduce both alcohol use and alcohol-related problems.

[zipplewrath]

1. AA works differently in other countries

The US is in the minority, last I heard, in the treatment of alcoholism primarily through abstinence. There are always alcoholics that require abstinence, but a tremendous number of people aren't addicted in a chemical sense, and are more "abusers" who, through proper treatment of other issues, can stop abusing.

Even in the short term, this program may be finding out that abstinence, as a first step, might be too high a hurdle for many folks. Reduction first, may lead them to a place where they can begin to choose to avoid alcholol.

[Voice for Peace]

2. very interesting -- I don't know about AA in other countries

but I do know that for many, when a substance is completely
Forbidden (and not adequately replaced by something better)
it is given great power over the person --

such that "Can't Have" = "Must Have"

[bemildred]

3. Blasphemy! nt

[handmade34]

4. excellent

"wet houses" too bad there is so much controversy over the concept

http://www.nytimes.com/2011/05/01/magazine/mag-01YouAreHere-t.html

[MineralMan]

5. There is a wet shelter here in the Twin Cities, too.

They're helping people who have been through many programs and continue to drink alcohol. They're caring for them, and allow them to drink at the shelter itself. These are not people who are seeking help for the first time, but people who, for one reason or another, cannot stop drinking. The shelter gives them a place to sleep, food to eat, and other services, but does not insist that they abstain from alcohol. For many of their clients, it's either that or starve and freeze on the street.

The St. Paul Pioneer Press did a long story on the shelter. It was very interesting. Surprisingly, not many people had anything bad to say about it.

[Warpy]

6. I think there was another shelter years ago in California

that allowed their residents to drink. They also found out that simply being off the streets and having a room to come back to with a lock on the door so their stuff didn't get stolen was enough to get many (but not all) their residents to get clean and sober.

Shelters that specify only sober residents do none of them any favors. Talk to any homeless person, they'll tell you if you don't drink and drug before you hit the streets you'll start after you get there.

True addicts do need to stay away from their substance of choice. People with dependencies don't, they just need to have whatever stress that steered them toward substance abuse relieved. My own somewhat educated opinion is that true addicts are pretty rare.

[Heddi]

7. I live/work in Seattle, and the 1811 Eastlake house is a godsend

It saves tons of money in the long run because these folks aren't vunerable, on the street, drunk, getting beaten up, robbed, etc. They're safer than their other, less desirable, housing alternatives allow.

It's been copied around the country with positive results.

http://www.desc.org/

http://www.desc.org/1811.html

A study on 1811 was published in JAMA in 2009:
http://jama.ama-assn.org/content/301/13/1349.abstract

Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems

Mary E. Larimer, PhD;
Daniel K. Malone, MPH;
Michelle D. Garner, MSW, PhD;
David C. Atkins, PhD;
Bonnie Burlingham, MPH;
Heather S. Lonczak, PhD;
Kenneth Tanzer, BA;
Joshua Ginzler, PhD;
Seema L. Clifasefi, PhD;
William G. Hobson, MA;
G. Alan Marlatt, PhD

[+] Author Affiliations

Author Affiliations: Department of Psychiatry and Behavioral Sciences (Drs Larimer and Atkins), Addictive Behaviors Research Center (Ms Burlingham and Drs Clifasefi and Marlatt), and Alcohol and Drug Abuse Institute (Drs Lonczak and Ginzler), University of Washington, Seattle; Social Work Program, University of Washington, Tacoma (Dr Garner); and Downtown Emergency Service Center, Seattle, Washington (Messrs Malone, Tanzer, and Hobson).

Abstract

Context Chronically homeless individuals with severe alcohol problems often have multiple medical and psychiatric problems and use costly health and criminal justice services at high rates.

Objective To evaluate association of a “Housing First” intervention for chronically homeless individuals with severe alcohol problems with health care use and costs.

Design, Setting, and Participants Quasi-experimental design comparing 95 housed participants (with drinking permitted) with 39 wait-list control participants enrolled between November 2005 and March 2007 in Seattle, Washington.

Main Outcome Measures Use and cost of services (jail bookings, days incarcerated, shelter and sobering center use, hospital-based medical services, publicly funded alcohol and drug detoxification and treatment, emergency medical services, and Medicaid-funded services) for Housing First participants relative to wait-list controls.

Results Housing First participants had total costs of $8 175 922 in the year prior to the study, or median costs of $4066 per person per month (interquartile range [IQR], $2067-$8264). Median monthly costs decreased to $1492 (IQR, $337-$5709) and $958 (IQR, $98-$3200) after 6 and 12 months in housing, respectively. Poisson generalized estimating equation regressions using propensity score adjustments showed total cost rate reduction of 53% for housed participants relative to wait-list controls (rate ratio, 0.47; 95% confidence interval, 0.25-0.88) over the first 6 months. Total cost offsets for Housing First participants relative to controls averaged $2449 per person per month after accounting for housing program costs.

Conclusions In this population of chronically homeless individuals with high service use and costs, a Housing First program was associated with a relative decrease in costs after 6 months. These benefits increased to the extent that participants were retained in housing longer.

[Heddi]

8. And I'd like to add that 1811 Eastlake doesn't require sobreity.

It really doesn't even encourage it.

The people who live there, or at least the ones I'm in contact with through my job, have been alcoholics for *decades*, have been to rehab, have been to detox, have been to jail, have been on the streets.

Sobriety isn't a realistic goal for every alcoholic/drug addict. It really isn't. And that's okay. As long as these folks are safe, and have a safety net, then I really don't see what the push for sobriety will bring. That's not to say that if they want to be sober, that we shouldn't help them be, but I work with these folks EVERY. DAY. (well, every working day). They come in after having falls, or being in a fight, or because they have stomach pain, and they are always approached by a chemical dependency councelor and detox is offered. For the most part, they all decline. And we keep offering, and they keep declining. That's okay. We treat them like human beings, we give them free meds because they can't afford them, we give them meds to keep them from withdrawing, and if they're admitted to the hospital, the MD will Rx (in many cases) a 12oz beer with every meal. Comes from the pharmacy, like a medication. It is medication for them. I'd have to give them so many benzodiazepines to keep them from going through withdrawls and having fatal seizures that I'd kill them from the amount of drugs I'd have to give them. And it's only a short-term solution.

SEattle doesn't do everything right, and many services are lacking, but we have the best services for the homeless, working poor, new immigrant, underemployed, street kids, etc, that I've ever seen.

[hedgehog]

9. Understand, I think the war on drugs is a farce. That said,

i think we need to look at the consequences of people abusing a legal drug and face up to what is likely to happen should other recreational drugs be legalized.

I'm all for wet houses and versions of wet houses for other drugs. My guess is that most people can handle most drugs just fine, but that there will always be people who hit the skids. We can have them skulking at the edges of society, stealing to survive, showing up at the ER, urinating and defecating in alleys, or we can provide decent shelter. The second option is cheaper, safer for society and just more humane. Of course, some will oppose it because the possibility of living on the street is all that keeps the rest of us from looking at life through the bottom of a bottle or end of a needle!