Hennepin County Commissioner Jeff Johnson has no quarrel with publicly funded treatment for alcoholics. But he said he struggles with taxpayer money going to housing for chronic alcoholics that offer no treatment at all.
Not only that, he was surprised to learn, the so-called "wet houses" don't even require their homeless residents to stay sober.
"I understand these people are very sick, but I don't think that means you should expect absolutely nothing out of them," Johnson said. "If we're going to provide you housing, you should figure out how to stop being drunk all the time."
[sigh]
Jeff is a nice guy, generally. I used to work with his wife, so I've met him and the kids, and a cuter family you're not likely to meet. But this....
According to the American Indian Community Development Corp., which operates the home with Project for Pride in Living, Wakiagun saves taxpayers more than $500,000 a year by reducing detox admissions, emergency room visits and jail bookings.
In the JAMA study, published in April, University of Washington public health researchers monitored 95 homeless chronic alcoholics before and after they moved into a wet house, and compared them with 39 others waiting to get in.
Before the wet house, the median cost of each of the 95 was $4,000 a month. After a year in the wet house the cost per person dropped to $960, mostly for housing.
This works. It cuts down on crime, both those perpetrated by the residents and those with the residents as victims. It cuts down on drinking. Several of the people interviewed for the story had quit while residents, even though sobriety wasn't a requirement of residence.
Still, Johnson isn't persuaded. "If what you're doing isn't right, the fact that it might be cheaper in the long run doesn't mean it's the best outcome. ... It seems to be spending money to help people give up on themselves," he says. That would indeed be terrible--if it were true.
The only way Johnson's point of view would be valid is if alcoholism were the vice the Victorians and Edwardians thought it was instead of the disease we now know it to be. Like any disease, what the JAMA study shows is that treating the symptoms of alcoholism, the homelessness and victimization, leads to a better outcome for the patient. Acting as though those symptoms are a visitation from God for a life of sin does not. It just adds a burden of stress for a patient whose disease is worsened by stress.
This is why I want my politics to be reality-based.
20 comments:
Seattle had som esimilar battles a couple of years ago - the Seattle Times did a whole expose on the issues as I recall. they ultimately went the publically funded housing route because it cut down on police, fire and medical expenses fo rthe city, which more then offset the cost of running the facility.
I agree with you that the "morally wrong" part of his arguement is flawed. One could argue (as, sadly, most Conservatives do) that almost any government action to help less anyone is morally wrong. But that doesn't mean we should stop things like MediCare, Head Start, or building roads.
reality-based politics? It's a nice dream, but I wouldn't hold my breath if I were you...
This is why I want my politics to be reality-based.
Then you will be happier in the world of fiction...
But seriously, yes, when this sort of rhetoric spews out (and it is only to appease the dumb asses that might possibly vote for you) it should be slapped down and shown for what it is right away. And, that should be done at a level much higher than the "reality check" crap we see on the local news.
This is an issue that particularly burns me.
If we're going to provide you housing, you should figure out how to stop being drunk all the time.
Which is a hell of a lot easier, when you aren't on the fucking streets. This is also a hell of a lot easier said, than done. There are mountains of evidence that these programs are effective at bringing down the cost to the public and while the numbers aren't exactly staggering, they also have been shown to increase the numbers of people who actually get sober.
With all due respect, Johnson is either an inexcusably ignorant fool, or he is just plain vile. I am increasingly sick and damned tired of these responsibilitarians. These people who seem to believe that everything bad that happens to a person is all their fault for being weak, foolish or unprepared.
I am over it.
DuWayne,
In a former generation, "responsabilitarians" were called Social Darwinists. Given that the Republican party is infested with them these days, are this guys statements really a surprise?
"If what you're doing isn't right, the fact that it might be cheaper in the long run doesn't mean it's the best outcome."
Mighty big "if" there, Jeff. Starting from baseless assumptions isn't anything new from politicians at any level, though.
Wet houses to a large extent are a pragmatic social 'loss leader' decision. As one that has dealt with chronic alcoholic patients in Emergency rooms for over 20 years it is clear that society will end up paying for the patient's care one way or another. This point gets missed by so many. Wet houses are far more affordable to society than the hidden costs of filling jails and ED beds unnecessarily which is how most sufferers receive services now. Those costs have to be absorbed somewhere and programs such as this end up being the least costly alternative to a problem unlikely to go away any time soon.
Pliny -
You aren't kidding. As a Michigander, I am really concerned about where those funds are going to come from. I have started attending my local Community Mental Health board meetings and what is happening to funding here is truly scary - we need to save every penny we can.
At risk of sounding melodramatic, I am afraid we are rapidly approaching the point where we are going to have to start letting these folks die in the streets. I wish that were a hyperbolic statement, but I am serious as a heart attack. We are in a world of hurt and unless they are actually endangering public health or safety, we don't actually take drunks into jail anymore. And we're on the verge of losing at least twelve percent of our state general fund - that is already a done deal. Congress is talking about cuts as high as twenty percent, with the republicans calling for a sixty five percent cut.
Best case scenario, our county CMH's are going to be hurting. Worse case (not the republican push, but possible compromises) we are looking at cutting essential services, which means that there will be less places for these drunks to go - ER's will have to start turning them away.
I am afraid that my state is moving headlong into becoming more like a developing nation, than a U.S. state.
I'm not about to hold my breath. I'm going to keep talking about this sort of thing where people can hear me. Sure, some of them will have made up their minds already, like Johnson, but others just won't have thought about it before. They're reachable if someone takes the time to put it to them simply and in such a way that they have to confront their assumptions to argue about it.
DuWayne, the situation in Michigan completely freaks me out. We have it bad enough in a city that's had federal and state funding cut but isn't dominated by any one industry, much less one that's collapsed. I'm terribly afraid we're about to get a very stark object lesson in the reason we redistribute funding.
And on the same page, you get the "we don't need needle exchange programs, they just shouldn't be doing the drugs."
"We don't need public toilets, those people should get jobs and places of their own."
All of this played with a background of Bruce Hornsby.
Funny how we don't hear about "we don't need police, people should just hire bodyguards."
And you will note (and probably already did), D. C., that he's not recommending spending the money on intensive treatment programs instead.
I can sympathize with the moral argument. It is immoral just to house alcoholics without any treatment. However, Johnson sounds like he has it backwards... the moral failing isn't (mostly at least) on the part of the alcoholics.
"Wethouses" (and other public housing of this sort) are a damn fine first step. Not everyone will take, much less succeed at the following steps of actually getting to recovery, but the need to be given the opportunity.
Anyway, to put it short and sweet:
Wethouses don't solve the problem, but they do mitigate the effects and provide an opportunity for individuals to work on a real solution.
Travc -
It is immoral just to house alcoholics without any treatment.
With all due respect, why?
Coerced treatment has an absolutely massive failure rate. And in a lot of places that have programs like this, the people who enter them, are people who have already been in (or are in) mandatory treatment. Many of them are going to die of their disease anyways - whether it is on the street or in an apartment is up to programs like this. Or put more coldly, how much it will cost us is up to programs like this.
I am all for making sure they have options - which is part and parcel with these programs. Universally, as far as I am aware. But the entire point of these programs, is to get drunks off the street, who can't, or won't go into treatment and qualify for other options. Deciding that they must get treatment to maintain their housing status, is a lot like telling indigent cancer patients that if treatment is ineffective, we are going to put them out on the street to die in the gutter. Because that is exactly what that would mean for a lot of these street drunks.
It isn't immoral to house drunks - making their lives a little more livable and cutting costs to us, without coerced treatment. In my mind what's immoral, is pushing this ignorant notion that for people with mental illnesses to get housing, they have to get treatment specified by the state. Because honestly, there are a lot of people who really don't need much, if any - as long as they have a roof and some basic needs met. People who are not going to be terribly functional no matter how much is spent treating them. People who are content to live in the headspace they have and who are really desperately afraid to get treatment.
And this argument can be extended to other mental illness. Without taking meds and seeing a psychiatrist once a month (a psychiatrist who is probably seeing an average of three hundred plus patients a month) most group housing facilities won't take people on. There are a lot of people who just can't do that - especially not when they have gone without treatment and are living on the street - many of them drunks, mind you.
Bottom line - housing them is cheaper and more humane. Coercive treatment is rarely successful, because for treatment to be effective, the addict must want to get sober. The rare person who coercive treatment would help, is quite likely to take advantage of help that is offered, once they are stabilized with a roof over their heads. And finally, we can't afford to push these folks into treatment. Especially where I am living. I am not joking when I say we are on the verge of letting folks die in the gutter - we are that fucking broke.
So tell me, what exactly is moral here? Waste money that could be used to make the lives of more homeless drunks and druggies more reasonable and lead more of them to treatment options because they want it? Or deciding to help as many of these folks as possible?
I work in the AODA field, not at the treatment end but housing. In our corner of the world there is virtually no structured housing for drunks in recovery that is not gospel based. A significant percentage of government monies must go to religious entities. The failure rate at these places is large. I have been at the same building for eleven years and remember that the old protocol was to lean heavily on the canon 12-steps, meaning "higher power" got all the credit for success and the individual got all the blame for failure. Once I got to the point where I could change the protocols I started jettisoning magic-based tools in favor of making my guys responsible for actually thinking about and then implementing the changes they sought. Some of the men I deal with have been around and around for years treating addiction as a moral issue, but are having some success looking at merely changing habits of thought.
As a side note I ignore the whole disease model of addiction. It makes things easier to explain to most people if we stick to habits/consequences.
Christ Davis
Milwaukee,WI
Christ -
I like to get folks to consider that the difference between addiction and average firmly ingrained habits that most people have, is harm. When people start to recognize that their addiction isn't a whole lot different than the same sorts of things most people do, it makes it easier to redirect their behavior. It also makes it easier to relate to non-addicts. And this also works in the context of non-addicts and their perception of addiction.
While I can understand shying away from the disease model of addiction, there are several reasons why it isn't always a good idea to do so. Foremost are the political considerations - something that is, admittedly, not relevant to individual treatment. But there are also personal reasons why it can be relevant. The bottom line, I don't buy the notion that every addiction is the same or every addict the same. There are different reasons that people develop harmful relationships with particular substances and/or behaviors. For some people, the disease model of addiction is exactly what they are dealing with and I suspect that for those who fall into that category, it is important that their treatment recognize that. I would note that those who fall into that model, are probably a relatively small minority of addicts. The only reason I use disease as a more general descriptive, is purely political.
This is not to say that people who don't fit the disease model are any less valid or deserve any less help. To the contrary, many of us are dealing with other neurological disorders that create a propensity for addiction level substance abuse. While still others, are dealing with situational mental issues and have turned to a substance of abuse, that in turn became an addiction. Those of us who don't fall into the disease model of addiction, are no less addicts for not doing so.
Sorry if this was convoluted, but it is hard to clarify this concept in a blog comment. I've written two twelve+ page papers and innumerable blog posts on this particular aspect of the addiction discussion and barely scratched the surface. Bottom line, I think it is important to recognize the disease model of addiction, when it is appropriate to the addict. At the same time, when it isn't appropriate, of course it is going to confuse the addict - because it isn't relevant to them.
DuWayne,
I believe and wish I had said:
"When people start to recognize that their addiction isn't a whole lot different than the same sorts of things most people do, it makes it easier to redirect their behavior."
and:
"(M)any of us are dealing with other neurological disorders that create a propensity for addiction level substance abuse. While still others, are dealing with situational mental issues and have turned to a substance of abuse, that in turn became an addiction. Those of us who don't fall into the disease model of addiction, are no less addicts for not doing so."
I haven't written any papers but I have been thinking/reading and talking about this subject since I got dried out. I didn't think your post was convoluted. I segue into and out of ancillary topics too.
Christ Davis
I hate to be a consequentialist but reading the ER blogs and seeing the public cost of some of these 'frequent fliers', I'm all for wet houses insofar as the net social cost posed by homeless drunks goes down.
When one bum can burn $1M+ a year in ER costs, it's just cheaper to pay for an efficiency apartment and a minder to keep track of him.
I can hear the howls of 'welfare queen' already. The Calvinist, social darwinist economic/ethical purism is utterly destructive and it needs to be framed that way and rammed down their damned throats. Some won't want to pay for it - surprise! - they already are.
I just got back from my second trip to Sweden on a 10 day engineering consulting gig (my day job) and I'm convinced that if you maintain the baseline needs for citizens (food, shelter, medical care) it costs less and leads to a happier (less stressful) life than the alternative. What you don't pay for education, medical care, etc. ends up going to law enforcement, courts, jails, and the ER. Further, I'll assert that the degree and specific breed of religiousity of the US makes the punishment approach far more palatable than a pragmatic and economic alternative. Working for a Catholic university for six years disabused me of any notion that they give one whit about caritas, at least as far as the sandy-cootered bints in the HR department were concerned.
See Curbing Emergency-Room "Frequent Fliers" and New Jersey Program Finds Alternatives for ER 'Super Users' for anecdotal reporting on the cost of frequent fliers and public health programs formed in response.
apthorpe, one of the things that makes me laugh when conservatives talk about fiscal responsibility is that there isn't a single social welfare program I've seen studied that doesn't pay for itself in reductions in other service use (emergency services, prisons, disability payments).
The 'thought process' seems to be: "I know the social net option would lead to decrease in costs and crime and suffering...but it's just not right!"
Khan would have been more accurate to write :
The 'thought process' seems to be:
"I know the social net option would lead to decrease in costs and crime and suffering... it's just not right!"
I removed "but" from the last phrase.
other Greg
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