At St. Paul 'wet house,' liquor can be their life - and death

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

Interesting. I can see how it would be appealing to long-time alcoholics (the "endless optimism" <i>would</i> get pretty sickening).<p>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.<p>On the flip side, rehabilitating someone who doesn't <i>want</i> 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.<p>If nothing else, it has jogged my thinker; I'll probably debate with myself for a while on this :)

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.<p>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.

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.<p>I just haven't heard it being done for chronic alcoholics. But the hospice analogy is correct.<p>It is the equivalent of palliative care for cancer patients who have given up (or their doctors have given up) further treatment.

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.<p>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?

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).<p>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?

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.<p>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.<p>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 <i>hopeless</i>. Whereas some of the greatest benefits and victories for society seem to come from goals that seemed impossible, aka <i>hopeless</i>.<p>If we undermine that, we will be the worse for it.

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

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<p><a href="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" rel="nofollow">http://www.metafilter.com/100658/Everyone-is-going-to-keep-d...</a><p>I still don't know how I feel about it, though. Just sad rather than strongly for or against.

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?

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

State sponsored homicide on the installment plan.

Why precisely is this Hacker News material?

"They have peed on their last couch"<p>Hilarious