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"Everyone is going to keep drinking, it's probably going to kill them, and no one's going to talk them out of it"
February 17, 2011 11:28 AM   Subscribe

The men at this St. Paul 'wet house' don't want your help, or your hope. And they won't get better. It's a place where the most hopeless of alcoholics can drink away their final days at less risk and cost to the public. [via]

Conversely: How some homeless alcoholics are drinking their way to good health

More on wet houses:
A proposal for San Francisco.
Short clip (NSFW language) from the 2002 documentary "The Wet House"
posted by Burhanistan (116 comments total) 45 users marked this as a favorite

 
On his weeklong binges, he chugs vodka, beer or mouthwash. They are interchangeable to him, he said, gazing around his 12-by-12-foot concrete apartment.

"I drink," he said quietly, "until I kill the damn day off."


I agree with the idea of wet houses fully, but damned if this doesn't sound like an excerpt from a late-19th-century Temperence Movement pamphlet.

That aside, isn't there a wet house in Seattle where they provide recovery resources, and some of the residents actually do get better?
posted by Afroblanco at 11:37 AM on February 17, 2011 [4 favorites]


To get money, the alcoholics beg on the streets, collect cans for cash or work odd jobs.

If the goal is harm reduction, and they are already paying for their room and board, why aren't they also providing the guys with alcohol? I can't imagine that concentrating them into one place is going to make it easier for them to find work and so forth, making it all the more likely they check back out or resort to crime.
posted by DU at 11:37 AM on February 17, 2011


This is one of the saddest things I've ever read. I guess I'm just not the type to give up hope for anyone.
posted by Rarebit Fiend at 11:38 AM on February 17, 2011 [4 favorites]


You can't force hope on people though.
posted by josher71 at 11:38 AM on February 17, 2011 [14 favorites]


Housing the homeless slashes use of hospitals and emergency rooms by 50 percent to 75 percent, according to studies cited by Hearth Connection, a nonprofit group that fights homelessness in Minnesota.

Holy moley. How much of our rocketing healthcare costs are due to homelessness? And why are we obsessed with fixing symptoms rather than causes?
posted by DU at 11:40 AM on February 17, 2011 [21 favorites]


Related simultaneous askme.
posted by activitystory at 11:40 AM on February 17, 2011


Hope was the last curse in Pandora's box. These stories are much better than hopeful, they're grounded in realism.
posted by benzenedream at 11:46 AM on February 17, 2011 [12 favorites]


St. Cloud, MN, also just opened the River Crest home for chronic inebriates.

I found the slideshow from June 2004's Mayor's Task Force on Homelessness was very informative on how we got to have this type of housing in town 6 years later.
posted by jillithd at 11:46 AM on February 17, 2011


This seems the most compassionate, the most merciful response.
posted by orthogonality at 11:47 AM on February 17, 2011 [7 favorites]


DU: Holy moley. How much of our rocketing healthcare costs are due to homelessness? And why are we obsessed with fixing symptoms rather than causes?

Malcom Gladwell discussed this at some length in a New Yorker article.
posted by paisley henosis at 11:48 AM on February 17, 2011 [5 favorites]


For those of you wondering about the cost of hospital treatment and social services for the homeless, take a look at Malcolm Gladwell's excellent article, Million-Dollar Murray.
posted by googly at 11:48 AM on February 17, 2011 [7 favorites]


Maybe it's just time for we as a civilization to come up with something better than AA. I know if I were told that the only way to get better was to accept a bunch of god shit (or engage in some disingenuous question-dodging) I'd be like "fuck this."
posted by Afroblanco at 11:51 AM on February 17, 2011 [22 favorites]


That aside, isn't there a wet house in Seattle where they provide recovery resources, and some of the residents actually do get better?

Yes. Its the 1811 Eastlake building, and my lab at UW conducted the study evaluating its effectiveness (I'm not on that team, but my mentor is a PI on that grant). The main outcomes were published in JAMA in 2009. The abstract is below, and the citation if you're interested in reading the article is JAMA Vol 301(13), Apr, 2009. pp. 1349-1357.

-J

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.
posted by oceansize at 11:53 AM on February 17, 2011 [27 favorites]


As a daughter of an AA member who has been sober for 25 years, I'd love to be able to say that this program should try harder to get people dry, but with many of my other male relatives in jail/hospices/hospitals because of drinking...that's hard for me to say. A recovered alcoholic is still a rare bird.

I do wonder what would happen if someone took over the place and gave them really high quality alcohol and food? I feel like alcoholics get into a vicious cycle of malnutrition that can exacerbate alcohol cravings. I notice the second program uses wine, which I think is much healthier than mouth wash...
posted by melissam at 11:54 AM on February 17, 2011 [4 favorites]


The men at this St. Paul 'wet house' don't want your help

People that commit suicide don't want your help either. Shall we shut down the suicide hotlines?

Answer = no. Someone standing on a ledge screaming, "I'm gonna do it!" is insane an in need of professional help. Someone that deliberately wants to drink themself to death is insane and in need of professional help.
posted by Cool Papa Bell at 11:58 AM on February 17, 2011 [5 favorites]


Someone standing on a ledge screaming, "I'm gonna do it!" is insane an in need of professional help. Someone that deliberately wants to drink themself to death is insane and in need of professional help.

Who decides?
posted by empath at 11:59 AM on February 17, 2011 [7 favorites]


Successful suicides don't call hotlines.
posted by Splunge at 12:01 PM on February 17, 2011 [8 favorites]


You can't force help on anybody. You can't force change on anybody. You do the best you can for them, let them know their options, and hope they make the better choice. But somebody who is going to drink himself is going to do so until he decides not to, and if you put him in the streets as punishment, his path to perdition will include being the victim of crime and frostbite and illness and starvation.
posted by Astro Zombie at 12:02 PM on February 17, 2011 [27 favorites]


Suicide booths would be cheaper. Only a quarter, if my screencaps are to be believed.
posted by Eideteker at 12:03 PM on February 17, 2011


I would like there to be an ecstasy house so i can move in.
posted by empath at 12:04 PM on February 17, 2011 [6 favorites]


"Maybe it's just time for we as a civilization to come up with something better than AA."

I don't think "we as a civilization" ever came up with anything. You might. And I might. And you and I might. But "we as a civilization" ain't never done nothin'.
posted by MarshallPoe at 12:04 PM on February 17, 2011 [11 favorites]


I've always believed that environment is a major contributor to alcoholism, and to addiction in general. It's no surprise that living in Rat Park is better for folks than living on the street, even if their alcohol consumption holds steady or even increases.

Harm reduction is a question of changing the variables we can change, rather than tilting forever at the windmill we perceive to be the "root cause" of the problem. Providing housing is something society is reasonably good at; forcing people not to drink, not so much.

Yet here we are in the 21st century, still more concerned with the latter than the former...
posted by vorfeed at 12:05 PM on February 17, 2011 [19 favorites]


Suicide booths would be cheaper.

Wouldn't do much good for folks who, like dock worker Joe, are tired of living but scared of dying.
posted by Astro Zombie at 12:05 PM on February 17, 2011 [3 favorites]


The Managed Alcohol Program in the second link is fascinating. (Without anything to back it up) I've always thought that maybe alcoholics could be "cured" by slowing reducing the amount they drink.

Someone standing on a ledge screaming, "I'm gonna do it!" is insane an in need of professional help.

What if she's just been sentenced to death?
posted by mrgrimm at 12:05 PM on February 17, 2011 [1 favorite]


Afroblanco, I didn't mean to sound snippy. Sorry. But, like a couple of others up thread, this makes me sad. AA doesn't give up on anyone. Anyone. Ever.
posted by MarshallPoe at 12:06 PM on February 17, 2011 [4 favorites]


Vice Magazine published an interesting article on a wet house in Copenhagen a few years ago
posted by el chupa nibre at 12:06 PM on February 17, 2011


It's 2011, and this is the best we can do?
posted by tommasz at 12:06 PM on February 17, 2011 [2 favorites]


"we as a civilization" ain't never done nothin'.

Tell it to the American Bison. (Or the American Indians.)
posted by mrgrimm at 12:08 PM on February 17, 2011 [2 favorites]


I would like there to be an ecstasy house so i can move in.

If I can get this DeLorean running, I can take you to my friend's house in 1989 that would fit that description quite well.
posted by The World Famous at 12:10 PM on February 17, 2011 [1 favorite]


I use "Clinging to the Wreckage" because not so long ago I was completely lost in alcohol. I had tried a few things and did have a supportive family. One night I was fairly gone and my car overheated. I was near my aunt's house and went there to get some water to fill up my radiator. She was quite helpful, but realized immediately what was going on. Between her gentle help and other family members' help, I got into a program that has worked for me. It took a bit to see what was really happening because I was lost enough to believe my own bullshit. At about this time, I watched a TV news story about a plane crash where people were literally clinging to the wreckage to survive (and they all did thankfully) and I realized that I have been clinging to who I thought I was and probably actually was at one point. I was no longer that man and I truly wanted to be something close to that man again.

If there had been something like a wet house that would have enabled me to keep going I'd be there today, not caring about what else happened anywhere in the world. I would not have cared what food, clothes, family, or stuff I had if I could collect enough cans to recycle to get my next bottle.

I do realize that I did horrible things and I do know how these people feel, but I pray every day that no one else has to go through this kind of thing. Encouraging this behavior is frightening to me and I want no part of it.

AA is not the best thing for everyone, and there are other groups and means of treatment that may or may not work, but pretending that people cannot be helped in any way and should be put in a place where they can kill themselves peacefully is an absurd proposal to me.

And on preview: there is most certainly an insanity piece to this. I like to think of myself as a fairly smart guy, but alcohol can make me very much insane - as in "not of sound mind." That's one of many reasons I feel much sympathy for people who are gripped by something they do not understand. I hope more people can get help to be better rather than being put in a place where they can continue to be destructive to themselves and out of our way and thoughts.
posted by Clinging to the Wreckage at 12:17 PM on February 17, 2011 [29 favorites]


It's 2011, and this is the best we can do?

same as it ever was...
posted by quonsar II: smock fishpants and the temple of foon at 12:19 PM on February 17, 2011


tommasz: It's 2011, and this is the best we can do?

Based on oceansize's comment, it's an effort at cost-reduction for society at large. And from the slideshow (PDF; alt: Google quickview) linked by jillithd, these centers are for "late stage alcoholics providing a healthier and safer environment than living on the street."

Given the general (largely financial) dispassion towards those in serious need of help who have extremely limited facilities to help themselves, I regretfully say yes, this is the best we can do. If there are no family or friends to pull someone back from the brink, this appears to be our current best. And it breaks my heart.
posted by filthy light thief at 12:20 PM on February 17, 2011


I agree with anyone saying that getting treatment and help is better than drinking yourself to death in a wet house.

However, can anyone with the least bit of empathy disagree that drinking yourself to death in a wet house is better by far than drinking yourself to death in a gutter? Or worse, freezing to death because you don't have any shelter?
posted by infinitywaltz at 12:21 PM on February 17, 2011 [18 favorites]


Between her gentle help and other family members' help, I got into a program that has worked for me...I do realize that I did horrible things and I do know how these people feel, but I pray every day that no one else has to go through this kind of thing. Encouraging this behavior is frightening to me and I want no part of it.

Don't forget most of these people have been through many programs. I don't think this house just accepts young folks who never tried to quit.

I love AA and am thankful for the way it changed my father every day, but for example male relative X has been through 4 programs. Right now his liver is failing and he is expected to die. I don't think we should even bother trying to get him dry at this point.
posted by melissam at 12:22 PM on February 17, 2011 [6 favorites]


I am not sure that drinking yourself to death in a wethouse is better than drinking yourself to death any other place, to be honest.
posted by Mister_A at 12:23 PM on February 17, 2011 [2 favorites]


I am not sure that drinking yourself to death in a wethouse is better than drinking yourself to death any other place, to be honest.

Did you read the article? Some of them seem not so great, but personally I would rather die in bed than getting run over on the street, lying in the gutter, etc.
posted by melissam at 12:25 PM on February 17, 2011 [9 favorites]


I wonder what would happen if you took a place like this and instead of ever asking them to stop drinking, just asked them if they wanted to *start* doing other things. You can drink and write in a journal. You can drink and work with clay. You can drink and tell a story about where you came from to someone who wants to listen. For that matter, just learning a new card game.

I wonder how long it's been since most of these guys had anybody who expressed interest in who they are without simultaneously implying that in order to have value, they have to be trying to stop drinking. I wonder how long it's been since any of them had an opportunity to try new things without anybody caring that they were an alcoholic while they did them. I just... wonder.
posted by gracedissolved at 12:25 PM on February 17, 2011 [30 favorites]


I am not sure that drinking yourself to death in a wethouse is better than drinking yourself to death any other place, to be honest.

I disagree, but perhaps. However, this does allow them to be overseen, and not disappear for a month only to check into an emergency room with a hole in their heart, pneumonia, and a hematoma on their brain from falling over, which costs $100,000 to repair before sending them outside to start the process over.
posted by Astro Zombie at 12:27 PM on February 17, 2011 [2 favorites]


I wonder what would happen if you took a place like this and instead of ever asking them to stop drinking, just asked them if they wanted to *start* doing other things. You can drink and write in a journal. You can drink and work with clay. You can drink and tell a story about where you came from to someone who wants to listen. For that matter, just learning a new card game.

I don't think you understand alcoholism.
posted by mazola at 12:27 PM on February 17, 2011 [30 favorites]


Hey oceansize : sadly, I don't have the mental wherewithal today to read an academic journal piece. Since you have some experience with the Seattle facility, could you please tell us a little more about it? Specifically, how it offers recovery resources to residents, and how often those recovery attempts are successful?

Because, to me, that seems like the happy medium : get them off the street, let them drink, and give them resources to help themselves when they're ready.
posted by Afroblanco at 12:30 PM on February 17, 2011


I am not sure that drinking yourself to death in a wethouse is better than drinking yourself to death any other place, to be honest.

Shelter is a pretty basic human need, way down there on the pyramid if you're a van of Maslow's hierarchy of needs. If you separate the alcoholism and its associated morality questions from the issue, wouldn't you rather die having that need met, and with people around you, than alone on a street somewhere?
posted by infinitywaltz at 12:31 PM on February 17, 2011 [3 favorites]


My grandfather, who I never had the chance to meet, died in a gutter. He was a raging life-long alcoholic. It makes me sad to think that he died in a gutter to be found by some stranger a day or so later.

To be safe, to have a bed to sleep in, a home to keep you warm, to be able to die with dignity, to be afforded some respect. . . how is that a terrible thing?
posted by Sassyfras at 12:31 PM on February 17, 2011 [17 favorites]


I love AA and am thankful for the way it changed my father every day, but for example male relative X has been through 4 programs. Right now his liver is failing and he is expected to die. I don't think we should even bother trying to get him dry at this point.

I have learned from my experience and that of close relatives that there is always a point in getting oneself dry. Even for one day at the end. It may be hard to understand, and I get that, but it really is a big thing.

I'm not afraid of alcohol (anymore) and I don't ascribe some religious belief to the whole thing generally, but one day with a clear head can mean more than a year without.
posted by Clinging to the Wreckage at 12:35 PM on February 17, 2011 [1 favorite]


People that commit suicide don't want your help either. Shall we shut down the suicide hotlines?

True, but people that are seriously thinking about or even about to commit suicide frequently do.

Help for those who want it, sure. I'm positive that if anyone at St. Anthony's woke up one day and decided they wanted to get sober the staff would refer them to an appropriate program. But, look, the place is a Catholic charity for crying out loud. They obviously don't think this is a problem, and if there's anyone who would, it'd be them, what with the whole suicide-as-mortal-sin bit.
posted by valkyryn at 12:35 PM on February 17, 2011 [2 favorites]


I don't think you understand alcoholism.

I don't think anyone understands "alcoholism."

Jude Thaddeus Program

I think all the different programs all have about the same success rates. That indicates to me than almost any solution is as good as any other.
posted by mrgrimm at 12:39 PM on February 17, 2011 [3 favorites]


Hey oceansize : sadly, I don't have the mental wherewithal today to read an academic journal piece. Since you have some experience with the Seattle facility, could you please tell us a little more about it? Specifically, how it offers recovery resources to residents, and how often those recovery attempts are successful?

If you want a good-faith discussion about a topic, invoking If You Won't Educate Me, How Can I Learn is probably not the way to do that, especially when oceansize has already provided the abstract that includes the conclusions the research group drew.
posted by fairytale of los angeles at 12:51 PM on February 17, 2011 [2 favorites]


It's 2011, and this is the best we can do?

No, it's not the best we can do. But then again, we've gotten really good at doing the worst we can do.
posted by Mister Fabulous at 12:52 PM on February 17, 2011 [1 favorite]


Just the fact that you can provide some safety, hygiene, and normalcy to these folk's lives would seem like a good starting place for them to actually start thinking about hope, were they so inclined.

And if not, well it's certainly better than living on the streets and doing the same thing, and it's cheaper?

Sounds like a pretty effective solution.
posted by Windopaene at 12:53 PM on February 17, 2011 [8 favorites]


"This is about meeting people where they are and loving them. It's not rocket science," she said. "They still grieve, love and hurt. They still need food and shelter. They are you and I."

This is a great post: the people who make this centre work are doing wonderful humanitarian work.

It seems a characteristic American virtue to focus all the time on maximising the chances of success, however slender. But sometimes it does much more harm than good. Sometimes one has to stop and consider the other important things that this attitude is putting at risk or directly harming, such as the dignity and quality of life of those concerned.

It also reminded me of an excellent recent New Yorker article about hospice care: Americans don't seem to know when to stop fighting and the whole medical system is predicated on maximising every possibility for life. Result: people die in much greater pain than necessary and without ever coming to terms with what is coming.
posted by Philosopher's Beard at 12:56 PM on February 17, 2011 [23 favorites]


If you want a good-faith discussion about a topic, invoking If You Won't Educate Me, How Can I Learn is probably not the way to do that

I think that's a pretty uncharitable reading of Afroblanco's request. I think he genuinely can't read the article and would like a little summary of it beyond the rather impenetrable abstract.
posted by Rock Steady at 1:01 PM on February 17, 2011 [4 favorites]


If you want a good-faith discussion about a topic, invoking If You Won't Educate Me, How Can I Learn is probably not the way to do that

aka the "Hush Up, Grown Folks Are Talking" defense.
posted by electroboy at 1:12 PM on February 17, 2011 [1 favorite]


Housing the homeless slashes use of hospitals and emergency rooms by 50 percent to 75 percent, according to studies cited by Hearth Connection, a nonprofit group that fights homelessness in Minnesota.

Holy moley. How much of our rocketing healthcare costs are due to homelessness? And why are we obsessed with fixing symptoms rather than causes?


Nobody ever got rich curing "causes".
posted by blue_beetle at 1:17 PM on February 17, 2011 [3 favorites]


I think that's a pretty uncharitable reading of Afroblanco's request. I think he genuinely can't read the article and would like a little summary of it beyond the rather impenetrable abstract.

Yeah, I mean, seriously, I'm at work right now. I don't have time to read a lengthy journal article. Besides, oceansize already mentioned their experience with the subject matter, and lots of people like to talk about stuff they've done, especially if others are interested.
posted by Afroblanco at 1:18 PM on February 17, 2011 [4 favorites]


I worked for a year with homeless young adults and on occassion with homeless older adults. I have never been homeless, but these have also been some of my peers, so in saying this I dislike the "othering" that happens therein--- it's ultimately what made me loathe to be a part of social work.

But we had a similar program in which there were a series of efficiency apartments designed to be as cheap to maintain and small as possible and could offer a price of 50 dollars a month without going over. I'm looking on their web page and can't find the stats but if I remember correctly it was a dramatically high number of people who used the counseling and basic job skills training to get employed and moved up to paying the full rent which was about 300 for an efficiency. And when I say a lot, I mean like 70%ish (this would be so much more meaningful if I could find that page with the stats... sorry)

While the program did depend heavily of governemnt funding and donations--- users of the program paying this money mitigated the burden to tax payers heavily.

I am deeply in favor of creating as efficiently run as possible housing for chronically homeless people. It IS complicated. When we would get the kids into housing they wanted to let all their friends stay there and then you have a huge drug party and then you have legal liabilities---

It's complicated and it's not easy-if it were happy and easy to house homeless those of us who care would have already made it happen. But I do think we are learning more and more about ways that we can improve quality of life for homeless folk/chronic drugs addicts without burdening tax payers too heavily.

I think if we focus on efficiency and FUTURE financial gains, we might have better luck unifying the concerns and goals accross the political spectrum.

(I know I have hope in miracles. LOL)
posted by xarnop at 1:24 PM on February 17, 2011 [6 favorites]


I have learned from my experience and that of close relatives that there is always a point in getting oneself dry. Even for one day at the end. It may be hard to understand, and I get that, but it really is a big thing.

Only goes to show that different people have learned different things from their experiences. I knew a girl whose grandfather was a terminal alcoholic. I met him on a few occasions. I forget what remark I made to her, but it was something about helping him quit. She looked at me and said "what for? What exactly would he have to live for, given who he is? He's 70 years old, he's been drinking his entire life, and he's happiest drunk." It blew my mind. I was at a loss for words. I was quite young back then, and it just never entered my head that there was any other perspective than getting alcoholics to quit. I went back in my mind to our encounters, and I did remember that he was a boisterous drunk who seemed to know exactly what he was doing - further, he was contemptuous of the nanny attitudes of social workers and the like. I never forgot that, and it quite changed my perspective on addiction.

Any absolutist solutions, that involve "always", "never" and the like, in such situations, are simplifications at best. People ARE different. Their circumstances are different, their makeup is different, and standing on some kind of ideology rather than looking at every single case as an individual human being is to be blinded to the truth. And when you serve ideology rather than truth, you depart from reality and the results are always suboptimal. The world is a big complicated place, and simplistic solutions rarely work. Childish suppositions, magical thinking, moralizing and hectoring are going to be as ineffective as they have been for the past 5000 years of recorded history, when it comes to dealing with addiction.

I certainly wouldn't suggest that people should just go ahead and do whatever, "we have free will". Many, if not most can be helped. But the flip side of it is that sometimes you just need to let go. People are different. Respect that.
posted by VikingSword at 1:26 PM on February 17, 2011 [29 favorites]


"I drink," he said quietly, "until I kill the damn day off."

This takes my breath away. It is exactly what my father did for the last two years of his life, until he was saved, ironically, by a terminal cancer diagnosis that left him confined to a nursing home. He had lost everything at that point; after his diagnosis, my sister and I discovered he was down to his last few hundred dollars, and surely could not have maintained his apartment for much longer. It's inconceivable to me that he would have ended up homeless, but it's just as inconceivable to me that he would have had the capacity in the depths of his disease to seek out a place like this. His existence was no longer tied to the day/night cycle; he woke up, drank, and passed out, on and on and on. It's absolutely heartbreaking to me that his story is common enough to necessitate this type of facility springing up in cities all over the country. Close to impossible for me to fathom, really. I can't imagine what it takes for those employees to get out of bed and go to work in those places every day.

I've always believed that environment is a major contributor to alcoholism, and to addiction in general.

This kind of statement makes me angry and also sad. The vast majority of alcoholics and addicts - every one I know, in fact - are born into a loving homes, get a good education, hold down decent jobs, have a caring circle of friends and significant others who are not addicts or alcoholics and who try everything they can to support and save them from themselves. And it's not enough. It may look like environment is a factor in addiction, but it's really just a consequence; you're seeing the ones whose families have given up on them. Who have lost their straight friends and discovered a community of other people like themselves, who are unwilling or unable to stop destroying their own lives. But that's not how it begins.
posted by something something at 1:31 PM on February 17, 2011 [3 favorites]


Maybe it's just time for we as a civilization to come up with something better than AA. I know if I were told that the only way to get better was to accept a bunch of god shit (or engage in some disingenuous question-dodging) I'd be like "fuck this."

You know, "we as a civilization" didn't come up with AA. A bunch of "god shit" people came up with it, because their lives were in crisis and alternatives were thin on the ground. Well 75 years later alternatives are still pretty thin on the ground. If you're broke, if your transportation is limited or unreliable, if your personal support network is gone then the options are even thinner. But just about anyone can find an AA meeting and if they come in declaring "I think God is a bunch of shit" as a general rule they're not going to be shown the door (meetings being generally self-organized and independent I couldn't say this is a universal truth). There are plenty of skeptics, atheists and agnostics in AA meetings. Of course being against "god shit" is a very convenient excuse for someone who is still hell-bent on evading dealing with their problem.

AA isn't a social institution, and if it gets treated like one sometimes it is because the equivalent alternatives (free, anonymous and fully voluntary) are so few and far between. No AA group ever went to a judge and demanded that he force some unwilling, disinterested criminal into their voluntary group so that "we as a civilization" could act like we were doing something about an intractable substance abuse problem without actually having to come up with any money or resources for it.

The field is wide open for self-organized, self-funded, voluntary mutual assistance movements, so please, have at it. I promise none of us "god shit" people will stand in your way.
posted by nanojath at 1:31 PM on February 17, 2011 [25 favorites]


Thanks, Philosopher's Beard. That's the analogy that struck me too -- a safe place to cease to exist, slowly, when death is the imminent endgame. That is not nothing.

Frost, from "The Death of the Hired Man":

“Warren,” she said, “he has come home to die:
You needn’t be afraid he’ll leave you this time.”

“Home,” he mocked gently.

“Yes, what else but home?
It all depends on what you mean by home.
Of course he’s nothing to us, any more
Than was the hound that came a stranger to us
Out of the woods, worn out upon the trail.”

“Home is the place where, when you have to go there,
They have to take you in.”
posted by MonkeyToes at 1:34 PM on February 17, 2011 [7 favorites]


VikingSword: You make a bunch of sense here and point taken. I was probably being to absolute in my statements, but I stand by the fact that anybody can get sober and we should not pretend that we're all better off by giving people a place to be drunk where it's accepted that that's better for them.

Also, thanks for a reasoned argument on addiction. It's getting rarer all the time when everybody thinks they know all of the causes and solutions. I try not to act like I know it all, but it can be hard when it's something so close to my heart.
posted by Clinging to the Wreckage at 1:37 PM on February 17, 2011 [1 favorite]


I don't think anyone is arguing that a wet house is better for anyone than sobriety. The argument for wet houses is that they're better than homelessness for the kind of people who are aggressively resistant to any kind of treatment, the people who don't want help and will tell you upfront that if you try to put them in treatment, they'll escape and live on the streets and beg and drink mouthwash, and people who have done so multiple times already.
posted by infinitywaltz at 1:43 PM on February 17, 2011 [8 favorites]


No mention here yet of the Anishinabe Wakiagun, which I think is still in operation across the river, and if it is, it's been running for 15 years now.
posted by gimonca at 1:45 PM on February 17, 2011 [1 favorite]


"Wouldn't do much good for folks who, like dock worker Joe, are tired of living but scared of dying."

Wasn't there a line somewhere about getting "busy living or get busy dyin"?

Don't get me wrong; I'm pretty close to rock bottom right now and dealing with some of the same issues. I'm not looking to make light, here; just trying to paint the picture of how desperate they must feel. Spending your whole life on pause, never moving forward but scared of the alternative. You have to do something to break free, or you might as well be dead already.

I'm not suicidal; stories like these often serve to remind me that no matter how low I feel, there's so much further I could fall. My thoughts are with these guys right now.
posted by Eideteker at 1:47 PM on February 17, 2011 [4 favorites]


I'll also add that regardless of whether or not 12-step programs are effective, both sides tend to agree that they're significantly less effective for people who don't invest themselves in them (you have to "work the program," in 12-step parlance), which is why court-mandated AA attendance generally doesn't work all that well.

For people who aren't interested or willing to "work the program," wet houses offer an alternative that provides a better quality of life than homelessness while also saving taxpayer money. That's a Pyrrhic victory, of course, but Pyrrhic victory is still better than abject failure.
posted by infinitywaltz at 1:51 PM on February 17, 2011


I used to work near the wet house in Saint Paul. Had no idea what it was until I read an article about it last fall. My coworkers and I saw people walking to and from it on the streets (no sidewalks, and often lots of snow), but just thought they were walking to and from jobs.
posted by ZeusHumms at 1:51 PM on February 17, 2011


Wasn't there a line somewhere about getting "busy living or get busy dyin"?

shawshank redemption.
posted by quonsar II: smock fishpants and the temple of foon at 1:54 PM on February 17, 2011 [2 favorites]


I read that AskMe and the links in it with some awe. What compassion, what love, what willingness to meet people where they are.

It's a little startling to me that people feel that this kind of work is giving up, because it seems (to me) so very practical, so willing to get down and do the heavy lifting.

There is a line (I may be mangling this really badly) in Nora Gallagher's Things Seen and Unseen: A Year Lived in Faith. The author is part of a team that runs a soup kitchen for the homeless. A person from some other church comes to visit, and watches as the food is served to the down and out folks who frequent the place. And the person eventually says "Where's the prayer?" That is: why aren't they talking to these dudes about Jesus? How are you going to get them out of the alleys and the doorways if you don't tell them about God? How are you going to fix them if all you do is feed them?

And Nora Gallagher, sort of startled by this, says: "The food is the prayer."

I guess I am assuming, perhaps wrongly, that the kind of people who are going to wet houses aren't... you know, handsome, well-groomed middle-school teachers who binge-drink at night but can mostly keep it together. I think these men are beyond the help most programs have to offer. And that is awful, and I hope our great thinkers continue to work toward ideas to help them in bigger ways.

But the choice these gentlemen make isn't somehow magically between a wet house and abstinence. It's between a wet house and the really awful lack of dignity offered by life on the street as a drunk. I am not any kind of expert or even someone who has thought very deeply about this. But a wet house seems like a tremendous boon to all of us, when you consider the lousy alternatives.

This post and the question that inspired it are really Best of the Web to me. I didn't know this stuff existed, and I'm so glad I read about it today. Thanks.
posted by thehmsbeagle at 2:06 PM on February 17, 2011 [27 favorites]


No mention here yet of the Anishinabe Wakiagun, which I think is still in operation across the river, and if it is, it's been running for 15 years now.

The building is certainly still there. It's quite far back from Franklin (I assume it's not actually on Franklin) and I've never been close enough on foot to be able to see a sign (it looks like there is one in the picture in the link).
posted by hoyland at 2:12 PM on February 17, 2011


anyone who's ever watched a loved one in the grips of the hideous disease of addiction knows there is NOTHING you can do to make them change. not a damned thing. all your hoping and wishing and support and good intentions cannot make it so.

the most sensible thing to do then, is to face the obvious: people will change only when they want to. and even then, wanting to and being able to are not the same thing. in the meantime, if they're denied shelter or medical care because you have moral qualms about their life choices, you've just made it *that much harder* for them to ever get better.

in this case, compassionate pragmatism is also the last lifeline - they can still reach out for help if they want it. would you deny them that?
posted by wayward vagabond at 2:18 PM on February 17, 2011 [5 favorites]


There were some good links in answers to my question here.
posted by i_am_joe's_spleen at 2:22 PM on February 17, 2011


I've always believed that environment is a major contributor to alcoholism, and to addiction in general.

This kind of statement makes me angry and also sad. The vast majority of alcoholics and addicts - every one I know, in fact - are born into a loving homes, get a good education, hold down decent jobs, have a caring circle of friends and significant others who are not addicts or alcoholics and who try everything they can to support and save them from themselves. And it's not enough. It may look like environment is a factor in addiction, but it's really just a consequence; you're seeing the ones whose families have given up on them. Who have lost their straight friends and discovered a community of other people like themselves, who are unwilling or unable to stop destroying their own lives. But that's not how it begins.


I am not just talking about people who look to us like they have a "bad environment" -- there's an entire world of environment which exists beyond "loving homes, getting a good education, holding down decent jobs, and having a caring circle of friends and significant others who are not addicts or alcoholics". There are hundreds of thousands of people who have all those things and are miserable in any number of ways, and I suspect that our inability to admit that these things may not constitute an optimal environment for everyone is part of the problem.
posted by vorfeed at 2:30 PM on February 17, 2011 [4 favorites]


gingerbeer's response in the AskMe thread has some good insights. "Wet house" is a pretty slangy term compared to the more systematic "housing first".
posted by Burhanistan at 2:34 PM on February 17, 2011


I know if I were told that the only way to get better was to accept a bunch of god shit (or engage in some disingenuous question-dodging) I'd be like "fuck this."

If you're aware you're an alcoholic, you're aware you're engaging in something that's destroying you, and that you are unable to stop it. If you were certain that there was nothing bigger than you and your will to make you stop it, you'd be fucked. Simple as that. It's a cognitive crutch, but a useful one.
posted by Diablevert at 2:52 PM on February 17, 2011 [3 favorites]


I was hoping we could sidestep the whole AA discussion altogether, especially since the original comment was ranty and not substantive.
posted by Burhanistan at 2:59 PM on February 17, 2011 [1 favorite]


Yeah, as the person who opened up that particular can of worms, I'm in favor of ending the derail. Basically all I was saying was that it would be nice if there were a god-free alternative to AA that was just as effective, and apparently that made some people mad. Okay, noted, you're mad at me. Let's move on.
posted by Afroblanco at 3:01 PM on February 17, 2011 [2 favorites]


vorfeed, I guess I'm not sure what you mean by environment, then. Most of the addicts I know have said they could tell their reaction to substances was different from the norm from the very first time they got drunk or high. And ones who are able to achieve recovery are able to live perfectly happily with all of those things I described - the loved ones, the jobs, the "normal" life.
posted by something something at 3:04 PM on February 17, 2011


Dr. Gabor Maté has some interesting things to say about how environmental factors influence brain development and hence addiction susceptibilities.
posted by Burhanistan at 3:07 PM on February 17, 2011 [5 favorites]


I wouldn't disagree that environment plays a role for some people, but I think to view it as the major cause for most addicts is a stretch.
posted by something something at 3:18 PM on February 17, 2011


> I think to view it as the major cause for most addicts is a stretch.

Did you listen to that interview?
posted by Burhanistan at 3:19 PM on February 17, 2011


I really don't know how I feel about this. On one side I don't believe that treatment is "right" or helpful for everyone on the other side enabling people to this degree is really sad. I have no answer. This is a very difficult issue. Thanks for sharing.
posted by lhc67 at 3:22 PM on February 17, 2011


That Dr. Mate interview was really fascinating (although I am not sure I necessarily agree that everything is environmental) and worth a read or a listen.
posted by thehmsbeagle at 3:27 PM on February 17, 2011


If you were certain that there was nothing bigger than you and your will to make you stop it, you'd be fucked.

Not if you can convince someone that her will is enough. I'm all for AA if it works, but different strokes for different folks.

Interestingly enough (and you all probably know this but), Bill Wilson, the inventor of Alcoholics Anonymous, was a big proponent of LSD, including use as therapy for alcoholism.

Clancy Martin wrote a great article about AA for the December Harper's: The cult that cures:

In one of the most thoughtful books about alcoholism, Heavy Drinking, philosopher Herbert Fingarette argues that the label "alcoholic" may harm the heavy drinker in a variety of ways. It can excuse behavior ("I can't help it, I'm an alcoholic, my life is unmanageable"). It may interfere with recovery ("I have to quit cold turkey: I'm addicted, I'm an alcoholic"). It has a social stigma ("Poor bastard. He's not just a real drinker, he's an alcoholic"). And—most important, for those of us who worry about the relationship between self-knowledge and will—it creates a self-fulfilling prophecy: Because I am an alcoholic, my life will always be determined by the stalwart, morally praiseworthy denial or the disastrous, perverse acceptance of this drug. For Fingarette, with help, honesty, and the disciplined exercise of will (this last in particular is anathema to A.A., which insists that we have become powerless before alcohol), we can recover, and even continue to drink.

To its credit, A.A. insists that the alcoholic who cannot recover should not be blamed for her failure. But listen to the language:

"Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty."

It is tempting, here, to bring out Bill W.'s old Ouija board and confront the raised spirit of the author of the text with his well-documented post-sobriety years of infidelity to his wife, and ask him more specifically what he intended by "rigorous honesty." Ad hominem attacks are not logical fallacies for this crowd: what's at stake is the kind of person you are. You must take fearless moral inventories, admit wrong, confront defects of character, and practice "these principles in all our affairs" (no pun intended).

The point I'm trying to make, with Fingarette, is that A.A. is deeply, perhaps irredeemably infused with a moral view of alcoholism.

posted by mrgrimm at 3:27 PM on February 17, 2011 [5 favorites]


... Basically all I was saying was that it would be nice if there were a god-free alternative to AA that was just as effective, and apparently that made some people mad. Okay, noted, you're mad at me. Let's move on.
posted by Afroblanco at 6:01 PM on February 17



Googling "god-free alternatives to AA" brings up the science-based SMART Recovery organization, and doesn't insult persons of faith in the process.
posted by magstheaxe at 3:27 PM on February 17, 2011 [1 favorite]


I wouldn't disagree that environment plays a role for some people, but I think to view it as the major cause for most addicts is a stretch.

something something, there seem to be a lot of studies that demonstrate a very strong correlation between childhood abuse and addiction:

"A questionnaire on family intactness, parental and sibling relationships, and personal physical/sexual abuse histories was completed by 178 adults in treatment for drug/alcohol addiction. Results revealed that 84 percent of the sample reported a history of child abuse/neglect."

- A Study of the Relationship between Child Abuse and Drug Addiction in 178 Patients (abstract), Child Abuse and Neglect: The International Journal, v6 n4 p383-87 1982.
posted by mrgrimm at 3:37 PM on February 17, 2011 [1 favorite]


Did you listen to that interview?

I read the transcript, yes. And my own personal experience knowing many actual addicts contradicts his own personal experience that "extraordinarily difficult lives" involving, in most cases, childhood abuse is "without exception" a factor. So, yeah, I still disagree with his idea that environment is the only important factor. His position is quite extreme, actually; nearly everything I've seen before says biology plays a significant role.
posted by something something at 3:38 PM on February 17, 2011


When I read that this was a Catholic charity, it made a lot of sense. (Disclaimer: I am an atheist and have plenty of problems with the Catholic Church as a whole.)

I see this as similar to the work they do with Death Row inmates, as seen in "Dead Man Walking." In both cases they are acting from the idea that literally everyone is worthy of love. I'm sure they don't endorse alcoholism any more than they endorse a convicted murderer's crimes. But they are human and deserve unconditional love.

I believe there is a place for conditional treatment programs: "You can't come here unless you're sober" - but what they are saying here is, "We love you whether you can stop drinking or not. We love you no matter what and there is a place for you no matter what." And I think that is worth something.
posted by drjimmy11 at 3:38 PM on February 17, 2011 [17 favorites]


"His position is quite extreme, actually; nearly everything I've seen before says biology plays a significant role."

If what I've been reading about epigenetic research and the affect of trauma on genemethylation is true---

the biological factors you're talking about may in fact be due to trauma in the parents or grandparents.

So trauma may still be the root. It's just up a generation or too.

Also toxic exposure in rats caused about four generations of epigentic changes. Meaning alcoholics may produce biologically different children, who are physically more likely to get addicted.
posted by xarnop at 3:43 PM on February 17, 2011 [3 favorites]


xarnop, I would love to hear more about that. Can you recommend sources?
posted by something something at 3:45 PM on February 17, 2011


The Kevorkian Center for Nihilist Drinking. (Not a Hazelden related program)
posted by clavdivs at 3:47 PM on February 17, 2011 [1 favorite]


Here's one

Here's one
posted by xarnop at 3:52 PM on February 17, 2011


Children inherit abuse
posted by xarnop at 3:53 PM on February 17, 2011




I'd like to highlight that the individuals in the second linked program of the OP - the managed alcohol program - are making huge cutbacks in intake. Drunks drink to pass out. The system can't even be gamed hard enough to get a sleep on - one drink an hour, you could take your drinks all day, then save your second to last and put it on top of your last, and it still wouldn't be, without meds, enough to get to sleep. Those people - the program and the participants - are doing really interesting work.

It's similar to what happens at home when a supported addict becomes incapacitated by some other factor. Ok, I will do this for you, if you will do this for me. I will give you a drink at this time, not that time. I am aware that this is the classic co-dependent model, but -

In absent of a family or support system, I have to respect the MAP participants, who are willing to do that much x in return for that much y feeling of community. I think it's great harm reduction, and the participants have the capacity for paid work, and - what drove me to comment in the first place - it may sound easy, having a drink handed to you on the hour, but it's not. It is not enough.

I will do this much for you, if you will do that much for me.
posted by rainbaby at 4:01 PM on February 17, 2011


MeTa on the GodTa
posted by toodleydoodley at 5:06 PM on February 17, 2011


I would really hate to be the Wet House's janitor. I'm just saying.
posted by jonmc at 5:24 PM on February 17, 2011 [3 favorites]


Structured Relapse Prevention works well and is an alternative to AA.
posted by ThatCanadianGirl at 5:30 PM on February 17, 2011


Keep coming back.
posted by Divine_Wino at 5:52 PM on February 17, 2011


So, here's a question: Have they thought about seeing if they drink less in these homes compared to what they drank on the streets? Have they ever tried maybe taking in an alcoholic off the street who's not quite at the point-of-no-return in his drinking and seen if good conditions motivate him enough to recover?
posted by mccarty.tim at 5:56 PM on February 17, 2011


One of the Canadian links (Ottawa or Seaton House - the Modified Alcohol Programs) says that they definitely drink less.
posted by ThatCanadianGirl at 5:59 PM on February 17, 2011


It's absolutely heartbreaking to me that his story is common enough to necessitate this type of facility springing up in cities all over the country.

In part, these facilities are a response to the disappearance of SRO's and cheap boarding houses. A lot of cities have lost most or all of the privately-owned, for-profit lodging places that accepted wet alcoholics. Those places were a really integral part of the safety net, and their absence causes problems, especially for people who aren't as far gone as the guys in the house in the FPP.
posted by Forktine at 6:19 PM on February 17, 2011 [1 favorite]


AA doesn't give up on anyone. Anyone. Ever.

But they do often claim that the "only alternative is jails, institutions or death," which is false and often denies people hope if AA doesn't work for them. That slogan should be dropped. There are many alternatives.

What people often don't get about harm reduction is that there's incredible power in unconditional love. Alcoholics and addicts are getting judged and prodded all the time— everything is about pushing them to stop drinking and using. When you do something like provide shelter or clean needles, it often opens the door to recovery sometimes because it's a gift that says "You deserve to live, regardless of what you put into your body." We care about you. I have seen that transform lives.

For others, it simply reduces harm and allows them to live better. The bottom line in harm reduction is not letting the best be the enemy of the good. People who focus on abstinence relentlessly seem to think that if addicts get all the drugs and drink they want, they'll be happy and never want to stop. If that were the case, addiction wouldn't be a *problem* except for among the poor dealing with illegal substances. It's a problem because the compulsive use occurs *despite* negative consequences. And that also means that you need to use reward to stop it: if punishment stopped addiction, it by definition, couldn't exist.

That doesn't mean that some people don't stop under punitive conditions. But it does mean that you are more likely to get recovery by helping people feel better and live better than you are by forcing more deprivation on them.

Also, it's absolutely the case that early life trauma is a huge risk factor for addiction and that the greater the number of early life traumas you experience, the higher your risk becomes. This isn't limited to child abuse, of course. And it doesn't mean non traumatized people don't get addicted— but trauma is certainly more important than any single gene that's been found so far. Another huge risk factor is co-existing mental illness: about half of addicts have one. Of course, trauma increases risk for these as well.

Unemployment and purposelessness are the final two big risk factors. Find me a happy person with no mental illness, no early trauma, a wonderful job and family that they love and a sense of meaning and purpose and while they aren't at *no* risk, the very few of these that do fall into addiction also have the highest chance of recovery. Addiction is *not* an equal opportunity disorder: it hits the poor (and extremely wealthy who also have issues with structurelessness and purposelessness) at much greater rates than it does the middle class and is rarely seen for long among people who have strong relationships, meaningful work and no mental illness. Yes, it can happen— but far less often than you think because many people look happy on the surface but are hiding deep pain.
posted by Maias at 7:18 PM on February 17, 2011 [13 favorites]


People that commit suicide don't want your help either. Shall we shut down the suicide hotlines?
Answer = no. Someone standing on a ledge screaming, "I'm gonna do it!" is insane an in need of professional help.


People calling suicide hotlines are reaching out for help.

That's very different from the ones stockpiling meds until they have enough to overdose, then quietly overdosing without involving anyone else.

People standing on a ledge screaming are very different from the people who walked up to the ledge, and then stepped quietly off.

Some people may be happier without help. They may be insane in a peculiar way, but they may still be happier without help.
posted by galadriel at 7:19 PM on February 17, 2011


Stuff like this really separates the people who truly respect individual freedom from those who only do so to the extent that the resultant actions do not abhor their sensibilities.
posted by tehloki at 8:23 PM on February 17, 2011 [3 favorites]


There is an important* parallel stream of work and thinking regarding Drug Consumption Rooms. The Joseph Rowntree Foundation published a report and assorted supporting documents about this a few years ago.

*I'm bound to say so. I helped write the report ;)
posted by Neil Hunt at 10:14 PM on February 17, 2011 [3 favorites]


I think this is brilliant. Why? Because some of us, in one way or another, ARE "hopeless" by society's standards. There are people who cannot live according to one or another of the precepts which are advanced as necessary elements of functional existence. This doesn't mean that these people are by their nature Bad, or Stupid, or Worthless. It just means that, in some significant way, they do not fit.

Not fitting hurts. Not fitting scares you. Not fitting, even in one way, makes you believe, sometimes, that the world doesn't want you, and doesn't have a place for you, and the best or even only thing you can do is try to escape from it, try to stay out of its way. Try to forget that the world has no use for you. And that can lead to a very nasty spiral. It can come from addictions, from undiagnosed mental disorders, or even from shyness or social awkwardness. Sometimes these people who slip through the cracks wind up hurting others, and then we hear about it. But often, they end up hurting only themselves.

And these men, who have scraped bottom for god knows how many years, are among the latter group. They've become dysfunctional in more ways than anyone could be expected to handle, and rejected so many times by so many segments of society that I doubt they can come anywhere close to a sense of self-worth anymore. And then there are the Wet Houses. And suddenly, there's a place for them. Suddenly, they're accepted.

When bringing someone back from a very dark place, you *cannot* impose the condition that they become something else before you offer them love and support. Because they can't imagine a way out. It feels like an empty promise to them. "If you do something you cannot do, then I will love you." There's cruel laughter in the background, even though the well-meaning person urging improvement doesn't mean it that way at all. But if someone can show genuine acceptance to the alcoholic, the heroin addict, the severely depressed person, the STD-riddled prostitute... There's a place. And some day, when they get used to having a place, there might just even be hope.

And if not, well, these men can die with the dignity of having been treated like human beings, at least for a little while. I see what everyone is saying about not giving up hope. But believe me, there are much worse things than dying clutching a bottle, but dying like a real human being.
posted by Because at 10:29 PM on February 17, 2011 [10 favorites]


I don't quite understand how these folks drink this much without being totally miserable sick all the time. I know when I was in my early twenties I could have 7 or 8 drinks in a night and be more or less ok but still feeling pretty crappy in the morning.

Now, anything more than 3 or 4 and it's just a suffer fest - nothing escapist or desirable about it.

Maybe its just genes or something...
posted by AndrewKemendo at 12:38 AM on February 18, 2011


Tolerance, Andrew, tolerance.

And yes, let's force these guys back out onto the street. Where there is hope.
posted by telstar at 12:45 AM on February 18, 2011


They also probably drink fairly continuously so might not hit crippling hangover very often.
posted by josher71 at 7:11 AM on February 18, 2011


If you're aware you're an alcoholic, you're aware you're engaging in something that's destroying you, and that you are unable to stop it. If you were certain that there was nothing bigger than you and your will to make you stop it, you'd be fucked. Simple as that. It's a cognitive crutch, but a useful one.

See this is the problem with AA. Empirical studies show that 12-step programs are not more effective than going it alone. In other words, "You are unable to stop it" is a dangerous lie. Abstinence-only is also a dangerous lie. (Sure, either might be true for a given individual, but I don't know that for a fact and AA doesn't either.)
posted by callmejay at 8:46 AM on February 18, 2011 [1 favorite]


Because that was so beautiful.

I am watching two counsins die of drug and alcohol abuse related diseases and I love them both very much. I would prefer to know that they had somewhere safe to die than die out on the streets.

My cousin has boils all over his skin and he's bleeding out of his ears. He is brain dead. There is no way even if he tried with all of his might, that he could function well enough to hold a job without assistance to get there on time, wake up in the morning, remember what day it is--- and it's unlikely that he would really even be able to perform well enough to stay there.

His sister is googly eyed. Not yet forty and she will repeat the same exact questions over and over without realizing you just answered them. I am totally down with hoping and praying (God please exist I beg you)--- that miracles will happen for people who JUST TRY HARD ENOUGH.

But it would takea miracle for her brain to recover and she literally does not even have enough brain cells to make the kind of decisions she would need to in order to get better IF it were possible.

She's going to die, I don't see what good forcing her to be sober and coherant to face that will do anyone. We've all made peace with the fact that she is going to go this way.

But I will still love her and I still value her as a human being even though I know the majority of people will never value someone like her as a human being-- and it doesn't matter what she does--- she knows that in societies eyes she will always be a crackhead prostitute. You can never shake that. Good people find that out and they walk away. the only people who will take you, and understand that you struggle to function at work or in life are people who are often using drugs too because it's just so damn hard.

The ideology behind harm reduction is to be able to offer assistance and love to people who are struggling, where they are at. Showing them that you believe they are still a human being that deserves to live even though have unspeakably messed up lives and most human beings don't care if they live or die.
posted by xarnop at 11:26 AM on February 18, 2011 [6 favorites]


(Good job Niel!)
posted by xarnop at 12:30 PM on February 18, 2011


See this is the problem with AA. Empirical studies show that 12-step programs are not more effective than going it alone. In other words, "You are unable to stop it" is a dangerous lie. Abstinence-only is also a dangerous lie. (Sure, either might be true for a given individual, but I don't know that for a fact and AA doesn't either.)

If what you're getting out of AA is that you're unable to stop drinking, you're doing AA wrong. I'm not sure where you're going with comparing AA to an abstinence-only sex ed program, but if you're advocating moderation as an alternative to the "unnatural" state of sobriety, the danger here is you. In fact, unless you can point to an empirical study that says your philosophy, whatever it is, has helped people stop drinking, I really think you should not talk about this, now or ever, ever, for all time, just stop, you are the opposite of helping anyone who has a real problem.
posted by kittens for breakfast at 7:16 AM on February 19, 2011


Actually, kittens, there's lots of data suggesting that AA is not superior to other approaches: Project Match compared it to cognitive behavioral therapy and motivational enhancement therapy, for example, and overall, there was little difference except in one part of the 12-step Facilitation arm which had had outpatient only treatment, there was a slight increase for AA members in unbroken abstinence. Since the goals of the other branches were not necessarily complete abstinence and since in all other outcomes involving things like actual functioning, the treatments were identical— and that was the biggest study ever funded in the alcoholism field— it is ridiculous to make the claim that AA is superior.

Further, the major epidemiological studies on people with alcoholism find that there are many more who go from a diagnosis of alcohol dependence (AKA alcoholism) to not having a drinking problem than have ever attended AA or treatment— which basically means that most people diagnosed quit or moderate without any help at all.

AA is superior for those who find it helpful (ie, if you study people with alcoholism who choose to attend v. those who don't choose to do so)— but that's not a majority of alcoholics and when you force people into it, you can actually get *worse* results. And what that seems to reflect is that when people find something they like, they stick with it—whereas those who aren't helped drop out, so it's not telling you that this approach is actually responsible for the effect, though I do think it's clear that the social support aspect is very helpful and probably some other things as well.

Finally, "abstinence only" is a reference to the way people in the treatment field refer to non-harm-reduction based programs— nothing to do with sex ed in this context.
posted by Maias at 8:28 AM on February 19, 2011 [5 favorites]


Hope was the last curse in Pandora's box. These stories are much better than hopeful, they're grounded in realism.

I wish I could antifavorite this. Not only is it wrong in terms of the story, its wrong in its implications about the usefulness of hope. Hope isn't a cure-all, and if these folks have decided that they're beyond hope that's their call, however sad it makes me. But for the vast majority of people it isn't a curse. I would be dead without hope, and I know a lot of others would be too, because sometimes it's all you have to hold onto. Maybe your life has always been roses but that isn't the case for everybody.

As for the story, there are two main interpretations, and neither line up with what you're saying. The first is that hope was not a curse, but was put into the jar because it can relieve our suffering from those ills. The second is that the word often translated to "hope" in this story is in most contexts translated as "expectation" and can be positive or negative, such as the expectation that all the world's recently-released ills will befall us. In other words, it might actually mean something closer to "hopelessness". I have never seen a translation of Pandora's box that implied that hope, as the word is used by the article and the people in this thread, is any sort of curse.
posted by purplecrackers at 8:23 PM on February 23, 2011


I have never seen a translation of Pandora's box that implied that hope, as the word is used by the article and the people in this thread, is any sort of curse.

Now you have.

I would be dead without hope, and I know a lot of others would be too, because sometimes it's all you have to hold onto. Maybe your life has always been roses but that isn't the case for everybody.

My life has not always been roses, and let me assure you, if I was an optimist I would be dead several times over by now. While hope can sustain one through periods of crisis, unreasonably optimistic expectations can be incredibly damaging. E.g., the persistent hope that "someone will figure it out" in the future so we don't need to deal with consequences today, or the hope that one can "fix" the personality of a spouse. False hopes gradate into damaging delusions easily.
posted by benzenedream at 12:59 AM on February 24, 2011 [2 favorites]


While hope can sustain one through periods of crisis, unreasonably optimistic expectations can be incredibly damaging. [...] False hopes gradate into damaging delusions easily.

This is otherwise known as the Stockdale Paradox:

"When [interviewer Jim Collins] asked Stockdale to explain which American prisoners did not survive captivity in Vietnam, the admiral replied, "Oh, that’s easy. The optimists. Oh, they were the ones who said 'we're going to be out by Christmas.' And Christmas would come, and Christmas would go; and then Thanksgiving, and then it would be Christmas again. And they died of a broken heart."

Stockdale went on: "This is a very important lesson. You must never confuse faith that you will prevail in the end -- which you can never afford to lose -- with the discipline to confront the most brutal facts of your current reality, whatever they might be."
posted by vorfeed at 11:46 AM on February 25, 2011 [5 favorites]


My wife's near the end of her MSW, working in a substance abuse clinic, child of a recovering alcoholic [he's AA, that's how he'd say it], and having dealt with substance- and person-abusers her whole life.

She thinks wet houses are a great idea, if the point is not to just subsidize drinking yourself to death. And as far as I can tell, that's not the point of any wet house I've ever heard of.

The point of "wet houses" is harm reduction: You reduce the amount of harm that addicts do not only to themselves, but (arguably, more importantly) to others. If they're in a wet house, they're not beating their family members (or being beaten by them), causing less of a strain on social services, providing less fodder for street-based networks that feed off addicts, spreading less disease, and so on.

Really this is no different except in degree from needle exchange or even condom distribution.

AA works for some people and for that reason I hate to see it cut down. But there do need to be other alternatives and other ways to reach people and, crucially, more ways to reduce or prevent harm.

The key thing that needs to happen is that people need to stop thinking of addiction as something to which there is a single solution. Even AA is moving away from that idea (depending on your meeting).
posted by lodurr at 7:19 AM on March 8, 2011 [1 favorite]


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