Hope for the homeless

January 10, 2006 3:08 PM

A new study indicates that giving homeless alcoholics controlled access to one drink and hour may reduce their alcohol consumption and cut down on emergency hospital visits. This harm reduction approach, and the related housing-first model, although controversial and in need of further study, appears to be one of the more hopeful developments in homelessness policy of the past few years.
posted by footnote (35 comments total)

Oh, politicians and radio hosts are gonna love this one ...
posted by kaemaril at 3:19 PM on January 10, 2006

Typical consumption before MAP enrolment was reported to average 46 drinks per day.

Wow. How can anyone drink that much daily(!) and stay alive?
posted by _sirmissalot_ at 3:20 PM on January 10, 2006

They don't.
posted by brundlefly at 3:22 PM on January 10, 2006

You wouldn't think so, but:

Study participants had been alcoholic for an average of 35 years, with most consuming nonbeverage alcohol regularly.

Apparently, nonbeverage alcohol = mouthwash. Alcoholics are depressing.
posted by _sirmissalot_ at 3:25 PM on January 10, 2006

And how about creating a society that doesn't creat homeless people ?!
posted by zouhair at 3:25 PM on January 10, 2006

zouhair: What society would that be? Heaven?
posted by billysumday at 3:34 PM on January 10, 2006

And they can all live together in a big apartment building in Seattle! Cool!
posted by fixedgear at 3:36 PM on January 10, 2006

They should just go to college and join frats.
posted by bardic at 3:58 PM on January 10, 2006

Typical consumption before MAP enrolment was reported to average 46 drinks per day.

How can they afford to drink that much....

Study participants had been alcoholic for an average of 35 years, with most consuming nonbeverage alcohol regularly.

Oh.
posted by PurplePorpoise at 4:01 PM on January 10, 2006

Like those things that give water to the cats.
posted by smackfu at 4:07 PM on January 10, 2006

How can they afford to drink that much....

Give me a dollar!

This reminds me of something I heard on the radio. Paying meth users to stop using meth.

I suppose that from a utilitarian perspective, such programs make sense, as the rewards from drug addicts and alcoholics becoming productive members of society outweigh the costs of providing them with a small pecuniary or potable benefit. However, I, the heartless libertarian that I am, expect people to stop using drugs on their own, instead of forcing society to pay them to do or or give them free booze.
posted by gagglezoomer at 4:12 PM on January 10, 2006

Like those things that give water to the cats.

I was actually thinking more along the lines of a "bottle tied to the side of the cage" approach.
posted by Afroblanco at 4:21 PM on January 10, 2006

Typical consumption before MAP enrolment was reported to average 46 drinks per day.

What, there's about 34 oz. in a liter, that's 34 1 oz. drinks- so another half-liter and that's 'typical'. Sounds about right; I used to drink that much 10 years ago.

Of course, I no longer drink.
posted by exlotuseater at 4:23 PM on January 10, 2006

Pretty small sample group in the study, but you have to give props to the gals and guys who developed this very rational and radical approach to this particular problem. Give 'em a drink now and then, but don't let 'em get stinking drunk and wreak havoc.

(The various programs about providing homes to the homeless that I've seen are much more varied...but admirable. I have sympathies with the libertarian stream of thought, but if a solution to a problem can be implemented by municipal/state/federal govenments that reduce harm to the general populace, they can have my tax dollars for that.)
posted by kozad at 4:51 PM on January 10, 2006

I suppose that from a utilitarian perspective, such programs make sense, as the rewards from drug addicts and alcoholics becoming productive members of society outweigh the costs of providing them with a small pecuniary or potable benefit.
That would constitute, to a sane and intelligent person, an argument to do it.

However, I, the heartless libertarian that I am, expect people to stop using drugs on their own, instead of forcing society to pay them to do or or give them free booze.
The trouble with that plan is that it almost never works. If we want to reduce harm done by drugs, we have to come up with something other than demonization, marginalization, and expecting people whose capabilities have been greatly diminished to do something that the average fully capable person has great difficulty with, "on their own".

I don't care to distinguish between the reasons why people might want to continue to propose non-working plans, ignore facts, and expect the plainly impossible. You can call yourselves libertarians, conservatives, respectful observers of personal liberty, what-the-fuck-ever. In my view, people who base their views on what "ought to be" rather than what works, support policy that doesn't work, fight policy that does work, and don't change their attitudes in response to emergent facts deserve one label only: stupid.

You can stop being stupid any time. That is up to you. You very probably do have the capacity. And if you don't, then you're in the category that has to be "managed" for the benefit of yourself and others, just like alcoholics, for the same reasons.
posted by aeschenkarnos at 5:02 PM on January 10, 2006

However, I, the heartless libertarian that I am, expect people to stop using drugs on their own, instead of forcing society to pay them to do or or give them free booze.

And I don't care.
posted by delmoi at 5:13 PM on January 10, 2006

I agree with aeschenkarnos. The only word to describe people like gagglezoomer is not "libertarian" but "idiot".
posted by delmoi at 5:15 PM on January 10, 2006

besides if children are born into a cycle of poverty and neglect, it's their own fault for choosing such stupid parents!
posted by delmoi at 5:15 PM on January 10, 2006

Thanks guys! I really appreciate the support. Ad hominem attacks in place of rational argument is always preferable.
posted by gagglezoomer at 5:36 PM on January 10, 2006

And you are both stupid too! Of course, its always good to know that if I fall off the bandwagon the taxpaying community will have a cold one waiting for me. Actually, can we expand this program to pot? Sometimes I have a really troublesome time finding it and I would appreciate a volunteer rolling me a nice doob. I apologize if my roundabout stridency failed to illuminate what I found to be the absurdity of a program like this.
posted by gagglezoomer at 5:44 PM on January 10, 2006

It's nothing personal, gagglezoomer. Libertarians can be idoits - it's got nothing to do with you specifically.

I apologize if my roundabout stridency failed to illuminate what I found to be the absurdity of a program like this.

But you highlighted the fact that it could work, from a utilitarian perspective - and if it works, what's the objection? Your objection was not to the mechanics of the program. Your objection was to the whole concept that society, as a whole, can achieve things that the individual cannot. Holding onto this ideological platform in the face of evidence to the contrary is what makes libertarians idiots.
posted by Jimbob at 6:23 PM on January 10, 2006

Thanks guys! I really appreciate the support. Ad hominem attacks in place of rational argument is always preferable.

Would you try to rationalize with a rampaging Ape? I suspect not, you would seek to destroy it, or render it incapable of harm. Such is an appropriate response to the idiot. A person who would spend money in order to make someone suffer needlessly is not really a human, and clearly beneath reason, so why try?
posted by delmoi at 6:43 PM on January 10, 2006

and, of course, they want more funding for more studies. makes me wonder where all the money comes from. of course, i'd rather fund this than the idiotic war in iraq.
posted by brandz at 6:55 PM on January 10, 2006

What exlotuseater said pretty much goes for me. Back when I was drinking that much, one drink an hour would have been just enough to piss me off.
posted by marxchivist at 7:28 PM on January 10, 2006

It turned out that several of the homeless alcoholics in this experimental program died during it.
posted by Steven C. Den Beste at 9:03 PM on January 10, 2006

It turned out that several of the homeless alcoholics in this experimental program died during it.

It turns out that several U.S. troops in this war died during it. Turns out several car drivers died during this whole "highway" thing. Turns out several old people died during this whole "life" thing.

Turns out republicans would rather crazy drunks die frozen in the street then asleep in warm beds.

Film at 11.
posted by delmoi at 9:13 PM on January 10, 2006

The guy that runs the Seattle program was doing interviews
a couple of weeks back. The alcoholics in the program in
there are of a population and age that has historically
shown less than 5% success at alcohol withdrawal.
They are basically all goners.

There is a nurse at the facility at all times, and they are
encouraged to enter treatment, but housing them this way
costs the taxpayers about a quarter of what these
chronic inebriates cost the taxpayers in medical and
emergency services.

You can read more about it here.
posted by the Real Dan at 10:12 PM on January 10, 2006

Delmoi, your comments are specious. Saving the lives of those alcoholics was the goal of the program.
posted by Steven C. Den Beste at 10:37 PM on January 10, 2006

Most of the things people dislike about alcoholics are preventable. The damage isn't necessary. The damage to the kids who grow up with alcoholic fathers -- hasn't been necessary for some sixty years now.

Grain alcohol and polished white rice both cause related damage and for the same underlying reason -- the B vitamins, particularly thiamine, are removed in processing.

Nowadays, rice has the vitamins put back in. Alcohol doesn't.

Society has never been willing to protect alcoholics from the consequences of alcoholism -- doable simply by adding a trace of vitamin B-1 (thiamine) to the cheapest over the counter booze and making it available to displace non-food alcohol consumed.

If that were done, it which would let someone go on being an alcoholic without Korsakoff's syndrome developing:

> difficulty in walking and maintaining balance
> memory damage
> much difficulty with the ability to learn new information
> unawareness of the memory defect
> complete lack of worry or concern when it is pointed out
> peripheral neuropathy
> paralysis of the eye muscles

Those are the major consequences of thiamine deficiency. They are _preventable_ but most aren't _curable_ after the damage happens.

So, do we take the penny-a-barrel expense on and require a trace of thiamine be added to cheap booze, taking the threat of disability and death out of alcohol addiction, and making it easier for people who do become addicted to function at a level that gives them a better chance to recover?

Nope.

The question was first raised -- to my knowledge at least -- in the 1930s, shortly after thiamine was discovered to cure both beri-beri (nutritional deficiency caused by eating polished white rice) and Korsakoff's. It was immediately raised as a public health question. I learned about it from a college biology teacher who had understood the utter vindictiveness of the culture that watched alcohol damage people and refused to consider making the damage less.

Polished white rice isn't sold nowadays, not without some of the B-vitamins being put back into it -- and beri-beri is rare now. The same thing could have been done with booze, long ago.

We could be a culture able to see addiction as a medical problem from which some people need more protection than others, rather than a moral failure that must cause harm, even when we know how to prevent the harm.
___________________________________________

"What do you think of Western civilization, Mr. Gandhi?"
"I think that it would be a good idea."
posted by hank at 10:46 PM on January 10, 2006

Steven C.--

The mean age of these folks was 51, and it sounds from the study like most of them had been living rough. I don't guess that they were in the best shape when they came into the program. My question is, was the mortality rate among the MAP participants higher, lower, or the same as the mortality rate for homeless alcoholics of a similar age who didn't have supported housing?

Hank-- Interesting note re: the thiamin. I had no idea.
posted by palmcorder_yajna at 2:59 AM on January 11, 2006

Delmoi, your comments are specious. Saving the lives of those alcoholics was the goal of the program.

No. In any large enough group of people, some of them are going to die. The question isn't "did any die" it's "did less die then expected".
posted by delmoi at 6:10 AM on January 11, 2006

delmoi : "The question isn't 'did any die' it's 'did less die then expected'."

And even further, as you aptly points elsewhere, those who died, did they die in better conditions (more comfortable, in less pain) than they would otherwise?
posted by nkyad at 8:48 AM on January 11, 2006

I thought it was a pretty neat idea.
posted by sgt.serenity at 9:06 AM on January 11, 2006

Saving the lives of those alcoholics was the goal of the program.

Not at all. It was to reduce public costs these alcoholics incur, including public urination and defecation, breakage of objects, harassment of other citizens, the spread of tuberculosis, car and pedestrian accidents, and costly admissions to drunk tanks and emergency rooms. Saving the lives of these people may or may not be a worthy goal, but those of us who work with these people every day realize it's not a realistic goal. People drink themselves to death despite all best interventions aimed at getting them to not drink themselves to death.

Thiamine blah blah blah thiamin blah, Society has never been willing to protect alcoholics from the consequences of alcoholism -- doable simply by adding a trace of vitamin B-1 (thiamine) to the cheapest over the counter booze, thiamin blah blah

This is nonsense. I will demolish your foolish argument stepwise:

• Thiamine deficiency is only a very small part of the story of the damage done by alcoholic beverages. Korsakoff syndrome and wet and dry beri-beri are clinical curiosities, seen perhaps a handful of times in any U.S. physician's career; they have nothing to do with the severe burden of liver, kidney, neurologic, psychologic and vascular disease caused by alcohol. And in fact, most authorities accept that susceptibility to Wernicke-Korsakoff syndrome requires a hereditary abnormality (in an enzyme known as transketolase.) Most alcoholics will never suffer thiamine deficiency.
• Beer is chock full of thiamine. A pint of Guinness has nearly a full day's supply of B vitamins.
• The presence of alcohol impairs thiamine absorption. You could further fortify alcoholic beverages with thiamine and other B vitamins until they all glowed banana-yellow and tasted like breakfast cereal - your wine drinkers wouldn't like that very much - and it wouldn't help, because alcohol spoils your gut's ability to absorb these vitamins.

posted by ikkyu2 at 2:50 PM on January 11, 2006

And just to clear it up: Thiamine does not cure Korsakoff's syndrome. Nothing cures Korsakoff's syndrome. It is irreversible.
posted by ikkyu2 at 2:54 PM on January 11, 2006