At St. Paul 'wet house,' liquor can be their life - and death
twincities.com
twincities.com
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.
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.
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.
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.)
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.
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.
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.
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.
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.
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.
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.
Good article. It brought back a lot of interesting memories. :)
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.
On the flip side, rehabilitating someone who doesn't want 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.
If nothing else, it has jogged my thinker; I'll probably debate with myself for a while on this :)
America is on a huge "everyone should be happy" kick - smile all the time, buck up and be cheerful, if you're not happy take this pill - but that has its own problems, and masks problems like these people are having, making them worse. It also trivializes pain / unhappiness - everyone can have it! Why don't you? Try this pill, go to a meeting, look everyone can do it! - and given the amount of depression occurring can it even be said to be working? For some, sure - there are outliers in any system of people..
There's also that it can cause things to get even worse - if everyone really can / should be happy, and I can't, clearly something's wrong with me. You'll find a lot of depressed people in that line of thinking, and it crops up in suicides pretty often too.
Not really disagreeing, just debating with myself / you / the Internets.
Should people with diabetes just kick the insulin habit? Please.
You fit the profile, and it's a profile I find repugnant and dangerous to the mental health of depressed people everywhere.
There is an important difference between unhappiness due to life events and clinical depression. One may trigger the other; but the fact is that depression is a neurochemical disorder that is, in most cases, directly and immediately treatable with cheap, safe, effective pharmaceuticals with a minimum of fuss.
I've had the deep dark nights of despair. The black nights of the soul. I spent years trying to stare down the black dog. It is exhausting and I gained nothing by it. It has borne me no fruit whatsoever.
It's not fair, and it's not rational, but if there's anything I've learnt from taking zoloft it's that dualism is rubbish. We are illusions of ourselves, running on a largely hacked-together substrate made of meat.
I used to put the position that the drugs are over-prescribed, that it's a societal problem etc. But I don't feel that way any more, because thinking like that was another reason that I did not seek treatment. I basically lost my 20s to this disease, I don't want others to suffer as I did.
If that means erroneously attacking a few false positives on HN, so be it.
Now I'll proceed to shoot somewhere near my foot, maybe hitting it :) I'd rather be understood and disagreed with than misunderstood and have fake happiness. And I would honestly be curious what your take is on this, I obviously haven't experienced everything there is in the world. There's no hard feelings here, I've seen that stance before, and I hate it too. It does indeed prevent people from getting help.
My main view with anything that tweaks your brain is that your brain is enormously flexible. Barring issues where you're not making enough / too much of a certain chemical (ie, largely genetic), you quite literally did this to yourself (as bad as that sounds). Your life habits have caused you to get stuck in the loop of depression / anxiety, and it builds on itself, pretty frequently until it controls you unless you are lucky enough to find a way to break out before then. Or someone drags you out. Drugs help get you out of that loop, but if your habits don't change you'll train your brain to go back to where it was in spite of the drugs (and this happens, it's not just dualism / zomg-natural-only. That's part of what causes psychological addictions, and depression is highly addictive). Again, unless there's a more permanent biological problem - then you're using drugs to reach normalcy, which is where your body / brain wants to be anyway. But enforced normalcy while you keep pulling yourself away from it is doomed to failure and high costs.
There are plenty of cases of, say, insufficient dopamine production due to genetics. And cases where depression / anxiety have caused chemical imbalances (ie: nearly all, especially severe cases). And the existence of medications to help that is utterly wonderful. But using drugs to ignore a problem isn't a solution. To solve a problem, yes, but that's not how many (possibly most) people use them, in part because of how quickly these medications are leapt at. Can't focus? Try hyperactivity drugs. Can't sleep? Try sleep aids. Can't be happy? Try antidepressants. Therapy, on the other hand, gets nowhere near as much medical support, despite similar success rates and often longer-term solutions. It has plenty of failures as well, everyone's different and there are plenty of bad therapists out there; I'm merely saying that it gets far less support than drugs do.
I think you're conflating the illusion of consciousness with the brain itself. It is possible to take actions to intervene in my own neurochemistry -- I am a self-observing system. I can avoid situations that upset me, I can spend more time with friends and family, and so on.
But my personal experience of depression is that it removes the will to be cured. Yes, you can seek therapy, spend time with friends, take up meditation and these will help. But when you are depressed even the thought of getting help is ... exhausting. A cause for dismay, even. It is a particularly invidious disease.
Each of us has different systemic set points for our internal processes -- dynamic equilibria which our systems drift to over time. Most of these are necessary and useful, they keep us alive. But some of us have set points with unpleasant side-effects. Some people have trouble regulating blood sugar, and they use exogenous insulin to do it manually. I have trouble regulating serotonin, and I use sertraline hydrochloride to influence it manually.
High doses broke the back of a depressive episode that lasted 5 years. Low doses have kept me functioning since then.
Is it perfect? No. I could do without the side-effects, but I expect that as time goes on these drugs will become more specific and effective. Or someone will come up with a gene therapy. Who knows?
I do not regard what I experience as fake happiness. It is as real as anybody else's.
I'm not claiming it's fake happiness. You've clearly made it work for you. I'm merely saying that many people expect drug X to solve all their problems, because it makes them feel better, and do nothing to solve the root problems (which will come back in time). Maybe not most, but even a small percentage means hundreds of thousands of people, and tons of kids who have no choice in the matter.
>it removes the will to be cured
Absolutely, that's why it's such a hard thing to fix. And drugs are a fantastic way to crack your way out of it, to break that relentless loop. And our current culture sneers at anyone (particularly men) seeking help to solve personal problems. That needs to change. It is, slightly, thankfully, but there's a very long way to go.
I take no issue with medicating. Only over-medicating. And neurochemical-manipulating drugs have been crammed down America's collective throat for a while now, without long-term trials, frequently with barely-detectable improvements over sugar pills (and later studies showing none or worse), and without really understanding what they're doing or their ramifications.
Not that I think that's surprising. It's a powerful, successful-enough new line of treatment that's helping a lot of people, and exposing a lot of existing problems that are now getting treated. Of course such a thing would be used before long-term trials were run. People would take it voluntarily - the immediate almost always out-weighs the long-term in any creature, but it's entirely founded when the immediate threatens your life.
The problem I find with the current everyone-must-be-happy trend (as nice as it would be to achieve) is that a) it adds more weight against those who are unhappy to conceal their problems rather than publicly seek help, as everyone else is clearly happy (ignoring the truth) and they don't want to cause unhappiness, and b) it has lead to over-prescribing short-term (in that they work quickly, not that they don't continue to work - that's debatable and essentially unknown currently) solutions, when the causes are the real demons that must be exorcised. It is masking the problems because people quit dealing with them because a fast way out is a doctor's visit and a complaint away. Which is their fault for being lazy, but that's human (and efficient), and it shouldn't be that readily handed out or advertised as a magic bullet.
It also doesn't help that hyperactivity drugs have been pushed by elementary schools (or individual teachers) for unruly kids when it's far more likely that they are bored or weren't raised properly. But that's a rant about our education system, which (especially at elementary levels) I feel is fundamentally, enormously flawed and contributing to a lot of problems. I won't go further on that.
What needs to be done is to treat the imminent danger, and then immediately work with people to solve the causes. But that's cross-discipline - medication and (essentially) psychotherapy - thus rare in a single person, and because the initial danger is gone people quit trying. It appears to be a solution, without actually being one, and long-term / long-term-use side-effects are very real and very dangerous, and largely unknown. One of which I do feel is that it teaches people to medicate their problems instead of dealing with them directly. It's encouraging people to take fast exits.
---
Anecdote time! I had a couple years of depression a while back, and didn't take anything for it. I was lucky enough to find a way out of it before I got wholly stuck, and I'm incredibly aware of how close I was to getting stuck and how powerful the loop is - that realization is what shocked me out of it. I'm a minority in that, and I know I was lucky, not strong-willed or somehow better.
Once I got out of the loop, I knew it was just a matter of time before I was back to normal, so I just kept doing what was working. Drugs could likely have shortened it, but I'm leery of drugging my brain after trying various sleeping aids left me hung over and brain-dead for good chunks of that year. It's not entirely rational, and I fully admit it, but I think I made the right choice for me. The process of fixing it has improved me, as I work at fixing things much sooner now.
And if that's rambly, apologies! I'm sort of rambly-feeling right now, and this touches on a lot of areas so it's hard to make cohesive.
"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."
Dr. Steven Miles, professor of medicine and bioethics at the University of Minnesota, agreed.
The reason to support St. Anthony is not the money saved but the kindness extended to the residents. "It is the humanity of it, just like humanity drives the hospice system," he said.
It's not really direct "harm reduction" in the same sense as needle exchange clinics. More a way to make a few people's lives slightly less miserable; I find it difficult to object to that.
Not really. Euthanising long-term alcoholics would mean taking a syringe full of paralytics, potassium, versed and morphine and pushing as a lethal injection.
Hospice is realizing they are dying from their disease and providing for them while the disease runs its course.
The difference is that people have the right to choose what treatment they take or don't take. Forcing a treatment on someone (antibiotics, chemotherapy, sewing a laceration) when they don't want it is legally called medical battery, and it's against the law.
This is particularly poignant in the case of diseases like alcoholism or drug addiction. I often have conversations with alcoholics along the lines of "Your alcohol level was 5 times the legal limit. If you keep drinking at this level, in a couple of years, your liver will be shot, and you're going to die of liver failure. Liver failure is one of the worst ways to die, because you die looking like a swollen yellow gourd."
Most don't care, and keep on drinking. Same thing with smoking. I smoked for 10 years while I was a Critical Care nurse. It was my choice and my addiction. It took trying to quit 15 times before I did it successfully. Some people aren't able to quit, or don't want to quit, and it kills them.
Should we deny people with lung cancer hospice because their disease was self inflicted? Should we deny people with heart disease hospice because they didn't manage their cholesterol properly? Should we deny people with type 2 diabetes hospice because they didn't manage their diet appropriately, exercise or lose weight?
I largely agree with what you're saying (how could I not?), but I'm having difficulty finding testable definitions in it. Something hard-edged and consistent that can serve as a basis.
One of the problems with respecting the person's choices in cases of addiction is that there's room for arguing that they're not capable of making decisions for themselves due to the addiction. This comes up all the time in legal and medical situations - otherwise, we'd have no insanity clause, no forced rehab, no insane asylums (not that I think those are fantastic places, of course). I have no idea where the legal line lies in most situations, but would be interested if anyone does know it.
At what point do we decide whether it's the person or the disease that's talking? Alcohol in particular has a far longer history than the newer, "harder" drugs that our society has drawn clear distinctions for, and it's going to be much harder to find or make or convince others where the line for it lies.
Sure, I deal with this on a nightly basis, when I'm at work. Most state laws stipulate that the only reason a hospital can hold someone against their will, is if they are a danger to themselves (in imminent danger of committing suicide), a danger to others (in imminent danger of committing homicide.) or gravely disabled ( e.g. walking around quacking like a duck and drinking from puddles).
And, even then, an ER can only place someone on a 72 hour hold. Then it has to go to court to hold someone against their will on a 10 day paper.
Getting someone committed to rehab for alcoholism is generally a court driven exercise that happens after a person has multiple DUI's or instances of committing crimes that are drug use related.
The law takes committing someone to drug, alcohol or psychiatric treatment against their will very, very seriously and only does so in extreme circumstances. And, frankly, providing a wet house for people to continue to choose to drink themselves to death is probably the path of least resistance, it's cheaper and in my opinion is the most humane of all the bad options.
I don't quite follow that sentence... is that to get a 10 day period enforcement, or to go over 10 days? Or something else?
All in all, pretty clear, thanks! That sounds like a pretty rational set of rules. My main difficulties lie in that people seem to only care about things when they become imminent and obvious, while ignoring steady trends that are just as dangerous (or more). Legally, imminent is a nice, clean line to choose, because it's pretty clear most times. It's a line that can be protected, which is hugely important.
Ethically, I don't know, and any actions would be at odds with their free will... unless you view addictions as violations of their free will to begin with. A loss of free will that they chose, but that decision doesn't hold up against extremes like suicide. Is suicide somehow worse when it's immediate rather than over the course of, say, a year? What if they planned it for a year, and you only interrupted it at the crucial moment?
I think it could be taken a step further by providing an alternative to going out onto the street to try to get alcohol in various forms (including mouthwash).
While I'm certainly no expert on psychology, my experience has shown me that sometimes the best way to get some tiny bit of purchase on a group of people is to offer a minimally reasonable alternative.
For example, if scrapers are constantly inundating your website one solution is to publically offer an API. Obtaining the data is easier through the API and reduces the automated hits to the human readable part of your website. You can require API users uniquely identify themselves and you are then able to throttle and better track how your data is dispensed.
Following this line of thinking: Why not put in a alcohol vending machine that dispenses variable percentage alcohol based on BAC of the user and frequency of use? It could also adjust the alcohol content up or down based on other factors, like recent civil service or run-ins with the police.
I could think of hundreds of ways this could be improved. Since you are likely getting BAC readings on a regular basis you have a measure of how successful your dispensing profile is. With enough machines you could even split test different percentages, etc... If the machine is not getting any use at first the alcohol level could be stepped up.
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.
Right now MAPS.org is doing an observational study of Pangaea Biomedics, one of the more famous ibogaine clinics in Mexico. Claire Wilkins (who runs it) gave a pretty amazing talk at Horizons this year, which you can watch here:
I just haven't heard it being done for chronic alcoholics. But the hospice analogy is correct.
It is the equivalent of palliative care for cancer patients who have given up (or their doctors have given up) further treatment.
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?
Every life has a beginning, a middle, and an end. Some lives are very short, a few are very long, and most somewhere in the middle of the curve (something the insurance companies call the actuarial).
Everyone wants to live as long as possible, but how you get from beginning to end varies widely. What works for me, may not work for you. Trying to impress one social groups idea of 'proper lifestyle' is what causes most of the problems in America (possibly elsewhere) today.
There are times, when a little bit of the problem, is a better cure than all the societal enforced behavioral change. For the most part, we really are smart people.
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?
It the liver that is the problem, and exercise won't help there.
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.
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 hopeless. Whereas some of the greatest benefits and victories for society seem to come from goals that seemed impossible, aka hopeless.
If we undermine that, we will be the worse for it.
Transplant patients are prioritized, among other things, on the chance that they will be able to recover from their illnesses. Alcoholics are never given transplants for that reason.
At some point you have to take into account what works best statistically, otherwise you are being unfair to those who have not wasted their chances.
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.
http://www.metafilter.com/100658/Everyone-is-going-to-keep-d...
I still don't know how I feel about it, though. Just sad rather than strongly for or against.
If it wasn't cheaper, their would still be an argument to be made in favor of wethouses because it seems to be far more humane than allowing people to rot away on the streets. But then the debate would be whether or not society should have to bear the cost of their poor decisions. In fact, they will have a cost to society no matter what. It just so happens that the best thing for them is also the cheapest thing for society, so there is no possible objection. So the argument goes.
No one is saying, "Do it because it's cheaper." They're saying, "Don't not do it because it's more expensive, because it isn't -- it's cheaper."
The article implies that all of these men are incorrigible, but many might simply be people with families who don't have the resources to get treatment, or that simply don't care enough to get it. There is a great danger that because it's cheaper, we'll rationalize away the moral argument in much the same way you do, by pretending that there is no alternative but putting them on the street.
It's quiet...almost too quiet... :-)
You state an opinion as if it were fact.
And social engineering is not engineering, unless anything involved in influencing the universe through action is engineering. Your analogies are based on logical fallacies.
Aside from that, bioethical issues, while using quantified information as tools to measure effectiveness, need an equal or greater amount of thought to the basic philosophy of the clinic, and ultimately require human judgement where we determine what is "better" and what we want as a society.
So, yeah, wrong on all counts.
I think you're absolutely correct. What does a vote mean? What does a flag mean? Do they differ at an article or comment level? (Other than the obvious flag:downvote difference)
I do prefer upvotes to "+1" or "me too" responses, but downvotes can either be indicators of "I disagree with you," or "this is inappropriate for this forum/discussion/etc." It's unfortunate that there is little way to disambiguate them except in certain obvious cases.
What to Submit
On-Topic: Anything that good hackers would find interesting. That includes more than hacking and startups. If you had to reduce it to a sentence, the answer might be: anything that gratifies one's intellectual curiosity.
Are there good hackers that find this interesting? look at the votes.
Uhrm... there's a flaw in this logic somewhere. You could drive a train through it.
As far as the article being off-topic.
http://ycombinator.com/newsguidelines.html Off-Topic: Most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon. Videos of pratfalls or disasters, or cute animal pictures. If they'd cover it on TV news, it's probably off-topic.
This thread is worth perusing:
I could not understand why you were bugging me for my use of the term good hackers, when the obvious main point to be made was, if yes or no the article was, in fact, HN material, which I felt and continue to feel it is.
Many of us haven't been around this site as long as some of the people raising their concerns in the thread you pointed me to. We don't know what it was like in the old days, our only compass for what makes a good HN post is the guidelines, which can be interpreted subjectively in many situations ([...]That includes more than hacking and startups[...], [...]anything that gratifies one's intellectual curiosity[...]). Some of the best articles that I've found on this site snuggly fit within those characteristics (e.g. http://news.ycombinator.com/item?id=1978295). I believe the current one to have some of those same characteristics, because it highlights an out-of-the-box approach to a problem so very uncommon in the mainstream. 4 days ago I was chatting about homelessness with my business partner, and we were discussing hypothetical solutions to fix it, or at least make it less of a problem and reasons why they would or wouldn't work and some of our solutions were pretty much along those lines and also raised some ethical/moral questions. We're both programmers and though this is arguably not hacker material, we're also entrepreneurs and our ideas often stem from these little discussions that help us look beyond the status quo.
It seems from the thread that you posted that some old timers are trying to get HN to fit back into its old box. I'm still unsure if it would have much appeal to the kind of topics I'm referring to. If their veteran status grant them a say in the direction of HN, I can only suggest to push for clearer guidelines.
Btw, I cannot remove the good hackers from the original post to the thread, it appears that the "edit" timer has expired.
So we agree, then?
Good. Glad to put that to bed.
I consider this article to be noise. Sure, it's interesting to read, but it's contributing to the creation of the sort of volume that will require either a) spending too much time skimming HN to find interesting content, or b) categorization à la Reddit/Slashdot/etc.
Chicken Scheme, the startup incubation in Chile, DSPL: Dataset Publishing Language, and "At St. Paul 'wet house,' liquor can be their life - and death."
Which of these doesn't belong?
p.s., sorry you got hit with the "I disagree with you, so I'm downvoting you" reaction on this one.
I could read this article, about an interesting and unusual approach to a common problem. It seems to cost less than the previous solutions, and help those affected.
Or i could read:
\* 5 Amazing Vim tips (all of which are covered in your average vim tutorial)
\* Why I like $LISP_VARIANT (and you should too!)
\* Usability rant suffering from tragic flaw #1 (giving up power for instant understanding).
\* Some fluff piece about how "our startup is great and unique because we worked really hard and didn't like the big corporate structure!".
for the 10,000th time each. Which is more likely to benefit me?
Granted, the approach described here is more morally ambiguous than Gladwell's piece, because it has the added dimension of allowing people to continue to harm themselves. But I think there are interesting arguments to be made in both cases, and I'm glad to have had this piece brought to my attention.
Much of the Gladwell posting here recently seems to be of the,"Look, I can make up an article or book with no intellectual rigor behind it as well as Gladwell can!"
Hilarious