For alcoholics, a bed to sleep it off, or a shove toward treatment, sobriety

November 15, 2011

Every town has these sad souls — chronic alcoholics, most of them homeless, who get hauled to the nearest emergency room by frustrated police. Hospital personnel check them out and try to make them comfortable. Once sobered up, they walk out the door.

Within days or weeks, they're back.

The visits are costly for hospitals in staff time and emergency room space. While clinicians can respond to alcohol poisoning, emergency rooms aren't set up to deal with the psychiatric underpinnings of addiction.

Two Catholic hospitals 1,000 miles apart on the West Coast are trying different ways to care for chronic alcoholics by teaming with agencies in their communities. One program provides a dry, safe bed overnight and a meal. The other offers repeat offenders a stark choice — participate in treatment or stay in jail.

Success at both programs is mixed, largely because chronic alcoholism is a daunting issue. But leaders for both hospitals say they offer alternatives that have reduced the number of costly, ineffective visits to their emergency rooms.

In Tacoma, Wash., Franciscan Health System is a sponsor of the Sobering Center, an 11-bed facility that gives chronic alcoholics a safe place to spend the night. A local social service agency runs the center, and the agency's social workers offer assistance and counseling to the overnight clients. But it's up to a client to act on referrals for longer-term help.

In Santa Cruz, Calif., Dominican Hospital is a sponsor of the Serial Inebriate Project, a program that includes the Santa Cruz County health department and courts. If the police pick up someone for public inebriation five times within six months, a judge gives that person the choice of 30 days in jail, or equal time in a treatment facility.

Both hospitals help to pay for their respective local programs.

A warm bed
Tacoma's program began in 2004. The Sobering Center is about 10 blocks from St. Joseph Medical Center, the Franciscan Health System's downtown hospital. Franciscan is affiliated with Catholic Health Initiatives of Englewood, Colo.

Pamela Brewer, community integration director for the five-hospital Franciscan system, said the program began with conversations among police officers, paramedics and emergency room workers. Police officers now can take inebriates to the Sobering Center provided they don't require emergency medical attention.

"Just moving people from the street to the ER wasn't solving anything," Brewer said. "The Sobering Center gives them a safe place to sleep it off, and a sandwich and some juice the next morning. This is another way to act upon our mission to serve. Otherwise, many of these people would be sleeping in the streets."

Brewer said the program is realistic about its ability to turn lives around. "Because this is a hard core, chronic population, there aren't a lot of success stories," she said. "Social workers offer them housing and (longer-term) detox. We always hope they decide to make some changes in their lives. But at least, for one night, they're in a safe place."

Brewer said Franciscan pays about $100,000 annually to help operate the Sobering Center. She said the emergency room staff supports the program "because, with the reduced visits (by alcoholics), there is more time to deal with medical emergencies." 

Lauren Clinton, the Sobering Center director, said it serves about 150 people per month. Some of them are repeat clients, but they are welcomed back. "If there is a need, we fill the need," Clinton said.

She said her staff offers all clients referrals to treatment and long-term housing through the affiliated services of the Metropolitan Development Council, an umbrella agency that runs the Sobering Center. Many of the clients are homeless. Clinton said about one in four clients agrees to undergo treatment.

Greg Hopkins, a former Tacoma police officer who helped lead the original efforts to establish the Sobering Center, encountered many chronic alcoholics as he worked the downtown beat for 15 years. Hopkins said he realized early that using emergency rooms as "de facto sobering centers is not a good way to reach out to that population and makes no financial sense. It was an extremely expensive way to do sobering."

Hopkins said he supports the Sobering Center's approach of making treatment and other services available to those clients who decide to accept that help. "It's not punitive but done with compassion and concern for their well-being," he said. "And, ultimately, it becomes a personal decision to seek treatment and stay sober."

Jail or treatment
Opening access to treatment and services also is the goal of the Serial Inebriate Project in Santa Cruz, but that program delivers a treatment ultimatum. The Santa Cruz project also began in 2004, but it was halted in 2008 because of recession-induced public budget shortages. The local coalition, including Dominican Hospital, reestablished it in 2010, and it continues today. Dominican is part of San Francisco's Catholic Healthcare West.

Unlike the program in Tacoma, it doesn't have a place set aside for chronic alcoholics to go for an overnight stay. For a person's first four arrests within six months, he or she is processed at the jail and released within a few hours.

On the fifth arrest, the person remains in jail until he or she can go before a judge, who then offers the choice of jail or treatment. The program contracts with local private agencies to provide the treatment. The program budget pays for the treatment and a caseworker to arrange for and monitor it.

Martina S. O'Sullivan, director of community engagement at Dominican Hospital, said that without the moment of decision in court, "There'd be no incentive for anyone to do anything. They'd end up back in the hospital and out again on the street. I don't see it as an 'either/or' so much as a way for human beings to make their own decisions. We are happy any time chronic alcoholics can be more involved in making their lives better."

A 2010 study for the project by the County of Santa Cruz Health Services Agency outlines the burden upon hospitals for continuing the revolving-door approach. It says each emergency room visit by a serial inebriate costs Dominican Hospital $554 in unrecovered expenses. The report reviewed the cases of 48 repeat inebriates who had been taken by police to the hospital an average of seven times each over a six-month period.

Bill Manov, director of drug and alcohol programs for the Santa Cruz County health service, said another review of 31 chronic alcoholics in 2006 indicates that the Serial Inebriate Project reduced their emergency room visits by 41 percent and arrests by 10 percent. He said that saved all project sponsors about $1.50 for every $1 spent on the effort.

Since the program was revived in July 2010, Manov said, 50 chronic alcoholics have had to face a judge in Santa Cruz. Of those, 19 refused treatment and went to jail. But 14 of the 31 who chose treatment haven't been arrested since.

"It can be a path to progress," Manov said.

O'Sullivan said the hospital provides about $21,000 annually to the project. The city and county of Santa Cruz combine to cover about two-thirds of the project's $220,000 budget.

 

Copyright © 2011 by the Catholic Health Association of the United States
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