Chris Rickert: Managing, not curing, disease of alcoholism may be best option

I’ve known enough alcoholics in my life to know that, for them,getting and staying on the wagon is really, really hard.

So I wasn’t all that surprised to see the news last week thatjust because Dane County has cut $200,000 from its detox programand refocused its efforts on drunks who want to stop drinkingdoesn’t mean there are any fewer drunks who need detox because theycan’t or don’t want to stop drinking.

Nor was I surprised to find out that a Madison ordinance thatwent into effect last August to blacklist chronic alcoholics frombuying packaged liquor isn’t really having much of an impact.

The ordinance is “difficult to enforce” and “hasn’t reallybroken up the cycle” of intoxication, said Mark Woulf, the city’salcohol policy coordinator. 

I suspect the reason they aren’t working is because they rely onavoidance, in the first case, and punishment, in the second. and asanyone who has dealt with the hard-core alcoholic knows, thedrinking doesn’t stop just because you choose to ignore, or,conversely, punish it. 

So what is to be done with these people, many of whom arehomeless, and who, according to Woulf, were once estimated to costas much as $3 million a year in police and other publicservices?

The choices under the city and county’s current approach arestark: Keep running up the tabs and bickering over which group oftaxpayers gets to pay them, or leave inebriated people in thecommunity causing havoc or dying from overdose and exposure.

And they reminded me of a news story I’d seen a while backdescribing an alternative approach that relies, in part, on ahighly unorthodox notion in the world of traditionalsubstance-abuse treatment: let them keep drinking.

The Seattle Office of Housing’s 1811 Eastlake project has earnedaccolades for providing services and housing to homeless drunks —while also allowing them to drink in designated areas of theshelter — because it has been shown to cost taxpayers less andactually leads to less drinking among residents.

Pamela Bean, a member of Madison’s Alcohol License ReviewCommittee who has a doctorate in experimental pathology and studiesalcohol abuse and treatment, said the 1811 Eastlake project is anexample of the kind of approach that combines “two key componentsof recovery: motivational readiness to change and harmreduction.”

“These habitually intoxicated people need a change in lifestyleto help them modify their behaviors and a structured environmentthat provides stability without overwhelming them with unreachablerequests,” she said.

In short, mitigate the damage they cause and don’t expect themto jump on the wagon right away.

It should be clear that people whose alcoholism has them livingon the street or getting seven or eight drunken-driving convictionsaren’t drinking because they lack willpower or haven’t beenpunished enough or because no one’s told them they can’t. 

They’re drinking because they have a chronic illness. As withany chronic illness, sometimes the best you can hope for is tomanage it, not cure it.

Contact Chris Rickert at 608-252-6198 , as well as on Facebook and Twitter(@ChrisRickertWSJ). His column appears Tuesday, Thursday, Saturdayand Sunday.