My first job in a hospital (I'm an ER nurse ) in 1993 was as an ER tech at Hennepin County Medical Center in Minneapolis.
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. :)
Interesting. I can see how it would be appealing to long-time alcoholics (the "endless optimism" would get pretty sickening).
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 :)
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.
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.
Even as something of a liberal, this makes me feel conflicted. It doesn't quite feel like harm reduction - just cost-reduction for the agencies. It's very bleak.
My step brother's uncle was an alcoholic for ~25 years (off and on for 25 years? I don't know how this works). He joined the native American church, where he presumably used peyote, and the alcoholism eventually went away and he is now happy.
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.
"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:
This is the equivalent of heroin injection galleries that has been trialled in various parts of the world. The basic idea is that these people are at less risk of overdosing, or sharing needles. Basic medical care is readily available should these people need it.
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 don't think I have a problem with it yet, because I'm rationalizing. It somehow makes sense. I'm not sure I would feel the same if someone I cared for decided this would be the solution to their problem though.
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.
I have read of a shift from treating addiction as a criminal issue to treating it as a public health issue, and this seems to fit with that. As with cancer, when a cure seems sufficiently improbable, trying to salvage remaining dignity while also reducing costs to society, through hospices, is certainly thought of well around here.
I wonder how much of the $18K per resident cost is defrayed by taxes on the liquor they are drinking (though Listerine as mentioned in the article as something some drink, would only have sales tax on it).
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?
I don't like to think anyone is hopeless. That's because to be truly hopeless requires mathematical certainty, which usually isn't possible in the real world. In the real world, we don't know everything; there are always unknowns. Where there are unknowns, there is a chance; there is hope.
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.
If the money saved on treatment for these people can be better spent in improving policy and other aspects in society, then it appears to be money well spent.
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.
It seems pretty logical that St. Anthony's -- in certain cases -- is preferrable to the AA model.
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.
The MeFi thread on this a few days ago had some good content, including the abstract from a study on just how drastically housing the homeless and/or alcoholic reduces overall costs to society
Wow, someone downvoted that. Could you elaborate on why you think reducing social cost is a valid argument for promoting suicide? Note that I'm not saying there aren't valid arguments supporting the St Paul's approach, I'm only suggesting that "because it's cheaper" is an incredibly callous and cynical one.
Seriously though, I found it interesting and am glad it was on Hacker News. Social engineering is engineering, and engineering is Hacker News. You are minimizing the harm and cost in a society by providing a place where people can safely use alcohol. It's far better and cheaper than leaving them to do it on the streets.
I'm not sure this is a good question. If significantly more people vote it up than flag it, and PG doesn't specifically ban it, it's Hacker News material. Personally, I thought it was an astonishing article that I was happy to read, but flagged it for fear that HN is starting to lose focus. I think the right question is how votes and flags should be weighed.
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.
How is it not HN material? This reminds me of the 2006 Malcolm Gladwell piece about "Million Dollar Murray" that showed up here last summer ( http://news.ycombinator.com/item?id=1582582 ). Both stories pose a problem that has a well-known set of "accepted" solutions, and describe a novel and counterintuitive solution for an edge case. Which sounds like one definition of a hack to 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.
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?
[+] [-] iamelgringo|15 years ago|reply
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. :)
[+] [-] vdm|15 years ago|reply
[+] [-] Groxx|15 years ago|reply
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 :)
[+] [-] iamelgringo|15 years ago|reply
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.
[+] [-] barefoot|15 years ago|reply
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.
[+] [-] jackolas|15 years ago|reply
[+] [-] joe_the_user|15 years ago|reply
[+] [-] RevRal|15 years ago|reply
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.
[+] [-] Alex3917|15 years ago|reply
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:
http://www.youtube.com/watch?v=L0tt3mgT8gA
[+] [-] teyc|15 years ago|reply
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.
[+] [-] verysimple|15 years ago|reply
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?
[+] [-] cosmicray|15 years ago|reply
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.
[+] [-] hessenwolf|15 years ago|reply
[+] [-] patrickgzill|15 years ago|reply
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?
[+] [-] ars|15 years ago|reply
It the liver that is the problem, and exercise won't help there.
[+] [-] 6ren|15 years ago|reply
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.
[+] [-] Daishiman|15 years ago|reply
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.
[+] [-] seertaak|15 years ago|reply
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.
[+] [-] Pahalial|15 years ago|reply
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.
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[+] [-] btmorex|15 years ago|reply
[+] [-] verysimple|15 years ago|reply
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.
[+] [-] SamReidHughes|15 years ago|reply
[+] [-] geeksam|15 years ago|reply
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.
[+] [-] sophacles|15 years ago|reply
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?
[+] [-] ekoontz|15 years ago|reply
[+] [-] AndrewVos|15 years ago|reply
Hilarious
[+] [-] smcl|15 years ago|reply