Commitment intended to break alcohol cycle

The Salvation Army’s Clitheroe Center is gearing up to accept alcoholics involuntarily committed to a new detoxification program, becoming the only rehabilitation facility currently in town that will hold patients for a month or more to force them to sober up.

The scheduled opening this month comes on the heels of a spate of homeless deaths across town this spring and summer: Eight men died. Alcohol caused or contributed to at least four of the deaths, according to information released so far by police.

The new Specialized Treatment Unit won’t be the complete solution to the problem of street alcoholics, but it could certainly help, said center director Robert Heffle.

“This is not an attempt to incarcerate the chronic inebriate,” Heffle said. “This is an attempt to intervene and to help a population that cannot make good choices for themselves.”

Police, too, doubt the program is a cure-all, but see it as advancing on the problem.

“One of the big pieces of the answer to dealing with the homeless problem is the ability to involuntarily commit people so that they’re off the substance they’re addicted to long enough to come to their senses and be able to think rationally,” police Lt. Dave Parker said.

The facility plans to start with four beds ready for patients to help them get sober and stay that way. It also wants to add another six or eight treatment beds where patients can stay for up to a year if they choose, Heffle said.

It’s a pilot program pushed by Sen. Johnny Ellis, D-Anchorage, who started seeking funding for it more than two years ago. Ellis says the roughly $1 million the treatment will cost a year could end up saving money in the long run.

“We spend $4 million of Anchorage taxpayer dollars on the 100 most chronic public inebriates,” Ellis said. “Right now the revolving door involves public safety, and prosecutions, and the courts, and Community Service Patrol and the sleep-off center.

“The status quo isn’t working when people are dying on the streets. We’ve got to try something new.”

Judge Makes Final Decision

For a person to be involuntary committed, a family member or doctor first needs to petition seeking it — though that initial step can itself be a barrier to street inebriates getting help, said attorney Ernie Schlereth, who has represented many of those being committed in other programs. If the individual is “a derelict person on the streets that is in very, very bad shape, there’s not often going to be a family member,” Schlereth said.

State law requires the person to be an alcoholic who is either incapacitated by drink or who has at least threatened violence and is likely to inflict physical harm unless committed. A medical official examines the person, but a judge makes the final decision.

Though the involuntary commitment law isn’t new, commitments haven’t been happening in Anchorage in recent years because there is a lack of detox beds for them, said Steven King, behavioral health specialist with the Department of Health and Social Services.

A bed needs to be ready and waiting before a person can be committed, he said. Facilities like Cook Inlet Tribal Council’s Ernie Turner Center have medical detox beds for voluntary patients, but waiting lists preclude them from being used for involuntary commitments, King said.

“You couldn’t really say ‘seventh on the waiting list’ because you don’t know when that’s going to happen,” King said. “And so they won’t even start the legal procedures without having that ready for them, ready to go, at that time.”

The new beds at the Clitheroe Center will be specially dedicated for the forced commitments, he said. The program also will provide further rehabilitation and services.

“It’s not just detox and sending them back out on the streets, it’s detox into treatment, and then even after treatment, they’re receiving services from this program,” King said.

Ellis said whether funding for the program will continue is dependent on whether it produces results. That there have been so many homeless deaths this spring and summer shows there is a need for something to happen.

“What we’re doing now clearly does not work,” Ellis said. “We’re trying to be creative and smart about spending our dollars and maybe be able to get a better outcome in terms of avoiding human tragedy and avoiding some future cost to the taxpayers.”

Nurses Will Supervise

Detox is a medical procedure that carries with it health problems including seizures, alcohol poisoning in new arrivals and other dangers, Heffle said. For that reason, the unit will be staffed 24/7 with licensed practical nurses with a registered nurse managing them under the care of a physician assistant, he said.

In the first few days of treatment, staff members try establishing relationships with the patients to show they can help. The goal is to get them to volunteer, after they’ve cleared their heads, to get into the longer-term treatment, Heffle said.

Heffle described the facility as “semi-secure,” meaning the patients are urged not to leave but aren’t restrained or guarded. Patients who refuse to comply with treatment or want to leave are coaxed by the staff into staying, even just for another night, Heffle said. Just that is often enough to keep them there.

If they do walk — the facility is a fair haul from civilization at Point Woronzof — the staff will call police to bring them back. Repeated absconding can lead in rare cases to more severe action, including commitment at the Alaska Psychiatric Institute, Schlereth said.

Past evidence has shown that “most people will just play out the 30 days,” Schlereth said. “Every now and then someone will walk, get picked up by the police, be brought back and then they’ll stay the rest of the time.”

Judges also have the option of extending a 30-day commitment to 180 days.

Joshua Mathlaw, a 62-year-old peer mentor at Clitheroe, said he thinks the treatment could help those on the streets who need to clear their heads of booze and get back on track. He knows how hard it can be — he used to live on the streets.

Mathlaw is an Army Vietnam veteran originally from Nunavak Island who says he lost control with the bottle after he came to Anchorage.

“It was difficult to understand why it happened,” Mathlaw said. “I’d have a glass of beer and leave it at that when I began. And when it started to progress I was just looking forward to weekend drinks, having a night of drinking. But I didn’t really understand it until I began to lose jobs because of drinking.”

He wound up with just the clothes on his back, and eventually realized his body couldn’t take the abuse. He went into treatment a few times; he’s now been sober since 1993, he said. The treatment he got at the Clitheroe Center helped him stay clean, and the new unit could help others realize that they need it, he said.

“For some people who are very much into the culture, I know it’s hard, it’s difficult to change your perspective. It’s difficult to have your mind changed,” Mathlaw said. “If we do it carefully, it’s going to be a real help, because I’ve had the same issues.”

source: Anchorage Daily News