Homeless alcoholics need a wet house. When you sleep with your bottle, you've passed a milestone in your addiction. You've got to have it against your chest, all night, easy to reach. Your relationship to it is like other people's relationships with their smart phones; it's crucial to your existence, always clutched in your hand. You feel unsettled when you can't see it, until it's easier to just sleep with it.
But there are other, worse stages to come. As I ask my clinic patients about them, I hear a ding in my mind, like an elevator does each time a door opens, each time a patient answers yes.
Do you wake with the shakes? That means that you're so addicted that you begin to withdraw every night as you sleep. Ding.
Do you wake up in the night to take a drink? Your brain must be bathed in alcohol, awash in the acrid sea of it, at all times. You can no longer make it to morning. Ding.
Do you seize if you stop drinking? Deprived of alcohol, your tender brain begins to crackle and sizzle, and then ignites like a gas-explosion - ka-whoom - as a depth charge of neurons fires. Ding.
Can you remember how this happened? It looks like something hit you pretty hard, sir, the way your cheekbone is caved in here under all this blood. Do you remember? You never remember what happens when you're drinking. Ding. Ding. Ding.
At what point does society decide that someone has become a danger to himself because of his addiction? And what can be done about it?
The large numbers of public inebriates on our sidewalks represent a financial, ethical, and moral crisis in cities across America. These suffering humans also represent a public health crisis. Mortality rates are sky high, with life expectancies equal to, or worse than, those of people living in the most devastated, violence-riddled pockets of our globe.
The issue of people drinking themselves to death on a sidewalk is one that unites and divides us in unpredictable ways, crossing "normal" divisions of politics, compassion, and fiscal conservatism. There are those who want a person slowly dying in plain sight to at least have a roof over his head. There are the more law-and-order, throw-the-bums-out types, who just want public inebriates off the streets. And no one can look at the eye-popping cost of this public, drawn-out suffering and death without thinking that, at $8 million dollars a year in health care costs for 100 people, there has to be a better - and cheaper - way.
Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.
Photo credit: George Erws via Flickr
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