Friday, November 21, 2014

Most heavy drinkers in Homeless World aren't addicted to alcohol

An article in the New York Times, today, tells us that most heavy drinkers are not alcoholics. For Homeless World, Sacramento, I am guessing that what should be the profound effect of this better understanding of people’s relationship with alcohol will pass unnoticed by the programs that exist to stop alcohol consumption by homeless people.

We will see.

The reason I am pessimistic is because homeless-help programs and charities always seem to become little fiefdoms that expend their energies to maintain their existence, rather than being nimble organizations that stay abreast of changes, such to reformulate their services to best help suffering homeless people in an altered landscape.

The Times article is based on a US Government study conducted by the Centers for Disease Control and Prevention. Findings of the research was published in the November issue of the journal Preventing Chronic Disease in an article titled “Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011.”

Succinctly stated in the journal article, the conclusion of the study was this:
Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services.
The "90 percent" can better be helped by prompting or encouragement to change their behavior, rather than being tagged as alcohol dependent (which they aren't) and being subject to unwarranted, ineffectual invasive interventions into their lives.

Homeless World is certain, however, to have a proportion of its drinkers who are addicts exceed the ten percent estimate of heavy drinkers identified by the study. This is so since one of the findings of the research was that impoverished heavy drinkers are much more likely to be dependent on alcohol than middle-class or wealthy binge drinkers. Also, adults who have not been to college are more apt to be alcohol addicts than heavy drinkers who have attended college at some point in their lives. A higher-than-typical proportion of homeless people have never gone to college, when matched against that likelihood for the general population.

The Times article tells us that simply raising the price of alcohol [most easily done by increasing the sales tax] "could make a significant dent in [reducing] excessive drinking." Also, "[z]oning laws that reduce the number of establishments that serve alcohol in a given area can also curb excessive drinking. Importantly, a simple intervention by a physician, talking to patients about their alcohol use, has been shown to help people make better choices and curb excessive alcohol consumption."

A question for Homeless World: Will the alcohol-anonymous type programs that exist in Sacramento county for homeless heavy drinkers change their approach in light of the government survey? Or will it be "business as usual" with the programs focusing on maintaining jobs for their staff rather than best meeting the needs of those who suffer?

Likely, something like 75% of those identified in the bi-annual census of homeless people in the county, that are tagged as alcohol addicted, are not. They are drinkers who opt to drink and can, as a function of will power, freely chose not to with friends or as a lifestyle choice -- thus, to maintain better health.

The most recent Sacramento Countywide Homeless Count was conducted in 2013. [The next one is likely to be conducted this coming January.] In the report of the census, 993 individuals were tallied as being "chronic substance abusers" out of 2,538 total people counted as being homeless in the county. Of course, a substantial percent of those tagged as substance abusers are doing drugs. Many are doing drugs AND drinking. A small number -- maybe as few as 200, my lowball guesstimate -- are 'only' drinking heavily without much interest in drugs and meet the classification from the CDC study of being heavy alcohol consumers who are fully capacitated with the will power to stop or lessen their drinking. should they choose to.

The Times article ends with this perhaps-sobering sentiment from Dr. Robert Brewer who leads the alcohol program at the Centers for Disease Control and Prevention that conducted the study: “I don’t want to minimize the fact that excessive drinking can be a difficult behavior to change even in those people who are not alcohol dependent, So many of the cues people get about drinking behavior in our society are confusing. People think drinking to get drunk is part of having a good time.”

Yeah. There's a lot of that in Homeless World: Guys who not just "think" but are quite sure that drinking to get drunk is the very definition of having a good time. I write this, not as a rebuke, but as an observation that many homeless people's lives have devolved into one of always seeking their next drink.


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