On the one hand, young people shouldn't act addicted -- because it can become a lifelong habit. On the other, we shouldn't regard young people as lifetime addicts due to their current situations (think Drew Barrymore); this is a horrible mistake that is more likely to exacerbate and prolong their problems (cf. Lindsay Lohan).
At the other end of the life cycle, there are people not likely to quit drinking et al. any time soon.
And what do we do about them? We can harangue them to join AA, go to the Salvation Army, and straighten up and fly right.
But here's another way of dealing with "incorrigibles":
Dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic "nip at night," said Tena Alonzo, director of research. "Whatever your vice is, we're your folks," she said.
Once, Ms. Alonzo said: "The state tried to cite us for having chocolate on the nursing chart. They were like, 'It's not a medication.' Yes, it is. It's better than Xanax."
It is an unusual posture for a nursing home, but Beatitudes is actually following some of the latest science. Research suggests that creating positive emotional experiences for Alzheimer's patients diminishes distress and behavior problems.
Okay, I recognize that dementia is not addiction.
But the same situation arises with long-time street alcoholics and addicts, who are typically denied public housing or shelter.
The result? Extreme danger to their lives (George McGovern's daughter died frozen in the streets following her stay in a dry shelter after a later-life relapse) and great public expenditures, because street inebriates are regularly incarcerated, hospitalized, treated -- with little to no success.
What if you let them drink and still gave them shelter? Not your ideal lifestyle, you say? Like the tragic figure of Lee Remick at the end of "Days of Wine and Roses," whom Jack Lemmon visits and abandons -- returning to his AA meetings with Jack Klugman -- while Remick continues drinking in a run-down hotel room.
When I was a high schooler growing up in Philly, I hitched with my friends to New York -- where the drinking age was then 18. We would drink at Bowery bars amongst men who boozed most of the day and spent the nights at local two-bit "flop houses."
Horrible, I know. Who could tolerate such behavior? Who would want to be with such people? They hardly deserve to live and be called humans, you say.
Seattle joined several Canadian cities in offering wet housing. The results of these shelters where street alcoholics were allowed to stay and yet drink were published in JAMA. Compared with alcoholics not given this opportunity, those in wet housing halved their public health costs and drank less.
The study compared 95 chronically alcoholic men who were allowed to drink in shelters, on the one hand, with another group of 39 who were wait-listed, on the other. The study was thus "quasi-experimental," comparing randomly selected groups in terms of outcomes based on a single intervening factor: being allowed to continue drinking and yet still have housing.
The results were unquestionable. Leaving drinking alcoholics on the street is a remarkably expensive proposition: due to their repeated stints in jails, hospitals, and detox, the alcoholics admitted to "wet housing" had spent $8 million in public funds the year before the study. For the year of the study, their costs were approximately two thirds less (counting housing costs), going from a median of $4,000 monthly to $1,500 relative to the control group and their own prior costs.
And the costs continued to decline the longer they stayed in the wet housing, down to a thousand dollars monthly at the end of the year. Even more striking, despite the permission to drink, these long-term alcoholics reduced their consumption, from an average of 16 drinks daily at the start to 14 drinks at six months to 10 drinks daily by year's end. (These men were not taught to drink less -- this was a natural consequence of their changed situations.)
Wet housing is an example of harm reduction. We all wish life -- and people -- would be perfect (like us). AA proponents can boast how quitting drinking has sanctified them. They can then claim these men's lives would be immeasurably better if they only got sober. But this is not everyone's reality, and at some point in later adulthood, there are many more such people than those who enter and succeed at AA. Instead, if you are interested in science, public health, and humanity, you need to be aware that discarding the bromides of American alcoholism treatment improved these men's lives decisively.