The Sobering Facts

For alcoholics, recovery can be as simple as a vow kept. But usually it takes many tries, often with the help of a program like Alcoholics Anonymous or a residential recovery home. Meanwhile, a San Diego researcher is unlocking the secrets of success in overcoming alcoholism.

By Margie Farnsworth

In an unpretentious office at the Veterans Administration Hospital in La Jolla, one of the world’s leading scientists who studies the genetic factors of alcoholism can look at a glass and see it half-full. The data Dr. Marc A. Schuckit have collected in 30 years of research show certain strong biological links within families of alcoholics. A professor of medicine at the University of California, San Diego, Schuckit has dispelled several myths about the disease, as well as uncovered evidence that shows how genes interact with a person’s environment to heighten the risk of becoming an alcoholic. He has great hope this research will lead to alcoholism-prevention techniques.

Across town, in three large houses in Golden Hill, 40 alcoholic men look at the glass and see it bone dry. These men, at the residential recovery homes operated by Pathfinders of San Diego, are tapped out. Each has hit his own personal bottom and is now—with the support of the others—undergoing the only known “cure” for the disease of alcoholism: abstinence.

A few thousand other alcoholics are on the same course at dozens of recovery homes in the county. During stays at these homes, men and women are educated about their shared disease, with much of the medical information coming from Schuckit’s work. They also learn that becoming sober is an event, while recovery from alcoholism is a lifelong process.

The public probably doesn’t often think of alcoholism. A person’s experience with the disease may be limited to a neighbor or a boss or a driver who’s ready to pass him on a freeway. According to Schuckit, in the United States the risk of developing alcoholism is about 15 percent for men and 8 percent for women, giving rise to the oft-cited figure that approximately 10 percent of the population is alcoholic.

But the public ought to be interested in what alcoholism and other drug abuse costs them. Nationally, the figure is about $500 billion a year. In San Diego County, it’s estimated at $3.8 billion a year, including direct costs—such as emergency medical care —and indirect costs, such as loss of earnings when a family breadwinner dies of alcoholism.

Yet a cost-effectiveness study funded by the state Department of Alcohol & Drug Programs shows that each $1 invested in a treatment program saves taxpayers $4 to $7, mostly due to reductions in crime and need for medical care. These studies have the attention of the county Board of Supervisors, which adds $6 million to $7 million annually to the $45 million in state and federal funding San Diego receives for alcohol and drug programs. Much of the county money comes from tobacco settlement funds.

“In the past five years, San Diego has made its own investment of local resources in a big way,” says Al Medina, the county’s alcohol and drug services administrator, even with the steady erosion of state funding for alcohol programs because of budget cutbacks. California’s current budget crisis undoubtedly means less funding in the coming fiscal year, Medina says, although he is uncertain where cuts will be made.

“There is a treatment gap,” he adds. “Despite the substantial evidence of the cost benefits gained through treatment and prevention, there hasn’t been an equal investment in expanding the programs that provide it.”

To help alcoholics who are committed to becoming—and staying—sober, the county contracts with 24 state-licensed and certified recovery homes and a network of outpatient services. Seventeen of these homes are known in the recovery world as social-model systems—programs strongly rooted in the 12-step philosophy of Alcoholics Anonymous, focusing on self-motivation and peer support. There are no doctors or therapists in a social-model program, only other alcoholics who are in varying stages of sobriety. Employees at these homes are usually in long-term recovery themselves.

Lots of alcoholics, of course, stop drinking and stay sober without going to a residential recovery program. Many do it through AA (there are more than 700 AA meetings each week in San Diego County). Some seek counseling. Some check into the Betty Ford Center, a medical-based program in the Palm Springs area, where a 28-day stay can cost nearly $20,000.

Schuckit cites research that shows as many as 30 percent of alcoholics go through a “permanent spontaneous remission.” For some unknown reason, these drinkers say for the umpteenth time they’ll quit, and they do, and—unlike all the other times when they started drinking again—this time their sobriety sticks.

For other alcoholics, “the safe, supportive and structured environment of a recovery home is needed for them to change,” says Medina, “and that’s where the social model comes into play.”

Pathfinders of San Diego is the state’s oldest alcohol recovery home and a pioneer in social-model programs. Several men who were AA members opened it in 1950 in a downtown storefront where men living on Skid Row could find a sober setting.

“The idea was simple and effective,” says S.G. “Stan” Stanley, executive director of Pathfinders. “Sober alcoholics were helping practicing alcoholics stop drinking. We’re still doing it 53 years later.” Pathfinders grew through the years and was incorporated as a nonprofit organization. Three residences in Golden Hill were purchased in the 1960s and remain today as the group’s main recovery homes.

The program was one of the first organizations to be given a county contract for alcohol recovery services. Pathfinders currently receives about $245,000 a year from the county for the 40 recovery “beds” it provides—roughly half its operating budget, with the remainder made up from donations and residents’ fees of $250 per month.

“We’ve had doctors, lawyers, welders, teachers, street drunks, you name it,” Stanley says of Pathfinders’ residents. “Most have tried to get sober many times and have failed miserably at it—that’s what they have in common. By the time they come to us, they’ve lost family, relationships, jobs and possessions.”

The only requirement for admission is a willingness to accept responsibility for one’s own recovery, says Stanley, a Pathfinders resident 13 years ago. There is always a waiting list for admission, he adds, and prospective residents are interviewed at length to gauge their commitment. “We don’t want anyone who is only here because of coercion from family, employers or the courts,” he says. “They must have the sincere desire to help themselves.”

As with most recovery homes, men at Pathfinders typically stay three to nine months in a highly structured environment. Once admitted, each is handed a five-page list of resident guidelines—“No sleeping in after 6 a.m.” “A copy of the Big Book of Alcoholics Anonymous MUST be on your nightstand.” Daily AA meetings and alcohol education classes are mandatory, and residents must get a job, as well as volunteer for community-service projects. If a resident is caught drinking or taking drugs, he is immediately evicted and will not be readmitted.

How well does it work? How many stay sober after they leave? There are no official numbers for graduates of Pathfinders or other recovery programs, primarily due to federal Privacy Act provisions. Stanley estimates, however, that about 60 percent of Pathfinders alumni continue long-term sobriety. “We usually get a good feel for it, because residents keep coming back to meetings, or they’ll stay in touch by phone,” he says. “I heard from one guy the other day for the first time in three years. He’s in Chicago, and he’s still sober.”

Researcher Schuckit says an alcoholic who remains sober for one year has about a 70 percent chance of long-term sobriety, especially if he or she has a support system of family and friends and has job skills. He also points to studies by other scientists that show with continued abstinence, body and brain damage caused by alcoholism—a terminal disease if not treated—continue to improve every month.

 North County Serenity House opened in 1966 as the area’s first nonprofit social-model recovery home for female alcoholics. When Francine Anzalone-Byrd was hired as its executive director in 1994, North County Serenity House had 25 beds at its Escondido site. Today it provides housing for 172 women and children, including a 100-bed residential facility, three recovery homes, four transitional living homes and two child development centers. An eight-house project dubbed Serenity Village will open this year to provide an additional 48 beds. Escondido also is home to several recovery groups for male substance abusers who want to get sober.

“Escondido has been extremely friendly to recovery homes, primarily because we have a proven track record of being good neighbors,” says Anzalone-Byrd. She credits recently reelected Mayor Lori Holt-Pfeiler and the Escondido City Council for using some of the city’s redevelopment funding to help Serenity House expand. The annual budget for Serenity House is $5.3 million, with the county contributing about half, Anzalone-Byrd says. Residents pay $275 a month for rent.

Serenity House began offering drug-abuse treatment in the 1980s as the connection between drug and alcohol abuse became more apparent, says Anzalone-Byrd, who has been a recovering alcoholic for 22 years. “Now we refer to poly-substance abuse,” she says, “but the gateway drug is always alcohol.” As with other recovery homes in the county, Serenity House has a long waiting list for admissions.

There’s never enough money, and there are never enough beds,” says Warren Stewart, president of the California Conference on Alcohol Problems, a 28-year-old program that focuses on issues related to social-model recovery homes across the state. “Even if you do have the money, there’s the problem of where to put the beds.”

Stewart refers to what’s become well-known as NIMBY—the not-in-my-backyard sentiment. In the context of recovery homes, it means a neighborhood’s resistance to having health or other social services in the area.

“We have maxed out our available capacity of [recovery] beds,” says the county’s Medina. What solution does he see? “We need to increase the public’s understanding of alcohol- and drug-abuse recovery programs. We have to show the cost benefits [of these programs] to the taxpayer.”

Stewart notes another facet of this problem: A substance-abuse recovery facility that provides six or fewer beds does not have to be licensed and certified by the state, nor must it have a conditional-use permit, which is required for a larger recovery program. These small facilities are often known as sober-living residences, but some may not provide even basic supervision for renters.

“A lot of these places are springing up, and they’re fly-by-night operations,” says Warren Stewart. “The public, though, often confuses them with legitimate recovery homes, and they give us all a bad name. It doesn’t help in trying to get more sites for recovery homes.”

How the county implements Proposition 36 concerns many operators of social-model alcohol recovery homes. Passed in 2000, the voter-approved statewide initiative allows many nonviolent drug offenders the choice of entering a recovery program rather than doing jail time. The county must provide about $13 million for funding the proposition locally, and there’s the dilemma of where to find beds for the participants who require residential treatment, estimated to number between 350 and 500.

Recovery home providers are concerned that funding for their programs will be reduced, and they don’t want to have to accept court-ordered drug offenders solely to maintain county funding. Moreover, social-model advocates don’t want residents who may be participating only to avoid jail, because their commitment to staying clean and sober is often lacking.

At some early point in their drinking careers, most alcoholics are proud they “can drink anyone under the table.” They knock back their drinks faster and longer than their pals and often don’t appear to be as intoxicated as someone who’s had the same amount to drink. Researcher Schuckit, who is also the director of the Alcohol Research Center operated by the V.A. Hospital in La Jolla, has discovered what’s behind this phenomenon: genes.

These apparently high-tolerant pre-alcoholics, he believes, don’t get the same physical reactions to alcohol as the usual person gets when drinking the same quantity. “In other words,” Schuckit says, “they don’t receive the same warning signals that it’s time to stop drinking if heavy intoxication is to be avoided.”

Schuckit’s findings are drawn from ongoing research he began in 1978 by studying 227 sons of alcoholic fathers and a control group of 227 men who had no known alcoholic biological relatives; all were about 20 years old at the time. Today, 97 percent of the study’s original participants are still involved in the research, although they’re scattered across the United States. By studying these men at five-year intervals, Schuckit has found that the decreased reaction to alcohol among sons of alcoholics who are first seen at age 20 does predict what he calls “severe future alcohol problems”—as much as a 60 percent risk of becoming alcoholic by age 30 and an even higher risk at 35. He is now at work on the 20-year follow-up.

Men participating in the test groups also have agreed to have their biological children studied by Schuckit. The scientist will follow this second generation—503 youngsters in all—from birth into their mid-20s.

Schuckit stresses that genes don’t cause alcoholism, but they do affect the risk of becoming alcoholic. If 60 percent of alcoholism is attributable to genes, he says, 40 percent is attributable to an alcoholic’s environment—the milieu long thought by science to be the primary reason alcoholism runs in families. Through his ongoing study of sons of alcoholics—plus other research he has under way, including the role certain brain chemicals may play in a person’s vulnerability to alcoholism—Schuckit hopes to learn from people who have genetic markers for alcoholism but do not develop the disease. What is it in their environments that could be used to help prevent alcoholism?

Given the genetic component of alcoholism, active and recovering alcoholics alike might ask if Schuckit foresees a day when science may develop a way in which an alcoholic could continue to drink, as they say, responsibly and in a controlled manner.

“There’s no silver bullet,” the scientist says. “It’s not likely to happen.”

Source: San Diego Magazine©, April 2003

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