Alcoholism is a disease that can hit anyone, and the impacts of the disease are far reaching.

Take into account the health impacts of the disease alone and the statistics are harsh.

The World Health Organization states alcohol accounts for 2.5 million deaths each year worldwide and is the third “largest risk factor for disease burden.”

According to the National Library of Medicine, about 17.6 million people in the United States either abuse alcohol or have alcoholism, a disease.

What does alcoholism actually do?

“What alcohol and drugs do, it does it to their body no matter where they’re living,” said Rainforest Recovery Center Director Sandy Kohtz. “It more has to do with the ingestion of the drugs. And it has to do with what’s their physical shape before they started drinking to excess. There is some hereditary stuff too. If they’re prone to heart illness in their family it’s just going to be affected more. The three biggest things we probably see here are diabetes, heart issues and liver failure. Diabetes is pretty rampant in the alcohol abusing sector of this population. It’s also pretty rampant in this population (Alaska).”

According to the National Institute of Health, alcohol impacts the brain (slurred speech, slow reactions and many other side effects) — so prolonged use and abuse of alcohol compounds the issue.

Some of those brain responses to high levels of alcohol include blackouts and memory lapses, but what can develop are more serious diseases involving the brain.

The liver also processes everything humans consume, so an overabundance of alcohol for prolonged periods can have significant impacts, including cirrhosis of the liver.

Juneau’s alcohol-dependent population — homeless or otherwise ­— faces some pretty serious health risks.

“Just living on the street is just not easy on your body, period,” Kohtz said. “Then you also look at family heredity, if they’re prone to diabetes, prone to liver malfunctions, those are just higher risks. What we see, when we see people that are coming in to sleep off, truly living on the streets. We will see not so much malnutrition but lack of nutrition. When they come in, if we actually bring them in for treatment they actually gain about 20 pounds.”

Rainforest Recovery will take in people for emergency, short-term or extended stay recovery and provide related services, but their space is limited. Kohtz said another issue is they don’t have handicapped-accessible beds.

Kohtz doesn’t believe cirrhosis of the liver is necessarily caused by alcohol, but it exacerbates the problem.

“If they have a predisposition or if they have had it, it wreaks more problems with it,” she said. “Cirrhosis of the liver and liver failure doesn’t mean that everyone that drinks is going to have that. Research is showing, if you have cirrhosis of the liver, there is some predisposition of that as well. If it really was caused by alcoholism, everybody would have it and they don’t. We have people with very healthy livers that are drinking themselves to death.”

Services

As the Juneau Homeless Coalition looks to assist chronically inebriated homeless people in Juneau, they recognize there are an array of services available to help people recover. Rainforest is one of the primary options.

Assistance starts with a phone call — either from the public, law enforcement or the individual. Rainforest Recovery also patrols downtown with its van.

“We have a continuum of care — inpatient, outpatient,” Kohtz said. “We have to schedule an assessment for them. That’s the first thing we have to do. We try to get them in as soon as we possibly can. From that assessment we determine what level of care they need: detox, inpatient, outpatient. We have counselors that do the assessment, they’re also assessing for mental illness as well. We’re looking at the whole system, what’s all their problems. We look at everything that affects a person.”

Some who go through the emergency room at Bartlett Regional Hospital end up in its mental health unit because of their medical history.

The facility has 16 beds, four of which are reserved for detox or emergency situations. Priority is given based on need, such as if a person has just gone through detox.

Rainforest patients participate in a very structured program from 7:30 a.m. until 9 p.m., including Narcotics Anonymous and Alcoholics Anonymous meetings, group therapy and activities.

Since Rainforest is a residential facility, not medical, it also partners with SouthEast Regional Health Consortium’s Front Street Clinic and private physicians.

Kohtz said they’re also partnering with Juneau Alliance for Mental Health. She said part of looking at treating alcohol or drug dependency is taking a look at the whole person — and they’ve found that approximately 75 percent of the population has a co-occurring disorder. That means that in addition to alcoholism or other substance abuse they may also have a secondary diagnosis requiring psychotropic medication.

“This is not odd in the addiction population,” Kohtz said. “It tells me we’re moving in the right direction because we’re looking at the whole picture. We’re becoming more of a behavioral health program than substance abuse. We and JAMHI were chosen to receive intensive training. We’re doing that in January. We’re going to be able to develop a full continuum of care that will serve everybody. ... We’re really looking forward to building a program that’s really integrated and addressing all of the issues. The substance abuse field is much different than mental health field. Substance abuse treatment puts the responsibility for treatment back on the person. While we recognize they have a whole myriad of problems, they are still responsible for making the changes.”

A dual nature

Dixie Hood, a local substance abuse counselor, agreed that dual diagnoses are common.

“And so it can lead to various disorders in terms of depression and bipolar, their dual diagnosis is pretty common,” she said. “But the main one is that alcohol abuse and addiction is really slow suicide. It’s like every single organ in your body is ultimately impacted in a negative way. It leads to death.”

Hood said her mother was an alcoholic and was in recovery in her 50s. Her father and brother died from alcohol-related illnesses and her sister identified herself as an alcoholic.

“There really needs to be a willingness to acknowledge there is a problem and you want to do something about it,” Hood said.

Hood said it would be incredibly difficult for someone living on the streets to successfully complete an outpatient recovery program because there isn’t any structure to their lives or much of a support system. That’s where a housing model would be more effective.

Kohtz said the continuum of care and recovery is important. She said when she first started in the field, if you relapsed that was it. No second chances. Today’s medical outlook is different. Relapses are part of the recovery process.

“We don’t measure success by whether or not they drink,” Kohtz said. “We measure success by quality of life. ... Part of the treatment process is relapse does happen. They don’t want to hear this, but 1 in 10 of people in treatment stay sober the rest of their lives. I always consider the ones that are successful are the ones that make it back to treatment.”

For some, treatment doesn’t begin with a ride in the Rainforest Recovery van. It can come in the form of the Juneau Police Department bringing them to Bartlett’s emergency room for an assessment, and either a hold in Lemon Creek Correctional Center or a civil commitment for treatment if recommended by Rainforest. The city typically has to issue five commitments a year.

“The jail will not take them unless they have medical clearance first,” said JPD Officer Thomas Penrose. “If it’s a Title 47 hold, we’ve got to take to hospital first before we take them to the jail, period. Whether or not they are intoxicated at (a blood alcohol content of) .30 or over, the jail will not take anybody over .3 if arrested without medical clearance.”

For those who may be considering treatment, Kohtz said it’s important that they are willing to be an active participant.

“They don’t need to be willing to say ‘I want to be sober the rest of my life,’” she said. “They need to be willing to learn and participate. If they’re not willing, they probably need to wait until they’re ready.”

Solutions

Pamela Watts, director of JAMHI, said their mission is to “help adults with mental illness live their own best lives.”

“Part of that is trying to help people, especially people with severe mental illness live in the least restrictive environment possible,” she said, and that includes co-occurring disorders involving substance or alcohol abuse.

Watts said that in JAMHI’s group homes and supported living facilities, no alcohol is allowed. Watts supports the Housing First model proposed by the Juneau Homeless Coalition (see the related article), but believes it doesn’t go far enough.

“I know there’s a lot of talk about Housing First, and I know that’s a wonderful option for many people,” she said. “If someone has been living on the street for years and someone talks to them about getting sober, it’s kind of hard to focus on working on sobriety when you don’t even have a place to live. So that’s one side of it. On the other hand, for people who are working on sobriety and who may have completed a treatment program, not having a sober place to live with necessary supports can make recovery very difficult. ... Of course housing is essential, but if we don’t also have that step-down level of care for long-term alcoholics just getting out of treatment, we are missing the boat.”

Southeast Alaska Independent Living, a member of the coalition, is also interested in helping this population.

Jorden Nigro, director of SAIL, said they serve people with disabilities of any age, including seniors.

“Our mission is to inspire personal independence,” she said. “Whatever it is, our goal is to help people be independent. Whatever that looks like for them. That looks different for everyone.”

Nigro said personal independence with the homeless chronic inebriate population is important to address.

“The chronic inebriates downtown, that level of alcoholism is a disability,” Nigro said. “We want to help. We want to see them be successful and be in a safe place. ... Why we feel its important is because right now what we’re doing isn’t working. We need to think outside the box. This model that has been used in other communities has proven to be successful in keeping people safe. Right now if someone is drinking they can’t be at the Glory Hole. That means they’re on the street. Someone’s going to die. We don’t want to wait until we’re having deaths downtown because people don’t have a place to stay.”

Hood doesn’t believe the solution is in picking on the liquor stores or bars, but in housing.

“Because the degree of their addiction and the amount of time that it has probably developed over isn’t something that’s going to be fixed that readily,” Hood said. “They can haul them into inpatient treatment some place, but a month which is about all most of them cover through insurance or anything, isn’t enough to do them any good even if they succeed when they’re there. Usually they will go back to drinking on release. That’s one of the things about alcoholism. Relapse is such a typical part of the recovery process. Keeping them off the streets and with food and medical care as needed would be beneficial for the whole community.”

Medical care also is available via the Front Street Clinic, which is Juneau’s only provider catering specifically to the homeless population.

While the Empire has highlighted just a handful of treatment venues and housing options, others exist. Please see our sidebar on Page A1 for a few more options.