By Bob Shaw, St. Paul Pioneer Press
St. Paul, Minn. (AP) -- Marion Hagerman appreciates your concern. But it's OK to give up on him, he says. Everyone else has -- which might be the only sensible thing to do.
Hagerman has been drinking for 39 years. He drinks despite decades of lectures, prayers and punishment. He drinks despite two years of homelessness, six DWI convictions, six treatments for alcoholism and 13 months in jail.
What's ahead for Hagerman? The 54-year-old can see only one thing in his future -- more drinking.
That's why he feels lucky to live in a hospice for alcoholics -- St. Anthony Residence in St. Paul. There, 60 men can -- and often do -- drink until they die.
There are no counselors, no scolding, no 12-step programs, no group hugs. Just the love of Hagerman's life, waiting for him every day -- alcohol.
On his weeklong binges, he chugs vodka, beer or mouthwash. They are interchangeable to him, he said, gazing around his 12-by-12-foot concrete apartment.
"I drink," he said quietly, "until I kill the damn day off."
For three years, St. Anthony has been operated by Ramsey County, St. Paul, the state of Minnesota and Catholic Charities, at a cost of $18,000 per person per year. It's one of four so-called "wet houses" in the state.
Like a growing number of wet houses across the country, it allows alcoholics to drink, even when it's killing them.
Some experts attack places like St. Anthony. "To me, a wet house is nothing more than a house of despair and death," said William C. Moyers, vice president of foundation relations for Hazelden treatment centers.
"It is never too late for someone to get help," Moyers said. "Just because there are people who have been through treatment before does not mean we can write them off."
But the men staying at St. Anthony say alcohol isn't just a habit -- it is who they are. If any kind of treatment were required, they would return to a homeless life of fear, disease and tremendous public expense.
It's not uncommon for a homeless alcoholic to cost the public more than $1 million during decades of drinking -- for multiple jail stays, emergency room visits, rounds of alcoholism treatment and other costs.
But the costs and the suffering are greatly reduced once they arrive at St. Anthony.
"This place is a godsend," said 61-year-old Ron, a 40-year alcoholic and former South Dakota farmer who didn't want his last name published.
He plans -- as much as he plans anything -- to drink until he dies at St. Anthony.
"I am happy here," he said.
'IT'S JUST SO HONEST HERE'
Social workers refer homeless alcoholics to St. Anthony.
That usually happens after a dreary cycle of drunken-driving arrests, hospital visits and trips to detox, the county-run centers for sobering up.
"A counselor might say: 'You've been through treatment six times. This doesn't seem to be working for you,' " said Bill Hockenberger, a former alcoholic who manages St. Anthony.
These are not soccer moms on chardonnay. Hockenberger's clients have no family connections, no jobs and no money. "These people have burned their bridges. They are done couch-surfing," he said. "They have peed on their last couch."
The alcoholics arrive at the 3-year-old building, which looks like a modern twin-tower hotel out of place in an industrial park. There's no sign outside.
Inside, each room is like a minimum-security jail cell, with one light on a wall, one window and concrete floors, walls and ceilings.
They arrive as refugees of countless anti-drinking treatments.
"Treatment is a bunch of B.S.," snapped Ricky Isaac, a three-year resident, as he drank a beer on the center's drinking patio.
"Those AA (Alcoholics Anonymous) people make me sick. I hate hearing about other people's problems. I have my own problems. If you want to quit, you quit on your own."
They rebel against the chirpy optimism of abstinence-based programs: Try harder. Pray. Ask for help. Don't give up. We feel your pain.
In contrast, St. Anthony feels like Death Row. The message is refreshingly grim: Everyone is going to keep drinking, it's probably going to kill them, and no one's going to talk them out of it.
"It's just so honest here," Hockenberger said. "I ask someone, 'Have you had a drink today?' and they say: 'Definitely! I wish I had some more!' "
Once inside, the men come and go as they please.
Mostly, they go to buy alcohol. They walk to nearby liquor stores. Or to drugstores, for mouthwash -- which has up to 28 percent alcohol.
Hockenberger had to ask the nearby Holiday gas station to stop selling 99-cent bottles of rubbing alcohol -- too tempting for his men, he said.
To get money, the alcoholics beg on the streets, collect cans for cash or work odd jobs.
When they bring the alcohol back, they check it in at the front desk. When they want to drink, they check it out and take it to the backyard patio.
There, they drink with others, shouting and waving bottles and telling stories. Or they sit alone, taking a sip every minute or so.
They stagger back to their bedrooms, sleep it off, wake up and do it again.
At St. Anthony the men know each other, but it's not like a college frat house. "It's a friendly environment, but they are not my friends," resident Hagerman said. "They are the people I drink with."
The isolation was notable on Thanksgiving Day. During a festive turkey dinner, alongside men they had lived with for years, many sat alone in the lunchroom, eating in silence.
That's because their primary relationship is not with other people, Hockenberger said, but with a bottle.
"I have seen men coming in and they chug down their vodka right there, just because they were afraid of losing it," Hockenberger said.
When that happens, he gently tells them: "It's OK. Check it in. It will be there for you in the morning."
Once alcoholics become residents, the police know their names. If one is found passed out in a park, the police simply return him to St. Anthony -- no ambulances, hospitals or trips to detox.
If needed, residents get medical care from an in-house nurse. If they get sick, they go to a hospital.
And when they get extremely sick?
There's an in-house hospice service. Three to five residents die every year.
Resident Wayne Britton, 59, who has 12 DWI convictions, recalled the death of his best friend, Dave, from throat cancer in 2008. In his final days, Dave was given food and alcohol in his room.
"He would send for me and say, 'Come in and have a bump with me,' " said Britton, sadly shaking his head. They sipped vodka together, which Britton said the dying man found comforting.
The deaths don't get Hockenberger down -- it's the evictions that bother him most.
He sometimes has to kick someone out for misbehavior. When that happens, Hockenberger knows the man is going back to a homeless life of depression, frostbite and loneliness.
"When I see a client walk out of here," Hockenberger said, "sometimes it's the end of the line for them."
PARALLELS WITH HOSPICE
The St. Anthony approach is anathema to treatment programs, which are based on abstinence as the path to recovery. They believe any alcoholic can stop, and should try to.
"AA does not give up on people," said Tom Noerper, director of the St. Paul Area Intergroup, which refers alcoholics to AA meetings through a hot line.
"We will talk to anyone who wants to talk to us. Even if they were dying, we would want to be with them, as long as they want to see us."
Hazelden's Moyers said that even if St. Anthony's men refuse treatment, housing them with public money is a tacit acceptance of their drinking.
"This is just a place to allow chronic alcoholics to keep drinking and steal from them any sense of hope or redemption," Moyers said.
Jan Hennings, spokeswoman for the Minnesota Hospital Association, questioned whether the wet-house model was humane. "I know some people would say we should keep trying -- eight times or whatever -- until we break through," she said.
But other experts say the bottomless optimism is naive.
The St. Anthony model accepts the obvious -- that a certain number of alcoholics are indeed hopeless, said Katie Tuione, program manager at Dorothy Day Center in St. Paul, a homeless shelter.
"This is about meeting people where they are and loving them. It's not rocket science," she said. "They still grieve, love and hurt. They still need food and shelter. They are you and I."
Dr. Steven Miles, professor of medicine and bioethics at the University of Minnesota, agreed.
The reason to support St. Anthony is not the money saved but the kindness extended to the residents. "It is the humanity of it, just like humanity drives the hospice system," he said.
He said seeing people drink themselves to death is like watching chemotherapy patients gathering outside hospitals to smoke.
"Certainly no one encourages them to do this. But this is a society where people get to make their own choices, however bad they are," Miles said. St. Anthony's, he said, "is a rational response to meeting people's needs."
The approach, manager Hockenberger said, isn't treatment at all, but a "harm-reduction model."
'I KNOW I CAN ALWAYS FIND MY WAY HOME'
And the harm is indeed reduced. Housing the homeless slashes use of hospitals and emergency rooms by 50 percent to 75 percent, according to studies cited by Hearth Connection, a nonprofit group that fights homelessness in Minnesota.
Studies in Seattle, Denver and New York City have concluded that providing housing to homeless people with chronic health conditions -- common among alcoholics -- cuts time in jail and detox by up to 75 percent.
At St. Anthony, the men are healthier because of the on-staff nurse. She monitors their medications for such diseases as diabetes. Officials know the men and their conditions -- so they don't have to rely on emergency rooms for routine care.
St. Anthony residents say the housing quells the anger that homeless people feel. When the men feel cared for -- even loved -- they aren't as likely to hurt others and themselves.
"This place is different. The staff is great. They are like brothers," said resident Isaac, a 30-year alcoholic who has served time for assault. "It's called respect."
The residents were aghast to hear anyone would question the wet-house approach.
"If not for this, I would be drinking in the street, in and out of detox," said Hagerman, a 39-year alcoholic.
St. Anthony has lifted him out of a life of homelessness. He remembers the panhandling, walking into detox to get some sleep, the petty crime to slake his thirst for mouthwash, which he calls "wash."
"I would buy a bottle of wash or take it away from someone else," Hagerman said.
He was told that some experts question spending tax money on hopeless causes. Hagerman waves at the four cinder-block walls in his tiny room. It's not much, he said, but it is safe.
"Here," he said, "I know I can always find my way home."
One sunny November afternoon, a drunk staggered up to the building's front door.
His clothes were a mess, his eyes were bloodshot, his words were slurred, and he smelled like a bathroom in a cheap bar. Most any treatment center in the state would have immediately kicked him out.
He ran into Hockenberger at the entrance. "Hey, Bill!" the man said, hoisting a 12-pack of beer. "I went shopping!"
"All right!" said Hockenberger, as he held the door open.
Information from: http://www.twincities.com, St. Paul Pioneer Press
(Copyright 2010 by The Associated Press. All Rights Reserved.)
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