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The Sobering Facts


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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.”
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