Paul Bacon had long since advanced from detox to stints in jail. It was 2002 and he was incarcerated again, looking at 90 days. One morning, a public defender arrived at his cell to offer him the chance to get out. Bacon turned her down. “This time I was going to plead not guilty,” he says. But he began to consider the opportunities. “When the lady walked back past my cell after visiting other prisoners, I called out to her and changed my mind. The deal was that I’d go into the Serial Inebriate Program, and I didn’t even know what that was.”
In 2000, the police department adopted Serial Inebriate as a pilot program, an effort to help chronic alcoholics get sober and stay off the street. Instead of arresting the same “drunk-in-publics” over and over, the courts would offer them a free six-month recovery program, including housing and food. The idea was to end their cycle of incarceration, medical emergency, and back to booze and homelessness again.
The program is now in its ninth year. Paul Bacon was one of its early test cases. Today, he admits that the public defender’s deal seemed the shortest path to his next drink.
“All through the 1980s,” Bacon tells me, “I drank mainly on weekends, or after work. I got a job I really liked around 1990; it was maintenance supervisor for University Towne Centre. After a while, one of the other guys, who’d been there longer than me, blew the whistle to the manager and said that he smelled alcohol on my breath. They fired me. So I made a decision. I said, ‘Why should I work my butt off for the rest of my life just to pay for a roof over my head? Forget it.’ This was when recycling was getting big. So that’s what I was going to do, recycle and camp out. I actually believed that I would do that for the rest of my life. It justified my drinking career. ‘If I keep working,’ I figured, ‘I’ll just give it to the man and have nothing for myself.’ I made that decision, a very bad decision. And I lived it for the next 12 years.
“Soon the police were tired of seeing me on the streets. One night, a cop woke me up at the dead end of a street. ‘Mr. Bacon, you’re drunk again.’ Of course I was drunk because I was always drunk back then. This particular cop was always after me and would load me into his patrol car and take me downtown. There was one time I started to do pretty well at detox and even got a job there. But I showed up to work drunk one morning.”
Over many nights sleeping out in the cold, Bacon progressively injured his spine. “Up in Clairemont, where I hung out, I always had a spare sleeping bag hidden,” he says. “But I’d sometimes just fling myself into bushes drunk. If it rained, I went under a church awning. One night, on the hard cement, I told my friend that I couldn’t move. He called 911, and they took me to the emergency room. I figured they were treating me for alcohol poisoning. They did give me Gatorade to rehydrate, plus a sandwich and a sponge bath. But they also gave me some crutches.”
The pilot Serial Inebriate Program called for police to take public drunks to jail after they’d been transported to detox five times in 30 days. If candidates then accepted formal court offers to join the program, officers escorted them to treatment providers who agreed to accept them.
Pathfinders on Streamview Avenue in East San Diego was the recovery home where Bacon began treatment. There he lived in an apartment, attended daily Alcoholic Anonymous meetings, and met with program counselors. Within weeks of his arrival, Pathfinders decided to stop taking Serial Inebriate clients, opting instead to work with persons having dual diagnoses, substance abuse plus mental illness. But Bacon was allowed to stay. “I did learn a lot that was useful in those dual-diagnosis meetings,” he says.
A Serial Inebriate counselor eventually arranged for him to have surgery on his back. But he still has great difficulty walking and spends most of his days in a wheelchair.
It was last summer that I first interviewed Bacon and three other graduates of the Serial Inebriate Program. Off and on, I’ve discussed their situations with Robert, my most curmudgeonly acquaintance. I haven’t told him whether Bacon stayed sober. “Doesn’t matter whether he did or didn’t, the man is clear that he wanted to drink as his life’s career. He should have to take the consequences without public money rescuing him,” argues Robert, who thinks he sounds too hard-ass to have his full name known.
But could it be even costlier to let chronic alcoholics go untreated? In 2006, a group of researchers under the leadership of James Dunford, the city’s medical director, published in the Annals of Emergency Medicine an evaluation of the Serial Inebriate Program’s first three years. The study looked at health-care records of 529 chronic alcoholics, so determined through detox denying them service. Prior to courts collaborating with the program, the alcoholics put the following strains on local resources: 308 “were transported by emergency medical services 2335 times; 409…amassed 3318 hospital emergency-department visits; and 217…required 652 [hospital] admissions, resulting in 3361 inpatient days. Health-care charges totaled $17.7 million.” Of this total, $1.3 million was spent by ambulance service, $2.5 million by emergency departments, and $13.9 million for inpatient care.
“I should have been dead four or five times,” says Lou Fanucchi, by all accounts the most accomplished accordionist in San Diego. He has played occasionally for the San Diego Symphony, whenever it needs an accordion. He’s worked with Luciano Pavarotti and Bette Midler. Recently, he traveled to Chicago to perform in several venues.
“After my divorce in 2000,” says Fanucchi, “I was staying for a while at my mother’s, and one day she watched me come crashing down from the second floor. The stairs have one of those old Mission Hills wood banisters with sharp corners. I gashed my head and dropped to the carpet right there in front of her. Blood started gushing from my head and soaking the carpet. My mom panicked and called the next-door neighbor instead of 911. The irony to this is that a guy I knew who was a meth addict happened to come to the door right then because he wanted to borrow money from me. He looks in the door and sees me sprawled out and blood all over, and he says, ‘Did you guys call 911?’ Eventually, he did it. I learned later that, when the ambulance came, they weren’t even sure I would live, that’s how much blood I lost. I woke up in the hospital with these weird thumps to my head and the surgeon saying, ‘It’s okay, we’re putting a few staples in your head.’
“Twice this happened in my mother’s house. You know, your mothers, they love you and they can enable you without even knowing they’re doing it. She knew I was drinking. Well, it happened again right there in the house. I tripped again and hit the other side of my head on a corner of the coffee table. Again I was down and bleeding.”
Fanucchi had even more serious problems. “One time I was drinking heavily, and I was in horrible remorse, and I tried to just make it over to the emergency room. I picked up some more alcohol on the way and ended up lying in an alley in Hillcrest somewhere. The police came and took me to the hospital, where they put intravenous tubes in me and flushed my fluids to get the alcohol out. They flushed me for 24 hours.
“Some people can do fairly well on the streets,” he continues. “Not me. I had to get inside, St. Vincent de Paul or somewhere. The longest time I was out on the sidewalks was three weeks, and it was no fun. When you’re out there, sometimes you can’t get your alcohol, for whatever reason. I’ve had seizures during withdrawal, which is dangerous and can even kill you. So I’d get panicky and go to the emergency room to get Librium, which they use along with some other stuff to prevent the seizures.
“The last time I was in the emergency room, a nurse pulled me inside and gave me a harsh lecture. She showed me her computer screen and said, ‘You know what? You’re a jerk. You’re not even trying to get better. Look at this. This whole screen is you coming in here to get Librium.’ ”
After numerous trips to jail, Fanucchi entered the Serial Inebriate Program in June 2006, graduating in the prescribed six months. For a long while afterward, he hauled his musical equipment around on the bus and trolley. He has stayed sober and been welcomed back by the local professional musicians’ community. His career is taking off better than it ever did. Eventually, he got his own apartment and now lives in Banker’s Hill.
According to the Dunsford study of the early Serial Inebriate venture, 268 individuals were offered participation in the program and 156 accepted. Medical assistance subsequently declined by 50 percent for those who took up the offer. Researchers estimated decreases in monthly average-user charges as follows: $5662 for ambulance services; $12,006 for emergency-department visits; and $55,684 for hospital-inpatient stays.
“There was no change in use of services for individuals who refused treatment,” wrote the researchers. “There was a significant increasing trend in acceptance among individuals with longer jail sentences. Treatment acceptance was 20 percent among those with sentences of 0–30 days and reached 63 percent for those with sentences longer than 150 days.” As a result, judges began handing out stiffer sentences.
According to Deni McLagan, the Serial Inebriate Program’s total funding is approximately $220,000. McLagan is the program manager for Mental Health Systems’ Mid-Coast Recovery Center. From the organization’s Loma Portal offices, she also directs the Serial Inebriate Program.
“Initially piloted without funding, using available resources,” McLagan writes me by email, “the county’s Alcohol and Drug Services Division [now] provides $140,000 in case-management dollars.” (The division is a branch of the county’s Health and Human Services Agency.) The city’s Housing Commission also “funds $80,000 to cover the cost of housing expenses.” The housing money “funds the purchase of 12 transitional-housing beds in a sober-living environment.”
Then, “We received a one-time $6000 grant from Price Charities,” writes McLagan, “that supports some of the unfunded needs of our clients, such as transportation, hygiene, clothing, and food.”
McLagan wants me to know one more thing. The San Diego County Taxpayers Association recently awarded the county a Golden Watchdog Award for saving taxpayer dollars in its treatment of alcoholism through the Serial Inebriate Program.
A brown recluse spider bit Brook Butterfield on the inside of his knee shortly after he hit the streets in March 2000. At the time, he was sleeping out near 70th and El Cajon Boulevard. He’s not sure when he received the bite, but the wound, he says, “comes up like a pimple, then collapses, and the flesh starts dissolving. The hole keeps getting deeper and wider. On the evening I went to the hospital, they told me, ‘If you leave tonight, you may lose your leg.’ I felt I had to leave anyway. So they gave me a prescription for Keflex, which is a powerful antibiotic. I didn’t have the $50 or $60 to get the prescription filled, so I never took the medication, and because I didn’t, the infection went from my knee down my lower leg. I ended up getting encephalitis, an infection of the fatty tissue in the bottom part of my leg. So the first year I was homeless, I was walking around with one shoe on, because I couldn’t fit a shoe on this one foot due to the swelling. My foot was way too big. There were numerous instances when I got picked up by the ambulance and had to go to the hospital, all related to the spider bite.”
Butterfield, who is now 47, says he remained uninterruptedly outdoors through the end of 2005. “During that time,” he says, “alcohol determined where I slept, what I ate.” Before that, he had always been gainfully employed. “But alcohol had been a part of my life since I was 18.”
The recluse spider bite wasn’t Butterfield’s only encounter with small critters. Once, in Pacific Beach, he was coming down an alley with friends. They were drinking from a bottle of vodka. “I blacked out,” Butterfield tells me, “and fell forward, straight down on my forehead. I woke up in a hospital with sand fleas in my hair and scabs all over my scalp from sleeping on the beach.
“I had intravenous tubes in me, and when it came time to eat a meal, there were two beers on my plate. I was in the hospital for five days, and I drank two beers for breakfast and one for dinner. It was part of the detox process.”
During his hospital stay, “I couldn’t feel my feet,” Butterfield says. “The doctor started prodding me with a little poker and determined that my feet were completely numb. He said I had peripheral neuropathy, nerve damage caused by too much drinking.
“I used to get arrested a lot, mostly for being drunk in public, illegal lodging, public trespassing, once for public nudity, a couple of different times for petty theft — way, way too many times.
“So at the beginning of January 2006, down at Pacific Beach — it was wet and cold — I didn’t want to go through another winter outside, and there was just something in my heart. I’d alienated my family. You know, I graduated from SDSU with an MBA in finance. My heart was saying this has got to stop. It’s insane. Help yourself; do something. So one day I got really, really drunk and walked up to a cop car in a 7-Eleven parking lot at the foot of Grand Avenue, and I said, ‘I need to go to jail again; I’m drunk.’ And the cop said, ‘Put your hands behind your back, yes, you are, that’s where you’re going.’ ”
It was during that stay in jail that a counselor from the Serial Inebriate Program came to Butterfield. “Yeah,” he says, “and while I was still down at George Bailey’s, an officer came to pick me up and let me sit in the back of the cop car with no handcuffs. Took me straight to St. Vinnie’s, where they gave me a physical exam and some thiamine and other vitamins. From there, straight to the apartment complex. So I went from being in Bailey’s one morning to living that evening in a two-bedroom apartment with freedom to walk away if I wanted. I could go anywhere. The liquor store was only a block up the road. I could have left that first night and never come back. That’s just the freedom they give you. When the cop picks you up, he makes sure you know that you are still technically incarcerated for the next six months. It’s only that you’re not behind bars. If you do walk away, a warrant for your arrest will be issued. So just know that. They do make it clear.”
Butterfield finished the Serial Inebriate Program in six months, satisfying all his legal obligations. But “when I left in October 2006, I went straight to the liquor store, bought my poison, and relapsed. I wasn’t financially ready to move out on my own yet.”
My trusty curmudgeon Robert argues that most chronic alcoholics, those who live drinking on the street, eventually relapse, even after the best treatment. “I’m hardly alone in that view,” he says. “Even Arnold Schwarzenegger says something like it.”
Robert has exaggerated Governor Schwarzenegger’s criticism of Proposition 36 that too many offenders who enter the program fail to complete it. The proposition addresses problems of drug abuse rather than alcoholism. But it shares this much with the Serial Inebriate Program, that treatment replaces jail time as a solution to addiction problems.
Should recidivism be a deal-breaker for public funding of alcoholism treatment? The Serial Inebriate Program’s Deni McLagan cannot say how many clients relapse and never come back. Never is a long time. But she does acknowledge that “for this year, 67 percent of our clients were readmissions to the program. It is important to note that this is a positive number! Recovery is a process, not an event.”
The program is “a six-month treatment episode,” McLagan continues, “and it is difficult to anticipate that someone who has been a homeless chronic inebriate for over 15 years will experience a full, sustained remission of their alcoholism with a limited length of intervention. The program is six months because that is the sentencing for…
often a greater length of care would be beneficial. Clients would likely not enroll in a program longer than six months, whether or not it was mandated; they see this type of coerced treatment as excessive. Therefore, we work with them in stabilizing them, laying foundations, and reintegrating them back into treatment should relapse occur.”
Butterfield returned to the Serial Inebriate Program seven months after his relapse. Now, he says he realizes that “the program has allowed me the time to understand that I truly am an alcoholic and that, if I don’t learn to like myself, my life’s going to get nothing but worse. I’m going to be back on the streets again, I’m going to be locked up again, and I’ll have no dignity. And the program made me realize that I’ve got work to do if I want to change the way I’ve been living.”
Besides his regular recovery activities, the work eventually included weekly meetings with a psychiatrist. “I have a great relationship with him,” Butterfield tells me. “He’s helping me to get rid of the anger toward my parents and resentments toward people around me.”
At home in the program’s apartments, Butterfield says he’s acquiring “the ability to live in an environment with other individuals who have the same sickness.” In the process, “I’m finding out who I am. By believing that I have a better life ahead of me, I don’t need to numb myself and can learn to be happy. I’m finally coming to terms with God and becoming able to say, ‘I’m okay.’ I don’t have to beat myself up anymore. I’m going to learn to like myself.”
Even though Butterfield relapsed during his first try, “There’s one thing I’d like to emphasize, and that’s that the freedom the program gives you is crucial to recovery. The choice is to run or to have the courage to face this God-given opportunity and have faith that this is where you need to be right now. In the long run, nobody else can do it for you. Motivation is critical. To recover, every alcoholic has to make that personal choice.
“What’s really nice now is to be able to say I have no outstanding warrants. Since I’ve been in the program, when warrants have popped up, I’ve been able to go down and tell the judge that I’m already legally incarcerated.”
Gary Garrin, 59, says he ended up as “one of those guys who sits in the daytimes outside the NBC building, next to that 100-year-old fountain and across from the US Grant Hotel. I didn’t do much panhandling because I never really liked that. But when I did, I was good at it.”
In 2004, before moving to San Diego, Garrin suffered a stroke that left him unconscious in the hospital for six weeks. He had been living out of a cave in Orange County, “within sight of [Nixon’s] Western White House,” he says. In the minutes before the stroke, he was drinking heavily. He fell and hit his head, which the doctors told him slammed his brain into the inside front of his skull and set the stroke off. His right lung collapsed in the same incident, he says.
“I guess I’d been having seizures but just didn’t know it, probably because I was in blackout at that time. I used to drink to blackout. The doctors said my smoking would probably cause more problems in the aftermath of my stroke than even the drinking, even though drinking adversely affects every part of your body. I know that.
“Up to that point, I always worked,” Garrin says. He was a door-to-door salesman, peddling automotive services. “I drank and worked simultaneously for many years. Half the day would go by, and I’d quit and go drink somewhere. My company tolerated it because I made them money. They even let me sleep in their office. But they were concerned about my seizures. I was taking Dilantin for them so I could keep working. Some people might say I was a functioning alcoholic. I think I just got away with it.”
Garrin hasn’t been employed for the past four years. After the stroke, he started receiving Veterans Administration benefits, which don’t allow him to work. By the time he reached San Diego in 2005, he was receiving a check. But in lying around the sidewalks downtown, he says, “I would pass out and somebody would steal my money. I was broke a lot.”
During stays in Orange, Los Angeles, and San Diego counties, Garrin has gone to the emergency room over 30 times. “I only remember going in two, maybe three times on account of being a blackout drinker. I’d come to in the hospital. They occasionally kept me overnight. A few times, I was pretty shaky leaving, having a hard time walking, and they’d give me a wheelchair. I ran off from UCSD with the wheelchair once. My head was still buzzing, and that seemed to make sense. I took it about four blocks, over to Washington Avenue, before they tracked me down and retrieved it with a pickup. I was looking for cigarettes and something for the tremors.”
Garrin praises the San Diego Homeless Outreach Team’s watching out for him while he was homeless downtown. “They were mainly kind,” he says. Because his initials are G.G., the officers referred to him as G squared. “I was not one to argue with the police, and they told me I was one of the more polite drunks.”
I ask Garrin about the effect that hostile officers have on intoxicated men and women lying about the streets. “I can understand why they are hostile. They see it over and over, usually the same people. But the hostility, in my opinion, only hardens the resentments alcoholics already have.”
The Serial Inebriate Program approached Garrin in the summer of 2007. He said he didn’t want to go at first because he saw so little hope that he’d give up drinking. He’d gone to Alcoholics Anonymous and been through treatment regimens before. Why would another effort turn out any differently? But the program’s head counselor, Carrie Finley, encouraged him strongly this last time he was in jail. “She told me, ‘You’ve got so much to look forward to, if you get sober — a daughter, a grandson, and son-in-law.’ Just the way she said it got to me,” Garrin says.
He went to live at the same apartment complex that housed Brook Butterfield. He took the same ride from George Bailey, was taken to St. Vincent’s for the same physical exam and any medications he might need. And he still lives at the apartments after graduating from the six-month program and starting to pay rent from his Veterans Administration check.
“Since I’ve been here,” he says, “we’ve had group meetings three times a week. Then they require we go to at least five outside meetings, which can include church. We also volunteer time at various places. In turn, the program will give us things like appliances, clothing, help with getting a California identification card, and a free monthly bus pass for the first month. Then you’re eligible to buy the senior/disabled pass. And everybody gets $1.75 per week to cover laundry.”
Perhaps the most important thing to Garrin is that “they don’t talk down at you, they treat you with respect, though you might not deserve it. Some people come in rougher around the edges than others, usually because they’ve been out there a lot longer.
“And they give you enough room to hang yourself. You have responsibilities, things you have to do around the apartments. Guys who don’t make it aren’t willing to take direction. You take a drunken fool and sober him up, you’ve got a sober fool.”
By now, Garrin has seen his grandson several times, even though the boy, who is eight, and his parents live in Riverside. “A lot of alcoholics,” he says, “end up permanently estranged from their families. My daughter, though, she never stopped loving me, even during the worst of my times.”
The successes achieved by the Serial Inebriate Program have come through a customized approach. “St. Vincent de Paul and other organizations,” says Deni McLagan, “devote themselves to helping homeless people, and traditional treatment programs help alcoholics and substance abusers. For [our program], we needed to help individuals who were both. They need a group strictly for themselves. So we wrote our own curriculum for the people in their unique category.”
McLagan tells me that her recovery center used to employ a standard screening questionnaire to determine whether an individual is an alcoholic. “There were questions like, ‘Do you ever drink before going to a party?’ Well, homeless guys don’t go to parties,” she says. “So when homeless inebriates read that, they might even use it to deny they were alcoholics.”
Street drunks belong to a much different demographic than problem drinkers or people who are alcoholic but have a roof over their heads and still go to work every day. “If homeless alcoholics hear somebody in a meeting talking about a meth problem interfering with his job, they can’t relate and want to run off by themselves. They don’t feel comfortable in groups like that,” McLagan says.
“We have learned,” she continues, “that conventional forms of treatment have a tendency to disenfranchise our clients…Most, if not all, have past experiences with conventional programs that did not sufficiently address their needs…For those reasons, we have developed a comprehensive and strategic program that focuses on the specific needs of this unique population.”
Sober-living housing can also be a problem, according to McLagan, even if only formerly homeless alcoholics live there. She relates a story about a man she tried to place in a group apartment complex. “We gave him his own bed, but he slept outside on the porch instead. These guys are so independent, so used to making do all by themselves, that he couldn’t bring himself to sleep in a bed. Gradually, we moved him inside, first onto the living-room couch, and then to the bed in his room.”
With only 12 beds available, I wonder how McLagan’s program could help very many people at a time. “Many of our clients we treat on an outpatient basis,” she says. “And we make use of other sober-living providers around town that are willing to help. Clients come to our meetings at the Mid-Coast Recovery Center. We usually have about 30 enrolled at any particular time. As soon as one of our beds comes open, though, we fill it right away.”
Whether clients are housed in an apartment or only come to regular meetings, they must follow program rules, the most important of which is to stay sober. A short relapse may not cause a rift in clients’ treatment, especially if they immediately report what happened to program counselors. But if they leave the program to drink for good, law enforcement won’t be far behind. “It doesn’t take the police long to locate them,” McLagan tells me. “These are not guys who keep a low profile.”
For the last two weeks, I have been calling Paul Bacon to no avail. It’s been ten months since I’ve seen him. I am worried that the many times he threw himself into the Clairemont bushes might have caused him more problems than his confinement to a wheelchair. Could he even be drinking again?
I remember Bacon telling me that, during the first 90 days of his treatment at Pathfinders, he constantly planned to leave the county and drink again. And the counselors seemed to know it. “If I went to a convenience store,” he told me, “they’d be out front, looking in the window to see if I was pointing at a bottle of vodka.”
Bacon also said that, while in treatment, the obsession to drink eventually left him. And when it did, he said, he gave up his bed and left the program to live on his own. He rented his own apartment. He bought a Ford Focus with money from his disability payments. “I only drive when I need to go somewhere,” he said. “Otherwise I take the bus, which is my only opportunity these days to flirt with pretty ladies. Of course, I know they don’t want somebody like me, but it’s fun anyway.”
“Of course he’s drinking again,” says Robert the doubter.
If Bacon did drink, he can be sure that the Serial Inebriate Program would be willing to help again.
“Fools,” says Robert. “Fools with our money.”
Deni McLagan looks at it like this: “Think about cancer patients who are in remission but whose cancer comes back. How would it be if Kaiser told them, ‘No, you can’t come back for treatment because your cancer returned’? Some alcohol-treatment programs do tell their clients to leave after relapses. But we see treatment as improvement over time, and if our lapsed clients come back still manifesting the disease of alcoholism, we want to help them toward the next steps of their recovery.”
“Disease my ass,” says Robert. “When will they stand on their own two feet?”
Finally, Bacon gets in touch, and we talk. He sounds great. “I missed your messages because I’ve been staying in my girlfriend’s place,” he says. I ask if he met her on the bus. “No,” he says, laughing. “She lives in the same building I do, in the front. We met one day when I drove home and didn’t stop my car in time. It smashed into her apartment. My legs are giving me more trouble than they used to. I think I’m going to sell the car.”