At the detox center on Chicago Avenue in south Minneapolis, the evening of Dec. 4 began like many others — with the cries of a severely intoxicated patient echoing through the ammonia-scented corridors.
“I feel like I’m going to die!” cried the woman, who was sobbing and shaking uncontrollably. “God, please help me!”
Two nurses caught her as her legs began to buckle, then eased her into a chair and took her vital signs, and within 20 minutes she was passed out on a bed of clean linen, where her sleep was deep and unhurried.
“People ask me, ‘Why do you help these people?’ ” said center director Sharlee Benson, gesturing toward the patient. “This is why. Because addiction is a nasty thing, and people need a safe harbor.”
But drug and alcohol detoxification centers like the one on Chicago Avenue are fast becoming relics of the past.
Quietly and with little debate, more than half of the licensed detox centers in Minnesota have shut down in recent years. There are now just 23 in the state, down from nearly 50 two decades ago, as counties from the Iron Range to the Red River Valley have sought to cut costs.
The network of treatment centers grew rapidly in small towns and cities across the state in the 1970s, a period when Minnesota sought to decriminalize public intoxication and create safe, inexpensive alternatives to c©ounty jails and hospital ERs.
Today in many counties, detoxification is seen as a dispensable luxury for a small population of chronic alcoholics, many of them homeless or mentally ill — even though the patients also come from comfortable homes in prosperous communities.
Yet the need for acute care for people with severe addictions has never been greater, state and county officials say. The rate of binge drinking among Minnesotans is among the highest in the country; and a surge in heroin-related deaths has alarmed public safety officials.
Increasingly, the burden of treating chronic alcohol and drug users has fallen on local sheriffs, police and hospital ERs, which are ill-equipped to provide counseling or long-term treatment.
The emergency room at Hennepin County Medical Center in Minneapolis is treating 700 to 800 people a month who are chronic inebriates, according to county estimates. Most of these patients could be treated at a detox center or other facility if beds were available, said Jennifer DeCubellis, assistant administrator for health for Hennepin County.
“Detox is always full and the emergency rooms are being overrun with intoxicated people,” DeCubellis said. “We need an array of services that simply don’t exist today.”
Now, in an effort to divert chronic alcoholics from costly ERs, Hennepin County is considering the creation of a “sobering” center for intoxicated people who need a place to sleep and sober up, but who do not require acute medical care. The county estimates that a single 30-bed sobering center could result in $4 million in annual cost savings for public and private payers.
‘Something has to change’
The situation is most dire in rural counties.
People who are severely intoxicated, but aren’t visibly injured or suffering from alcohol poisoning, are sometimes turned away by local hospitals. Left with no alternative, local police often travel hundreds of miles to deliver intoxicated people to distant detox centers. The long drives can be fatal for a person suffering through severe withdrawal.
In Mankato, which saw its detox center close in 2003, police regularly take heavily intoxicated people to New Ulm, about 30 minutes away. If beds there are full, police will transport people in squad cars to detox wards as far away as Albert Lea and Hastings.
The detox center in Duluth is now getting patients from as far away as Brainerd and Baxter in Crow Wing County, about two hours away. Police officers who normally would be patrolling streets for crime are sometimes spending hours shuttling drunk people to distant counties.
“You can’t leave people lying in the snowbank when it’s 10 degrees below zero,” said Matt Westermayer, deputy director of public safety/police for the city of Mankato. “It’s our obligation to help these people, but something has to change.”
Though some counties are exploring alternatives to detox — including less-costly drop-in centers — advocates for people with addictions argue that the state government should be taking greater responsibility.
“If we do nothing, then people are going to die,” warned Roberta Opheim, whose title is state ombudsman for mental health and developmental disabilities.
The widespread closure of detox centers marks a significant shift for a state that once was considered a pioneer in the treatment of chronic alcoholics.
In 1971, as public opinion shifted toward treating alcoholics instead of punishing them, the Legislature passed a law eliminating public drunkenness as a crime. Later, the state mandated that each county provide detoxification services. In the ensuing decade, detox centers sprouted up all over the state, from Morris to Duluth.
But, as with many other unfunded state mandates, counties were left to fend for themselves. When budget pressures hit, counties shuttered their detox centers and, to satisfy the requirements of the law, contracted with regional centers in neighboring counties.
“The primary problem has been a lack of support from the state,” said Gary Olson, executive director of the Center for Alcohol and Drug Treatment in Duluth, a detox center that opened in 1972. “They regulated the heck out of them but provided little funding.”
One of the obstacles is the public perception that detox wards are just way stations for hopeless inebriates, say detox administrators.
“People have this idea that we’re only serving chronic alcoholics who don’t work and are sucking the blood out of the system,” said Benson, director of the Chicago Avenue center. “What taxpayer wants to pay for that?”
The reality is much different. In Hennepin County, two-thirds of the people treated last year at the county’s public detox centers had just one admission in the past 12 months. At the 21-bed Mission Detox Center in Plymouth, about one-third of the patients admitted so far this year are first-time visitors. Many of them live in such outer-ring suburbs as Minnetonka and Chanhassen, and are dropped off at the center by family and friends. More than half of the patients arrive voluntarily.
After stabilizing the patients, the detox center provides counseling and helps connect them with long-term treatment.
“There is this myth that people come here to hang out and have meals, and then it’s back to the streets to drink,” said Brian Zirbes, program director at the Mission Detox Center. “This misperception misses the success stories.”
Homeless and addicted to alcohol, Odonnis Percy wept into a tissue as she recounted the times — five — when nurses at 1800 Chicago Av. saved her from an early death.
There was the night last month when, after a day of bingeing on malt liquor and vodka, she staggered in with a blood alcohol level of 0.47 — nearly six times the legal limit for driving in Minnesota.
“If it wasn’t for detox, I wouldn’t be here right now,” said Percy. “My grandmother raised me, and I don’t want her to bury me.”