There are no medical detox facilities in Santa Clara County.  What does that mean for homeless people?  Let me explain.

When a person is addicted to any drug (or alcohol), he or she will go into “withdrawal” when the drug is stopped.  Most withdrawal syndromes are very uncomfortable but will not kill you, ranging from caffeine withdrawal headaches to tobacco withdrawal irritability to heroin withdrawal vomiting and diarrhea and severe anxiety.  Alcohol or benzodiazepine (xanax, valium, klonopin, etc.) withdrawal, however, can be life threatening.  Patients who stop drinking suddenly can experience vomiting, shakes, Delirium Tremens, and seizures in the most severe cases, and some people die.  So, if an alcoholic who is drinking heavily wants to quit drinking, it is recommended that she do so under the care of a doctor.

I see this very frequently.  Many of my patients come in and tell me they are “sick and tired” of drinking too much, they want to be free from their addiction, they will do whatever they need to do to quit.  Ideally, in that situation, I would admit them to a medical detox facility, and the nurses would follow a protocol to dose them medicine over the course of several days.  They would gently come down to a safe physiologic state, when they would be able to enter into inpatient rehabilitation and their greatly coveted sobriety.

The reality is, in Santa Clara County, the vast majority of the alcohol and benzodiazepine detox happens in hospitals and the jail.  There are a handful of “social detox” beds in the inpatient rehab facilities, but they are not staffed with nurses and are not designed to handle any kind of medical complexity.  When I am in the exam room with the sick and tired patient, I have a dilemma.  I can write for a valium taper and ask them to do their own detox at “home” (in the streets), and hope they don’t take all of the pills at once while drinking because they will likely kill themselves.  I can try to talk the hospital into letting me admit the patient for alcohol withdrawal (a long shot, as this is expensive  and sometimes not efficacious, and they can be hard to convince).  I can tell the patient to try to taper their drinking down (“so you usually drink 24 beers a day, so tomorrow drink 20, then 18, then 16, then 14…” not something your average alcoholic is capable of).  What I usually do is this: I give them a few pills to get them to the following day, then ask them to return to clinic, blow in the breathalyzer, and if it says “000,” they get the next day’s pills.  Very few people come back to complete the outpatient taper, though, as most go back to drinking.

This is heartbreaking for me.  My patients, beaten down by the world, are short on hope.  The windows to sobriety open for only a short time for them.  I want to help them crawl through the window while it’s open.  If we had a detox facility, I would send them over in a taxi right then and there, knowing the capable nurses and staff would get them the calming meds and have them quickly feeling at ease.  I feel certain that more patients would be able to enter into sobriety if we could really help them in their moments of readiness.

The reason this matters is that 59.1% of my patients responded “yes” to the question, “Do you consider yourself to be an alcoholic?” in a recent survey.  Some of those are in recovery; many are actively drinking.  And it is nearly impossible for a person to maintain housing or even stay at a shelter if he is drinking heavily.  Once his alcoholism goes into remission, however, he can do very well in housing.  I have seen it happen again and again.