When I read CNN’s article about the “wet house” concept (providing a state-funded safe space for alcoholics to continue drinking), my first concern was with the medical appropriateness of this model, given the brain damage that will likely ensue. Heavy long-term drinkers – the group the “wet-house” attracts – are at a stage of alcoholism that causes progressive and irreversible damage to the cerebral cortex.
This type of drinking, no matter where it occurs, can lead to Wernicke-Korsakoff syndrome, commonly known as “wet brain,” where the brain is basically pickled due to malnutrition. This is not just because individuals drinking this much don’t eat well—it’s because excessive alcohol consumption prevents the body from absorbing nutrients from food. The effects are similar to those of a head injury; people with “wet brain” lose frontal lobe function and can no longer walk steadily, think clearly, or take care of themselves. Although the condition is easily treatable in the very early stages, there is no effective treatment for late-stage “wet brain” and the mortality rate is 20%.
Because of this, I feel differently about “wet houses” than I do about the heroin safe houses. Although heroin is extremely harmful, it causes a different type of damage than alcohol—in short, it doesn’t destroy the brain. Costs incurred by individuals with “wet brain” will negate any of the supposed cost-savings of the “wet house” model. Although residents in the “wet-house” cost 53% less over the first 6 months compared to the heavy drinkers on the wait-list, what about afterwards? “Wet brain” leaves individuals prone to falling and unable to engage in proper decision-making, thus increasing the likelihood of additional brain injury. In the long run, the condition becomes a terrible cost burden because some of these folks will need 24-hour care.
In addition to facilitating brain damage, “wet houses” take a major toll on morale. The residents CNN interviewed seem profoundly depressed—after all, who would live like this if they had a choice? For these individuals, life in a “wet house” isn’t giving hope, it’s giving up; in CNN’s video, one of the residents shrugs, saying, “people die here all the time.” These folks need to be reminded that people can and do get sober no matter how much or how long they’ve been using. I remember a woman who got sober with me 25 years ago and then relapsed; she started using heroin again, and one day she said to me, “I just love shooting dope, I’m know I’m going to die like this, but this lifestyle is all there is for me.” She really believed that at the time, but she went back into treatment and has now been sober again for the past 10 years.
We have to find a way to keep people safe while still giving them hope, even if they aren’t quite ready to quit using. We also need to try to protect them from the lasting brain damage that results from lifelong, ongoing, heavy alcohol use—just like we try to educate IV drug users to protect themselves from acquiring HIV and Hepatitis. Can’t we focus more on motivating people to start treatment and on providing referrals to different programs? Can’t we try putting them on the newest FDA-approved medications for alcohol abuse such as Vivitrol? Although the “wet house” harm reduction model may have its pros, let’s not celebrate this option too quickly; it doesn’t appear to be saving lives. Treatment, on the other hand, saves lives each and every day.
Deni Carise, Ph.D.
Chief Clinical Officer, Phoenix House