October 2003

Detox never sleeps: A look at the world of the Durango Detox

By David Grant Long

Editor’s note: The incidents described in this story are true, but identifying features have been changed to protect clients’ privacy.

Although its heavy wooden door is always locked, the Durango detox never closes.

Any time, any day, including Sundays and holidays, clients reel, lurch, stagger or even walk with great dignity through its entrance once the magic key has been inserted in the lock.

They cover the spectrum of humanity - the young and old, the healthy and sickly, the light-skinned and dark-skinned, college students and high-school dropouts, the belligerent and bellicose, the humiliated and humbled. But above all, the intoxicated.

DPD Edwards here with a 45 YO Cauc male; BAC .273; no hold, DUI charge; 2 previous detox episodes; client cooperative but angry at police and wife because “she let me drive”; abrasions on left cheek and forearm, which he reports were sustained in a fall; does not admit ETOH problem; pulse slightly elevated, other vitals WNR; hygiene poor (apparently urinated on himself); client to begin safe detox.

So begins a typical progress note in the file of a new arrival. Translated, it means a Durango police officer brought in a 45-year Caucasian man with a blood-alcohol content of .273, or nearly three times the threshold for a DUI; that he’s been treated at the detox twice before, but denies he has any problem with alcohol; and that his vital signs are within normal range.

“I’m not that drunk - I don’t care what that goddamn machine says. Give me back my shoes -- I just want to go home. You’re as bad as those goddamn cops! I want to phone my lawyer. I need a cigarette. Come on, man, I’m hungry, I haven’t had anything to eat in two days. I can’t wait till breakfast.”

Those are typical reactions of a new arrival, who has his (or her) alcohol level measured and shoes, belt and all personal possessions taken away before the intake interview can proceed. The detox counselor seeks some personal information – income, drinking habits, drug use. In this case, the man answers reluctantly and with anger. He keeps mentioning that he is hungry. But it’s 4 a.m., and the detox kitchen, such as it is, closed at 7 p.m. He’s missed his chance at a TV dinner or cup of soup.

Welcome to Detox, the world of sobering-up drunks and druggies, where the usual ticket for admission is a blood-alcohol content of more than .040, although the more regular clients, referred to as frequent flyers, often are admitted with alcohol levels that could be lethal to the novice drinker.

A few clients arrive without alcohol in their systems, but hallucinating on speed or sick from heroin withdrawal. Those are usually sent to detox from Mercy Medical Center’s emergency room, depressed and despondent, occasionally to the point of what’s referred to as “suicidal ideation.”

Such clients are accepted on an “emergency commitment” until they are sober and can be evaluated by a professional from Southwest Colorado Mental Health Center, which operates the detoxification unit.

A nearly infinite variety of people are profiled in the long rows of cabinets contained in a locked file room - except, of course, those records of drunkards and drug addicts and abusers are strictly confidential.

“No one will ever know you’ve been here unless you want them to,” clients are reassured during the intake. “We’re prohibited by federal law from releasing any information concerning your stay here without your written permission.”

Most arrive in handcuffs, escorted by police who have nabbed them driving drunk or engaging in a variety of petty crimes - from vandalism to theft to public indecency (often urinating in public) - or who just have concerns for their safety.

Usually they are given a choice of coming to detox with minor or no charges, or going to jail, which requires a charge, booking, mugshot, fingerprinting and bonding out.

Some clients, called self-admits, enter detox voluntarily, convinced, temporarily, at least, that the time to end their substance abuse has come

The new arrival isn’t one of them. He’s indignant at being in detox and expects to be treated like a respected guest. Intake interview finished, he is taken to a bed to sleep, but before long he’s up again, pounding on the property cabinet in the hallway. He’s told that if he doesn’t settle down, he could end up in jail after all.

“I’m paying $225 a day to be here and I deserve to eat when I want!” he shouts. “Food or jail!” The detox counselor points out that he arrived well after dinner time, to which he sarcastically replies, “What am I supposed to do – say to myself, ‘It’s time for dinner at detox – I’d better get up there?’”

Aside from the basic intake information, clients are also asked to answer numerous questions contained in a 16-page file that includes a drinking and drug history (If you used any of the following substances, how old were you when you first used them and when did you last use them? Alcohol, speed, cocaine, opiates, etc.), as well as a recent personal history (How many days out of the last 30 did you drink alcohol? Any hospitalization in the past six months?), and a financial agreement. A stay at detox costs a maximum of $225 a day, it is explained, although for Colorado residents of modest means the fee may be adjusted to as little as $45.

Once sober, clients are also asked to fill out a four-page infectious-disease screen, which determines their risk of having tuberculosis, HIV or other sexually transmitted diseases. Those who are at medium or high risk are referred to the county health department or other medical clinic for testing.

Because the 45-year-old man won’t quiet down, the police are called. They tell him that if he doesn’t behave, he’ll be taken to jail, where breakfast won’t be served any earlier than at detox and most likely will be similar fare – cold cereal, milk and juice. He subsides and goes into a Quiet Room – a simply furnished cubicle where the most agitated clients can be isolated. Everyone breathes a sight of relief.

On the average, about 100 clients a month receive services at detox, with more being brought in on weekends and holidays, usually for periods of a day or less. A few, however, decide it’s time to do something about their problems and elect to stay and complete a “five-day packet,” which involves finishing a lengthy written self-assessment, viewing treatment videos and attending Alcoholics Anonymous meetings, while awaiting placement in a residential treatment program.

These clients must usually wait for a bed to open up at St. Mary’s in Grand Junction, which receives funds from the Alcohol and Drug Division of the state health department. It is the only option for people on the Western Slope who can’t afford to pay a hefty tab for private treatment and the wait can be a matter of weeks.

The chance to change

Law-enforcement agencies that use the service as an alternative to jail include the Durango, Southern Ute, Ignacio and Fort Lewis police departments, as well as the La Plata County Sheriff’s Office, with each paying a portion of detox’s nearly half-million dollar budget through an Intergovernmental Agreement (IGA). The Colorado State Patrol and the Bayfield Marshal’s office occasionally bring people to the detox as well.

The state also provides some financial support, according to Deborah Karn, substance-abuse services program coordinator for SWCMHC, but that funding has suffered from large cuts in the state’s budget for social services, so the local communities pay most of the cost.

Nearly $300,000 comes from the various entities through the IGA to help detox provide services, with almost $200,000 coming from the state, she explained.

“Other detoxes that have not had that kind of community support have been in much greater jeopardy of closing,” she said. “This kind of care is expensive to provide, and it’s neat that our community stepped up to the plate.

“Our mission is to provide both community safety and safety for the intoxicant,” said Karn, who has supervised the unit for more than two years. “We also offer the opportunity for people’s lives to change (and) we’ve seen it over time – some people do get better.”

Sobering up can be physically risky for alcoholics, she added. “Alcohol withdrawal is one of the most dangerous withdrawals there is.”

The effects of withdrawal can include seizures, delirium tremors (uncontrollable shakes accompanied by hallucinations), unstable blood pressure and pulse, sleeplessness, severe headaches and nausea, all of which can be controlled with drugs such as Haldol and Librium.

Choosing to be sick

The relief is short-lived. As soon as the man goes into the Quiet Room, he begins pounding on the door. “Give me my clothes!” he shouts. “I’m going to jail, dammit!” The cops roll their eyes at each other, then handcuff him and take him away.

Detox isn’t primarily about changing people’s behavior, regardless of how destructive it obviously is, Karn said.

“I respect an individual’s choice to be sick or to be well. Being well is a value judgment, a bias,” she said, “and while I would certainly advocate for people to make healthier choices, I can respect it when some people say, ‘No, I’m going to stay sick.’ Sometimes we’re more of a hospice than anything - we watch people slowly killing themselves.

“The bottom line is this is a free country, and I’d like to see it stay that way.”

Detox counselors, who have basic first aid and CPR training, measure blood pressure, pulse and respiration rates during the intake interview, and at least three times daily thereafter. If a client’s vital signs are unstable – abnormally high or low blood pressure or heart rate – Mercy’s ER staff is consulted, and that usually means a trip to the hospital for a check-up. Or if an adult client’s BAC is above .400 (.100 is the threshold for a DUI charge), or if a juvenile’s is above .300, medical clearance is necessary before intake. Karn makes it graphically clear when hiring new staff members that as well as dealing with often unruly and hostile clients, they will occasionally be cleaning up vomit, urine and feces.

“I think it is a very humble and very noble profession that we do,” Karn says. “I think we are of service in a way that is not glorified, but very important.

“For the one-time or first-time detox person, what their detox counselor says to them sticks out more in their mind than what half of the treatment counselors will say to them after that,” she said. “They’ll remember that one face in the morning when they woke up or that one thing the counselor told them – it’s powerful, it’s a big deal.”

‘I fell for it’

Detox counselor Megan McCullouch, a recent Fort Lewis College graduate with a well-rounded liberal-arts education who has worked at the facility for close to a year, remains enthusiastic about her job, though it’s hard for her to explain why. She works the graveyard shift – 11 p.m. to 7 a.m., the period when many of the most intoxicated clients arrive, and is considering a career in law enforcement.

“I just like it,” she said. “I like the excitement, the action, but I like working with the people who come in here that are obviously having some serious life issues – most of them, not all of them — and I like the people I work with.”

The rewards of the job are personal, she said.

“At the end of my day I feel better about myself, like I’ve done the community a service, and I feel like, maybe, I’ve helped out some people out who couldn’t have helped themselves.”

But the job has its disappointments, such as clients who seem very serious about seeking long-term treatment, only to fall off the wagon within days, or hours, of their discharge. McCullouch recalls one for whom she had particularly high hopes that supposedly left to go to long-term treatment, but stopped at the nearest liquor store instead.

“That was the first time (at detox) I’d seen anyone making an effort toward making a positive change in their life, and then when it turned out it was almost a sham, it was that much more disappointing.”

Still, she hopes he really wanted to turn his life around.

“I hope that’s true, because if at some level he believes that, then he’s sincere. I’d like to believe that rather than think he just lied to us the whole time, because if so, then I’m a sucker. I fell for it.”

It’s another Saturday night in Durango. At detox a lone chronic client who has been there for two days and hinted he was considering treatment is now anxious to leave. He is still thinking about treatment, he says while signing the discharge forms, but is crazy for a cigarette.

Still, he’s concerned about whether his girlfriend will take him back because she has given him “several” last chances.

“This may be it,” he says, now sober in more ways than one.

Just then the buzzer at the front door sounds twice, despite the posted sign that reads, “Ring the buzzer ONCE and staff will open the door.”

The sad nightly parade of alcoholics’ antics and anger that accompanies their slow march toward sobriety or death begins anew.

Detox never closes.