Correction: This story originally and incorrectly reported that nearly 1,700 Wisconsin residents died and more than 5,600 were injured in alcohol-related vehicle crashes. These numbers, reported by UW Health based on a state report, are actually for all causes of deaths linked directly to the use and abuse of alcohol.
The facts are, pardon the pun, sobering:
In 2006, nearly 1,700 Wisconsin residents died and more than 5,650 people were injured in alcohol-related incidents, while law enforcement officers arrested another 88,000 citizens for drunk driving.
And Wisconsin that year had the highest rates of alcohol consumption and binge drinking in the nation.
"Wisconsin is the No. 1 state for alcohol abuse," says Susan Crowley, University Health Services Prevention Services director. "It's a statewide cultural issue." And it's a constant problem at the UW: "We find students passed out in bushes, stairwells, stumbling around and incoherent."
The question is: What can be done?
"People really want a magic bullet, but it's so complex and multifaceted that we have to come up with a lot of different strategies," says Carol Lobes, who is helping run a citizen coalition to address the challenges of alcohol abuse in Dane County.
Last year, Lobes logged some late-night hours watching law enforcement officers book people into the Dane County jail. She was stunned at how many were intoxicated.
"The public would be shocked to see what's going on," Lobes says. Indeed, one coalition goal is to work with Dane County Sheriff Dave Mahoney "to have more people spend time at central booking to see what they are dealing with."
The Citizens' Coalition on Alcohol Abuse, launched in November by Dane County Executive Kathleen Falk, consists of more than 80 community representatives. They include: Dr. Robert Golden, dean of the UW School of Medicine and Public Health; state Rep. Terese Berceau; and Dan Nerad, superintendent of the Madison Metropolitan School District. Lobes is a facilitator. The group has met three times and is creating an organizational structure and topic areas.
"This community," says coalition member Crowley, "can take on the statewide issue of alcohol abuse and break the cycle of excessive drinking in this community."
The emphasis will be on curbing alcohol abuse before it causes chaos in people's lives. "The whole Wisconsin culture teaches young people that drinking too much is not only not a problem but something to be emulated," says Falk. "This is our effort to begin to start countering and changing that message."
While the coalition's work is just beginning, Falk is also throwing support behind a trio of innovative programs. All three were to some extent pioneered in Dane County and are major beneficiaries of the $260,000 in new spending on alcohol initiatives in Falk's 2009 budget. The programs are:
- Pathfinders, a jail-diversion program that will serve 65 adults in 2009, 15 more than in 2008. The plan is to increase the program by 15 additional slots next year.
- Project HUGS, an early-intervention program aimed at helping children and parents engaged in high-risk behaviors associated with alcohol abuse. The program was originally aimed at high school students, but the county is increasing funding to expand the program to middle-schoolers.
- Motivational interviewing, a technique aimed at getting people to identify reasons for making changes regarding their own behaviors. Again, the focus is often on young people.
"Kids engaged in alcohol before the age of 14 are four times more likely to have chronic emotional, physical or sociological problems later in life," says Lobes. "Parents still have credibility and can influence their kids when they're still in middle school."
What follows are profiles of the three initiatives.
Can we talk?
Motivational interviewing helps people reach their own conclusions
It was hardly a small sample. The survey, conducted in 2005, included 23,500 area students in grades seven through 12.
The survey found that one out of three underage students reported having consumed alcohol in the last 30 days. And one in 10 did so at levels that constitute binge drinking.
"Alcohol is the gateway to all other substances," says Scott Caldwell, a counselor at Connections Counseling, an outpatient alcohol, drug abuse and mental health clinic in Madison. "Addiction just rips up families. The earlier a person gets to treatment, the more likely they can beat it."
To jump-start a useful change process, Caldwell and other counselors employ a technique known as motivational interviewing. Whereas some other strategies involve a form of confrontation, as in an intervention, the goal of this approach is to get the client to come up with his or her own arguments for change.
Motivational interviewing is more like a dance than kickboxing. Good counselors lead the one-on-one sessions in a gentle, responsive, imaginative manner.
"When people participate in motivational interviewing, they feel understood," says Caldwell. "If I were to argue for change to a teenager who is ambivalent, the predictable response is that he's going to argue to continue the drug use."
In motivational interviewing, counselors seek to help the people they talk to make good decisions.
For people in recovery, the counselor may say things like, "You're really enjoying your life without opiates. What would it be like to go back to opiate use?"
If a client persists in using drugs, the counselor may ask open-ended questions. For instance: "What do you like about marijuana? What do you not like?" Often people come around to wanting to change their behavior.
"People are inherently resourceful and capable of changing their lives," says Caldwell, who feels the techniques are particularly effective with young people.
"When a teen argues in favor of change, he will be more likely to follow through with it and succeed," Caldwell says. "The counselor selectively reinforces the reasons and desire for change."
Falk's 2009 budget includes $15,000 for Caldwell and Connections Counseling colleague Beth Schreiber to train providers in this approach. Both are experts in motivational interviewing, with Falk heaping special praise on Caldwell: "He's just fabulous."
One of Caldwell's teenage clients agreed to discuss his two-year journey to success. He spoke on condition that his real name not be used.
Here is a condensed version of his story.
At 13, "Tim" started drinking as a way to mask the upheavals caused by his parents' dreadful relationship that ended in a nasty divorce.
Before he graduated from a Madison area high school, he skipped classes to smoke pot and snort opiates, including OxyContin. "My sister's boyfriend," he recalls, "offered me some crack when I was 14."
When a friend suggested trying OxyContin, a narcotic prescribed for his mother's back pain, Tim turned him down. The friend persisted, asking, "What's one time going to hurt?"
Tim relented, but soon found that one time was not nearly enough: "It's that addicting."
Poor high school grades gave Tim few options. Despite enrolling in a two-year technical college, he found that the path to his future was full of potholes.
"I could never keep money in my pocket or save up for anything," he says. "People I was hanging around with were not good people."
At Tim's suggestion, he and his mother met with counselors at Connections Counseling, where he has attended sessions for nearly two years. And relationships with his family have improved.
"It's a much better quality of life now that I'm not involved in substances," says Tim, now 19. "You don't resolve anything when you're using.
"I told my mom I wanted to help myself. I'm entering a new phase. It's exciting."
Finding a new path
Jail diversion program succeeds where other efforts have failed
At 25, "Rhonda" doesn't have many happy memories from her childhood.Her parents - both alcoholics - never graduated from high school. They engaged in violent clashes.
Rhonda (a pseudonym) spent many of her early years taking care of six younger siblings. She wanted a different life, but ended up falling into one that seemed like much of the same.
Despite earning good grades and working as a waitress, bartender and library assistant, Rhonda dropped out of a Madison high school after completing the first semester of her senior year.
"I'd get right to where I was going to succeed, then I'd blow it," she recalls. "I'd self-sabotage."
Rhonda used ecstasy, cocaine and psychedelic mushrooms. She was arrested, more than once, for drunk driving. She even spent time in prison for child neglect. She went to treatment programs seven times. That's also how often she failed.
And then came Pathfinders, a county-funded program that Rhonda credits with turning her life around.
"They believed in me and were willing to give me a chance at sobriety again," she says.
Rhonda is now a college graduate who hopes to become an alcohol and substance-abuse counselor or some other kind of therapist. "After all my experiences, I want to help people so they don't have to go through what I did," she says. "I want to be a better mom."
Pathfinders is one of six substance-abuse treatment programs run by Hope Haven-Rebos United in Madison. The program has had about 300 clients since it began in 2003.
In 2007, the program ran checks of its graduates using an online court records system. It found that only 10% had relapsed to where they were again charged with crimes. Thus it claims a 90% success rate.
"We put the right people in the right places to do the work," says program director Bruce Nicholas. "We have people in recovery on our staff who have had their own problems with the law and addictions who make a real human connection.
"It gives clients hope when they see other people overcome problems and find success in life."
Under criteria developed by the Dane County Sheriff's Office, the program is open only to persons convicted of certain substance-related offenses, like drunk driving. The participants must volunteer and undergo an assessment.
Pathfinders consists of three phases. Phase one is intensive residential treatment at Hope Haven, 425 W. Johnson St., which combines education and therapy Phase two involves twice-weekly group sessions at the Chris Farley House, 810 W. Olin Ave., or North Bay Lodge, 3602 Memorial Dr., as well as individual counseling and case management. And in phase three, clients meet for group sessions once a week.
Nicholas says clients identify how they are affected by their substance abuse and develop an understanding of what it takes to maintain recovery. "We also examine a range of issues that could block recovery," he says.
The Pathfinders program last year received $150,000 from Dane County. In 2009, it will get $50,000 more, to increase the number of adults served from 50 to 65.
Nearly 50% of the people locked up in the Dane County jail in 2007 were there for drunk driving and other alcohol infractions, says Topf Wells, Falk's chief of staff. The annual cost of housing an inmate there is $29,400.
In contrast, says Lynn Green, the county's director of human services, it costs only $3,090 to treat a person in the Pathfinders program.
Rhonda turned to Pathfinders in 2006, on the advice of her attorney. Her road to recovery began with a 30-day stay at the program's 22-bed residential treatment center.
"They show you videos of what people in prison do when they get out," she says. "It's hard hitting. I didn't want to go to my own funeral."
Rhonda thinks Pathfinders worked for her when other programs did not because the counselors and fellow clients had stories very much like hers.
"The most important part of recovery is who you surround yourself with," she says. "I've met a lot of really neat people who have fun. We play cards. We laugh. We joke. We discuss relapse prevention and set up support networks. I like that counselors came back to me often and asked how they could help."u
HUGS, not booze or drugs
Program supports the parents of troubled youth
In December, "Tina" ended up in jail. She was 17 years old. A series of run-ins with the law - over shoplifting, truancy, drinking, smoking weed and gang activity - had finally brought her to the end of the line.
Her family saw it coming, but didn't know what to do.
"She's a smart kid, but she couldn't handle the school environment socially," says Tina's mother, an administrative assistant. "She started drinking at 14 and hung around with older boys who were gang members. Nobody thinks a girl is going to end up in a gang."
Over the last few years, the disruptions - middle-of-the-night phone calls, truant officer reports, police knocking on the door and emergency room visits - have taken their toll.
"I'm exhausted, tired and emotionally drained," says Tina's mother. "I'm certainly not the parent I dreamed I would be." She wants to be hopeful and loving, "but I'm protective of my heart. It's difficult to find balance."
Tina's parents (her father is a law-enforcement officer) examined a variety of inpatient and outpatient programs for alcohol and drug abuse in the Madison area. One that looked like it would meet their needs had a price tag of $10,000.
"Our insurance was already tapped," the mother says. "That was the clincher."
Finally a series of telephone calls led the family to Project HUGS (Have U Gotten Support?), an advocacy and support services program operated by Youth Services of Southern Wisconsin. It serves parents and youth involved in harmful behaviors, including substance abuse.
"I had heard about them at a PTA meeting, but at the time I didn't think I was in need," says the mother. "As soon as I called, I felt immediately relieved. I realized it wasn't just us."
The program recommended resources and went with Tina's mother to school to talk about the truancy issues. She considers this a godsend: "When you're advocating for your kid in instances like this, it's exhausting. You lose your confidence."
The county's 2009 budget includes $60,000 for Project HUGS, mostly to launch programs at Sennett Middle School in Madison and River Bluff Middle School in Stoughton. CUNA Mutual's foundation also provided a $15,000 grant to support the effort.
Falk says the middle schools that are taking part do not have worse problems than other schools, but are committed to addressing them head on: "I give them a lot of credit."
By the time most parents turn to Project HUGS, says program coordinator Stacey Slotty, they're at the end of their rope. "They are afraid they will be seen as bad parents. They're embarrassed. They want help, but they don't know where to go."
Since it began in 1985, Project HUGS has served more than 1,000 families. Participants attend one-on-one sessions with staff members as well as parent groups.
Through extensive interviews, advocates help parents design strategies to get their families through crisis situations. "We educate parents in how to communicate with their kids and other professionals," says Slotty, a single parent of three grown children.
Slotty points out that adults often deliver harmful messages about alcohol use. Alcohol is served at birthday parties, baptisms, tailgate parties and church festivals.
"There's such a casual attitude," she says. "We hope to raise the awareness of parents to improve family cohesiveness and communication and reduce drinking and at-risk behaviors."
Slotty also encourages parents to attend a series of free meetings open to all Dane County residents. Speakers discuss a variety of issues from relaxation tips to raising challenging children. For times and locations, email firstname.lastname@example.org.