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• A family's love changes one woman's life
• Alternative program employs practicality
• Kittery leads way in prevention by giving youths a place to go
• 'Low-risk drinking' can prevent a small problem from getting out of hand
• Problem escalates among women; elderly learn to reach out for help
• 1997 deaths related to alcohol
• Team of reporters, editors, photographer produced series
• Series summary: Maine pays dearly as families are ruined by alcohol abuse

Marilyn Twitchell knew things were bad when the creditors started showing up at the door.

The Serenity House, a 31-bed halfway house for alcoholic men in Portland, has been in danger of shutting down three times in its 30-year history for lack of money. Staff photo by David A. Rodgers

''We were so behind in our bills for July and August that we were close to closing this house down,'' said Twitchell, executive director of Serenity House, a 31-bed halfway house for alcoholic men in Portland. ''It was really scary. A guy came in and said, 'We're shutting the water off for nonpayment.' ''

Twitchell quickly worked out deals with the utility companies and the businesses that supply the house with food and other essentials, and those creditors let the bills slide for a couple of months. A fund-raiser in September raised about $10,000, and the staff at Serenity House breathed a sigh of relief. For now.

It was not the first time the 30-year-old halfway house, which serves 120 men each year, came close to shutting down. It happened in 1981, and again in 1988, when the house was just two weeks from closing its doors.

But things grew dramatically worse after the state took money dedicated to substance-abuse treatment and put it into the general fund. With the federal government making cutbacks, too, the decrease in funds hurt badly.

Then the Legislature cut almost $2 million from the budget of the Maine Office of Substance Abuse, an agency whose budget was already slim.

Over the past 10 years, the halfway house has lost approximately $50,000 in funding from various sources, and has grown a deficit of $20,000 to $25,000.

Serenity House's perennial budget troubles illustrate the kind of problems alcohol-related programs are having in a state that doesn't want to face up to its alcohol addiction.

Substance abuse experts say that when it comes to attacking the problem of alcohol abuse, Mainers and their policy makers often act like the family of an alcoholic pronouncing judgment on the offensive behavior of their drunken kin.

They don't want to spend any money on prevention programs that don't have an immediate payoff. They don't want to hear that treatment would be much cheaper than an unproductive life spent in jails, emergency rooms or on the streets, or that it could prevent unwanted tragedies.

Instead, there's a deep need to punish, even though that won't make the alcohol problem go away.

''They get enraged, and then they get vindictive and carry on, and it doesn't solve anything,'' says Dr. Stanley Evans, an addictions specialist in Portland. ''It doesn't change anything. You can't stop this with slogans and threats and locking people up. It doesn't work.''

Maine's alcohol plague can be addressed, but it will take a commitment to comprehensive programs of treatment and prevention, along with more participation by communities in addressing their own alcohol problems.

Repeated attempts at sobriety

Staff art. Source: American Health Magazine/Mothers Against Drunk Driving.

Seventy-eight percent of the Mainers who entered the state's addiction treatment system in 1996 said that alcohol was their primary substance-abuse problem.

Many of them are there because they have to be, because they have gotten in trouble with the law. Others have come at the prodding of friends and relatives.

It's not unusual for a person to make several attempts at sobriety before something inside ''clicks.''

''Sometimes it's spectacular,'' says Crissa Evans, manager of Mercy Hospital's Recovery Center program. ''It's a spiritual event, a spiritual awakening. And then other folks are sort of one step at a time.''

That's the way it was for Wayne Russell - one step at a time. If you could take a snapshot of the typical Mainer who comes into the treatment system for help, the portrait would look a lot like Russell: a man in his 40s, a veteran, a working family man whose drinking damaged his relationships and cost him more than one job.

Wayne Russell, a recovering alcoholic, now is a substance-abuse counselor at Serenity House in Portland, where he achieved sobriety after other attempts failed. Staff photo by David A. Rodgers

Prodded by his wife and his employer, Russell tried two different treatment programs before finding success at Serenity House.

Even there, he resisted at first. For the first two months of his five-month stay at the house on Mellen Street, Russell couldn't even bring himself to unpack his suitcase.

''Every morning when I got up I said, 'I'm going to leave today,' '' says Russell, who is 49. ''I was very, very unhappy, and the people in here were reaching out to me constantly and saying 'Come and talk to me.' ''

By his own account, before he got help for his drinking problem Russell was an angry man. Loud. Obnoxious. Rude. So in love with his scotch that he couldn't hold down a job or maintain a marriage.

Russell started to drink when he was 15 years old.

He had been a fair student, but eventually his grades started to slip and he gave up on his plans to go to college. He joined the Marines instead.

''Other than boot camp, I more or less drank my way through that,'' he said.

When he came out of the service, Russell went into the management training program at Kmart. He stayed with the company for five or six years, and in the early 1970s accepted a transfer to Maine.

But in Maine, his drinking cost him his job.

For the next 15 to 20 years, he bounced around from one management position to another and married three times. His longest job was at Valle's Steak House, where he stayed seven years.

One of the reasons Russell never consciously considered that he had a drinking problem was that he kept bouncing back from failed jobs and relationships. But there was a part of him that knew.

Whenever he started a new job, he'd try to control his drinking until he felt his position was secure. Then he'd start drinking again.

Eventually, he would start making excuses for why he couldn't come to work for a few days, ''even going so far as to say there was a death in the family,'' he recalls. Sometimes he just wouldn't show up.

When he wasn't at work, he was on a binge.

''There were a lot of mornings when I woke up and I would be sick from the night before and hung over, and I'd say I'm not going to drink today because I got sick yesterday,'' he says.

''But once you feel a little bit better in the afternoon, the craving comes back. And I'd end up drinking again that day, even though I knew I got sick the day before. It just wouldn't stop.''

Early treatment works best

''It's a pretty rare person who comes into treatment on their own because they recognize they have a problem,'' says Kim Johnson, director of Crossroads for Women and president of the Maine Association of Substance Abuse Providers. ''You would think that people would recognize that their lives are falling apart, but they just don't.''

It's best to nip the problem early. But doctors often don't have the time or the training to deal with someone they suspect has either a budding alcohol problem or an alcohol addiction.

''Alcoholism and addiction is probably the most misunderstood and misdiagnosed medical condition there is,'' says Dr. Scott Treworgy, director of the chemical dependency unit at St. Mary's Regional Medical Center in Lewiston. ''People treat the cirrhosis and the pancreatitis and the cancer that comes from alcoholism, but that's just treating the end-stage problem. You need to treat more up front, and recognize it early on.''

The National Institute on Alcohol Abuse and Alcoholism estimates that almost 20 percent of American adults are problem drinkers whose flirtations with alcohol have not yet developed into dependencies. Curbing their alcohol abuse before it gets out of control could be a key to solving Maine's alcohol problem.

Doctors at the University of Wisconsin Medical School published a study in the Journal of the American Medical Association in April that showed how powerful just a brief, early intervention by a family doctor can be.

The study found that two 15-minute interventions, spaced a month apart, reduced the average number of drinks patients consumed each week, as well as their binge drinking, by 20 percent or more.

At Maine Medical Center, standard substance-abuse questionnaires are being added to the many forms that are filled out when someone is admitted to the hospital. People whose answers suggest they might have a problem with alcohol will get a consultation with Patrice Roy, the hospital's substance-abuse specialist.

''We'll be able to catch people earlier on, before they hit the pancreatitis level,'' she said. ''It will save everybody pain, time and money.''

Roy also tries to impress upon the doctors, nurses and residents at the hospital how important it is that she be called in to talk to people who have shown up at the hospital with injuries that are possibly alcohol-related, even if she's already met with them four or five times.

''It's important that I see them the sixth time and the seventh time,'' she says. ''Because you never know when something's going to click. Nothing's ever hopeless. This isn't a hopeless disease. People do get better, people do recover and people do stop. It's just a matter of when.''

Wayne Russell first tried to get help in 1988, after he had lost 40-50 pounds.

He didn't have any insurance, so when his wife pleaded with him to do somethng about his drinking, he went into the detox program at the Arnie Hanson Center in Portland.

He stayed sober for six months before he started drinking again.

About two years later, he tried Westbrook Hospital, at the insistence of his latest employer, L.L. Bean. That was a 14-day program, and counselors there suggested that he go into Serenity House afterward for more help.

''I said, 'No way,' '' Russell recalls.

When he went back to drinking, he lost his job at L.L. Bean. He left there with $8,000 to $10,000, and for the next six to seven months he stayed at home and drank until the money ran out.

During that last six months, he was drinking a gallon of scotch a day. When he got down to his last half-gallon, he'd go out and buy some more to make sure he never ran out.

By now he was physically sick all the time. He had the shakes and constant headaches when he wasn't drinking. There was an unending burning in his stomach, and he had constant heartburn. In the mornings, he'd throw up blood.

When he ran out of money, he called the VA hotline for help. Someone from the VA came to his house and started talking to him about his drinking and taking him to AA meetings. The person knew one of the counselors at Serenity House and arranged for Russell to have an interview there.

The way Russell saw it, he had little choice.

''I thought, geez, I'm out of money and I have no place to go,'' he says. ''Either I have to go back to work or I had to find some way of making money. I guess I wasn't real honest about my motives in coming in here as far as wanting to recover. It was just kind of a safe place to rest for a while.''

Programs see shift

Once, most people who needed treatment were placed in 28-day residential programs and left there until their insurance ran out. Then they were shoved back into the ''real world'' to sink or swim, sometimes with little follow-up.

Now managed care limits the amount and kind of therapy it will pay for, generally favoring outpatient treatment over residential care. And group therapy is favored over individual care.

It's not just finances that have driven the changes. Research has shown that the type and cost of care are not as important as the quality of care and the length of time someone sticks with a structured program, whether it's inpatient or outpatient treatment.

Today, recovering alcoholics may still spend some time in the hospital if they need to be medically supervised while they go through withdrawal. But alcohol treatment is no longer ''one size fits all.''

''Drinkers come into treatment systems with a whole variety of symptoms, and the idea that they're all sort of at the end of the road is a myth,'' says Robert Dana, a substance-abuse researcher at the University of Maine.

For most people, a trip through the system means shorter stays, more time making the transition back to their everyday lives, and treatment plans that are tailored more to individual needs.

One person may need just a weekly group session, while another may need to come to an outpatient program for a few hours each day. That kind of schedule gives them a chance to go home at night and see what kinds of problems come up around their drinking, then come in and discuss it with a professional.

''We've actually extended the amount of time we're working with people; they're just not living with us anymore,'' says Guy Cousins, therapy supervisor at The Recovery Center at Mercy Hospital.

Cutting back on 28-day residential programs has made care more efficient and effective in a lot of ways. But it hasn't been good for everybody. For example, there are few residential services in the state for adolescents who need them, notes Lynn Duby, director of the Maine Office of Substance Abuse.

''There are still a significant number of kids for whom residential treatment is the best option,'' she says. ''And if that's where you are, the availability is limited.''

At Serenity House, most of the clients are homeless or near-homeless. They don't have insurance, and most are unemployed. Without a bed at the house, ''probably most of them would be on the street,'' Marilyn Twitchell says.

It costs only $2 a day - about the price of a single beer in a bar - to care for one man who comes to Serenity House for help. Even the clients chip in: Once they are sober enough to start working, they are required to give up to a third of their net income to the house for their upkeep.

Five years ago, the halfway house's clients got all of their basic education about alcohol in the residential programs, then came to the house on Mellen Street for guidance in getting back to work, setting up a social support system and gaining a strong foothold in AA.

Now that most residential programs have closed down, programs like Serenity House have had to take up the slack - but with less money.

''We've had to do a whole lot more with a whole lot less,'' says Tim McBrady, the house's program director.

Twitchell and McBrady have restructured the way the house works, merging four staff positions into two, with each of them taking on extra duties. There are now only two fully licensed counselors on staff.

The staff, many of whom have worked there for years, has been taking the brunt of the budget problems. Determined not to cut their clients' services, they gave up their own retirement benefits. And every year, they go shopping for cheaper health insurance.

Serenity House isn't the only facility that has had trouble making ends meet.

After the Legislature cut the Maine Office of Substance Abuse budget two years ago, 1,600 to 1,800 people were left without any place to go for help.

''We've had a few agencies who hung in there, tried to continue to provide services at the same level and got themselves into some pretty substantial financial problems,'' Duby said.

Duby's staff is working with treatment providers to try to help them become more efficient. They are encouraging the use of group therapy, for example, because it is cheaper to work with many people at once than to give everyone individual help. They are training alcohol counselors to do shorter interventions where it's clinically appropriate. And they are encouraging programs to work with each other and share resources.

They also have been working on ''needs assessments'' to make sure the dollars the state allocates for treatment and prevention are going where they're needed most.

''Everybody wants measured outcomes for what they're putting their money into,'' says McBrady, the program director at Serenity House. ''But it's hard to measure success in this field because what you do today might not have an impact next week. But it may have an impact in three years.''

He points to a former client he bumped into recently. After he left Serenity House, the man started drinking again, and McBrady lost touch with him. He hadn't seen him in five years.

The man saw McBrady in a store, and walked up to thank him.

''Every time I picked up a drink for the next two years (after leaving Serenity House), something that you said to me stuck in my head and you absolutely ruined my drinking forever,'' McBrady recalls the man saying.

Scared to be sober

He calls it being ''stark raving sober'' because when the alcohol is taken away, all of the difficult feelings that were once buried inside the bottle begin to surface.

After he came to Serenity House in 1993, at age 45, it took him a couple of months to realize that maybe he needed to feel that pain - the anger, anxiety, depression, remorse and guilt - that he had tried to drink away.

''Sobriety is horrible,'' he says. ''It's horrible.''

Russell wasn't allowed to work for the first 30 days at the house, but six weeks into the program he went to the Hampton Inn in South Portland. He told the housekeeping manager the truth about his past and asked for a ''mindless'' job.

The manager hired him to do the laundry, and he worked so hard at it he eventually worked his way up to special projects manager.

Russell stayed at Serenity House more than five months. But after 30 years of drinking, he was still somewhat shaky and not yet ready to be on his own. So he stayed in a ''three-quarter-way house'' out back for another 18 months.

After he left Serenity House, Russell kept working at the hotel. Then he started volunteering at the halfway house on weekends, answering the phone and talking to clients. He did it as much for himself as for the men who needed help.

''I could see people starting off in the program where I was and where I didn't want to be again,'' he says.

A year and a half ago, Serenity House offered him a full-time job. He's since become a registered alcohol and drug abuse counselor and will be going back to school in January to work toward becoming a state-licensed counselor.

He's now working as the employment counselor at Serenity House. He lives in an apartment with another recovering alcoholic who went through the Serenity House program with him.

Although he is now sober, he still has a healthy respect for alcohol.

''I still try not to put myself into certain situations,'' he says. ''I don't hang around bars, obviously. That's crazy to do that. I used to move away from people I could smell alcohol on when I was at a major event. I used to avoid the liquor aisle in Shop 'n Save. And now it's not quite so bad. I can walk down those aisles and not be tempted.''

'Not an easy thing to do'

Although the decision to drink may have started off as a choice, notes Lynn Duby, once addicted it's hard to stop.

''People think that you just make the decision (not to drink) and then you just sort of go on,'' she says. ''And it isn't like that. It's an ongoing decision that you have to make all the time. And it's not an easy thing to do.''

That's why structured treatment programs are so important, she says: They help people make that decision not to drink every day.

Others believe Maine's effort to stop alcohol abuse should go even further if there is ever to be any hope of kicking Maine's addiction to alcohol.

While we shouldn't abandon people who need treatment, says Robert Dana, the university researcher, we should be putting more effort into prevention so people won't get into trouble in the first place.

And everyone should take a good, hard look in the mirror.

Alcohol abuse and alcoholism in Maine isn't going away, Dana says, ''because we hold onto these moral, reformative models that say, 'It's about them, it's not about us.'

''I think, frankly, that substance abuse is sort of barometric of the culture,'' he says, ''and it's about all of us.''