An ER alternative for substance abusers in Cambridge


It's late afternoon, and inside this emergency shelter for people with drug and alcohol problems guests are lining up, waiting to find out which bed they'll sleep in tonight. From behind the front desk, Bob calls them up by name, assigns a bed by number, and hands each a bundle of sheets and a towel for the night.

"Eleanor, bed four!"

Bob, who didn't want to give his last name, used to be on the other side of this desk. But 13 years ago, he got sober, and went to work in a shelter. He's been at this one in Cambridge, Massachusetts, for a few years. And he knows what his guests are going through, how a safe place can give some the opportunity they need to escape a powerful cycle.

"I've seen a lot of deaths from substance abuse. It's not an easy thing to battle."

For some, addiction is a seemingly endless battle. Doctors recognize it as a disease that's chronic, progressive, and often fatal. And it's greedy: addiction can take everything - your health, your home, your hope. That's where this place comes in. Wilfred Labiosa leads the tour.

"So this is the area, this is where they come in to check in..."

Labiosa heads the Cambridge and Somerville Program for Alcoholism and Drug Abuse Rehabilitation, or CASPAR. It's a place ambulance drivers can take the drunk or high people they pick up, instead of dumping them off at the ER. Unlike most other shelters, they're welcome here no matter how intoxicated. When guests first arrive, they're offered a meal, plenty of fluids, and a bed. And when they're stable, counselors and case managers reach out. They offer whatever services makes the most sense-anything from inpatient treatment to a sober living house. But the first step is usually sleeping it off.

"So we're just going to stay here because there are people sleeping it off. So this is the men's side..."

They can do that here, in this room off the main dining room. Labiosa pulls back the curtain on a dimly lit dorm lined with rows of cots with bare plastic mattresses, waiting for the night's occupants.

Rhode Island officials visited CASPAR earlier this year and liked what they saw. Creating something similar might help battle Rhode Island's growing problem of a small group of high frequency users of emergency services. Labiosa says CASPAR has helped Cambridge do just that. Staff nurses keep tabs on new arrivals. And those who have stabilized can sign up for an appointment with a doctor to take care of less urgent medical needs.

"We have two examination rooms..."

How long each guest stays varies. But Labiosa says for most it's between two weeks and two months. It's much cheaper than repeated trips to the emergency room. In Rhode Island those trips can climb to more than a thousand dollars. Each guest here at CASPAR costs about $49 dollars a day, on a budget of $1.3 million a year. Labiosa says the program has been around for 20 years not only because funders believe it's a good investment. But also because they're paying for more than a place to sleep it off. Labiosa says every day, an outreach team called "First Step" scours the city for clients.

"Staff go out in pairs. And they talk to them, try to reach individuals, telling them about services."

They've got a van and they're ready to take people back to the shelter. Not everyone is willing to come along the first time. But once they're in, Labiosa says his staff can start connecting guests with the services they need. Staff members assess each guest, and let them know there's help if they're willing to take it. Labiosa says recovery can be a slow process, different for everyone.

"It might not be the first day, it might not be the second day. But it might be in the first hour."

Of the nearly 750 clients the shelter sees a year, most move on to some kind of treatment. A small percent stay longer than two months. A few, Labiosa says, get stuck.

"We have had a lot of success stories. And we have had other stories of people who really feel so comfortable here that they have made it their home, unfortunately, because they don't have family, they don't have friends."

That's a small percentage, he says. And to his neighbors across the state line, he gives this advice: don't worry.

"Because these individuals are just seeking a safe place to get clean and sober and seek the services they need. And really less than one percent are going to consider it a home."

Plans for a pilot in Rhode Island are due December 31st. Then the General Assembly must decide whether to fund it.

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