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Sunday, April 18, 1999
Copyright © Las Vegas Review-Journal

DRINKING GAMES

As a 24-hour, free-booze city, Las Vegas contributes to substance abuse lifestyles, but most agree it is not the cause of addictions.


     Kevin Mills has lived here all his life but still is amazed at how little tolerance the city has for weakness. The restaurant owner has told some former employees to leave town. If you have any sense, he tells them, just get on the next bus and kiss this place goodbye.
      In 1991, he purchased the Omelet House on West Charleston Boulevard and inherited a group of employees more interested in getting stoned than doing their jobs, he recalls. Out of more than 20 employees, only about three were not abusing drugs or alcohol.
      Those who were abusing stashed alcohol in the back delivery area or came to work looking as if they'd slept in their clothes, he says. They were given a few chances to straighten out, but most of them never did. Find another place to live, Mills would tell them. This is not a town for the feeble.
     



     "One of the things that prompts us to pick our addictions is loneliness, and that can happen if you move from Las Vegas to Florida.
     
     Tracy Kaye, who operates two Christian-based
     Las Vegas halfway houses for recovering addicts
     

      Three years ago, Mills raised his wages, hoping the move would attract clean and sober job applicants, and adopted a drug and alcohol abuse policy. Prospective employees now are required to take a drug test, and those suspected of using also can be tested. But even last year, months after the policy was adopted, he fired 11 employees because of substance abuse.
      "I think these are good people if they weren't involved in this type of crap.
      "It's not just the drugs and the alcohol. That's their personal thing. It's the peripheral effects. ... And the town takes them like a piece of chewing gum, pops them in, takes all the flavor out and spits 'em out."
      Las Vegas is a city like no other. It relies on the nation's need to party, take chances and stretch the limits even just a little, even for a moment. But does this trickle down to residents, either causing the habitual use of drugs and alcohol or fueling addictions that already exist?
      Treatment experts know addiction comes with the person. Scientists have confirmed that the addictive brain is different from the nonaddictive brain. In other words, there is a physical predisposition to addiction, so it's just as easy to get hooked on drugs and alcohol in a small Midwestern town with no casinos, no 24-hour bars.
      "I want to sort of dispel the myth that alcohol causes alcoholism, because it doesn't," says Mel Pohl, service director for Charter Hospital's addictive disease program. "Long before they ever take their first drink, there is a difference in somebody who's got alcoholism or drug addictions from somebody who doesn't."
     

     "You know, you can go into casinos with $2 and you can drink -- say you're on methamphetamine and you're drinking, you could stay there for three days. It's been done. It's done all the time."
     
     Katherine, who counsels pregnant substance abusers
     for the Healthy Families Project
     

      Whether a person is living in Las Vegas or not, they are going to be exposed to messages that glamorize the use of substances such as alcohol, adds Ron Lawrence, executive director of Community Counseling Center, which provides treatment services.
      "The issues are the same as that person who lives in a nongaming community and has a corner bar and beer commercials on TV all the time. It's the same stuff, and in that way it's no different. So we have to look at the vulnerability that person expresses.
      "We have people in recovery, I mean, God bless, I have cocktail waitresses that are treated in this agency that are in recovery that do not drink. They manage to make that separation. They go out and serve the tourists. They do very well in hotel-casinos. They do not touch a drop. It's recovery. It's the ability to make those delineations between indulging and serving."
      Statistics do not necessarily point a finger at Las Vegas, either. There are no current data that actually compare cities or states based on the number of residents abusing alcohol or drugs.
      Nevada consumes more alcohol per capita than any state in the country, according to recent studies released by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. But these figures include sales of beer, wine and liquor to casinos, which means a significant portion of the alcohol is being consumed by tourists.
     

     "Some people have a genetic predisposition toward the use of alcohol and the behavior of alcohol. ... If I can break the cycle on the father, maybe the son won't emulate (the father)."
     
     Chief Deputy District Attorney Gary Booker,
     who oversees treatment of drunken drivers
     

      There are data that compare states as far as alcohol-related traffic deaths and mortality. A National Highway Traffic Safety Administration report shows that Nevada had 160 alcohol-related traffic fatalities in 1997, fatalities in which either the driver or pedestrian had a blood-alcohol concentration of .10 grams per deciliter or more. This represented about 46 percent of total traffic fatalities that year. Only seven other states had a higher percentage of alcohol-related fatalities.
      Another study, State Trends in Alcohol-Related Mortality, 1979-1992, from the National Institute on Alcohol Abuse and Alcoholism, looked at deaths caused by the use of alcohol. It included dozens of conditions such as cirrhosis of the liver and alcoholic gastritis, as well as accidental poisoning, suicide and traffic accidents. According to the study, 41.2 per 100,000 Nevada residents died of alcohol-related causes in 1992. Only five states had a higher rate: Alaska at 51.2; New Mexico, 48.1; Mississippi, 46.7; South Carolina, 43.6; and Louisiana, 41.6. The District of Columbia topped all 50 states at 75 percent.
      While these rankings are disconcerting, they do not necessarily make a connection between the very nature of this 24-hour town and substance abuse. Even recovering addicts give mixed opinions on whether Las Vegas life makes it difficult to stay clean.
      Tracy Kaye, a native Las Vegan, started drinking by the time he was 12. By 17, he was downing shots of 151-proof liquor every day. After a monthlong binge in 1996, a binge that left him about $4,000 in debt at local bars, he finally sought help. He has been sober ever since and has opened two Christian-based halfway houses, the House of Tom and Bud's Light House, for recovering addicts who need shelter while turning their lives around.
      Kaye, 39, sees no link between the town he grew up in and his cravings for alcohol. A dealer by trade, he is surrounded by alcohol for hours at a time but no longer drinks. An alcoholic can drink anywhere, not just in Las Vegas, he says.
      He does, however, understand how the throng of workers moving to Las Vegas, those who see it as the land of plenty, can get lonely and try to escape through drugs and booze. Some of them end up in his halfway houses.
      "I'm certain that there are people that come out here, who move out here, and they're not addicts. They move out here and might develop an addiction. One of the things that prompts us to pick our addictions is loneliness, and that can happen if you move from Las Vegas to Florida. Hungry, angry, lonely, tired ... those are the things that prompt us the easiest.
      "If you're a smoker and you're hungry or you're lonely, you want to pick up a cigarette. That's an easy analogy to understand. Well, the same thing with alcohol or whatever the addiction. All addictions are the same. Their primary purpose is to take our life."
      There are others, however, who say the 24-hour bars and the constant flow of free drinks at the casinos are definitely a danger. They say Las Vegas' partying atmosphere certainly can make it harder to take the giant step into sobriety, and gambling is just another habitual behavior that adds fuel to the fire.
      Katherine, who asked that her last name not be used, started drinking at age 9. By the time a judge finally forced her into treatment 18 years later, she was drinking and using methamphetamine, cocaine, marijuana and downers.
      She doesn't blame the city for causing her addictions. She grew up in a family soaking in it; her father died from alcoholism when she was 16. But the memories of sitting in a string of Henderson casinos for hours on end and drinking free booze still haunt her. Once, she played for 2 1/2 days straight, just sitting there tweaked on methamphetamine and drinking alcohol.
      "You know, you can go into casinos with $2 and you can drink -- say you're on methamphetamine and you're drinking, you could stay there for three days. It's been done. It's done all the time," Katherine says.
      She now works for the Healthy Families Project, counseling pregnant women who are using. She also speaks to groups around town about the effects of addiction and the vital role treatment plays in helping addicts get their lives back.
      It is easy, Katherine says, for some addicts to slip back in Las Vegas. Casinos and 24-hour bars are not the causes of their addictions or relapse, she says. But they are an enticement. She has watched friends go into the casinos to cash their paychecks, sit down at a machine and start drinking again.
      "Everywhere you go there's a memory," she says. "Whether you've been at that casino or not, it's there, it's alcohol. It's like, come and get me, come and drink me. They glorify it. They glorify it."
      The Rev. Bill Shumate of Grapevine Fellowship Church also contends the connection between Las Vegas and substance abuse is as obvious as the sea of clanging slots and cocktail calls. Shumate, who stopped using drugs and alcohol before moving to Las Vegas in 1992, works with parishioners who are in the midst of addiction and want to get help. About 70 percent of Grapevine's 850 members are current or recovering addicts, he says. Over the years, the church has become a haven for those struggling with addiction.
      "Once you cross the line from substance abuse to addiction, it doesn't matter where you go. You're gonna find it. But I'm just saying here, in the city of Las Vegas, we have an environment that allows all of that to be met pretty easily. It's not in other cities.
      "I've lived in New York City. I've lived in major cities all around the country. It's there, too, but it's just not like Las Vegas. This is an open environment. ... Here you can get a roll of quarters, and if you're an alcoholic, and even a down-and-out alcoholic, with a roll of quarters you can go get high every day. It's all that you need."
      This doesn't mean residents of Las Vegas ignore the issue of substance abuse, he adds. When a city runs on gaming, you try to balance the dangers and the advantages as best you can.
      "Outside of all that there's a community here. It's a pretty conservative community. It's people who care about other people, who care about these issues. ... The school district is very, very up on drugs, the DARE program, so there's a community here that is almost in total opposite, in a sense."
      Indeed, anyone who needs support in Las Vegas can find it. There are, for example, more than 600 Alcoholics Anonymous meetings and 70 Narcotics Anonymous meetings each week.
      "People come to Vegas and expect it to be very crazy here, but we have a very strong fellowship," says "Tom," a longtime Narcotics Anonymous member who asked that his real name not be used. "They just don't expect it to be so together, so rock solid."
      Most of the major Strip casinos also have proactive employee assistance programs. Mirage Resorts Inc., for example, allows employees to take up to six months' leave for inpatient substance abuse counseling. The company health plan also offers generous coverage for outpatient counseling for both workers and their immediate families.
      "Those of us that are involved in substance abuse treatment and prevention get a lot of, I'll call it, cooperation from the resort industry in that they have employee assistance programs," notes Lawrence, who also is southern vice president of the Nevada Association of Drug and Alcohol Treatment Providers.
      "Some hotels do random drug testing at frequent intervals, and they will mandate that person to treatment on the basis that they get to keep their job if they get treatment. So the way I see it, the fathers of the community want a healthy, substance-free, active, vital work force."
      But while support groups are thriving and the city's major industry is looking after its employees, treatment services are lagging behind. There are a string of publicly funded programs such as the Community Counseling Center, Nevada Treatment Center, the Economic Opportunity Board and Westcare that provide inpatient or outpatient assistance, not to mention private hospitals such as Montevista and Charter. But there still is a shortfall.
      According to a study, "Estimating Substance Abuse and Treatment Need in the State of Nevada," by the Center for Applied Research at the University of Nevada, Reno, about 13 percent of Nevadans suffer from substance abuse. Most of them are addicted to alcohol. Marijuana is the next most frequently used substance, followed by stimulants and cocaine. About 93 percent of those abusing at the time of the study had failed to receive treatment by the time the report was released in June.
      "We have reached the conclusion that in Nevada there is a significant need for increased educational efforts, including prevention, community outreach and expanded treatment availability," the report states. "Finally, there is an urgent need to increase the availability of treatment services throughout Nevada. This is especially true for outpatient treatment, but there are also significant shortages in terms of the availability of residential and detoxification treatment services as well."
      Last year, about 9,000 Nevada residents received treatment from publicly funded programs.
      "I think we could easily say that you could take that figure and immediately add 5 percent to 10 percent and we'd still just be meeting the need," says Rob Johnston, acting chief of the Nevada Bureau of Alcohol and Drug Abuse, which is a major funding source for many of the state's treatment programs.
      "We fund 13 treatment programs in Southern Nevada that offer outpatient counseling, day treatment for families, long-term residential care for men, women and youth, to programs specifically targeted to pregnant women and women with children to methadone programs. So we've actually covered the whole gamut, which is part of our salvation and part of our problem at the same time in that we have a little bit of everything and not enough of anything."
      One of the best indications of this problem is the backlog of people trying to get into treatment programs, Johnston notes.
      "In some cases you cannot get them in fast enough. I may be able to get somebody in for an assessment interview, but if they need a bed, it could be a three-month wait at a good many of our facilities in town. And the goal is that when somebody calls in for help, you want to be able to engage them as quickly as possible, and so if we can at least get them involved in some kind of counseling, even while they're living at home or with friends, until we can get them the level of care that they need, that tends to be what occurs right now."
      Outpatient treatment is not immune either. A few weeks ago, about 250 men and women were waiting for their intake interviews at Community Counseling Center, Lawrence says. Those on these lists usually have to wait about two weeks for their interviews, he adds.
      In addition to the expansion of services, Las Vegas needs a centralized referral system so people can be led to the right programs, Johnston says. There also is a great need for supervised transitional housing that does more than provide a roof over someone's head, he says.
      "I would like to see those places expanded so that we have certified staff who are kind of running those facilities so that you could build in more of an employment component, more of a case management kind of approach so it's not just going to bed and going to an AA meeting.
      "They need a sense that it'll get better. They need to have this sense that no matter what has happened, their lives can turn around. And part of the recovery process is such that it doesn't get better all at once. For many people, the drinking and the using has just been a symptom of other issues, and they've never had any time where they haven't been under the influence. ... To me, a supervised transitional living environment gives us that safety net that right now I don't think we have."
      While the major casinos have strong employee assistance programs, there are many small businesses that have nothing set up at all, Lawrence adds. This is a danger because employers hold a unique position. They can give workers some of the tools, such as insurance programs and leave time, to break the cycle, he says.
      "The theory behind this type of intervention is that a work force that can heal, and really be in a recovery mode and be strong that way, is much better than bringing employees in and throwing them out on a continuous basis, because if we do that, we can only be perpetuating the problem," Lawrence says.
      There have been strides, however.
      Local coalitions, city and county representatives and community leaders are working closer to address the problem of substance abuse on a communitywide basis, Johnston says. "I think we're in much better shape than we were five years ago in terms of at least who is all at the table and who is talking to one another."
      Even the criminal justice system is starting to take a different approach. The year-old Serious Offender Program run by the district attorney's office, for example, is trying to stop the cycle of habitual drunken driving by using treatment as the major component.
      The program takes offenders with three drunken driving convictions and, instead of placing them in prison, places them under house arrest. A breath interlock device is placed in their car so they cannot drive the vehicle under the influence. But in addition to the monitoring, they are required to join Alcoholics Anonymous and attend both an individual and group counseling session each week.
      According to Chief Deputy District Attorney Gary Booker, who oversees the program, every time a person is caught driving under the influence, there were an average of 75 previous instances they drove drunk without being discovered. The Serious Offender Program is aimed at getting the offenders off alcohol for good, something a jail sentence cannot do for some of the most chronic abusers, he notes.
      "Some people have a genetic predisposition toward the use of alcohol and the behavior of alcohol. ... If I can break the cycle on the father, maybe the son won't emulate (the father) and say, `Well, I don't want to do this. It will be unacceptable,' " Booker says.
      Booker's view is, perhaps, the linchpin in all of this, according to local treatment experts. The point may not be whether Las Vegas fuels addictions to drugs and alcohol. No matter how a person gets to the point of chronic use, a community has to look for solutions because addiction reaches most of us, somehow.
      "It's estimated that for every alcoholic there's four or five people that are affected by that alcoholic," Pohl says. "Typically it's families, but if there's someone who works with them, function is diminished when somebody's got alcohol or drug dependence. They don't work as good, they don't love as good, they're not as good parents, they're not as good friends, they're not as good children in terms of their ability to do the normal functioning things.
      "There's a sense of morality attached to addiction, like you're a bad person," he adds. "Hey, if you're a diabetic, people don't say, `bad diabetic.' The culture really judges people for their drug and alcohol addictions."

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Estimated percent of traffic fatalities in which alcohol contributed:
1. District of Columbia: 58.5
2. Rhode Island: 54.6
3. Texas: 49.8
4. Puerto Rico: 49.5
5. North Dakota: 47.8
6. New Hampshire: 47.7
7. Massachusetts: 47.4
U.S. average: 38.6
8. Nevada: 46.2
Source: National Highway Traffic Safety Administration, 1997 (Statistics gathered by National Center for Statistics and Analysis)

Alcohol-related deaths
(per 100,000 residents)
1. District of Columbia: 75
2. Alaska: 51.2
3. New Mexico: 48.1
4. Mississippi: 46.7
5. South Carolina: 43.6
6. Louisiana: 41.6
U.S. average: 33.6
7. Nevada: 41.2
Source: National Institute on Alcohol Abuse and Alcoholism, 1992.

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