At 10 a.m. on a Friday only a few people lay sprawled out on the black mats of the downtown Anchorage Safety Center, sleeping off the last of their drinks.
Most curl up into tight balls, covering their faces with heavy coats. Some stagger from the mats to the bathroom, flinging open the door and holding on tight to the frame and as they walk in. Some get up and grab sips of water from a nearby fountain before laying back down. Others are gently stirred awake by the emergency medical technicians at the facility, who not only check to make sure they're still breathing, but also to administer breathalyzer tests to see if their bodies have finally metabolized the alcohol that brought them into the facility hours before.
Many of these people are not unknown or uncommon to the workers at the safety center. As they filter in, the intake EMTs address them by the first names they already know. Francis. Augusta. Roger. Elena.
These people are part of the "Top 200" -- chronic users of the Anchorage Safety Center, a "title 47" facility that involuntarily holds those so drunk they pose a danger to themselves and the public.
Those top 200 often find themselves designated from the others, with their own breakout statistics on age, gender, and ethnicity.
There's good reason for that. For at least the last decade, the top 200 have consistently represented 50 percent of all safety center intakes. Of those, three-quarters of them spend 28 to 68 nights in the facility. The last quarter -- the "Top 50" -- use the facility even more, having anywhere from 69 to 188 stays in the sleep-off each year.
For the managers of the facility and those working in social services that address that population of chronic inebriates, there's nothing new about the top 200. Mark Lessard, emergency preparedness manager for the Anchorage Department of Health and Human Services, said he's known about the top 200 since he started working for the municipality in 1996.
"They panhandle for money, they're late stage chronic alcoholics, who are very medically fragile and they pretty much are not searching for shelter," Lessard said. "Obviously, they're spending a lot of time with us."
With a population so clearly identified, it seems logical that social service providers could easily target them. But ask any of them and they'll tell you the problem is complex, multi-faceted and without many clear-cut solutions.
Who are the top 200?
Per Alaska statute, the Anchorage Safety Center serves as a protective custody service for those who who are incapacitated by drugs and alcohol. The facility can hold people until they sober up enough to no longer be a threat to themselves or the public, or up to 12 hours. It operates on a $1.7 million contract to NANA Management Services, funded mostly through municipal funds and some grants from the Southcentral Foundation.
According to statistics from the city, the center counted 22,746 intakes in 2012, though those intakes represented only 3,415 "unduplicated clients." Lessard noted that the majority of users of the facility are only brought in once.
Lessard said for years the top 200 group has been described as the core group of homeless public inebriates. Statistics from the city paint a larger picure of what those people look like.
In 2012, three-quarters of the top 200 were men. Of that, 177 of them were Alaska Native, 21 white and four were either black or hispanic. Most fall within the ages of 30 and 60, with a quarter of the top 200 between the ages of 45 and 49.
Their average breath alcohol level at intake is 0.231, or about four times the legal drunk driving limit of 0.08. For a 180 pound man, that's roughly the equivalent of 11 drinks in an hour.
Kathy Olson, social services director for Bean's Cafe, the Anchorage soup kitchen that serves breakfast and lunch to hundreds of needy people each day, said the reasons people get to that level can be complicated. Many have mental illness and are self-medicating. Some have been kicked out of their villages for various reasons. Some come to Anchorage for an appointment and get stuck. Some come from the Lower 48 looking for work, but don't do "their homework" and fall into a cycle of homelessness and drinking.
"A lot of them just give up," she said.
Some just look at the safety center as another shelter, though Lessard made it clear that that's not the purpose of the facility.
"People are going there because there's nowhere else," said Terry Chubin, outreach supervisor for the the Rural Alaska Community Action Program, better known as RurAL CAP.
Starting soon, the Anchorage Safety Patrol will step up its game. Lessard said the municipality is just waiting for the city manager to sign off on the new NANA contract that would add an additional community service patrol van shift to the schedule. Historically, between 6 a.m. and 2 p.m. there has been no van patrol. Cops, fire fighters and paramedics generally bring people in during that time. With the new shift -- funded by a resolution from the Anchorage Assembly -- it means 24-hour van service for the first time in the program's history.
"The more of the calls we can take, the less calls that have to be responded to with the squad car," Lessard said.
Safety Center Manager Richard Gauntt said when police and the fire department get a call for a person "down," "99 percent of the time it's because of alcohol."
"You're tying up police with services that are better done through us," he said.
Lance Davis is an EMT who has worked at the safety center for the last seven years. He said on an average 8-hour shift, the vans will get 20 to 40 dispatches for pickups. The vans -- staffed with one driver and one EMT each -- are so busy with dispatches, they only do patrols on rare occasions.
Davis said there's no way to know what responders will find out on the street. Some like to play in traffic, he said. Most claim to be ex-Navy Seals or Army Rangers. Many work in the fishing industry and during the off-season end up drinking enough to end up in the center. Others are just out of Alaska Psychiatric Institute and are not taking their medications. Instead they self-medicate with alcohol. Many are in and out of jail. He said about 25 percent of all intakes are registered sex offenders.
"They're not the nicest people to deal with daily," Davis said.
Some days are slower, some are busy. During the winter, the facility can fill all 112 spots -- each person crammed in next to another. Others are more spread out. Some pickups can take hours to fill the van, other times the van can be filled in less than an hour.
Out on the streets
While the vans only respond, on a recent Friday, the spots they visited were familiar. Bean's Cafe. Benson Wal-Mart. Gambell Carrs. In just under 45 minutes, one van picked up six people.
First was a quick stop at Bean's Cafe, to find a drunk man with a brown leather jacket. The safety patrol didn't find him, but instead focused in on a man in a gray jacket, slumped over with his head between his legs. One of the officers gently roused him and got the man to blow into a hand-held BRAC -- Breath Alcohol Content -- reader. The man blew a 500 -- equivalent to just under 0.5 -- the highest level the machine will read, though the officers suspect he must have spit into the machine or had maybe just taken a shot.
As two officers hoisted the man into the van, another stumbled over and told them he was drunk. After a quick breathalyzer, he was in the van, too.
Another call sent the van to Benson Wal-Mart, where a couple was drinking next to the bus stop. The man was passed out in the grass next to an empty bottle of blueberry Smirnoff Vodka. It took two police officers and one safety patrol officer to hoist the man into the van, who had drank so much his eyes rolled back into his head and he had a wet spot on the front of his pants.
A woman, who identified herself as his wife, was able to stand and speak, but was still drunk enough to be taken into custody. As she got into the van an empty handle of R&R whisky dropped out of her backpack.
As the patrol assessed the drunk couple, a woman walked over to the safety patrol van. Officers immediately recognized her.
"Have you been drinking, Elena?"
She didn't respond right away. Moments later they gave her a breathalyzer. She blew a 350 and was loaded into the van, too.
Officers will tell you pick-ups like this are not uncommon. On Friday, officers had just finished mopping up the "safe room" a concrete room, it's walls weathered brown from decades of use. Moments earlier, an aggressive man had been put in the room and tried to beat in the steel door. His hands had lost that fight and officers had to clean up the bloodied door.
Gauntt tells new workers to be prepared for the worst of the worst. People will take their clothes off and try to masturbate in front of you. They will call you names and try to fight you. They'll drink any kind of alcohol: mouthwash, hand sanitizer, hairspray.
Davis said a man tried to light another man on fire in the center. Once he encountered a man who was eating his own feces and spitting it at officers.
"You've just got to roll with it and try not to lose your shit," Davis said.
What can be done
When it comes to options on how to help the chronic inebriates, the issue is as complex as the people who make up the population.
Susan Bomalaski, executive director for Catholic Social Services, said the Brother Francis Shelter -- a program of CSS -- had over 3,600 clients last year. She said chances are staff at the center have dealt with the top 200 many, many times. She said like the safety center, Brother Francis also has a chronic homeless population it serves, where about 20 percent of guests habitually use the program.
"You see something analogous there," she said.
Despite the resources that are available, for many chronic users of both the safety center and the shelter, there's a cycle that becomes hard to break.
She noted that programs like RurAL CAP's Homeward Bound program, Karluk Manor and the Anchorage Community Mental Health Services Pathways to Recovery alcohol treatment program have been helpful, but a longer, perhaps statewide approach would better serve the population. Bomalaski said she'd like to see the mayor host a homeless summit that brings in legislators and business leaders to talk about solutions.
"Everyone is trying little dribs and drabs, but we have have to address the cost to community," she said.
" … (W)e're letting people kill themselves and we're doing nothing to help these people. This takes some sort of law or something to change. Lets address it head on."
Bomalaski and Lt. Garry Gilliam, commander of the Anchorage Police Department's Community Action Policing Team, have both suggested that perhaps involuntary measures for some of the worst chronic inebriates could potentially help. Gilliam noted that per an Alaska Supreme Court decision, it's not a crime to be drunk in public, so criminalizing that behavior would be difficult. While some civil penalties could be assessed, similar to those for people who overuse police and fire department resources, it would probably be difficult to ever collect the restitution.
Still, he argues that something needs to be done.
"We have to intervene, for their safety and the safety of others," Gilliam said. "If they stumble into the road, it's devastating not only to them, but to the people involved. It's not just their lives they're affecting, its ours, too," he said. "That's the frustrating part about it."
For some, the issue comes down to personal responsibility. Lessard said that people can argue that there are not enough resources, but at the end of the day, even with all the resources in the world, it still won't motivate some to get the treatment they need.
"At the end of the day, too, alcoholism is a chronic disease," Lessard said. "You can't make someone get sober."
Contact Suzanna Caldwell at suzanna(at)alaskadispatch.com