Two rivers run through Great Falls, Montana, but one of them is nearly invisible. The Missouri River is the most obvious. It attracts boaters, water skiers, and swimmers. Canadian geese paddle on its surface and parks with picnic tables line its shores. Meriwether Lewis and William Clark explored it with the Corps of Discovery two centuries ago, and maps chart the current course of this river.

Less visible is the river of alcohol that is trucked daily into Great Falls and sloshed down nightly in its many watering holes. But this is something that we all grew up with and we take it for granted.

I wanted to explore this invisible river because I have been observing its effects all my adult life. Every newspaper editor and reporter sees the flotsam and jetsam of that stream - divorces, lost jobs, battered wives and children, crime and convicts, drunken drivers, car wrecks, and medical bills. It's just that we're all so accustomed to this debris underfoot that we rarely wonder why it's there - or if it's necessary.

That's why the Great Falls Tribune launched a 12-part series of stories - one segment a month for the calendar year 1999 - devoted to alcohol abuse. We called it "Alcohol: Cradle to Grave." It went on to win a Pulitzer Prize for explanatory reporting in 2000, and with some additional material, it is now available as a book by the same name, published by Hazelden. It proved enlightening for our readers in a number of ways.

First, many people were not aware of the prevalence of alcohol in our society. The first month looked at one day in the life of Great Falls, starting at dawn in the Rescue Mission, moving into a D.A.R.E. classroom at 8:30 am, the "suds and soaps" hour at a local bar at 9:30 am, Alcoholics Anonymous at 10 am, a recovery center at 10:30 am, municipal court at 11 am, a bartender training class at 11: 15 am, and so on. During the evening, I rode with a police officer who handled eight calls, all but one of them involving alcohol.

Second, many folks didn't know that alcoholism is a medical disease. I spent the second installment of the series looking at the genetic and the environmental reasons that some people are predisposed to drink. We talked about the importance of neurotransmitters such as dopamine and serotonin. That was also where we introduced Bill Broderson.

Broderson, who was then 49 years old, had lost 25 pounds and was down to 137 pounds as he sat in the Benefis Healthcare detox unit. His hands were shaking, his liver was shot, and his eyes were as round and glassy as a calf's.

"He is not trying to drink himself to death," said Dirk Gibson, the addictions program supervisor at Benefis Healthcare. "He just can't stop."

In fact, Broderson had been through the state's chemical dependency centers in Galen and Butte more than 50 times. He couldn't count the number of other 30-day treatment programs to which he has been committed. Although alcoholism is a medical illness, Broderson has no job or insurance ? and treatment isn't cheap.
Benefis writes off the cost of Broderson's detoxification treatment, which runs $400 to $500 a day. Most of the Montana Chemical Dependency Center funding comes from a state tax on alcohol, but an average visit can still cost a person $3,000 to $4,000.

There are reasons for Broderson's uncontrollable drinking. His childhood was stressful and alcoholism runs in his family. His parents divorced when he was six, he said, and he ended up in the Deaconess Children's Home in Helena. At 14, Broderson started drinking. He dropped out of school, lied about it, and spent as much time as he could on the golf course with a 12-pack of beer tucked away in his cart.

"There was always alcohol in his home," said Hal Harper, former minority leader of the state House of Representatives and Broderson's best friend during junior high. "I think he just got sucked down the tube."
By his 20s, Broderson was having blackouts. "I woke up in Idaho once and had no idea in hell how I got there." But he didn't think he had a problem.

"We fed him whenever he showed up, but we never gave him money," said Harper. "Companionship only goes so far, though, and when he needed another drink, he'd take off."

Through the years, Broderson has made many attempts to quit drinking, he said. Even as he sat in the hospital, though, Broderson was craving whiskey.

"I need a shot," he said softly. "There's a guy on my shoulder who keeps saying, 'No,' but the guy in red on my other shoulder, he has a louder voice or something." Harper sees it as a human tragedy.

"If he could have gone down a different road, who knows what he could have done," Harper said. "He was smart and popular with the girls because he was so cute. He could have done pretty much anything he put his mind to. But now, it's just amazing he's still alive."

By putting a name and a face to alcoholism, we made it real for our readers. There was such a positive response to Bill's story that I kept track of him for the entire year, providing a monthly update - and it was quite a year.

Bill tried to quit drinking, then fell off the wagon and ended up living down in the weeds by the Missouri River, where he awoke one morning with rats crawling all over him. When he realized they were DTs, he went back to treatment. He had several months of sobriety in which he was bored to tears, then won Social Security Disability benefits and used $2,000 of the lump payment to buy a small trailer. He hoped to live out along the Rocky Mountain Front, watching deer and elk trip through his front yard as he sipped coffee early in the morning with a black lab beside him. Unfortunately, he fell off the wagon again and pawned his trailer for $200 in a bar. Having sold his dream, he ended up in the detox center again at year's end. Because of the stigma attached to alcoholism, it's unusual for a newspaper to write about its victims by name. We did.

By identifying alcoholism as a medical disease, we reduced the stigma associated with it. We were convinced that the only way our readers would find the stories believable was if they knew they were reading about their neighbors, people they could identify with names, addresses and pictures. That also fit into the treatment program for recovering alcoholics by requiring them to take responsibility for their lives and giving them an opportunity to share their stories in the hope of helping others.

One of the elements to these stories was to show the human toll that alcoholism takes. One local counselor, Wava Goetz, began to review the 700 cases she had handled over the past five years and came to a stunning discovery. She found that alcohol was a factor in two-thirds of those cases. "Without alcohol, I'd probably be out of business," she told me, "and that would be a happy day."

Another key element of this series of stories was trying to estimate the cost that alcohol abuse inflicts upon our society. I spoke with welfare workers who estimated that half their caseload was so impaired by alcoholism that they couldn't work. The U.S. Department of Labor estimates that alcoholism costs American businesses more than $100 billion a year. "Thirty to fifty percent of all hospital admissions nationally are related to alcohol," said Dr. Dan Nauts, medical director of the Benefis Healthcare Alcohol Treatment Center.

I also visited the Montana State Prison at Deer Lodge, where I found 85 percent of the inmates are locked up for crimes fueled by alcohol or drugs. In 1998, the state spent $46.8 million locking away its adult criminals and another $1.5 million on pre-release centers and parole officers. Those figures don't include expenses for county or city jails.

"I know a few people in here who say they don't have a drug or alcohol problem," said inmate Marty Quick, "but I don't think I know any that I actually believe."

Scott Rule, who heads the prison's inmate advisory council, agreed that inmates commonly use alcohol to bolster their addictive personalities. "We're all addicts, whether it's booze, drugs, gambling, or sex," he said.
"Drug and alcohol abuse and addiction are implicated in the crimes and incarceration of 80 percent - some 1.4 million - of the 1.7 million men and women behind bars in America," said Joseph A. Califano, Jr., chairman of the National Center on Addiction and Substance Abuse at Columbia University.

"Contrary to conventional wisdom and popular myth," Califano added, "alcohol is more tightly linked with violent crime than crack, cocaine, heroin or any illegal drug."

As I looked at the costs of alcoholism, I realized that - like the invisible river of alcohol that I had seen flowing through our society - some of those costs are known, but some are also hidden. With the help of the governor's budget director, Dave Lewis, I began asking state agencies to tell me how much of their spending could be directly attributed to alcohol, but also what they estimated the hidden costs to be. By that, I was referring to things like the huge prison population or the welfare rolls.

The budget directors estimated that Montana spends between $150 and $200 million in treating the hidden costs of alcoholism, a figure that made Executive Editor Jim Strauss nervous. He insisted that we use the low range of the estimate, and he arbitrarily cut even the low range on numbers that seemed unreasonably high to us. First the known costs.

There is revenue incoming. In 1999, Montana expected to receive $21.8 million through liquor sales, selling liquor licenses, and taxing liquor, wine and beer. After subtracting the administrative costs of issuing liquor licenses and collecting the taxes, that left the state roughly $21 million in profit. Here's how we spend it:
Substance abuse treatment: State health officials spend millions of dollars treating substance abuse, primarily alcohol but also drug abuse. Some of those programs use federal funds that are administered by the state. Montana spends $5.5 million on substance abuse treatment programs, said Dan Anderson, administrator of the state health department's Addictive and Mental Disorders Division. It also spends $2.5 million to operate the Montana Chemical Dependency Center in Butte, plus an additional $1 million on regional and county centers.

Anderson said $3 million is spent on a federal alcohol-prevention program, and another $163,000 on an indigent youth treatment program.

In addition, the division spends about $850,000 dealing with high-risk pregnancies and caring for the young children of high-risk mothers. The program served 1,400 women across the state, of which 25 percent reported alcohol abuse and 9 percent illicit drug use, therefore one-fourth of the funding for high-risk pregnancies could be considered a hidden cost.
Known cost: $12.2 million.
Hidden cost: $212,500.

Foster care costs: Montana spends about $40 million on adoption assistance, foster care, and assisted independent living programs. Montana has 2,000 to 2,200 children in foster care on any given day, said Shirley Tiernan, chief of the health department's Family Services Bureau.

"Alcohol use is a big factor in children being removed from their homes," said Tiernan. "Most of our foster care cases are related to alcohol."

Roughly 75 percent of the cases have underlying chemical dependency issues, estimated Chuck Hunter, head of the health department's Division of Child and Family Services. That's a hidden cost of about $30 million, Tiernan said. But that was one of the costs that made us nervous, so we cut it again to $15 million.
Known cost: None.
Hidden cost: $15 million.

Family violence: The state spends $703,000 to counsel children on domestic violence. How much of that can be attributed to alcohol abuse?

"Most of our domestic abuse cases involve alcohol, either by one or both parties," said Great Falls Police Chief Bob Jones. "Alcohol plays a great part. People get angry, don't try to defuse the situation, and that leads to assaults." Last year, Montana instituted a Domestic Violence Program with a statewide budget of $652,000. According to figures provided by the YWCA Mercy Home, domestic abuse costs Montana businesses more than $10 million a year in absenteeism and medical bills. Again, Hunter estimated that about three-quarters of the domestic abuse cases have underlying chemical dependency causes. If half the cost of domestic abuse can be attributed to alcohol, that would be $8.5 million. But we decided to be conservative again and half that figure to $4.25 million.
Known costs: None.
Hidden costs: $4.25 million.

Counseling costs: Montana spends $260,000 a year on its Employee Assistance Program, which says that only four percent of the state workers report substance abuse problems. That seems low in light of the fact that the health department estimates that nine percent of the adults in the state need substance abuse treatment.
Known costs: $260,000.
Hidden costs: None.

Welfare costs: There's also the welfare world. The state spends $89 million in federal Medicaid funds, $52.4 million on food stamps, and $26.7 million on the FAIM (Families Achieving Independence in Montana) program. It spends an additional $16 million on child-care funds to cushion the transition from welfare to entry-level job wages, plus $185,000 to stock the state food bank network. State health department officials estimate that 25 to 50 percent of their clients are unable to hold jobs because of their alcohol abuse. The low end of that estimate would be $46 million.
Known costs: None.
Hidden costs: $46 million.

Mental illness: The state spends $84.4 million on treating mental illness. A percentage is related to alcohol. "There are clearly some people suffering from mental illness due to alcohol or drug use, either by themselves or by their parents," said Anderson. "And it's often impossible to determine which is the primary problem."Anderson noted that 26 percent of the patients admitted to state mental hospitals have a dual diagnosis with a mental illness and chemical dependency. That percentage of the mental health budget would be $21.9 million. Again, we halved that cost to $11 million to be conservative.
Known costs: unknown.
Hidden costs: $11 million.

Vocational rehabilitation: Voc rehab serves about 7,000 Montanans a year, but only 150 of them last year had alcoholism as a primary diagnosis, said Joe Mathews, head of the health department's Disabilities Services Division. The department doesn't track those who have alcoholism as a contributing problem, he said.
"My guess is that a fairly substantial number of people we serve have a secondary diagnosis of alcoholism," he said. "But that's strictly a professional guess," he added. "We don't track that and I don't have the data to back that up." The vocational rehab program is budgeted to spend $14.9 million this year, and Mathews estimated that 25 to 30 percent of that could be attributed to alcohol abuse.
Known costs: None
Hidden costs: $3.7 million.

Special education: The State Office of Public Instruction spends $1.9 million a year on an alcohol- and drug-free educational program for students. It spends $33 million educating children with various disabilities, including Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effect (FAE) ? both of which are caused by mothers who drink while they are pregnant. Only a small percentage of the students have FAS/FAE, but educators note that attention deficit disorder has the same symptoms as FAE, except that there's no proven cause.
Proving FAE "requires mothers to admit that they've been drinking during pregnancy," said Gail Cleveland, who was in charge of the Great Falls school district special education program. "So they deny it, and the physicians don't press the issue." Education officials can't estimate what percentage of the special education budget may be attributable to alcohol abuse, but a conservative 10 percent would be $3 million.
Known costs: $1.9 million.
Hidden costs: $3 million.

Justice Department: The State Department of Justice spends about $3 million each year on substance abuse programs, including the cost of the D.A.R.E. programs in public schools. It underwrites a DUI Task Force to the tune of about $250,000 a year. In fiscal 1999, Montana Highway Patrol officers wrote 3,300 tickets for driving under the influence of alcohol, about 6.5 percent of the 50,400 tickets written that year. And about 29 percent of the drivers involved in fatal auto collisions had been drinking, down from about 50 percent a decade ago, according Col. Craig Reap, former head of the highway patrol. The highway patrol budget is about $16.6 million a year, so 6.5 percent of its budget - $1.1 million - could be considered a hidden cost.
Known costs: $3.25 million.
Hidden costs: $1.1 million.

Corrections: Since the Legislature made felonies of all DUI offenses after the third conviction, Montana spends more than $1 million a year locking away drunken drivers. A number of prisoners were released on probation or parole, but were imprisoned again because their continued drinking violated the terms of their release. The Department of Corrections could not give a specific number because it does not track the reasons for parole or probation revocations.

The state spends $34,000 for a substance abuse program at Pine Hills, plus $265,000 more on a similar program at the Montana State Prison. But that's only a drop in the bucket for the juvenile and adult justice programs, which total $64 million. A health department study several years ago found that 60 percent of all prison inmates had a lifetime alcohol disorder, compared to about 9 percent of all Montanans. But a prison study showed that 85 percent of its inmates had substance abuse problems, were imprisoned for crimes committed while they were drunk or high, or committed crimes to get the money to buy alcohol or drugs.
"I know a few people here who are not addicted to alcohol and drugs, but they are very rare cases," said inmate Randy Pretty Weasel, an alcoholic who was serving a 10-year assault sentence. "They're a very small percentage of our prison inmates." Taking the lower of the estimates, 60 percent of the Corrections Department's $89 million budget could mean a hidden cost of $53 million.
Known costs: $1.3 million.
Hidden costs: $53 million.

Our conclusion was that the hidden costs of alcohol abuse may total an additional $135 million in Montana. "I can't quarrel with your numbers," said Lewis later. "It's certainly eye-opening to see the amount of money that alcohol costs the state." That amount is more than the state spends on the university system - about $120 million a year. That hit a nerve with many of our readers. It just doesn't seem right that we're spending more money alleviating the costs of alcoholism than we are on educating our college-aged youth.

Pulitzer Prize winning journalist Eric Newhouse is projects editor of the Great Falls Tribune in Great Falls, Mont. His yearlong series of stories on alcoholism won the Pulitzer Prize in 2000, and it has been rewritten as a book, Alcohol: Cradle to Grave, which was published by Hazelden.

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