Draws from Legacy of the 'Angel of Alcoholics Anonymous'

BY: BETSY TAYLOR

At Rosary Hall in Cleveland, they don't like to talk about waiting lists. When someone struggling with addiction seeks help, they try to provide it — right then, right there. During daytime hours, Rosary Hall accepts walk-in patients, people seeking immediate treatment for alcoholism and drug dependency. "When someone's ready, they don't want a bed tomorrow. They don't want an answering machine," explained Orlando S. Howard, director of outpatient treatment services and quality improvement for Rosary Hall.

The approach to immediately admit those in need hearkens back to Rosary Hall's founder, a slight but stalwart religious sister. Sr. Mary Ignatia Gavin, CSA, was first in the nation to admit patients to a general hospital for treatment of alcoholism. That was at St. Thomas Hospital in Akron, Ohio, in 1939. A one-time music teacher, she developed a reputation at St. Thomas for her commitment to aiding those with alcohol addictions and later moved to Cleveland, where she was the driving force behind the opening of Rosary Hall at St. Vincent Charity Hospital in 1952. Her order, the Sisters of Charity of St. Augustine, and the Alcoholics Anonymous organization both played key roles in the opening of the then-17 bed ward.

Several leaders, employees and former patients described the importance Sr. Ignatia's legacy and Rosary Hall's ongoing work to combat addiction. The work is more vital than ever. In 2018, nearly 152,000 Americans died from alcohol- and drug-induced fatalities and suicide. The figure is close to the number of deaths in 2017, the highest number ever recorded in the United States, and more than twice as many as in 1999, according to a June 2019 report from the Trust For America's Health nonprofit and the Well Being Trust.¹

Today, Sr. Ignatia is sometimes called the Angel of Alcoholics Anonymous for her early role in hospital-based addiction treatment. "They talk about religious life as being prophetic, and I don't know how much more prophetic she could have been," said Sr. Judith Ann Karam, the current congregational leader of the Sisters of Charity of St. Augustine.

When Sr. Ignatia was in charge of patient admissions at St. Thomas Hospital in Akron, she saw firsthand the damage excessive drinking could cause. The hospital treated those injured in car and other accidents where a person had been intoxicated; Sr. Ignatia also spoke with patients' family members who detailed how compulsive drinkers both suffered and brought suffering into their homes. Sr. Ignatia worked closely with one physician, Dr. Robert H. Smith, who talked with her about the devastating effects of alcoholism. Both Sr. Ignatia and Dr. Bob wanted to aid those struggling with addiction and their loved ones.

PATIENTS IN THE FLOWER ROOM
With patient beds at a premium, and with "very little enthusiasm around the hospital about admitting people who were imbibing too freely in those days," Sr. Ignatia cautiously admitted an intoxicated patient in 1939 — listing him under the not-too-accurate diagnosis of acute gastritis — to the care of Dr. Bob. Now known as a cofounder of Alcoholics Anonymous, Dr. Bob believed this patient would benefit from conversations with other men who had stopped drinking, so he asked Sr. Ignatia to move the patient to a private room. She did so, converting a "flower room," where patients' flowers were watered and arranged, into a private room for the man. Those who had achieved sobriety through Alcoholics Anonymous began visiting patients there, in a two-bed room, then four, six and eight beds — resulting in a new, hospital-based addiction treatment program that combined medical care and the Twelve Step program.² The Twelve Steps act as guiding principles in addiction treatment, providing a blueprint for addressing problems and toward recovery.

After decades of helping those struggling with addiction in Akron at St. Thomas Hospital (see sidebar), Sr. Ignatia's community asked her to relocate to Cleveland, about 40 miles north of Akron. The Rosary Hall alcohol and drug treatment center at St. Vincent Charity Medical Center in Cleveland continues to help people today.

FROM DETOXIFICATION TO WHOLE PERSON HEALING
Today, Rosary Hall has two locations within St. Vincent Charity Medical Center. Its 27 beds for medical detoxification are on the sixth floor of the hospital, with women on one ward and men on the other. Patients change out of street clothes, into pajamas or hospital gowns and slippers. It keeps them comfortable, but also can buy staff some time to convince a patient to stay and complete the detox treatment, if the person is thinking of leaving. It takes a beat to get your street clothes back on, and during those few minutes, staffers have sometimes been able to encourage patients to complete detox, Howard explained. Typically, patients wit

h an alcohol addiction need three days for a medical detox; those with opioid addiction need five, though a number of other medical conditions can affect their length of stay. A gathering room across from the nurses' station provides opportunities for support groups and art therapy. On-staff recovery coaches help patients working for sobriety.

Howard describes detoxification: the first two days, patients are quite uncomfortable and often don't even get out of bed. Day 2 is often the worst. On Day 3, they're encouraged to attend group therapy sessions. By Day 4, a lot of people are feeling somewhat better, but usually that's because they've been given medication to assist with detox, he said. It's a start on a long path. The care here is holistic — medical care, emotional and mental care, spiritual care.

The medical center brings together reminders of its founding, its holistic approach and its cutting-edge medicine throughout the property. Howard's office is in the original hospital building, with other Rosary Hall administrative offices and some quiet rooms for contemplation and education about alcohol and drug dependency. It's common in the rooms for group sessions to find a hot pot of coffee on the burner; when Rosary Hall first opened it included "an attractive coffee bar" where those admitted could gather with members of Alcoholics Anonymous to discuss their common problems. Rolls of old movies — no longer in use — are stashed in a projector room with titles from the days when addiction was less understood, but also that were likely meant to help those in recovery drop some of their own defenses — "I'm Not An Alcoholic," "One of Those People." Aspects of recovery that have stood the test of time are here as well. "The Twelve Steps of Alcoholics Anonymous" are on one wall. On another, "The Serenity Prayer," Reinhold Niebuhr's famous words that begin: "God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference." A "Jesus Room" in the hospital —nicknamed that way because it holds supplies to help patients—holds items like new underwear, fresh socks and clean clothes, so staff can supply them to someone in need of essentials.

Howard has a good sense for what dependent patients are going through, how someone is so much more than the addiction they have. He struggled with addiction himself after the murder of his sister. He takes a picture of her from a shelf in his office, sets it on a table and turns the image to face him as he talks. Carmela Howard, who worked as a flight attendant and owned a beauty shop, "got caught up in cocaine," he explained. She was abducted in 1986, and after 10 days her body was recovered from a dumpster, he said. Orlando Howard himself has been sober for years, has been working at Rosary Hall helping others for 13 years. "I think it was Carmela driving me to do this," he said. About 1,500 patients a year detoxify at Rosary Hall, he said. They are assessed, and once their acute medical needs are met, patients are referred to 30-, 60- or 90-day inpatient residential treatment programs elsewhere, or to an intensive outpatient program at Rosary Hall or a partial hospitalization program that began there in October 2019. In the Rosary Hall programs, patients come to the hospital several hours a day for several days a week over multiple weeks for treatment and therapy. Rosary Hall introduces patients to both best practices related to medical detoxification and the fellowship of a Twelve Step program.

THE MEDICINE EVOLVES
The beginnings of Alcoholics Anonymous trace back to 1935, when New York stockbroker Bill Wilson met Dr. Bob in Akron. Both men had previously taken part in the Oxford Group, a fellowship led by an Episcopalian clergy member that mostly espoused a nonalcoholic lifestyle and supported spiritual values in everyday life, according to the history of Alcoholics Anonymous.³ Bill W. was convinced alcoholism related to mind, body and spirit, something he had learned from a doctor at Towns Hospital in New York, where Bill W. had been a patient at times before gaining sobriety. Bill W.'s support helped Dr. Bob as he stopped drinking. Both men started visiting with patients at Akron's City Hospital, with other recovery groups forming in New York and then Cleveland. And on and on. Alcoholics Anonymous is today offered across the globe.

A textbook written by Bill W. and published in 1939, now commonly known as the Big Book, detailed A.A.'s approach and methods. At its core were the Twelve Steps of recovery, the guiding principles where those working for sobriety admit they are powerless over their addiction, put their trust in a higher power, take inventory of their past wrongs and make amends where appropriate.

Fairly well known to those in recovery in her lifetime, Sr. Ignatia's influence has grown as Alcoholics Anonymous has. Well before becoming a woman religious and a leader in health care, a teenaged Judith Karam worked as a pharmacy technician at St. Vincent's, where she sometimes saw Sr. Ignatia in action. Judith's dad owned Dave's Luncheonette down the street and fed those who eventually were cared for at Rosary Hall. During her first trip delivering medications, Judith saw how Rosary Hall took care of many of the same men her dad provided hot meals to. Sr. Karam recalled that some of the sponsors and former patients at Rosary Hall were so dedicated to Sr. Ignatia "they kind of followed her around the halls." In 2016, Sr. Karam accepted the 35th million copy of the Big Book in Sr. Ignatia's honor at an event at the Georgia Dome. Sr. Karam also recently joined the Alcoholics Anonymous General Services board as a Class A Trustee.

Ted Parran, Jr., MD, FACP, co- medical director of Rosary Hall, said, "Sr. Ignatia very early on, as an absolutely committed health care professional, recognized that addiction is a disease. It is a brain disease that requires a tremendous amount of support." Sr. Ignatia recognized that as a brain disease, addiction affects people's behavior and "strips people of their self-image and self-respect early on." By admitting people struggling with addiction to the hospital, Sr. Ignatia made it clear that part of the puzzle of treating addiction could be provided by health care organizations. In addition, she recognized that people with addiction need help overcoming shame and humiliation, validating the importance of other pieces of the puzzle, the importance of the Twelve Steps and the recovery community in the treatment of addiction, he said.

The science and medicine have evolved in many ways. A "tremendous amount of customization" is needed to care for addicted patients, Parran noted. While the basic withdrawal protocols can be shared with health care providers who don't specialize in addiction medicine, about half the patients they see for addiction have co-occurring substance use disorders: patients may be addicted to more than one thing. Patients often have substantial medical and psychiatric needs beyond their addiction diagnosis. "Although all of our patients at Rosary Hall may have the disease of addiction, their illness experience is unique based upon all of the unique aspects of themselves as a unique person here in God's universe," Parran said.

While relapses and even death can result if an addicted person doesn't give up their substance use, at Rosary Hall they say they treat many patients who maintain sobriety, and who, more than that, attain "happy sobriety," which Rosary Hall advocated for from its opening. It is hard to track substance use disorder recovery rates in general, because once someone completes detoxification and treatment they may no longer be in touch with the hospital and program they participated in. What is known is that integrating appropriate medicine, counseling and peer support can increase the likelihood of maintaining sobriety. About half the patients at Rosary Hall agree to "medication-assisted treatment," where medications can help someone struggling with addiction and ultimately assist many of them in their recovery.

Parran explained that if an addicted patient stops drinking or doing drugs all on their own, they have a very low percentage of being sober in a year. He said the single best predictor of sobriety from an Alcoholics Anonymous standpoint is more than three meetings a week with a home group — where you go every week for meetings — and having a sponsor — someone with continuing responsibility for helping another with an addiction adjust to a way of life without alcohol. From a counseling perspective, the best predictor of sobriety is completing an intensive outpatient program, he said. Doing both a Twelve Step fellowship program at those levels and the intensive outpatient program means the odds of a Rosary Hall patient remaining sober move to about 30% to 40% for one year, Parran said. "And that's pretty remarkable." About 60% of relapses happen in the first three months, about 80% in the first six months, so maintaining sobriety for a year can be a very good sign. He said top quality medical detoxification, plus counseling, plus sober support through the recovering community are cumulative in terms of outcomes. "I think that is the incredible legacy that Rosary Hall has, in that from the very beginnings with Sr. Ignatia and Dr. Bob Smith, they decided to take the best of a medical-surgical hospital — at St. Thomas in Akron and then St. Vincent Charity here — and the best of the very early recovering community and integrate them together in a seamless way, so that the medical side and the counseling side weren't denigrating or dismissing the Twelve Step side." The approach is biological, psychosocial and spiritual, he said.

After a three to five-day patient detoxification, many patients attend an on-site intensive outpatient program on site. For six weeks, they attend individual counseling and group support sessions several times a week. For the next eight to 12 weeks, they take part in a less intensive program for an hour and a half a week. They are encouraged to go to additional Alcoholics Anonymous meetings on their own.

WHOLE-PERSON CARE
Rosary Hall has a history of identifying unmet needs and figuring out ways to respond to those needs. At the peak of the cocaine epidemic, the hospital began a treatment program for women with cocaine-affected pregnancies, although the hospital did not have an obstetrician gynecologist on staff, Parran said. Rosary Hall knew the women needed assistance because they were addicted, and so began treating them because no similar program existed elsewhere in the state. Rosary Hall, in a joint program with University Hospitals also based in Cleveland, was an early adopter of an addiction fellowship training program, to train more physicians in addiction medicine. Such fellowships are increasing in numbers. In 2017, the hospital started a ride-sharing program, using a system that protects patients' health care privacy, to allow them to receive transportation to their therapeutic sessions after they are no longer staying at the hospital. It has boosted attendance, as staff realized that a lack of transportation was a problem for some clients, and some waiting or riding public transportation might put some people in the direct path of easy access to the liquor or drugs they were working to overcome. A new fund will assist patients without insurance needed for their care. In February 2020, Gary Storch started a new endowment in his name and in the name of his late wife, Patty. He made plans to give half his life savings to Rosary Hall, but first immediately began the fund with more than $50,000 for patients who cannot afford the inpatient detoxification program or who don't have insurance.

Storch came to Rosary Hall when he was a young man and couldn't stop drinking. He acknowledged missteps over the years but said he had been sober for more than four years at the time of his gift. He said he wouldn't be alive if not for Rosary Hall. "Before, I would tell God how big my problems were. With the seed of faith planted, I started telling my problems how big my God is," he said when the gift was announced.⁴

SR. IGNATIA — CHA AUTHOR
In October 1951, writing in this publication, then called Hospital Progress, Sr. Ignatia described aspects of addiction care that still underpin today's substance abuse treatment programs. "It is axiomatic that the alcoholic is never 'cured'; his ailment is simply arrested, but it is positively arrested if he perseveres in the program," she said. She explained the importance of the patient's Alcoholics Anonymous sponsor, and how the patient needed more than a sobering up process. "This time he is being treated not only physically, but morally and mentally as well," she wrote. At the time Sr. Ignatia wrote, she said "over 4,000 A.A. patients" had been hospitalized at St. Thomas Hospital, including some who came to Akron from all over the nation, including Alabama, Michigan and Texas. She called for more treatment programs — this was about 70 years ago. "They would not have had to travel so far if their local hospital had made it possible for them to receive the program nearer home."⁵

There were marked differences between the early treatment days and today. Sr. Ignatia wrote in Hospital Progress that care of alcoholic patients included "spirits of frumenti two ounces." That's whisky. Karam recalled that drams of Cobb's Creek whiskey used to be given to patients during their initial stage of detoxification, to taper them down off the alcohol. It was brought to patients on small silver trays, and its temporary medicinal use, rather than pleasurable use, was stressed.

Sr. Ignatia writes that patients were given fluids intravenously, Vitamin B complex, chloral hydrate (a sedative) and sodium luminol grains. In a sign of how much times have changed, she writes of sodium luminol, "It is given hypodermically so that the patient does not know that he is receiving a barbituate. And she adds in italics: "Barbituates are dangerous to the Alcoholic." She also outlines instances where some other medications are administered as well, and that some patients are moved off the A.A. ward if they are in pressing need of psychiatric care.

Sr. Ignatia came by her work in addiction treatment in a circuitous fashion. Born Bridget Della Mary Gavin in Ireland in 1889, Della moved with her parents and brother to the United States in 1896. She was 7 when the Gavin family arrived in Cleveland. The child had a knack for music, and her mother, in particular, made sure in addition to her classroom schooling, she got lessons in piano, voice, organ and violin. She went to a music college and began to teach lessons herself, but at various points expressed a calling to enter the convent. In 1914, she did so, at the age of 25.⁶

She was asked to open a private music school at St. Augustine's Convent in Lakewood in suburban Cleveland. While she enjoyed teaching music, she worked long days and didn't excel at teaching large groups of unruly children. She often displeased the bishop at the time, who considered himself something of a music scholar and had a reputation for making his point of view loudly known. One night, an intruder also broke into her convent room at an orphanage where she also taught, causing her further upset. Sensitive by nature, she experienced bouts of anxiety and insomnia. In 1927, she was admitted to a hospital, with bleeding ulcers, temporarily paralyzed arms and exhaustion. Many who knew her credit this dark period of her life, from which she recovered, as giving her a particular affinity for helping others who suffered emotional or mental distress. They also thought that because she lived in community, she may have understood the importance of having a support network to aid people through difficult times.⁷

Bobby Jackson, now 86, was a married father working at a Ford plant when he met Sr. Ignatia. He entered Rosary Hall in 1960 and has been in recovery since then; he has helped countless others into recovery programs. "I drank 'cause I wanted to, I guess," he said. His wife, so in need of help for her husband, once asked a man at a gas station if the man knew anyone in Alcoholics Anonymous. Jackson had heard of Rosary Hall earlier, but didn't enter right away. In the early days, Rosary Hall would only let people go through its program once, so sometimes people hesitated to start the program if they weren't ready to quit drinking for good, knowing that essentially they'd only have one chance to go through treatment there. That policy has changed, as the likelihood of relapse as part of the recovery process is better understood today. Addiction is a chronic disease.

"I didn't think nothing was wrong with me, but everyone else did. I'd been on this long drunk, and I was sick and tired of being sick and tired, I guess." Jackson said Sr. Ignatia asked him if he had a drinking problem. "I said 'no,' I don't have a drinking problem; if I get sober, I'll be all right."

Of Sr. Ignatia, he said she wore a white habit that could even be a little scary to those unaccustomed to seeing religious garments. "She was the kindest person you ever met, but she could (also) read you the riot act. She was good at both." She talked to all the patients, asking them about themselves and their drinking, praying for them and letting them meet with sponsors and other members of Alcoholics Anonymous on site. Sr. Ignatia gave each patient who participated in Rosary Hall programs a Sacred Heart Badge, a symbol of Jesus Christ's love. The badge included the Catholic devotional image of the heart of Jesus and could fit in a person's pocket or wallet. But she told each person they must return it to her before they took another drink. The concept was that a person could carry the Sacred Heart badge as a reminder not to drink, and if they did come back to visit Rosary Hall to "return" it, someone there might be able to help the person maintain sobriety through a weak period or a craving. Such badges in different form are still used to mark sobriety milestones today. And at Rosary Hall, the Sacred Heart badges are still given out.

Jackson remembered Sr. Ignatia had a sign on her door that read: Take hope all ye who leave here. "I got a little hope, probably that I never had, while I was here." He said at Alcoholics Anonymous meetings –where they used to raffle off cigarettes back in the day — "everybody was trying to help everybody." Jackson went on to start and assist with employee assistance programs at places of employment, linking people to resources to help them with life issues. He also went into some of the roughest neighborhoods in the region, listening to those struggling with substance abuse and encouraging them to attend Alcoholics Anonymous meetings.

A TRADITION CONTINUES
Visitors to St. Vincent Charity Medical Center, or those arriving to seek treatment, currently drive along Sr. Ignatia Way to reach the hospital. They may not even know who she was, as they pass the street signs with her name on the way to the detoxification program. The full name of the place they arrive is Rosary Hall Solarium — and the initials RHS are shared by Dr. Robert H. Smith. Staff at Rosary Hall said Sr. Ignatia wanted the overlapping initials to honor her friend and colleague, Dr. Robert H. Smith, the Alcoholics Anonymous cofounder.

Sr. Ignatia's presence is still felt. She died in 1966, but an annual Mass celebrated in her memory continues to pack the pews of a local Catholic church. On April 1 every year, an evening Mass is offered at St. Patrick's Church in Cleveland, for this woman who died more than 50 years ago. The memory of Sr. Ignatia and her reputation bring people to the Mass because she dedicated so much of her life to helping those with addictions get sober. Through that work, she served an integral role in the beginnings of Alcoholics Anonymous and hospital-based treatment for those with substance abuse disorders.

The stately Gothic Revival church fills up for the service, and one thing in particular stood out to Sr. Joan Gallagher, a Sister of Charity of St. Augustine, when she served as a Eucharistic minister at the Mass — the variety of hands in all different skin tones held out to receive Communion. It served both as a sobering reminder that addiction does not discriminate, and, more significantly, as a reminder that God's grace is given freely to all. Recovery is always possible.

"I was amazed by the hands," Sr. Gallagher recalled. "They were rough, calloused; they were dirty. They were jeweled, with rings on fingers. You saw all kinds of hands on those walking up and receiving the Lord," Gallagher said.

BETSY TAYLOR is the managing editor of Health Progress, the Catholic Health Association, St. Louis. She was a reporter at several newspapers and at the Associated Press before joining CHA in 2013.

NOTES

1. Pain in the Nation, Well Being Trust, Trust for America's Health, https://wellbeingtrust.org/areas-of-focus/policy-and-advocacy/reports/pain-in-the-nation/.
2. M. Ignatia, "The Care of Alcoholics — St. Thomas Hospital and A.A. started a movement which swept the country, Hospital Progress 32, no. 10 (October 1951): 293-96.
3. Alcoholics Anonymous website, "Archives & History," https://www.aa.org/pages/en_US/archives-and-history.
4. "Rosary Hall Donor Establishes Endowment to Help Support Uninsured and Under-Insured Patients," St. Vincent Charity Medical Center website, https://www.stvincentcharity.com/radiant/posts/rosary-hall-donor-establishes-50-000-endowment-to-help-support-uninsured-and-under-insured-patients/.
5. M. Ignatia, "The Care of Alcoholics."
6. Mary C. Darrah, Sister Ignatia — Angel of Alcoholics Anonymous (Chicago: Loyola University Press, 1992).
7. Sisters of Charity of St. Augustine, "Angel of Hope – The Life and Legacy of Sister Ignatia," DVD video.