Pubdate: Wed, 22 Nov 2000
Source: Vancouver Sun (CN BC)
Copyright: The Vancouver Sun 2000
Contact:  200 Granville Street, Ste.#1, Vancouver BC V6C 3N3
Fax: (604) 605-2323
Website: http://www.vancouversun.com/
Author: Glenn Bohn
Series: Searching for solutions - Fix on the Downtown Eastside
http://www.mapinc.org/thefix.htm

WHEN IT'S QUITTING TIME

It's almost impossible to kick heroin or cocaine without help. And help is 
impossibly hard to find.

It takes seconds for a heroin or cocaine addict with cash to buy drugs. If 
the same person were to decide to try beat the addiction, it would take 
days or weeks to get into detox, and weeks or months to get a bed at one of 
the handful of treatment centres, where non-profit groups try to help 
addicts remain drug-free. Of all the deficiencies in Vancouver's approach 
to its drug problem, experts agree, the shortage of treatment facilities 
may be the most frustrating.

The problem is worsened by the need to respond almost instantly during the 
rare interludes when an addict is focused on quitting. "You're dying today, 
your life is falling apart, and you have a window of opportunity that 
visits some people maybe four times in their lives," says Billy Weselowski, 
a former addict who co-founded a drug recovery society.

"Those are rare, precious opportunities, when you don't need anyone to tell 
you that you're all messed up. I remember when I was 17 years old, totally 
out of control, and I had a moment of clarity and realized this wasn't 
where I wanted to be. I remember feeling that again at 25 and at 33."

Then the window of opportunity closes. An addict's desire to stop using 
drugs wanes. And a chemically driven craving to use drugs returns, at least 
until the next crisis.

"The desire to change is very fleeting for an addict," says Lou, 40, a 
Narcotics Anonymous member who says he hasn't used cocaine or heroin for 30 
months. "That's the way addiction is. [Going clean] seems like a great idea 
one day, but it doesn't seem like such a great idea later."

Detox workers say people who have to wait for a bed keep using drugs until 
they can get in, because it's so hard to go through withdrawal alone and 
without medication. What happens if they're on a waitlist for weeks or 
months to get into a treatment centre or house?

"Let's see if you're even alive by then," Weselowski replies.

Long delays in obtaining help are the rule, not the exception, according to 
a Lower Mainland Municipal Association report based on information from 
more than 200 drug-treatment, law-enforcement, health and other agencies.

"The impact of these delays can sometimes be measured in terms of 
unnecessary deaths, deadly infections and crime," the September report 
states. "Many stakeholders believe that the delays caused by insufficient 
detox, outpatient counselling and residential treatment spaces are totally 
unacceptable."

A Typical Scenario

Here's a typical scenario: A cocaine addict prone to paranoia jumps out a 
window, breaks an ankle and is taken to Vancouver Hospital, where he's 
treated for his injury and then treated for his addiction by the hospital's 
chemical-dependency team. Dr. Brent Dickson says the patient might be well 
enough to release after one week in hospital, but would then face a 
six-to-eight-week wait for an out-patient clinic for drug users, or a 
two-to four-week wait for a bed in a support recovery home --usually a 
converted house where addicts live and try to stay clean.

"And what do the social workers in the hospitals do when they can't find a 
support recovery home?" he says. "They have to find the cheapest place -- a 
hotel room in the Downtown Eastside, back in the same environment they came 
from."

Dickson says many addicts tell him they have to get out of that Vancouver 
neighbourhood, because they can't walk down the streets without someone 
hawking drugs.

"That's death for an addict, because you can't resist that," he says. "You 
have to be as far away from drugs as you can possibly get."

"The System Has Failed"

Dr. Ray Baker, chair of the B.C. Medical Association's addiction medicine 
committee and specialist in the field for 15 years, blames the wait lists 
on the B.C. government's alleged "mismanagement of addiction services."

"I've given up trying to get people into treatment services in this 
province," Baker says. "The system has clogged up." According to Baker, 
there used to be a network of out-patient services in B.C., a continuum of 
services that began when a drug user was assessed and stabilized, then 
given appropriate treatment and followed up.

"The system has failed," he says. "Residential treatment centres are full 
of people who come off the street and aren't ready for treatment, but 
there's no other place to put them."

According to the B.C. government, injection drug users are not turned away 
if they are ready for treatment. If they can't get into a support recovery 
home, they are supposed to be offered counselling at an outpatient clinic 
or get help while staying with friends or relatives until a bed can be found.

"Let me contextualize this for you, if I may," says Miki Hansen, the B.C.'s 
government's manager of addiction services for the last five years. Hansen 
says treatment is part of a process, and outpatient services will help 
someone work on basic things like education in the meantime.

The B.C. government has budgeted more than $72 million this fiscal year for 
alcohol, drug and gambling abuse programs, but the money delivered to those 
programs drops to $58 million when things like buildings and government 
salaries are paid for.

Eighty-five per cent of the drug and alcohol programs are provided by about 
200 government-funded, non-profit organizations.

Where The Money Goes

On paper, this is where the money goes: $6.8 million for prevention 
programs; $20 million for out-patient services; $2.3 million for support 
recovery homes; $9.4 million for residential treatment centres (where 
there's more intensive counselling and treatment); $17.3 million for 
detoxification centres, including two in Vancouver.

Hansen says there are provincial standards for addiction services, and 
agencies getting more than $100,000 annually must be accredited. She says 
there is a high level of satisfaction expressed by clients for things like 
the food they are given, but she cannot say how successful government or 
government-funded services were in keeping addicts off drugs for a 
specified period of time.

"We don't collect relapse information," Hansen says. "At different points 
in time they may relapse, but that's not a failure of the treatment system 
or the individual. It's only part of a process, and they then get to use 
that as part of a learning experience and figure out ways in which they 
protect themselves from that kind of thing happening again."

A 'Discontinuous' Continuum

The need for a "continuum" of drug and alcohol services is a mantra 
embraced by professionals in and out of government. First, there are 
education and prevention programs, to try to stop substance abuse before it 
happens.  Second come early intervention programs. Then there are detox and 
treatment programs.

But a report this year by the non-profit Kaiser Youth Foundation says 
B.C.'s drug and alcohol program is poorly coordinated and fragmented. The 
report's indictment: "Inconsistent and under-funded education and 
prevention efforts.  Wasted opportunities for intervention. Inadequate data 
collection and research capacity on which to base good decisions. Waiting 
lists for counselling and for treatment.

"The province's [alcohol and drug services] continuum, despite the best of 
intentions, has become a 'discontinuous' continuum."

B.C.'s addiction treatment program began in the 1950s, run by separate 
foundations for drugs and alcohol. In 1973, a New Democratic Party 
government passed legislation to create a single provincial commission for 
all substance abuse services, but a Social Credit government disbanded the 
commission in 1992 after controversy ensued over a heroin treatment program 
that included methadone maintenance.

Alcohol and drug programs became the responsibility of the health ministry, 
then the labour and consumer services ministry, then the health ministry 
and finally, after a 1995 inquiry into the death of five-year-old Matthew 
Vaudreuil, it was placed under the aegis of the children and family 
services ministry.

Except for adult drug and alcohol services in the Vancouver/Richmond health 
region, the children and families ministry is still in charge. And critics 
say adult alcoholics and drug addicts with children don't want to seek help 
for their substance abuse problems, because they're afraid they will lose 
their children.

The Kaiser Youth Foundation is just one of the non-government bodies that 
wants Victoria to re-establish a better-funded, independent alcohol and 
drug commission, so the fight against drug and alcohol abuse will have a 
higher profile.

It's the same recommendation made in 1991 by the Royal Commission on Health 
Care and Costs -- a recommendation that has been ignored. 
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MAP posted-by: Richard Lake