Pubdate: Tue, 13 Jun 2000 Source: Honolulu Advertiser (HI) Copyright: 2000 The Honolulu Advertiser, a division of Gannett Co. Inc. Contact: P.O. Box 3110 Honolulu, HI 96802 Fax: (808) 525-8037 Website: http://www.honoluluadvertiser.com/ Author: Lynda Arakawa, Advertiser Capitol Bureau DELAYS BLAMED FOR DRUG RELAPSE Recovery advocates criticize QUEST Inmates released from prison often must wait for substance abuse treatment through the state's QUEST program for the poor, which hurts their chances of staying out of jail. Drug treatment providers and advocates say people who apply for QUEST sometimes have to wait as long as two months to receive health care coverage. New members may then be subjected to a 30-day waiting period for substance abuse treatment if the service is not considered urgent. Officials with QUEST health plan providers claim patients don't need to be active drug users to get help. But drug treatment advocates describe a system that essentially requires people who have been clean to use drugs again to qualify for treatment. Drug addicts, advocates and state officials have emphasized the need for released inmates to continue receiving treatment when they re-enter the community. Without such programs, prison officials say, addicts likely will fall into old habits and wind up in prison again. "It's kind of a vicious cycle," said Larry Williams, executive director of the Salvation Army Addiction Treatment Facility. "If you wait until they use drugs, they're violating the law. It's a Catch 22." While all health insurers have been pressured by advocates and some legislators to increase benefits for substance abuse treatment, QUEST is the target of complaints. As the state's health insurance program for the poor, QUEST is the likely insurer for those who are leaving prison. Charles Duarte, administrator of the state's Med-Quest program, said inmates must wait until they are released to apply for QUEST, because federal law prohibits anyone living in an institution from being a QUEST beneficiary. Duarte attributes the wait to receive benefits - which he estimated at five to seven weeks - to a shortage of staff. QUEST does provide coverage to anyone who has been waiting for more than 45 days, he said. However, QUEST allows health care plans to impose a one-month waiting period on new adult members for services not considered urgent, he said. Substance abuse treatment is considered a nonemergency, but a plan may make exceptions if it determines such treatment is medically necessary. "Surely someone who comes out and has been clean and sober for six months may not have as urgent a need for substance abuse treatment - although I do understand the need for continued treatment," Duarte said. "Quite frankly, the problem we have is we're underfunded and always have been for substance abuse treatment." Not all forced to wait Some plans, such as Queen's Hawaii Care and Straub-Care Quantum, don't impose a 30-day waiting period on new QUEST members, company officials say. The Hawaii Medical Service Association has a 30-day waiting period for new QUEST members, but case managers can waive it if necessary, said HMSA spokesman Cliff Cisco. Social service advocates and state officials argue that even inmates who have been drug-free in prison face a tougher challenge staying clean and sober on the outside. "You're doing everything at one time: You have to find a place to live, you have to find a job, many people coming out have anger management and psychological problems. It's a critical time," Williams said. "And the resources are so limited. If you can't get timely treatment, you're kind of doomed from the start." Hawaii Paroling Authority administrator Max Otani agreed that people released from prison need continued support, because they will likely face additional stress in adjusting to the community. "We've seen where these guys would be the ideal prisoners - no positive drug tests, completed their programming - and they come out and all of a sudden they fall apart," Otani said. "It's not unusual to see that." Drug abuse prevalent About half of the parolees who are returned to prison have a substance abuse problem, Otani said. Prison officials have estimated that 85 percent of the roughly 4,800 prison inmates in Hawaii have a history of drug or alcohol abuse. A former inmate who agreed to be identified only as "Jay" criticized the system, even drug treatment facilities, for failing to give addicts enough help when they need it. A 35-year-old Windward man who has been in and out of jail, primarily on drug charges, said he went to a drug treatment facility for help recently and was told he needed insurance. "I wanted treatment," he said. "I know what (the drug addiction) does to me-you get sick of everything that's happening around you. Everything starts falling down. "A person should be able to walk into a program and get help. It shouldn't be all about money or insurance, because you're talking about a person's life," he said. State officials say they are working to address the problem, and acknowledge it is still far from meeting the need. The Department of Health provides treatment to those waiting for insurance on a space-available basis, but its main priority is pregnant women and intravenous drug users. The paroling authority's Otani said QUEST workers have sometimes expedited his agency's request to get parolees enrolled inthe health plan within two to three weeks. In addition, the paroling authority is receiving $100,000 in forfeiture money from the Honolulu Police Department to pay for substance abuse outpatient treatment for parolees who don't have insurance and cannot afford treatment, Otani said. And the state Department of Health last year gave the Salvation Army a $63,000 grant for a pilot program to treat drug addicts immediately after they leave prison. Money also an issue Duarte said problems stem from not only waiting for insurance, but a shortage of treatment facilities and resources. "It requires more than just an insurance benefit to take care of the problem," he said. "We need dollars for a whole continuum of care so these folks don't fall back into the same trap." Anita Swanson, Department of Health deputy director with the Behavioral Health Administration, agreed. "If you don't have the `clean and sober' housing, and you send them back to the house with ice addicts nearby, no treatment is going to work," she said. "I think the bigger question is we have to look at substance abuse, alcoholism and mental illness as no different than any other physical health ailment." - --- MAP posted-by: Don Beck