Pubdate: Mon, 03 Jun 2002
Source: Washington Post (DC)
Copyright: 2002 The Washington Post Company
Contact:  http://www.washingtonpost.com/
Details: http://www.mapinc.org/media/491
Author: Serge F. Kovaleski
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

ADDICTS SEEKING HELP FIND LINE INSTEAD

Long Waits at D.C. Detox Center Will Dissuade Many, Advocates Fear

Unemployed, broke and battered from heavy crack use, Dwight Mosby 
thought it was time to beat the drug habit that has consumed him for 
five years. On Wednesday, he took the critical first step: showing up 
at the D.C. Detox Center. But after waiting nine hours for a bed to 
become available, Mosby gave up and then gave in, again, to his 
addiction.

He said he spent that night in the grip of another crack high before 
mustering the will to go back at 6 a.m. for another attempt at 
securing one of the 80 treatment slots at the city's main facility 
for the District's indigent and uninsured who need immediate 
treatment for drug and alcohol abuse.

"I came in on my own, but this is discouraging. You hit a moment when 
you want to get clean, and then you find out that they can't 
accommodate you," Mosby, 35, said after waiting another nine hours 
Thursday. "If they can't take me today, I don't know what I'm going 
to do. I'm about to leave."

With growing numbers of people seeking treatment at the 
detoxification center, lengthy delays in finding beds for them have 
become a serious concern for advocates, who stress the need to 
promptly tend to drug addicts and alcoholics who decide that they 
want to kick their addictions.

"Responding on demand to an individual's desire to get sober is one 
of the most important functions the D.C. government should provide, 
because these are fleeting moments in which to catch someone and help 
them," said D.C. Council member Jim Graham (D-Ward 1), himself in 
recovery from substance abuse for more than 25 years. "Denial is a 
major symptom of addiction," he said, "and we should not put hurdles 
in anyone's way, because anything that makes it more difficult 
reinforces their belief that they don't have a problem."

The consequences of crowded detox facilities -- felt in many other 
U.S. cities as well -- go well beyond those who need the treatment.

Of the 26,000 criminal cases handled by D.C. Superior Court last 
year, roughly half involved drugs or alcohol. Records from the D.C. 
Pretrial Services Agency show that 47 percent of the adults arrested 
in the District in April tested positive for cocaine, PCP or opiates. 
Drug-related cases have been straining the court system in a city 
where the D.C. Department of Health estimates that 60,000 residents 
- -- 10 percent of the population -- are addicted to illegal drugs or 
alcohol.

Drug use has taken a toll on District families, as well. Eighty-five 
percent of foster care placements in the city involve substance 
abuse, and nearly 15 percent of new mothers report having used 
illicit drugs during pregnancy. D.C. officials say that, overall, 
drug and alcohol abuse directly and indirectly costs the District 
about $1.2 billion a year.

The backlog at the 24-hour detox center on the D.C. General Hospital 
campus is so acute that even D.C. Superior Court Judge Melvin R. 
Wright has trouble placing people -- despite court orders or 
referrals from pretrial services.

Wright said last week that the glut was the worst he has seen in the 
16 months he has presided over a special drug court. He said that 
since December, there have been, on average, three or four instances 
a week when addicts sent by the court are not admitted to the center 
the day they show up because there's no room.

"It hardly happened at all before that," Wright said. "Everyone who 
we send over is involved in the court system, and if they can't get 
in, how can we expect other people who need treatment to get a bed 
there?"

A pretrial services case manager from his court spends half a day 
each week at the center to help coordinate placements, but timely 
admissions remain elusive.

Sitting on a railing Wednesday evening outside the boxy, red brick 
building that houses the facility, one 35-year-old woman who wanted 
to remain anonymous, which is the facility's policy, said that even 
though she showed up with a court order, she had been waiting nearly 
10 hours to get treatment for crack addiction.

"It is really frustrating, but if you want to get help, you just have 
to wait," she said, adding that in October, it took her two days to 
get a bed. "After detox, I went to an outpatient program. . . . But I 
just started using and stopped going."

Substance abuse experts and law enforcement authorities said the 
increased demand for detox assistance stems from a number of factors, 
including a sharp rise in heroin and PCP use in the District. Also, 
many illicit drugs are more potent than in the past.

Kwame Roberts, administrator for RAP Inc., a residential substance 
abuse treatment program contracted by the city, said that demand has 
also increased because in August 2000, the family division of D.C. 
Superior Court stated that if a child stayed in protective services 
for more than a year while a parent's addiction problem persisted, 
that parent could lose custody. That has driven more people, 
particularly women, into treatment, Roberts said.

"We all need more treatment beds, because the need for treatment is 
greater than it has been in six or seven years," he said.

The problem is even worse in cities including Baltimore, which has a 
population comparable to the District's. Joseph A. Sviatko, of 
Baltimore Substance Abuse Systems, a nonprofit group created by that 
city's health department, said that there are 34 inpatient detox 
openings that serve 1,200 people a year. The wait there is one to two 
weeks.

Nationally, more than 18 million people who use alcohol and nearly 5 
million who take illicit drugs need treatment, according to a 2001 
report by the Robert Wood Johnson Foundation. The study also said 
that fewer than one-fourth of those in need get treatment. The study 
faulted inadequate fund ing and treatment facilities.

Larry Siegel, who until Friday was senior deputy director for medical 
affairs at the District's Health Department in charge of the 
Addiction Prevention and Recovery Administration, said the center's 
$3.2 million detox program is no match for the demand.

Siegel added that to more effectively care for those with substance 
abuse problems, the District's detox services must be significantly 
expanded, as should long-term treatment programs funded by the city. 
Experts said relapses because of inadequate long-term treatment 
further strain detox programs. Currently, Siegel said, long-term care 
in the District spans four to six months, but programs that last one 
to two years would be preferable -- recommendations that are 
contained in a new citywide substance abuse strategy for the 
District. But finding the money will be a fight.

"If all you do is detox and you don't have effective treatment after 
that, then many people will relapse and go back to detox, and that 
will keep it full," he said.

In the city's detox program, patients check in for five to seven 
days. Siegel said that Greater Southeast Hospital plans to offer 10 
to 15 detox beds for pregnant women within the next month or so. The 
District also has six detox beds at the Psychiatric Institute of 
Washington.

Dennis Scurry, chief medical officer for the D.C. addiction 
administration, said that each day, 15 to 30 people seek treatment at 
the detox center, which is full at least 90 percent of the time and 
has one doctor per shift. "We are responding as best we can. 
Sometimes we will have to squeeze in 85 people," Scurry said. "We 
don't feel good about losing an opportunity to treat somebody. But we 
don't tell people not to come back. We tell them to make inquiries 
and persist."

Pete Schenck, outreach coordinator for the grate patrol program of 
the Salvation Army, said that the homeless, many of whom suffer from 
mental illness -- often view the detox center with great trepidation. 
"A lot of guys want to get into detox, but they are skeptical because 
they have been turned away in the past or they failed," he said. 
"There has also been an extraordinary amount of scorn on that front 
desk. . . . This is part of being overloaded."

Helen Harrington, the supervisory nurse at the center, said that in 
general, "the city does not have a whole lot of places to send them 
for long-term treatment. So the relapse rate is high. I see a lot of 
the same faces come in."

Bernice Davis, 42, is one of them. By last Thursday, the heroin 
addict had been waiting nearly 12 hours for a bed. Eight months ago, 
she waited for more than two days.

"I slept in a chair in the waiting room. If you leave and don't wait, 
you'll come up short," Davis said. "When you come in, you are already 
sick from your addiction, and this just makes you more frustrated and 
angry."

Staff researchers Kim Klein and Bobbye Pratt contributed to this report.
- ---
MAP posted-by: Josh