Source: Cincinnati Enquirer (OH) Contact: http://Enquirer.Com/editor/letters.html Website: http://enquirer.com/today/ Pubdate: Wed, 9 September 1998 Author: LARA BECKER The Cincinnati Enquirer HELP SCARCE FOR ADDICTS Waiting lists for treatment getting longer Hundreds of addicts are being turned away from Hamilton County's four live-in drug programs as the facilities struggle with the longest waiting lists in memory. The high demand for three-to six-month detoxification and therapy stems from increased drug-court referrals, insurance cutbacks on residential care and a shortage of similar programs in neighboring counties. As treatment stalls, program directors see an acceleration in the social costs of drug-related crime and poor public health. "Every year it is not unusual that someone gets into further legal problems or perhaps even dies while on the waiting list," said David Logan, director of Prospect House, a men's substance abuse treatment center in Price Hill. The number of Ohioans admitted into publicly funded treatment more than doubled from 1991 to 1997, soaring from 43,670 to 93,522, according to the Ohio Department of Alcohol and Drug Addiction Services (ODADAS). In Hamilton County, 28,000 people have been admitted since 1993, and five times as many people are seeking treatment today, said Marti Walsh, interim executive director of the Hamilton County Alcohol and Drug Addiction Services Board. But more people yet, including adolescents, have tried and failed to secure one of 244 beds in the county's long-term rehabilitation centers. The facilities are Prospect House, Crossroads Center in Clifton for women, First Step Home in Price Hill for women and Talbert House, which has more than a dozen locations for different programs. Mostly, they are men and women without family ties, without jobs, without clean criminal records. One of them, a 45-year-old Mount Auburn man who asked that his name not be used, says he has received several no-vacancy phone calls. His name appeared seven times in the past decade near the tail-end of waiting lists at various Cincinnati recovery programs, he said. He made it into short-term rehabilitation centers, but the break from drugs also proved short-term, he said."If you don't got no foundation, no solid ground," he said, "you're going right back into that madness again." He said he started swallowing barbiturates at 12. At 18, he began injecting heroin. To support his habit, he committed burglary, robbery, "anything to get money." In 1979, he was convicted of involuntary manslaughter and sentenced to two to 25 years in prison, he said. After stints at five Ohio state prisons, he attempted to kick his drug and alcohol habits. Each time he tried to enter a long-term residential program, he said he encountered a wait never less than six weeks, sometimes six months. "I felt like they didn't care," he said. "If they did, they would have taken me in right then. But they didn't care if I lived or died." Morre court referrals Some of the backlog originates in drug court, a special arm of the justice system created to treat drug offenders rather than punish them. With more offenders referred to treatment, fewer spaces remain available for others seeking the same treatment voluntarily. In Hamilton County, where the Ohio Supreme Court in 1995 installed one of the state's 17 drug courts, more than 1,220 people have been referred to drug treatment. "It's a quick response," said Debbie Brooks, whose department at Talbert House substance abuse center handles most drug-court referrals. "They're arrested and then in their beds the next morning." The men's facilities, 52 beds, are 95 percent full to accommodate relapses; the women's 16 beds are "booked all the time," she said. But waiting lists at other Talbert House substance abuse programs -- which number 24 and serve addicts who have not been referred by the drug court -- can feature a trail of 50 names or a wait of 90 days. Other programs that admit felons also have waiting lists, including First Step Home and Prospect House, which temporarily closed its list because "there's just no point in adding to it," Mr. Logan said. Drug offenders receive immediate attention because they pose the greater threat to society, said Common Pleas Court Judge Deidra Hair, who presides over Hamilton County's drug court. But, she said, "it's inexcusable that anyone should have to wait." "It's a matter of setting a priority," she said. "If we don't do that, we're paying a ton of money for them to go to jail." Between July 1997 and June 1998, drug court saved 80,629 jail bed days, according to Talbert House statistics. The longer addicts stay in residential treatment, the better their odds of recovering, Mr. Logan said. The average length of stay at Prospect House, which has 60 beds, hovers at six months but can stretch to one year. "Two-thirds of our clients are getting clean and sober and staying that way," he said. In residential care, clients experience a necessary hiatus from their surroundings -- long enough to acquire life skills, such as how to get a job and how to communicate with family members, Mr. Logan said. Insurance questions But insurance companies, which could shell out hundreds of dollars a day for residential treatment, contend that long-term outpatient care can teach the same lessons. "The strongest predictor of success has been how long a person has been in treatment, not where they received treatment," said Dr. Peter Boxer, medical director and vice president of Greenspring Health Services in Blue Ash. The insurance company, part of Anthem Blue Cross - - Blue Shield, serves 1.3 million Tristate customers with mental health care and substance abuse benefits. Treatment programs that last 90 days or more "are exceedingly long," Dr. Boxer said. By limiting coverage to outpatient services, "money is being saved without compromising the quality of services or the outcome demonstrated," he said. Northern Kentucky has two residential treatment programs, Droege House in Dayton for men and Women's Residential Addiction Program in Covington for women. One of 40 beds at Droege House or 25 at WRAP (plus 10 for children) may open by October or November, said Ann Perrin, associate executive director of Transitions Inc., which runs both facilities. Neither of the programs "offers the same level of care" as those in Hamilton County because they don't offer physician-monitored detoxification, said Sandi Keuhn, executive director of the Center for Chemical Addiction Treatment (CCAT) in Hamilton County. "Services just aren't available in those areas," she said. "So we're seeing an awful lot more calls, a 25 percent increase in admissions over the year before." In Butler County, the wait until this year never fell below 25 people for 71 beds -- half of which go to drug offenders -- in two facilities, said Vincent Sullivan, executive director of Southwestern Ohio Serenity Hall for men. Funding for another 36 beds came through in fall 1996 and became available the following December, whittling down the wait to three days, Mr. Sullivan said. Warren and Clinton counties have no residential treatment programs, said Bill Harper, executive director of Recovery Services of Warren and Clinton Counties, but "it is our No. 1 goal." In the past year, 21 people went instead to programs in Hamilton or Butler counties. Faced with waiting lists for residential treatment, thousands of people in Hamilton County instead turn to short-term care facilities to receive detoxification or therapy (and sometimes both). Each night they return to the environment that enticed them to use drugs in the first place. Just as frustration wells in the hearts and minds of people who can't stop using drugs, it collects among the people trying to relieve them of addiction. "It's a disease of immediacy," said Ms. Keuhn of CCAT. "If you can help when they ask for help, you can do something. If you put them on a waiting list, you've lost them." - --- Checked-by: Rich O'Grady