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.