SUDDENLY, NO WAITS FOR DETOX IN DISTRICT

These days, uninsured District residents seeking detox are being admitted
to city facilities without a wait -- a dramatic change from the years when
people queued up before dawn to improve their chances of getting a bed.

Officials throughout the D.C. Health Department, private agencies and the
criminal justice system say the waiting list for patients needing
detoxification treatment for drug or alcohol abuse simply evaporated
several months ago, when the District added beds and contracted with a
private group to take overflow cases.

"We are very pleased," said Susan Shaffer, director of the D.C. Pretrial
Services Agency, which refers many criminal defendants to detox. "We used
to direct people to go there at 5:30 in the morning to get priority in
getting in. Now we can send clients over at any time of day, and we get
them in."

The main facility for detox services is Building 12 on the campus of D.C.
General Hospital at 19th Street and Massachusetts Avenue SE. About 80 beds
are available in the 24-hour facility, operated by the D.C. Addiction
Recovery and Prevention Administration.

The hospital also operates a small inpatient detox unit, and some
city-sponsored patients are sent to the Psychiatric Institute of Washington
in Tenleytown, a private facility with a contract to take patients.

A detox stay can last a week, during which a drug or alcohol abuser goes
through withdrawal and considers long-term treatment options to attack the
cause of the addiction.

Long-term plans are often complicated by the fact that many patients use
multiple drugs and alcohol, and they might be diagnosed with mental
illnesses, including schizophrenia and bipolar disorder.

No one involved in treating the District's estimated 60,000 drug addicts
thinks improved access to detox is a panacea in a city plagued by substance
abuse problems.

Experts agree that many addicts do not seek treatment, though they differ
over why. But private agencies say the District's response to the problem
- -- an APRA budget of about $32 million this year -- might be inadequate
when compared with the estimated $1.2 billion that drug abuse costs the
city directly and indirectly, such as through crime, the courts and jails.

District health officials, such as Health Department Director Ivan C.A.
Walks, acknowledge that uncertainty about funding makes it more difficult
to expand treatment.

Nonetheless, a variety of officials hailed the progress made so far. Walks
said clearing the path to detox allows counselors to command the drug
user's complete attention at a pivotal moment.

"Detox is real treatment at the most critical time, when you have a
combination of physical illness and psychological addiction," Walks said.
"Getting people when they are at that crisis is critical."

In recent years, D.C. Council members have harshly criticized APRA, which
they said turned away people seeking detox even when beds were available
because of mismanagement.

"Now we can look at building a continuum of services beyond detox," said
Renee Lohman, executive director of Washington Behavioral HealthCare, a
private provider of detox and treatment services.

"We don't want people to leave the short-term stabilization of detox and go
back to their old neighborhood and be back at detox two weeks later," she
said. "We want them to have a whole treatment plan in the detox unit, with
a follow-up plan and someone they are accountable to."

D.C. Council member Jim Graham (D-Ward 1), a frequent critic of APRA, said
he was unaware of the elimination of the detox waiting list. "It's a long
overdue step," Graham said. Before, admission was a test of clout, he said.

Drug addicts say APRA used to block immediate care.

A 35-year-old uninsured woman who has been addicted to crack cocaine said
she has been through detox 14 times since 1985 and has always found the
experience maddening.

"You've got to go in at 4 o'clock in the morning to get seen at 7 in the
evening," said the woman, who spoke on condition of anonymity. "It would be
crowded and overloaded. And a lot of time, you would ask for inpatient
care, but they would put you in outpatient care. I'm not good at outpatient."

A few weeks ago, a psychiatrist effortlessly referred her to the
Psychiatric Institute of Washington. After detox was completed, she
continued on there in a privately funded 14-day transition program.

"It's essential to have immediate access," Shaffer said. "If a person is
drug addicted, you don't want to have to tell them to come back two days
from now."

The city's next challenge is to draw more addicts into long-term treatment,
said APRA Director Larry Siegel. The city can now put most addicts into
treatment with little or no wait, Siegel and Walks said, though private
agencies say the city's success in that area is not as clear as it is with
detox.

Siegel said the city funds 4,000 treatment slots, far fewer than the number
of addicts but adequate to care for most addicts who seek treatment. Many
of them also have access to treatment through private groups.

As part of its effort to track the many disparate groups offering drug
treatment, APRA is inspecting and certifying drug treatment agencies to
assure that standards of care are met.

"We don't yet have any way of assuring that every provider is qualified,"
Siegel said.