WHEN IT'S QUITTING TIME

It's almost impossible to kick heroin or cocaine without help. And help is
impossibly hard to find.

It takes seconds for a heroin or cocaine addict with cash to buy drugs. If
the same person were to decide to try beat the addiction, it would take
days or weeks to get into detox, and weeks or months to get a bed at one of
the handful of treatment centres, where non-profit groups try to help
addicts remain drug-free. Of all the deficiencies in Vancouver's approach
to its drug problem, experts agree, the shortage of treatment facilities
may be the most frustrating.

The problem is worsened by the need to respond almost instantly during the
rare interludes when an addict is focused on quitting. "You're dying today,
your life is falling apart, and you have a window of opportunity that
visits some people maybe four times in their lives," says Billy Weselowski,
a former addict who co-founded a drug recovery society.

"Those are rare, precious opportunities, when you don't need anyone to tell
you that you're all messed up. I remember when I was 17 years old, totally
out of control, and I had a moment of clarity and realized this wasn't
where I wanted to be. I remember feeling that again at 25 and at 33."

Then the window of opportunity closes. An addict's desire to stop using
drugs wanes. And a chemically driven craving to use drugs returns, at least
until the next crisis.

"The desire to change is very fleeting for an addict," says Lou, 40, a
Narcotics Anonymous member who says he hasn't used cocaine or heroin for 30
months. "That's the way addiction is. [Going clean] seems like a great idea
one day, but it doesn't seem like such a great idea later."

Detox workers say people who have to wait for a bed keep using drugs until
they can get in, because it's so hard to go through withdrawal alone and
without medication. What happens if they're on a waitlist for weeks or
months to get into a treatment centre or house?

"Let's see if you're even alive by then," Weselowski replies.

Long delays in obtaining help are the rule, not the exception, according to
a Lower Mainland Municipal Association report based on information from
more than 200 drug-treatment, law-enforcement, health and other agencies.

"The impact of these delays can sometimes be measured in terms of
unnecessary deaths, deadly infections and crime," the September report
states. "Many stakeholders believe that the delays caused by insufficient
detox, outpatient counselling and residential treatment spaces are totally
unacceptable."

A Typical Scenario

Here's a typical scenario: A cocaine addict prone to paranoia jumps out a
window, breaks an ankle and is taken to Vancouver Hospital, where he's
treated for his injury and then treated for his addiction by the hospital's
chemical-dependency team. Dr. Brent Dickson says the patient might be well
enough to release after one week in hospital, but would then face a
six-to-eight-week wait for an out-patient clinic for drug users, or a
two-to four-week wait for a bed in a support recovery home --usually a
converted house where addicts live and try to stay clean.

"And what do the social workers in the hospitals do when they can't find a
support recovery home?" he says. "They have to find the cheapest place -- a
hotel room in the Downtown Eastside, back in the same environment they came
from."

Dickson says many addicts tell him they have to get out of that Vancouver
neighbourhood, because they can't walk down the streets without someone
hawking drugs.

"That's death for an addict, because you can't resist that," he says. "You
have to be as far away from drugs as you can possibly get."

"The System Has Failed"

Dr. Ray Baker, chair of the B.C. Medical Association's addiction medicine
committee and specialist in the field for 15 years, blames the wait lists
on the B.C. government's alleged "mismanagement of addiction services."

"I've given up trying to get people into treatment services in this
province," Baker says. "The system has clogged up." According to Baker,
there used to be a network of out-patient services in B.C., a continuum of
services that began when a drug user was assessed and stabilized, then
given appropriate treatment and followed up.

"The system has failed," he says. "Residential treatment centres are full
of people who come off the street and aren't ready for treatment, but
there's no other place to put them."

According to the B.C. government, injection drug users are not turned away
if they are ready for treatment. If they can't get into a support recovery
home, they are supposed to be offered counselling at an outpatient clinic
or get help while staying with friends or relatives until a bed can be found.

"Let me contextualize this for you, if I may," says Miki Hansen, the B.C.'s
government's manager of addiction services for the last five years. Hansen
says treatment is part of a process, and outpatient services will help
someone work on basic things like education in the meantime.

The B.C. government has budgeted more than $72 million this fiscal year for
alcohol, drug and gambling abuse programs, but the money delivered to those
programs drops to $58 million when things like buildings and government
salaries are paid for.

Eighty-five per cent of the drug and alcohol programs are provided by about
200 government-funded, non-profit organizations.

Where The Money Goes

On paper, this is where the money goes: $6.8 million for prevention
programs; $20 million for out-patient services; $2.3 million for support
recovery homes; $9.4 million for residential treatment centres (where
there's more intensive counselling and treatment); $17.3 million for
detoxification centres, including two in Vancouver.

Hansen says there are provincial standards for addiction services, and
agencies getting more than $100,000 annually must be accredited. She says
there is a high level of satisfaction expressed by clients for things like
the food they are given, but she cannot say how successful government or
government-funded services were in keeping addicts off drugs for a
specified period of time.

"We don't collect relapse information," Hansen says. "At different points
in time they may relapse, but that's not a failure of the treatment system
or the individual. It's only part of a process, and they then get to use
that as part of a learning experience and figure out ways in which they
protect themselves from that kind of thing happening again."

A 'Discontinuous' Continuum

The need for a "continuum" of drug and alcohol services is a mantra
embraced by professionals in and out of government. First, there are
education and prevention programs, to try to stop substance abuse before it
happens. Second come early intervention programs. Then there are detox and
treatment programs.

But a report this year by the non-profit Kaiser Youth Foundation says
B.C.'s drug and alcohol program is poorly coordinated and fragmented. The
report's indictment: "Inconsistent and under-funded education and
prevention efforts. Wasted opportunities for intervention. Inadequate data
collection and research capacity on which to base good decisions. Waiting
lists for counselling and for treatment.

"The province's [alcohol and drug services] continuum, despite the best of
intentions, has become a 'discontinuous' continuum."

B.C.'s addiction treatment program began in the 1950s, run by separate
foundations for drugs and alcohol. In 1973, a New Democratic Party
government passed legislation to create a single provincial commission for
all substance abuse services, but a Social Credit government disbanded the
commission in 1992 after controversy ensued over a heroin treatment program
that included methadone maintenance.

Alcohol and drug programs became the responsibility of the health ministry,
then the labour and consumer services ministry, then the health ministry
and finally, after a 1995 inquiry into the death of five-year-old Matthew
Vaudreuil, it was placed under the aegis of the children and family
services ministry.

Except for adult drug and alcohol services in the Vancouver/Richmond health
region, the children and families ministry is still in charge. And critics
say adult alcoholics and drug addicts with children don't want to seek help
for their substance abuse problems, because they're afraid they will lose
their children.

The Kaiser Youth Foundation is just one of the non-government bodies that
wants Victoria to re-establish a better-funded, independent alcohol and
drug commission, so the fight against drug and alcohol abuse will have a
higher profile.

It's the same recommendation made in 1991 by the Royal Commission on Health
Care and Costs -- a recommendation that has been ignored.