This letter is written in response to the person struggling with
addiction who was disappointed with the wait required to receive
methadone treatment at Blue Ridge Center [Letters, "You don't tell a
junkie to wait," April 5]. The staff at Blue Ridge Center Narcotic
Treatment Program is unequivocally dedicated to [helping] narcotic
addicts achieve an improved quality of life through a recovery
process. We offer services in as respectful, caring and timely fashion
as possible. This does not, in our opinion, mean dispensing methadone
upon demand. We provide treatment, which is very different than just
being another available source for narcotics.

The fact that a person may have to wait for treatment is not an
indication of a lack of caring on our part. There is an admission
process, prescribed by the federal government, which a client must
complete prior to receiving methadone. We attempt to help the client
complete this process as quickly as possible. If a client is not
motivated enough to follow through, one might question how serious
that client is about receiving treatment.

The process is as follows:

When a client calls, we schedule the initial appointment as soon as
possible, usually within 48 hours.

The initial appointment consists of about a one-and-a-half-hour-long
assessment, [which involves] gathering the details of psychiatric
symptoms, social history, medical history, drug-use history, etc. The
client must then undergo a urinalysis test. This assessment helps to
determine the proper recommendations for treatment =96 whether it is
methadone treatment, abstinence-based treatment, detox or inpatient
treatment.

If the client is felt to be appropriate for methadone treatment,
he/she must then have a complete physical, with specific lab work (as
mandated by the federal government). We contract with a physician to
provide this service in a timely manner, usually within three or fewer
days of the client's request.

Following completion of the physical, the client must then meet with
our medical director for official admission to our program. This
usually occurs within two or fewer days of the completion of the
physical. Following approval by the medical director, the client is
admitted and dosed with methadone that day. The total process may take
a week, on average.

Our clients then participate in weekly individual and/or group
counseling, case management and urinalysis, to help them achieve an
ultimately more gratifying lifestyle.

Federal law prohibits us from exceeding a 50-to-one client/counselor
ratio. Because of this, there are rare instances when we have a
waiting list. In these instances, we always make clients aware of
other clinics and substance-abuse services in the area.

It is often difficult for a person experiencing the panic and pain of
withdrawal to accept not getting what they want when they want it, but
letting the impulsivity of the addiction process prescribe the
treatment is neither responsible nor, ultimately, helpful in treating
addiction. Part of treatment is understanding and practicing the
concept of "delayed gratification" =96 that is, in order to gain much
of what we want in life, we must participate in series of linked
behaviors resulting in some eventual gratification/goal achievement.
You work a week to get a paycheck; you don't expect to be paid in cash
before you begin the job and every hour on the hour after that. You
work in the garden for months before a harvest begins.

People suffering from addiction are conditioned to a dynamic of
immediate gratification. They want to experience a certain sense of
well-being, and taking a drug fairly immediately produces that effect.
Thus, they may come to expect to receive what they want when they want
it. When this immediate-gratification process is stymied, frustration
occurs. Being successful in treatment requires a persistent effort
over time. We encourage clients to stick with the process, even though
it can be frustrating, at times, for them =96 and for our staff, as
well.

Efforts to serve clients in a more timely manner than described above
are limited only by the amount of money it takes to pay for doctors
(our medical director works with us five to six hours a week, and has
at least four other services he is responsible for in the
mental-health center), counselors (we have two-and-a-half), nurses,
office space, etc. I do not in any way question the dedication of our
staff to provide treatment with the utmost integrity, efficiency,
respect and kindness to addicts.

P.S. Although withdrawal from narcotics may be extremely
uncomfortable, it is the use of =96 not the withdrawal from =96
narcotics that is potentially lethal.

Richard Trotman, M.A.,
Narcotic Treatment Program,
Blue Ridge Center