FIGHTING ADDICTION
Many Obstacles Hinder Treatment Of Meth Addicts

To treat methamphetamine addiction is to battle paranoia, violence and
intense craving for a highly addictive substance. Treatment can work,
but recovery is a slow process.

Snorted, smoked or injected, this illegal drug mixes up the brain's
chemistry so badly that crank addicts often can't concentrate on
treatment without weeks of detoxification. Once separated from
methamphetamine, addicts crave it so much that they frequently flee
treatment centers to get high again.

Treatment can be expensive - hundreds of dollars a day for private,
inpatient programs. And the waiting list is weeks long for Montana's
sole publicly funded adult inpatient program at the Montana Chemical
Dependency Center in Butte. The state doesn't fund a drug treatment
center for people under age 18.

Demand For Treatment

Yet the demand for methamphetamine treatment has grown quickly in
Montana over the past few years.

"Nothing's changed. It's still bad," Mona Sumner, chief operating
officer for Rimrock Foundation, said when asked about the trend in
local methamphetamine abuse in the past couple of years. Rimrock
continues to see methamphetamine used in younger patients,
particularly in people ages 18 to 30.

In 1998, for the first time, crank ranked as the No. 2 drug among
Rimrock patients, Sumner said. Previously, alcohol and marijuana had
always been the most prevalent drugs among those receiving addiction
treatment at the private, nonprofit center at 1231 N. 29th St.

In 1999, Rimrock admitted 330 patients. Forty-five percent came in for
treatment of alcoholism, 30 percent for methamphetamine addiction and
25 percent for all other types of addiction.

Also in 1999, 600 people were served in Rimrock's six-bed
detoxification unit. Detoxification - getting the drug out of the
person's system - is a challenge in treating methamphetamine addicts.
Meth addicts need four to six weeks for detoxification, Sumner said,
adding: "For the first two weeks, they can't do much. They need help
to manage their cravings."

Managed Care Limits

The challenge is that most insurance companies put managed care limits
on chemical dependency treatment. Typically, managed care allows two
or three days for detoxification.

About 80 percent of Rimrock patients have insurance, about 10 percent
are state-paid patients and about 10 percent are self-paying.

"We have to be incredibly creative to get people detoxed," Sumner
said. "Our biggest problem is you lose these people. They flee
treatment. We fight with insurance companies to get a 28-day stay."

At Rimrock, those who are maintained as inpatients for a few weeks,
which amounts to a detoxification period, then are entered into the
intensive outpatient program for actual treatment.

The state of Montana used to fund some adult inpatient treatment at
Rimrock. No more. However, Rimrock can evaluate individuals and make
referrals to the Montana Chemical Dependency Center in Butte.

A problem with MCDC referrals is the waiting. It can take a more than
a month to get an individual into the center, including time for
evaluation and paperwork just to get on the waiting list, according to
Stephen King, clinical services director at the Butte center.

"There isn't easy, quick access to the continuum of care," King said
in an interview from Butte.

Sumner and other treatment professionals interviewed by The Gazette
agreed that many crank addicts can't wait weeks or even days. They
don't return, and the treatment opportunity is lost.

The state does fund two beds for adolescents at Rimrock, paying $125 a
day for treatment that has a regular charge of $300 a day, Sumner
said. As of last week, the two state-funded slots already were
committed for the next two months.

There's no waiting to get into Rimrock, except for the state-paid
adolescent beds and the outpatient program, but the treatment center
is staying full or close to full at all times in both inpatient and
outpatient programs.

Expanding Rimrock

Because of the high demand for services, Rimrock is expanding. Sumner
said her organization is awaiting a city building permit and plans to
start construction as early as next month for an $800,000 addition to
the front of its building. The three-story addition would extend the
building 20 feet south into a parking area. The new space would be
used for four additional detox beds, to expand room for the outpatient
programs and to allow the treatment center to bring six inpatient beds
back into service.

"It will help a bunch, but it's not enough," Sumner said, explaining
that Rimrock could use 16 detox beds, but this is the expansion that
it can afford.

County alcohol tax funds help support a six-bed detox unit at Rimrock,
but don't cover all its costs, Sumner said. Rimrock subsidizes this
care for a population that is predominantly indigent. Ninety percent
of detox patients pay little or nothing for their care, she said.

Addicted Mothers

Virtually all of the patients treated at the state center in Butte are
indigent. The vast majority are unemployed, and more than half of the
women are mothers of young children. The men and women usually have
been compelled to seek treatment. For some, it is a condition of
probation in a criminal case. For others, treatment is required to
regain custody of children removed from the home because of neglect or
abuse.

Crank addicts streamed into MCDC last year from every corner of
Montana, from 34 of its 56 counties. Yellowstone County, Montana's
most populous, sent the greatest number of crank addicts - 68.
Although men suffering from alcoholism account for the biggest number
of MCDC patients, the women treated are more likely to be
methamphetamine addicts, according to statistics from the center.

"If I know there is a young female, single mother from Billings, I
know it's methamphetamine," King said.

Over the past couple of years, MCDC made program changes designed to
deal with the needs of methamphetamine addicts. For one thing, instead
of a basic 28-day stay, treatment at the state center now has a
variable length that can allow for the longer time that meth addicts
need to get through a critical craving period and actually start
treatment, King said.

While the length of stay at MCDC has gotten longer, the number of
patients treated declined from 957 in fiscal 1998 to 761 in fiscal
1999, according to center statistics.

"We lose meth addicts between 10 and 14 days," King said. To keep them
in treatment, MCDC has intensified staff one-to-one contact with
addicts during that period of their treatment. The result is that last
year, almost the same proportion of meth addicts completed treatment
as did other addicts treated at MCDC. Also, the state center reports
significant improvement in the number of people completing treatment
who actually show up for their aftercare appointments. It used to be
that less than half made it to aftercare. Now the center has a goal of
76 percent and achieved that goal last fall.

The improvement came after the center hired a discharge planner, King
said. But he knows there are still barriers for people to continue
with follow-up care in their communities: Some people don't have child
care, so they can't attend meetings. Some don't have transportation.
(The state Division of Family Services will pay for child care when it
is involved with the family, but money budgeted for child care is
running out, a DFS supervisor reported.)

Proposed Changes

A list of proposals released last week by the state Addictive and
Mental Disorders Division includes several that would address gaps in
the state's chemical dependency treatment system. These proposals are
part of a long wish list that will be considered in the executive
budgeting process. They aren't necessarily going to be part of the
governor's budget proposal for the July 2001-June 2003 biennium. The
proposals include:

Development of services and qualified professionals to treat people
who have diagnoses of both chemical dependency and mental illness.

Covering drug and alcohol psychoses under the state mental health
program for people who have low incomes but aren't eligible for Medicaid.

Establish certification for direct-care staff at all mental health and
chemical dependency treatment centers.

Increase payments to providers, particularly in rural
areas.

Amend the state Medicaid plan to cover adult chemical dependency
services and a broader range of adolescent chemical dependency services.

Medicaid coverage of chemical dependency treatment would be wonderful,
Sumner said. She said Rimrock would be willing to look at contributing
to the state matching funds for Medicaid.

The federal government pays 70 percent of the cost of all Medicaid
services for disabled and low-income Montanans. The state has to pay
30 percent. The Legislature would have to approve any change that
added chemical dependency treatments to the list of Medicaid services.