DOUBLE-TALK ON CRACK?

Guilford County officials have found a private agency to run a new,
56-bed drug-treatment facility in High Point.

St. Charles, Mo.-based Bridgeway Behavioral Health Inc. will operate
the facility in the same location as a previous service provider,
Alcohol and Drug Services, or ADS, on West Wendover Avenue in High
Point.

That's welcome and overdue news. All too often you can trace violent
crime, jail overcrowding, homelessness, prostitution and the spread of
AIDS and HIV in Guilford County back to the dirty needles of IV drug
users and, especially, the seductive killer high on crack cocaine.

In announcing the contract with Bridgeway, a county news release cited
its "strong record for innovative outpatient and residential
treatment." Some however, question whether the facility truly delivers
what the county commissioners originally promised to make a dent in
the county's considerable crack-addiction problem.

The Right Approach?

A 2004 News & Record series on the local crack addiction problem noted
a 20-year grip by crack on the local community that had reached
epidemic proportions. It also pointed out a critical need for, and a
glaring shortage of, long-term treatment centers in Guilford County.
Later, a consultant's assessment of the now-defunct ADS made clear the
agency's failure to adequately provide long-term drug-treatment services.

But the new facility has earmarked fewer than half of its beds for
"low-intensity long-term residential treatment." Bridgeway typically
provides a 21-day stay for patients, then a regimen of outpatient treatment.

When it comes to crack addiction, some say, this is nowhere near
enough. In the 2004 News & Record series, a facility frequently cited
as a model for crack addiction treatment, Triangle Residential Options
for Drug Abusers, or TROSA, typically involves a one-year residential
stay and another year of outpatient treatment and support.

This county's new facility "is just going to be turning over beds and
putting crack addicts right back on the streets," said Susan Mills, a
local drug-treatment advocate.

Has the mission changed?

Mills said the county commissioners gave the impression the new
facility would specialize more in long-term treatment. Others in the
drug-treatment community say they are surprised that the facility
appears to place so little emphasis on long-term inpatient care. "It
is the only treatment modality that allows the patient to begin the
process of getting better," said Brenda Smith-Williams, who operates a
treatment center called DREAMS.

Smith-Williams said she had hoped patients at DREAMS, which provides
up to 30 days of treatment, could graduate to long-term care at the
county facility.

Added Craig Thomas, executive director of Mary's House, which provides
long-term treatment to women with children, including pregnant women:
"There is much more of a success rate for long-term treatment. If they
go back to their old playgrounds and playmates, we're in trouble.

"When you're on a diet, you ought to not work at the Krispy
Kreme."

Mixed Messages

Joe Fortin, a substance abuse "best practices" specialist with the
county's mental health agency, The Guilford Center, said last week
that the terms of treatment in the new facility have not yet been
determined, although it could include 90-day stays.

That seems more than odd, given that Bridgeway has already been picked
for the contract and length and nature of treatment are no small
details. Fortin also argued that not every patient requires a
long-term stay at a treatment facility. "There's no agreement that
certain drugs require certain amounts of time," he said.

That's not what he told News & Record reporter Stan Swofford in 2004.
Fortin cited numbers back then that seemed to support the
effectiveness of longer-term care. After 90 days, the success rate of
treating crack addiction is 40 percent to 60 percent, Fortin said in
2004. It rises to 60 percent to 80 percent after a year of treatment,
he said.

What gives? Has the conventional wisdom changed? Can we get straighter
talk about what's going on here?

Of course, the proof of the new facility's effectiveness will be in
the results, and county officials say they will closely monitor those
results. They also rightly point out that the new facility was never
intended to be the be-all and end-all of drug treatment in Guilford
County, just one of the solutions.

But the new facility does seem to veer from the earlier commitment to
longer-term inpatient care.

Given the scourge crack has been in Guilford County, the millions of
dollars it costs the taxpayers every year and the many ways it
threatens public safety and the quality of life here, we need straight
facts and clear, candid talk about how to fix this vexing problem.

Spirited debate about which path to take is healthy. But the last
thing we need is mixed signals and muddled missions.

This is too important not to get right.