GETTING STRAIGHT, PART II

TED KOPPEL We love the image of declaring war on things we hate and
sometimes, as in the war on crime, it's an appropriate image.
Declaring war on drugs and drug addiction, on the other hand, is a
little more complex. As you may have heard on this program last night,
the most warlike approach-destroying drug production overseas-is also
the most expensive. Intercepting drug shipments at the US border is
cheaper, but also very costly. Law enforcement on the streets of our
towns and cities is a more efficient way of keeping drugs out of the
hands of our addicts. But the most efficient way by far, the cheapest,
the best, the most enduring way to reduce drug addiction in America is
through drug treatment.

It is also the least sexy, the most difficult to sell politically to
the taxpaying public. So we don't have enough drug treatment centers.
They tend to be insufficiently funded so that a lot of our addicts are
rushed through programs that are too short to be effective and all of
this, of course, assumes that there are enough trained, dedicated
people around to convince addicts that treatment is what they need.

Which brings us to Rafael Flores, who works from eight to four as an
intake counselor for the drug treatment clinic at Bronx Lebanon
Hospital in New York. Although it's not what he does on the job that
makes Rafael so interesting. It's what he feels compelled to do on his
own time. Nightline Correspondent Dave Marash has his remarkable story.

DAVE MARASH, ABCNEWS (VO) It's an hour before first light and already
a group of addicts is waiting in the vestibule of Beth Israel
Hospital. For Rafael Flores, fisher for souls, Beth Israel is like the
Gulf Stream.

RAFAEL FLORES I like finding people and offering them services. It's
as simple as that. People that are hurting and often there's drug
addicts, alcoholics, and I really like reaching out to people. I'm a
street worker. I've been doing it for 28 years and what I do is get
people into detox.

DAVE MARASH (VO) To be cleansed of their drugs or alcohol, people
start arriving as early as 2:00 AM for a detox unit that doesn't open
until 7:30. They know that many mornings not everyone in the vestibule
makes it to the unit. In New York City, as in the United States, just
one in four addicts seeking treatment gets it. For those who don't get
it, there's Rafael.

RAFAEL FLORES So like if there's any problems where you may not be
able to get in, you know, I could help you get into a detox and a rehab.

DAVE MARASH (VO) And mere detoxification without rehabilitation and
then long-term therapy is something Rafael says just doesn't work.
He'll accept nothing less than a commitment to all three.

RAFAEL FLORES Have you ever been at Beth Israel before?

1ST SUBSTANCE ABUSER Yes.

RAFAEL FLORES OK, so when was the last time you were
here?

1ST SUBSTANCE ABUSER Last year.

RAFAEL FLORES Last year? OK. The, have you ever tried a long-term
program before?

1ST SUBSTANCE ABUSER No, no.

RAFAEL FLORES He's been in detox six times. He was never referred to a
next level of treatment. There are those people that go into detox to
clean themselves out but we have perfect opportunity to refer them to
a rehab for like say 28 days or to a long-term program directly from
the facility. There are many people, many agencies will not work with
street addicts per se. This is the population that I'm looking for.
This is the population that we need to make an extra effort to reach.

DAVE MARASH (VO) This population, says one of New York's top experts
on drug treatment, requires the constant care and long haul philosophy
that Rafael espouses.

DR JEFFREY FOOTE, ST. LUKE'S ROOSEVELT HOSPITAL You're talking about
learning a life as opposed to going back to a former life that you may
have had. In that case, you need time and you need protection and
that's what a long-term impatient facility can offer you in a perfect
world.

RAFAEL FLORES You'll go in and you'll come out really quick and the
counselors may not be able to arrange long-term treatment from here. I
know I will be able to.

DAVE MARASH (VO) If you don't get in this morning, call me, says
Rafael. And if you do get into detox, call me when you get out.

RAFAEL FLORES If you make the right decision and say let me try this
or let me try that, let me do something a little different, it's
possible. It's possible to be clean. It's possible to wake up and not
have to need a drink.

DAVE MARASH (VO) With those final words of reassurance, Rafael's new
client enters the hospital. As we head uptown from Beth Israel, Rafael
is pleased. This street angel has accomplished his mission. He has
offered service and believes it will be accepted.

RAFAEL FLORES This client is motivated. He came here because he wants
to stop drinking, he wants to stop being in the streets. He told me
that he would like to learn how to walk and keep his head up high.

DAVE MARASH Rafael Flores, Ralph to his friends, learned his trade
here. Upstairs across the street there used to be an office called
Hotline Cares. Ralph ran the office for more than 20 years and saved
hundreds of his East Harlem neighbors from addiction. Then, the hot
line went bust. Ralph had messed up on his paperwork, offended some
funders and even some of his fellow workers so that today he
freelances his mission on the streets and at a place called Sister's.

RAFAEL FLORES We're going to go to what I call Sister's house. This is
a nun that has lived for the past 24 years, she has her own tenement
apartment in East Harlem and she provides a great deal of services to
people that are hurting, people from the streets. So I'm always
checking in with her to find out if anyone requires my services and we
just work together and try to hook it up. The place would not win an
award for decoration, but it has a lot of heart. Is sister in? Look
who's there! Look who's there!

2ND SUBSTANCE ABUSER Oh, thank you Jesus. It's been a long
time.

RAFAEL FLORES It's so good seeing you. I know, it has been a couple,
at least two years, right?

2ND SUBSTANCE ABUSER A little more than two years.

RAFAEL FLORES A little more than two years since I last worked with
you.

2ND SUBSTANCE ABUSER Yeah. You're the one that gave me a hard
time.

RAFAEL FLORES Yeah.

2ND SUBSTANCE ABUSER But you saw in me what I didn't understand in
myself.

RAFAEL FLORES And what do you think that was?

2ND SUBSTANCE ABUSER Tough love. What you gave me was tough
love.

DAVE MARASH (VO) Little does Rafael suspect what challenges await him
at Sister's, challenges to his toughness and to his ability to love.

RAFAEL FLORES OK, but she told me that maybe I want to work with one
or two persons. She wanted me to talk to you.

CATHY ORTIZ Yeah.

RAFAEL FLORES OK. I'm glad you're here. I'm really glad you're
here.

CATHY ORTIZ OK.

TED KOPPEL When Dave Marash continues, Rafael's next challenge, a
mother of eight.

(Commercial Break)

MICHAEL MASSING The overall number of people using drugs has declined
since the mid-'80s. If you look at the number of people who used
cocaine, let's say, at all on an annual basis, it has gone down sharply.

But the hard-core user population, those who are chronically using and
abusing heroin, cocaine, crack and methamphetamine has remained
stubbornly high.

DAVE MARASH (VO) Michael Massing, author of The Fix, introduced us to
Rafael Flores and to the world of America's four million hard core
junkies.

MICHAEL MASSING They are the ones who remain the core of the problem
because they're the ones committing crime, they're the ones
contracting AIDS, they're the ones who are neglecting and abusing
their children.

RAFAEL FLORES Sister told you I was coming.

CATHY ORTIZ Sister told you I where I was coming and she wanted to
know more exactly my problem and drug. I'm trying to get myself together.

RAFAEL FLORES OK, tell me what you're dealing with, you know, the
substance.

CATHY ORTIZ OK, I'm dealing-crack, heroin, methadone.

RAFAEL FLORES OK.

CATHY ORTIZ I'm on a methadone program.

DAVE MARASH (VO) Cathy Ortiz, still in her forties, a junkie more than
half her life. When Cathy started on drugs, the Nixon administration
was putting two thirds of its drug control budget into treatment
programs. Today, that proportion has been reversed and twice as much
money goes to law enforcement, to border control and to destroying
crops in foreign fields as goes to drug treatment.

RAFAEL FLORES When did you come out of the detox?

CATHY ORTIZ I came out a week and a half ago.

RAFAEL FLORES OK.

CATHY ORTIZ And I've been doing pretty good.

RAFAEL FLORES OK, so what we're talking about is a
rehab8A

CATHY ORTIZ Struggle.

RAFAEL FLORES A rehab?

CATHY ORTIZ Yeah, right.

RAFAEL FLORES OK. Tell me the issues that you want to deal with. What
do you want?

CATHY ORTIZ I want to get my life back together.

RAFAEL FLORES OK, what does that mean for you?

CATHY ORTIZ I want to get my kids.

RAFAEL FLORES OK.

CATHY ORTIZ And I want to live in my apartment with my
kids.

RAFAEL FLORES In the past year how many detoxes have you been
in?

CATHY ORTIZ I've been in about seven.

RAFAEL FLORES OK. Tell me-and we're going to get you in, but tell me
what is it that's motivating you this time? Why do you think it might
work this time or what decisions are you ready to make this time?

CATHY ORTIZ Because I'm just tired. I'm just tired. Being tired of
doing the same things over and over and over again.

RAFAEL FLORES How do I know it's possible to be clean and to learn how
to live without substance?

CATHY ORTIZ Exactly.

RAFAEL FLORES You know, and that has to be difficult.

CATHY ORTIZ It's a struggle every day.

RAFAEL FLORES That has to be difficult.

CATHY ORTIZ It's a struggle every day.

RAFAEL FLORES OK. We're going to start off with a rehab.

CATHY ORTIZ All right.

RAFAEL FLORES I will not place you in a rehab unless you commit to a
long-term program, OK?

CATHY ORTIZ OK.

RAFAEL FLORES Do you have your Medicaid?

CATHY ORTIZ Yeah.

RAFAEL FLORES Let's get on the phone. Listen, I kind of work a little
strange. It may happen even today.

DAVE MARASH (VO) One thing that may complicate Rafael's attempts to
book Cathy into rehab is the fact that she takes regular doses of
methadone to help her control her heroin addiction. Many drug-free
facilities won't accept people on methadone maintenance. But before
Rafael can even get to the telephone, he's interrupted by an old
friend and his second new client.

RAFAEL FLORES Sister, I'm meeting with Cathy 8A

SISTER Right.

RAFAEL FLORES She's ready to make a move. Hi, John.

JOHN CURTIS How you doing?

SISTER He's making a move, too.

RAFAEL FLORES Could I be of any help?

JOHN CURTIS No. I'm out of New York, period.

RAFAEL FLORES You're what?

JOHN CURTIS I'm out of New York, period.

DAVE MARASH (VO) John Curtis has fouled East Harlem's streets for
decades with drugs bought and sold, with lives laid waste, his teenage
son shot to death before his eyes, his two-year-old son in the process
of being taken from him and his wife dying of drugs and AIDS. Sister
has given him traveling money and a bus ticket west.

RAFAEL FLORES What did you want to say?

SISTER The thing that works very often best for us is to just get away
from this whole neighborhood, the whole scene.

RAFAEL FLORES Let him leave in five days. OK, I'll go along with that
if you let me get him in today, that way you'll get some basic medical
services that you could appreciate and be healthier when you do leave.
You'll still leave. You keep the ticket. But at least let me do my
thing.

JOHN CURTIS Well, I'll let you, I want you to do your thing. Hook me
up.

DAVE MARASH (VO) Rafael's thing is to get John admitted to detox, the
first stage of drug treatment.

RAFAEL FLORES I think John must have, his substance abuse history has
affected him, his ability to be rational even on a basic level. I
think John wants to die. That's your what?

JOHN CURTIS That's for my degree, we have a permanent ID I got my
Medicaid card.

DAVE MARASH (VO) As John Curtis pulls out his Medicaid card, he's
reminded of a complication.

RAFAEL FLORES Is your Medicaid restricted?

DAVE MARASH (VO) John's Medicaid account has been assigned to an HMO,
Metro Plus, with a short list of treatment facilities it will use. The
last one they sent John to set up what can be for him and other
addicts a recurring roadblock to treatment-the requirement that he
accept treatment for alcoholism as well as his drug addiction.

JOHN CURTIS I don't drink enough. You know, I haven't drank in 14
years. I had to lie because they won't take you on just drugs alone.
You have to have alcohol and drugs or they won't accept you. So I said
yeah, I just drank yesterday.

DAVE MARASH You talk to a lot of people who are saying I want help but
they don't really want help.

RAFAEL FLORES Right.

DAVE MARASH What tells you that these two are ready?

RAFAEL FLORES When they get to the facility.

DAVE MARASH So right now we're still guessing?

RAFAEL FLORES We're still guessing.

TED KOPPEL Getting addicts to accept treatment is tough enough.
Getting the treatment centers to accept the addicts can be even
tougher. That part of the story, when we come back.

(Commercial Break)

DR DENI CARISE, TREATMENT RESEARCH INSTITUTE Now, not only are there
more people on a wait list for the government programs, the wait lists
are longer.

DAVE MARASH So, in a sense, the neediest cases are the ones who go
untreated longest?

DR. DENI CARISE Right. That's true and what's so important about that
is that a lot of research has shown that when somebody's ready for
treatment and they want treatment, if they don't get it right away the
chances of them continuing and waiting and getting into treatment
later really diminish.

DAVE MARASH (VO) These are the conditions that face Rafael as he
starts phoning for John Curtis.

RAFAEL FLORES Joe, this is Rafael. I want to beep you. I have a client
here. I'm asking for a detox scholarship.

DAVE MARASH (VO) Rafael is sure that John's HMO will refuse to pay for
most of the programs that he can access so he's trying to get John a
scholarship for free care. Where's John, asks Rafael, pausing from his
non-stop dialing?

SISTER John will be with you in a little while. He was, he's crying
all right? He's a little upset.

RAFAEL FLORES OK, but where is he because I don't want to lose
him.

SISTER No, he's not going nowhere.

RAFAEL FLORES Hello? Give me a scholarship, I'll give you the next
five Medicaids I get. Thank you. Please call me at Sister's. Thanks.
That's the negotiation. If they give me this one scholarship, I'll
give them the next five clients I receive, the next five clients that
have insurance.

DAVE MARASH (VO) Before phoning up John's next hope, Rafael checks up
on his missing client. John was last reported in the local laundromat,
reputedly a place an addict can make a drug connection.

RAFAEL FLORES I'm just looking for someone. Sister, I temporarily lost
John.

SISTER Well, somebody told me he was in here.

RAFAEL FLORES Yeah. Well, we searched the place and he's not here.
Cathy said that he might be in some woman's apartment?

DAVE MARASH (VO) Rafael returns to the phone and soon gets good
news.

CATHY ORTIZ Some woman is here. It gotta be a woman.

RAFAEL FLORES Who?

CATHY ORTIZ John.

RAFAEL FLORES Very good, girl.

CATHY ORTIZ OK. I'm getting my clothes. I told you I'm
working.

RAFAEL FLORES Every time I meet with people I'm hoping that they might
be ready. I'm assuming that today is going to be a good day for them
and they might be ready today and it's my job to be ready when they
are.

DAVE MARASH (VO) And, says Rafael, he knew exactly when Cathy Ortiz
was ready.

RAFAEL FLORES I was working with her doing some intake and she said
look, Ralph, I have to go to the laundromat. I'll be right back. I
lose most people at that point. The fact that she came back and told
me, "I'm back," she was telling me a lot. She was telling me I'm
ready, let's go.

DAVE MARASH (VO) Once again, Cathy's case moves to the top of Rafael's
agenda.

RAFAEL FLORES I wonder if I might please be able to speak to an intake
worker regarding a possible admission for a client into your rehab. As
soon as possible, today or tomorrow. No beds until next week?

DAVE MARASH (VO) In New York City, the demand for treatment far
exceeds the supply of beds. So far, Rafael has been unable to place
either of his two new clients.

RAFAEL FLORES Yes, but if I have to wait more than 24 hours, I'm going
to lose her.

DAVE MARASH (VO) Meanwhile, John's HMO's veto power has stymied
Rafael's attempts to find him treatment. But Rafael has a plan for
John. First he'll put him into a city crisis center, which will then
send him on to detox at a hospital on Staten Island.

RAFAEL FLORES So why don't I get him down there at five o'clock? OK.
I'll do that. Now, would your worker open the door for us? I mean I'll
be there with him. The best we were able to do is get him into the
crisis center tomorrow morning at five o'clock. We pick him up, we
take him there, but they want him there at five o'clock on the
morning. So we'll be there.

DAVE MARASH Now, who's going to keep an eye and a leash on him between
now and 5:00 AM?

RAFAEL FLORES Sister. That's the reality cause we can't chain him. Hi,
my name is Rafael Flores and I have a client that was in your rehab
about four and a half months ago and she needs to reenter into your
rehab.

DAVE MARASH (VO) Now it's back to Cathy's case,which also has its
absurdities. Cathy is rejected by Beth Israel because her last attempt
at rehab ended less than six months ago.

RAFAEL FLORES Would you consider making an exception,
please?

She's highly motivated. She's been out of your rehab. She left in good
standing. She's been out of your rehab for four and a half months. She
has Medicaid. You have beds. Could we work out something? I would say
we have a shot. I would say we have a shot. If we don't, if it doesn't
work, then we get the next one, but we get your paperwork tomorrow.

CATHY ORTIZ OK.

RAFAEL FLORES So it's a little juggling but don't punk out on
me.

CATHY ORTIZ No, I'm not. I'm not.

RAFAEL FLORES Stay with me.

CATHY ORTIZ Sister knows I'm a fighter.

DAVE MARASH (VO) Quite a day's work. Rafael has one yes for John and a
maybe for treatment for Cathy.

RAFAEL FLORES They both are going to try to support each other for the
tonight and tonight is a critical night. They need to stay alive in
order to live, yeah.

TED KOPPEL I'll tell you about tomorrow night's broadcast when I come
back, in a moment.

(Commercial Break)

TED KOPPEL Tomorrow, will John and Cathy make it through their first
night clean and sober and will they get into a treatment program?
Getting straight, the final report tomorrow. That's our report for
tonight. I'm Ted Koppel in Washington. For all of us here at ABCNEWS,
good night.