COUNTY PROPOSING CHANGES IN DRUG TREATMENT

Linda Fantin

Drastic changes are on the horizon for Salt Lake County's
substance-abuse services. And while they were designed to drive down
costs, some counselors fear the new system will have the opposite
effect. After more than a year of study, the county has all but
decided to move toward a managed-care system of delivery for treating
addiction.

A public hearing on the changes will be held today at 2:30 p.m. in
Room N2003 of the County Government Center, 2001 S. State St., Salt
Lake City. The goal is to tailor treatment to a client's individual
needs rather than plug him or her into a set program.

To those familiar with the HMO model of health care, the changes
foreshadow cuts in the level of care as well as in costs. But many
counselors believe society ultimately will pay a higher price if
addicts are bumped from treatment before they are ready. ``Generally,
research indicates the longer in treatment, the better the client's
success,'' says Glen Lambert, executive director of Salt Lake City's
Odyssey House treatment facility.

And while managed care has reduced costs in private-sector hospitals,
Lambert says there is no conclusive research documenting whether
managed care works with publicly funded clients. ``I'm all for the
most effective and cost-efficient method of treatment,'' he says.
``But the alternatives -- hospitals, welfare and prisons -- are much
more costly in the long run.'' Barbara Hardy, director of the county's
substance-abuse services, does not dispute that the current system
works well. She even acknowledges research on managed care is limited.

But the county needs to do something to get a handle on rising costs
and caseloads, she says. ``It is an inevitable transition that will
give the county better controls over those programs,'' says Commission
Chairman Brent Overson. For decades, the standard protocol for
treatment has been to enroll clients in essentially the same program
regardless of their degree of addiction, Hardy says. That was fine
five to 10 years ago, when the majority of addicts were adult males.
But today's clients are more complex -- and more abundant.

There are many more women and children who need help. Also, a
substantial number of addicts are homeless, and many treatment centers
are hesitant to return those people to the streets after making such a
huge investment in getting them clean. Those changes, coupled with the
fact that federal funding has not kept pace with caseloads, has led
the county to re-evaluate its treatment programs in an effort to do
more with less. ``Our programs are not as individualized as they need
to be,'' Hardy says. By individualized, she is referring in large part
to the proposed tiered treatment plan, which includes time limits for
different phases of treatment. She says this is by far the most
substantial -- and controversial -- change in the county's proposal.
But even with the time limits, an addict's average stay in a treatment
facility will remain above the national average, says Salt Lake County
Commissioner Mary Callaghan. The other hot-button issue, Hardy says,
is the requirement that treatment facilities have a counselor on duty
24 hours a day. Hardy recognizes that increased administration will
result in fewer clients getting served, but says it is something
providers ``will just have to cope with.''

Luciano Colonna Utah Harm Reduction Coalition 81 O Street 95 Salt Lake

City, UT 95 84103 phone: (801) 532-5081 95 fax: (801) 532-5081
lcolonna@xmission.com

Checked-by: Rich O'Grady