HELP SCARCE FOR ADDICTS

Waiting lists for treatment getting longer

Hundreds of addicts are being turned away from Hamilton County's four
live-in drug programs as the facilities struggle with the longest
waiting lists in memory.

The high demand for three-to six-month detoxification and therapy
stems from increased drug-court referrals, insurance cutbacks on
residential care and a shortage of similar programs in neighboring
counties.

As treatment stalls, program directors see an acceleration in the
social costs of drug-related crime and poor public health. "Every year
it is not unusual that someone gets into further legal problems or
perhaps even dies while on the waiting list," said David Logan,
director of Prospect House, a men's substance abuse treatment center
in Price Hill.

The number of Ohioans admitted into publicly funded treatment more
than doubled from 1991 to 1997, soaring from 43,670 to 93,522,
according to the Ohio Department of Alcohol and Drug Addiction
Services (ODADAS).

In Hamilton County, 28,000 people have been admitted since 1993, and
five times as many people are seeking treatment today, said Marti
Walsh, interim executive director of the Hamilton County Alcohol and
Drug Addiction Services Board.

But more people yet, including adolescents, have tried and failed to
secure one of 244 beds in the county's long-term rehabilitation
centers. The facilities are Prospect House, Crossroads Center in
Clifton for women, First Step Home in Price Hill for women and Talbert
House, which has more than a dozen locations for different programs.

Mostly, they are men and women without family ties, without jobs,
without clean criminal records.

One of them, a 45-year-old Mount Auburn man who asked that his name
not be used, says he has received several no-vacancy phone calls.

His name appeared seven times in the past decade near the tail-end of
waiting lists at various Cincinnati recovery programs, he said. He
made it into short-term rehabilitation centers, but the break from
drugs also proved short-term, he said."If you don't got no foundation,
no solid ground," he said, "you're going right back into that madness
again."

He said he started swallowing barbiturates at 12. At 18, he began
injecting heroin.

To support his habit, he committed burglary, robbery, "anything to get
money." In 1979, he was convicted of involuntary manslaughter and
sentenced to two to 25 years in prison, he said.

After stints at five Ohio state prisons, he attempted to kick his drug
and alcohol habits. Each time he tried to enter a long-term
residential program, he said he encountered a wait never less than six
weeks, sometimes six months.

"I felt like they didn't care," he said. "If they did, they would have
taken me in right then. But they didn't care if I lived or died."

Morre court referrals

Some of the backlog originates in drug court, a special arm of the
justice system created to treat drug offenders rather than punish
them. With more offenders referred to treatment, fewer spaces remain
available for others seeking the same treatment voluntarily. In
Hamilton County, where the Ohio Supreme Court in 1995 installed one of
the state's 17 drug courts, more than 1,220 people have been referred
to drug treatment.

"It's a quick response," said Debbie Brooks, whose department at
Talbert House substance abuse center handles most drug-court
referrals. "They're arrested and then in their beds the next morning."

The men's facilities, 52 beds, are 95 percent full to accommodate
relapses; the women's 16 beds are "booked all the time," she said. But
waiting lists at other Talbert House substance abuse programs -- which

number 24 and serve addicts who have not been referred by the drug
court -- can feature a trail of 50 names or a wait of 90 days.

Other programs that admit felons also have waiting lists, including
First Step Home and Prospect House, which temporarily closed its list
because "there's just no point in adding to it," Mr. Logan said.

Drug offenders receive immediate attention because they pose the
greater threat to society, said Common Pleas Court Judge Deidra Hair,
who presides over Hamilton County's drug court. But, she said, "it's
inexcusable that anyone should have to wait."

"It's a matter of setting a priority," she said. "If we don't do that,
we're paying a ton of money for them to go to jail."

Between July 1997 and June 1998, drug court saved 80,629 jail bed
days, according to Talbert House statistics.

The longer addicts stay in residential treatment, the better their
odds of recovering, Mr. Logan said. The average length of stay at
Prospect House, which has 60 beds, hovers at six months but can
stretch to one year.

"Two-thirds of our clients are getting clean and sober and staying
that way," he said.

In residential care, clients experience a necessary hiatus from their
surroundings -- long enough to acquire life skills, such as how to get
a job and how to communicate with family members, Mr. Logan said.

Insurance questions

But insurance companies, which could shell out hundreds of dollars a
day for residential treatment, contend that long-term outpatient care
can teach the same lessons.

"The strongest predictor of success has been how long a person has
been in treatment, not where they received treatment," said Dr. Peter
Boxer, medical director and vice president of Greenspring Health
Services in Blue Ash. The insurance company, part of Anthem Blue Cross
- - Blue Shield, serves 1.3 million Tristate customers with mental
health care and substance abuse benefits.

Treatment programs that last 90 days or more "are exceedingly long,"
Dr. Boxer said.

By limiting coverage to outpatient services, "money is being saved
without compromising the quality of services or the outcome
demonstrated," he said.

Northern Kentucky has two residential treatment programs, Droege House
in Dayton for men and Women's Residential Addiction Program in
Covington for women.

One of 40 beds at Droege House or 25 at WRAP (plus 10 for children)
may open by October or November, said Ann Perrin, associate executive
director of Transitions Inc., which runs both facilities.

Neither of the programs "offers the same level of care" as those in
Hamilton County because they don't offer physician-monitored
detoxification, said Sandi Keuhn, executive director of the Center for
Chemical Addiction Treatment (CCAT) in Hamilton County.

"Services just aren't available in those areas," she said. "So we're
seeing an awful lot more calls, a 25 percent increase in admissions
over the year before."

In Butler County, the wait until this year never fell below 25 people
for 71 beds -- half of which go to drug offenders -- in two
facilities, said Vincent Sullivan, executive director of Southwestern
Ohio Serenity Hall for men.

Funding for another 36 beds came through in fall 1996 and became
available the following December, whittling down the wait to three
days, Mr. Sullivan said.

Warren and Clinton counties have no residential treatment programs,
said Bill Harper, executive director of Recovery Services of Warren
and Clinton Counties, but "it is our No. 1 goal."

In the past year, 21 people went instead to programs in Hamilton or
Butler counties.

Faced with waiting lists for residential treatment, thousands of
people in Hamilton County instead turn to short-term care facilities
to receive detoxification or therapy (and sometimes both).

Each night they return to the environment that enticed them to use
drugs in the first place.

Just as frustration wells in the hearts and minds of people who can't

stop using drugs, it collects among the people trying to relieve them
of addiction.

"It's a disease of immediacy," said Ms. Keuhn of CCAT. "If you can
help when they ask for help, you can do something. If you put them on
a waiting list, you've lost them."

Checked-by: Rich O'Grady