IN D.C., MANY ADDICTS AND FEW SERVICES

Lack of Treatment Programs Keeps Substance Abusers in Jail or in Trouble

Three women wearing jailhouse cotton assemble behind bars, District
prisoners all. Each possesses a blue form stamped by the D.C. Parole Board,
setting her free.

Except the women are not free. The forms tell them they can leave jail when
they are admitted to a residential drug treatment program. But in the
District's hard-pressed treatment system, there are not enough beds.

And so the women return to their cells. And months pass. And nothing happens.

Because drug treatment is so scarce in the District, prisoners who need
help routinely spend extra time behind bars, just waiting. In some cases,
inmates' sentences expire before they receive mandated treatment, leaving
them armed with little but their battered willpower when they return home.

Other criminal defendants, ordered by courts or parole authorities to
receive a variety of drug treatment, often find the options thin and the
attention haphazard. Specialists say the result is that too few addicts
shake their habits in the nation's drug-troubled capital.

"My experience here is that probably half the sentences for probation have
drug treatment required, but probably only 10 percent get any type of
services, and I use the word 'services' lightly," said University of
Maryland professor Faye Taxman, who studies the District. "The system has
been structured to provide the minimum. We provide something less than the
minimum and say we are providing services."

One D.C. Superior Court judge, facing a parade of addicts who commit crimes
or violate parole or neglect their children, calls the lack of adequate
treatment "horrible." Another calls it a "travesty."

Frustrations in the court system reflect problems citywide, where barely 10
percent of the District's estimated 65,000 substance abusers receive any
kind of treatment. Experts inside and outside the government say D.C. drug
treatment programs are in disarray, weakened by budget cuts and uncertain
leadership.

The problems in the District are part of an intense national debate about
the value of drug treatment in its many and sometimes controversial
incarnations. One school of criticism holds that treatment amounts to
little more than the coddling of criminals who need to grow up and take
responsibility for their troubled lives.

Even the most committed advocates concede that not every person who enters
a program will stay clean and sober. In fact, more addicts fail than
succeed at breaking their habits. Yet considerable scientific and anecdotal
evidence shows that treatment does help addicts who persevere.

In Washington, not only has the city's treatment budget been cut from $31.3
million in 1993 to $19.7 million this year, but coordination is poor and
essential components are limited or missing, according to interviews with
more than 50 advocates, treatment providers, judges, city workers and
addicts.

The costs can be counted in wasted dollars and lives. At least 40 percent
of adult arrestees test positive for cocaine, opiates or PCP. Nearly
three-fourths of all D.C. criminals report current or recent drug use, said
John A. Carver, a federal appointee who oversees probation and parole.

Frustrated by the District's failure to provide enough treatment, Carver is
negotiating contracts to provide 50 residential drug treatment beds, 50
alcohol treatment beds and 100 outpatient slots for offenders. His
associate Jasper Ormond said, "It's clear to us that we're going to have to
take control over some of the treatment continuum."

In the criminal system alone, Carver's office recently identified 159 D.C.
residents on probation or parole who are waiting for required drug
treatment. An additional 45 D.C. inmates remain behind bars as they await
inpatient placement or a treatment assessment.

One of them is Gregory Matthews, a drug user and confessed heroin salesman.
Superior Court Judge Eric Washington sent Matthews, 41, to the D.C. jail
Feb. 11, ordering him kept behind bars until an outside treatment bed could
be found.

"It's been over six months, and I haven't heard anything," Matthews
complained in a jailhouse interview. "This is just killing me, sitting
back, doing nothing."

The D.C. government's inefficiency compounds the problem, critics say. Last
year, for example, more than $1.4 million allocated to the principal D.C.
drug agency went unspent because of snarls in the District's many-layered
bureaucracy. At least $400,000 is likely to go unspent this year, health
officials told a D.C. Council committee.

In one case, the Bethesda-based Second Genesis group signed a contract in
August 1997 with a city agency to provide as many as 77 residential
treatment beds. City authorities rejected the contract for reasons they
decline to make public. Now, 18 months after bids were sought, the city is
reviewing new bids. The beds prepared by Second Genesis remain empty.

Other examples:

This year, the city provided money to open 32 spaces for youth treatment
but opened none. Officials blamed contracting problems.

The city's much-needed detoxification facility is built to handle 85 people
at a time. Only 35 slots are in use because of staff shortages. A project
advertised in December 1995 for drug programs at the Lorton Correctional
Complex stalled amid the turmoil of the federal takeover of D.C.
corrections operations.

The Whitman-Walker Clinic, the area's leading refuge for AIDS patients,
continues treating addicts on a city contract that expired 22 months ago.
Another provider said the District has been slow to renew contracts and has
fallen behind in payments.

"It's unconscionable," Whitman-Walker executive Patricia Hawkins said of
the city's performance. "It's so clear that when you spend money on
treatment, you save money on incarceration. We are spending a billion
dollars a year on criminal justice, most of which is drug-related."

City government staffers plead their own frustrations. They cite a lack of
money, a confused administrative hierarchy and what Department of Health
Interim Director Marlene N. Kelley described as "contracting challenges."

At a time of flux throughout the D.C. government, problems with drug
treatment are deepened by the lack of agenda-setting leaders. The D.C.
Council has not played an active role on the issue. The mayor is winding
down his term. Authority over the Department of Health, which oversees drug
treatment, was transferred last year to the financial control board, which
is itself in flux. Chief Management Officer Camille C. Barnett, who
oversees the Department of Health, declined to comment.

"There is no constituency in this city that works on behalf of people who
are addicted to substances," said D.C. Council member David Catania (R-At
Large). "That agency has languished without a voice for a long, long time."

Local funding for the D.C. Addiction Prevention and Recovery Administration
has dropped by 37 percent in five years, a casualty of the city's financial
crisis and choices made by budget-cutters. Searching for programs to cut,
administrators concluded that treatment money was not mandated by court
order or connected to a vocal city constituency.

Since 1996, federal funding for District drug programs has fallen by more
than 50 percent. Among the casualties of the parallel cuts: 890 outpatient
treatment slots, 820 methadone maintenance slots, 70 detoxification beds
and 220 residential treatment beds. Kelley described the cutbacks as
"devastating."

Kelley said the budget for APRA -- which expects to enroll 7,800 people
this year -- is designed to grow by $3 million in 1999. Next year's budget
includes money for 360 more methadone slots and 150 more inpatient slots
for clients diagnosed with both drug problems and mental disorders. She
pledged that the 77-bed residential contract will be executed by Sept. 30,
as will much-needed staffing contracts.

In the meantime, tumbling into the empty spaces between supply and demand
are thousands of D.C. residents -- the majority poor, uninsured, addicted
and struggling. Some are homeless. Some are prisoners or former felons.
Some are single mothers who will lose their children if they cannot get
straight.

Children are touched in profound ways. An estimated 80 to 85 percent of the
birth parents of the city's 3,060 foster children are substance abusers,
reports the Child and Family Services Agency. The same holds for the
parents of an additional 2,890 at-risk children who remain at home but
receive city support.

"You see kids who will be wards of the District of Columbia for 18 years
because the mother opted for drugs," said Superior Court Judge William H.
Jackson. "The mothers disappear. They're in a fog and they don't realize
that the kids need help or are being abused. You see the kids in the
juvenile system. You see them in the neglect system. There are tons of
these cases."

At the Addiction Prevention and Recovery Administration, three in four
clients tell counselors they have no income. Four in five have no health
insurance. Two in five failed to finish high school. Two in three have
arrest records.

Edward Hudgens, 42, is in treatment, occupying a slot funded with federal
dollars. An addict and father of two who first felt a heroin high as a
teenage soldier in Germany, Hudgens most recently pleaded guilty to
unlawfully entering a building, a misdemeanor.

He says that he wants to break free and reclaim some sort of normality but
that he can't do it alone. After nearly four weeks in an assessment program
at Karrick Hall on the grounds of D.C. General Hospital, Hudgens was
feeling anxious about moving to the next step, a residential program that
would demand an intense emotional commitment.

"I'm struggling. I'm feeling an anxiety attack because I'm pushing on to
the next level," Hudgens said. "I've gotten the cobwebs out of my head. I
want to jump out there and pick up all the pieces, but I know I don't have
the tools."

Angela Gorman, 34, understands. She cannot find it within herself to stay
away from heroin. As a result, she is one of the women with a parole board
release form, having waited since May 21 at the District's Correctional
Treatment Facility jail for a treatment bed to open up.

Gorman, sentenced to five to 15 years in prison for a 1985 heroin
conviction, has had her parole revoked twice already. Not because of
further arrests -- she says she has none -- but because she used heroin
between stretches of being clean.

The most recent time was last year. Nearing the abyss, Gorman reached out,
felt nothing, got nowhere: "I was strung out and crazy. I called my parole
officer two or three times, crying." And then it was too late.

Addicts and advocates say the path to treatment requires more strength than
many can muster or maintain. Because the window of willingness opens and
shuts so quickly, they contend, the District could help more people if it
provided faster access to quality programs and, in court cases, used a
tighter leash to help people battle their demons.

"When an addict makes a decision to go into treatment, it's a momentary
thing," said James Lanier, a treatment specialist who runs the assessment
program at Karrick Hall. "You need to get a client into treatment right
away, because if you put him on a waiting list, he or she is likely to use
again."

Beverly Jones, a senior family services administrator, remembers one mother
who said she was ready to try to leave drugs behind. She entered a
detoxification program to dry out, a step often required before addicts can
receive further treatment. But when the woman finished detox, there was no
inpatient bed available.

The woman hung on, tried to stay clean. But the one-month wait proved too
much. By the time the slot was available, the woman was using drugs again.

"Most people say, 'Well, that's not very long,' " Jones said, "but for an
addict, it's very long. If we know they need treatment, do we just say,
'Tough'?"

Jones's story is echoed throughout the system. On APRA's waiting lists, the
majority of the 600 men and women are in line for methadone maintenance.
APRA staffers and other experts say the hidden demand is far greater.

Aware of the competition for spaces, parole officers work the telephones on
behalf of their clients, hoping to wangle a treatment slot before addicts
return to drugs or commit new crimes. Public defenders fish into their own
pockets for air fare and bus fare for defendants seeking distant help.

"You're kind of up a creek if you don't have anybody to advocate for you,"
said William Perkins, a D.C. Public Defender Service counselor. "These
programs won't go out looking for you. And they won't let you in."

Addicts, in periods of sober clarity, describe places inside their heads
where good battles evil in a perpetual combat that may subside but never
disappears. LaTanya Witcher, 33, another of the women waiting in jail,
keeps finding herself drawn back to crack cocaine. Of frequent losing
battles in the past, she said, "I really got tired, but I was not at the
point where I was ready to stop."

University of Maryland academics who recently studied 412 District
substance abusers assigned to 12-month residential and outpatient programs
discovered that about one in three addicts completed treatment. Interviews
an average of 19 months later showed that users who finished the year-long
programs were less likely to use drugs and break the law, and more likely
to hold jobs.

Winners in the treatment wars swear by the results.

"Treatment works," asserted Michael Lintz, a recovering alcohol and drug
abuser who counsels addicts for Providence Hospital. "In less than a
minute, I've named six or eight people in recovery who are now taxpaying,
law-abiding, productive citizens. Without treatment, we'd all still be
lying, cheating, stealing or dead."

The intensity and duration of treatment matters, researchers say. Although
such group programs as Alcoholics Anonymous and Narcotics Anonymous can be
valuable for many people, specialists say they are insufficient for addicts
with deeper problems. Top APRA officials estimate that 30 to 40 percent of
their clients would benefit from months of residential treatment that few
will get.

"To just have an hour or two hours a week of programming is not sufficient
to address the need," said Andrea Weisman, director of mental health at the
D.C. jail. "We have lots of people who have been in various programs and
have gone through detox repeatedly. Short-term programs with which I am
familiar are not successful."

The D.C. courts have experimented successfully with a series of graduated
sanctions designed to motivate offenders to stick to sobriety and to hit
them quickly with understandable, measured, escalating penalties if they
fail. Even then, efficient access to treatment is a critical component.

Carver, who oversees pretrial services, probation and parole, is planning a
considerable expansion of the sanctions program, which includes strict drug
testing and reporting requirements.

"The pattern we see over and over is relapse leading to criminal behavior
leading to arrest, which can result in long-term incarceration. If you can
intervene immediately, you can stabilize that individual, maybe in the
community, maybe in a secure facility," Carver said. "That presumes an
infrastructure that we do not have but are working on."

Although some addicts may never be saved, supporters contend that treatment
saves money and heartache alike. For one thing, treatment costs less than
jail. When inmates remain behind bars awaiting treatment that does not
exist, it costs taxpayers $30 more a day for each inmate, said Carver's
general counsel, William Erhardt. When addicts get inferior treatment or
none at all, the price only goes up.

One experienced Superior Court judge contends that a government is
"shortsighted" if it expects to save money by scrimping on treatment for
addicts.

"I do believe that some -- though not all -- can be helped," said Judge
Reggie B. Walton, former deputy White House drug policy director. "If they
aren't, the city pays out a tremendous amount of money in foster care and
other kinds of care that could be avoided."

And what if money is spent and an addict returns to a drug life?

"There are benefits," another Superior Court judge said, "from having him
clean even a year."

The challenge, then, is to get addicts clean. Yet critics argue that APRA
remains poorly equipped to make the necessary difference.

"It strikes me as an agency on the defensive and not on the offensive,"
said council member Catania, who publicly questioned administrators
recently. "The sense I get from the people who are in charge is they seem
inundated, overwhelmed and not ready for the task."

Catania believes in spending money on "prevention and meaningful
treatment." He said, "That requires someone standing at the top of the
mountain and saying, 'This is where we're going, troops.' And we don't get
that."

Maryland professor Taxman believes the D.C. government must focus smarts
and money alike.

"They have not invested in a well-rounded quality of service," Taxman said.
"You get a hodgepodge, an episodic treatment. No one's looking at outcomes.
People say it's resources, but until we have a structure in place, it
doesn't matter."

(c) Copyright 1998 The Washington Post Company

Checked-by: Joel W. Johnson