S.F. Proposes OnDemand Drug Treatment Plan

It's aimed at poor, youth

William Carlsen, Chronicle Staff Writer

A San Francisco health department panel has drafted a plan one of the
first of its kind in the nation to provide for drug and alcohol
treatment on demand for the city's youth, prostitutes, homeless and
poor.

The ambitious plan proposes a dramatic expansion of residential and
nonresidential treatment and detoxification centers to deal with what it
called the ``epidemic of substance abuse'' in San Francisco.

No funding amounts are outlined in the proposal, but the city has
already begun to set aside additional funds for ondemand care which
calls for providing treatment promptly upon request. The health
department is asking for at least $4 million in extra appropriations
for treatment in the coming budget.

The proposal is remarkable for its sweeping goals in the era of
pareddown government, especially because it calls for new expenditures
targeted at largely fringe population groups like the homeless and
prostitutes.

But Supervisor Susan Leal, who conceived of the ondemand idea, said
studies show that the city will save at least $7 for every $1 it
expends on treatment.

She said the economic consequences of drug and alcohol abuse are
enormous and often hidden. ``The majority of people in San Bruno (jail)
are there because of drugs,'' she said. There are also large potential
savings in emergency room and county hospital costs, she also said.

``But less obvious,'' Leal said, ``is the fact that the overwhelming
majority of children who go into foster care, do so because their
mothers are addi cted to drugs or are alcoholics.

``And San Francisco is No. 1 in the nation in foster care placements.''

Leal said the Board of Supervisors and the mayor strongly support the
``on demand'' concept. She said the health department is planning on
yearly increases in funding for treatment programs over the next four
years.

Yesterday's report painted a grim picture of substance abuse in San
Francisco. The city has a death rate from drugrelated causes at 20.4
peo ple per 100,000, compared to the statewide average of 7.9. In
199496, San Francisco ranked in the top five cities nationally for
cocaine and marijuanarelated emergency room visits and AIDS cases. The
city was No. 1 in heroin and methamphetamine visits.

The report estimates that there are at least two untreated substance
abusers for every one now in treatment in San Francisco and more than
1,000 subst ance abusers ready and requesting treatment who are turned
away daily because of limited capacity.

``Approximately 10,000 are on waiting lists for treatment annually,''
the report said, ``and 23,000 are not seeking treatment since there is
insufficient treatment capacity to meet their needs.'' In 1996, for
example, a person had to wait 46 days for a slot in the city's
methadone program.

Using a formula created by Columbia University, the report estimates
that substance use in San Francisco costs $1.72 billion annually. That
estimate, which excludes the costs associated with tobacco smoking,
includes $432 million in criminal justice costs, $281 million in health
care costs and $358 million in lost economic productivity, as well as
other property loss, social service and education costs.

The proposal, called ``Substance Abuse Treatment on Demand: First
Steps,'' was put together this year by a panel of 37 experts, city
officials and citizens. It goes to the city Health Commission Tuesday
for its approval.

The plan calls for ``enhancements'' to existing programs, such as
expansion of the city's methadone and needle exchange services, and for
a series of new treatment services ranging from women and minority
group treatment facilities to direct outreach to dealers and gang
members.

The report stressed that all newly funded improvements must be
culturally sensitive and linked to other city services, such as housing,
day care, job training, employment, mental health and legal services.

``If this treatmentondemand system was focused solely on chemical
dependence,'' the report said, ``it would fail; substance abuse is not a
chemical problem, it is a life problem.

``For the mother with children, services must include care and treatment
for her family, and protection from being separated from them simply for
seek ing treatment. For homeless people, (the program) must include the
security o f safe housing from which substance dependence can be
overcome and a life intergrated in the larger community.''

The goal of the program is to make treatment available ``at every door
in to the system'' from jails to health centers.

The Chronicle Publishing Company