FIGHTING ADDICTION A LIFETIME PROCESS

Whether county efforts to dam up drug problems work, it's at least
worth a try, literally.

The average cost of treating an addict is about $1,500, Adam Brooks,
a researcher for the Treatment Research Institute, said. That's
compared to the $11,500 an addict costs a community through loss of
taxes, unpaid hospital bills, crime and more.

But throwing money at a solution isn't the answer, experts
say.

That means officials need to track treatment data to see what works.
Groups need to work together and share results.

The focus can't be on just rehabilitation either, officials say. They
suggest the county look at prevention programs in place and new ones
implemented elsewhere.

Then there are the problems that come with addiction -- many addicts
don't have a job or higher education, and often have money problems
that keep them from finding a place to live or paying for legal help.
Leaving those needs unanswered is like trying to treat a diabetic with
just insulin and no change in diet, officials say.

The county also needs to embrace the philosophy that a relapse is not
a failure or a reason to give up. It's part of the recovery.

"People panic because they think it should be all or nothing," Rocco
Schiralli, executive vice president of programs for Porter-Starke
Services, said.

How to chart progress

Part of the county's current problem is a lack of data that would
explain just how bad the problem is, Schiralli said. Many of the
numbers can be found; they're just scattered among various counseling
centers, medical offices and county programs, he said.

Porter-Starke Services is working with groups to collect that data in
one document that would be available to everyone. Using that data is
just as important, though.

"Before you start throwing money, you have to make sure it's something
worth throwing money into," Schiralli said.

Not all programs are created equal. One program might prove to be
helpful but might drain the county of funds. Instead, Schiralli said,
the county needs to look at the cost per addict served.

The data, then, will create a baseline everyone can check to see if a
program is worth the money.

The collaboration shouldn't stop there, though, said Brooks of the
Treatment Research Institute. If the medical community came together
and created a list of standard questions to assess addicts, it would
help normalize the system and give the community an even better idea
of what was working.

He compared it to how doctors take a patient's heartbeat as a basic
standard of telling if someone is healthy.

That's not the only way the general medical community can help,
according to a 2007 study by the National Quality Forum that found the
best treatment programs known to be effective. The study said doctors
and other medical professionals should be trained to ask questions
about drug use for every examination, no matter the patient.

The idea is that doctors can then identify drug addicts as well as
help get them into treatment, according to the report.

The collaboration effort isn't important for just locals, though. More
and more grant programs are learning that putting money into anything
and everything just drains their pockets while having little effect on
users, Schiralli said. Now, grant groups want to see results before
they give to a treatment program.

"You have limited resources," he said. "How do you spend
it?"

If the county wants to stretch its dollar even more, it could look
toward Delaware, Brooks said. The state set up a program that turned
its contracts with addiction treatment providers into a merit-based
system. Each contractor worked with the state to set a goal as to how
many patients it could serve. The contractors got paid for serving at
least 80 percent of that goal, along with how long they treated each
patient.

If the contractor didn't meet the goals, though, payment was
deducted.

The program was rated a success. When it started in 2001, the
contractors served had about 54 percent of capacity filled. By 2006,
they were up to 95 percent, Brooks said.

Prevention plays a role

Getting addicts to stop using drugs isn't easy, though, and experts
say it's a lifetime process, just like treating any other chronic
disease. Prevention, however, can stop the problem before it starts,
if done right.

In 2007, the Porter County Substance Abuse Council spent about $16,000
for the Red Ribbon Week. However, that program -- as well as Drug
Abuse Resistance Education, aka D.A.R.E. -- has never been shown to be
effective, Schiralli said. A study of local high school students
reflected national studies: Students don't buy into the program
because it's "too general, too simple," Schiralli said.

Harold Holder, a senior scientist at the Prevention?Research Center at
the Pacific Institute for Research and Evaluation, said some school
programs do -- but not on their own.

"The problem with education-based prevention is there's no sustained
effect," he said.

Instead, community policy needs to come into play. That can range from
changing planning codes so there can only be so many alcohol sellers
per person in the county or working with bars and restaurants to train
and enforce waiters to cut off alcohol to someone who's had too much
to drink, Holder said.

A study of several communities that took similar steps saw the rates
of drunken drivers decrease by 44 percent, Holder said. The point is
not to try to prevent addiction but to prevent behaviors that lead to
addictions.

"We don't actually know much about preventing addiction," he
said.

Other issues

Some programs the county has already implemented, specifically the
drug court and methadone clinic, have had success elsewhere in the
United States treating people. The National Quality Forum study said
methadone and other similar drugs should be offered to anyone
recovering from an opiate.

The county can't just focus on treating the addiction, though, Brooks
said. Programs that don't focus on other issues affected by the
addiction -- such as education, jobs, legal matters and other problems
- -- often end up seeing the addict start using again.

"When you've lived as someone with an addiction, you've deteriorated
almost every area of your life," Schiralli said.

The county is addressing some of these issues but it needs to do more,
he said, such as provide more housing and financial support.

Porter County can only get to that part if it treats the users first,
though. If the majority of people don't want help, then, is there no
other option?

Not necessarily, Brooks said. A new program, Community Reinforcement
and Family training, trains families and friends on how to approach a
user to get help. The theory teaches using support and leverage to
induce people to seek treatment. Brooks said the technique works on
about 60 to 70 percent of addicts.

Even if the person goes to treatment just to please others, they can
still be successful, Holder said. The main factor in recovering from
drug addiction is how long one is in a program -- not whether the
person wants to be there.

Relapse to be expected

The main thing to remember is that what looks like failure is actually
just part of helping people, Schiralli sad.

"A relapse is expected; not a sign of failure," he
said.

That's important to keep in mind because if people emphasize that a
relapse means an addict fails, it will just make the entire process
more expensive, Brooks said. If addicts feel they've messed up,
they'll likely get further sucked up in drugs to deal with feelings of
shame. That will lead them again back to all their costly habits --
stealing, medical bills, etc. -- and intense and costly treatment if
they ever go back to it.

If everyone looks at a relapse as part of treatment, though, addicts
will feel more comfortable in going to professionals for help sooner,
Brooks said, and will avoid many of those costs.

While the efforts Porter County has taken might not show results now,
that doesn't mean they won't. Addiction is a chronic illness, Brooks
said, and the only way to treat it is to prepare for the long haul.