RECOVERY FROM ADDICTION TAKES TIME

A crack-cocaine addict seeking help at Alcohol and Drug Services of
Guilford County is likely to down a six-pack and pretend to be an alcoholic.

Crack addicts know that alcoholics get up to 14 days in the ADS residential
treatment center for detoxification. Crack addicts, though, are usually
scheduled for outpatient care and sent home after a day or two.

Counselors at ADS know sending a crack addict back into the community after
two days of detox - even with placement in intense outpatient care - can be
like trying to put a Band-Aid on a spurting artery.

Even 14 days isn't time enough to stop a raging crack habit.

"That's a farce," said Stephen Daniels, an outreach worker and former
addict. "I've seen them head straight to the dope dealer."

Chuck Fortune, the ADS director, knows that's true. But he has little
choice. Fortune and more than a dozen other health professionals and
outreach workers interviewed for these stories said the No. 1 problem
facing Guilford County in its battle against crack is the shortage of
long-term residential care facilities.

Medically necessary

Crack addicts get only short-term care because health authorities don't
consider cocaine detoxification physically dangerous. Alcohol detox,
however, is considered life-threatening - and insurance companies, Medicare
and Medicaid base their willingness to pay on medical necessity.

That's maddening to those trying to loosen crack's almost 20-year grip on
the community, including caregivers at ADS, the nonprofit alcohol and drug
abuse treatment agency most low-income crack addicts turn to first.

Fortune would like to place all the 400 or more crack addicts who seek
treatment at ADS each year into area halfway houses where they can live and
find jobs while receiving treatment and counseling. But he can't. Most of
the approximately 350 beds in the area are filled at any given time.

Others agree there is a critical need for them, but they said another
problem just as serious - one that could keep new facilities from being
built - is the lack of knowledge throughout the community about crack,
especially how addictive it is and how it is linked to the spread of
HIV/AIDS and syphilis.

"Crack is different from other drugs," said Susan Mills, who has a friend
who has been a crack addict for more than 10 years. "The public has no idea
how addictive it is."

Revolving door

Mills, a member of the Guilford County Substance Abuse Coalition, has
pushed for years for a communitywide effort to fight cocaine.

She and others said the lack of facilities has caused crack addicts to be
released multiple times back into the community, where any number of
"triggers," such as seeing a drug dealer on the street or even handling
money, can cause an addict to start using crack again.

Some crack addicts told coalition members that they had been in and out of
detox at ADS five or six times at a rate of about $300 a day.

"A lot of people felt they just were not ready to go back into the
community after only a few days of treatment," said Nancy Hunter, who
prepared the coalition's substance abuse report, issued early this year.

They were right, said Becky Yates, founder and director of Caring Services
in High Point, one of the county's major residential care centers .

"Where are they going to go?" Yates asked. "What are they going to do? What
can they do?

"They're two or three days clean. Most have no money, food, clothes or a
job. Some don't even have a picture ID. The only person who is going to let
him in is the drug dealer. As long as he can breathe, the drug dealer can
use him."

Yates said crack addicts need long-term residential care just to relearn
how to survive in normal society. "Crack brings you to your knees, " she said.

NEED HELP?

Alcohol and Drug Services of Guilford - 333-6860; 882-2125

Caring Services - 886-5594

Christian Counseling and Wellness Group - 375-7530

Delancey Street North Carolina - 379-8477

The Guilford Center - 641-4993

Malachi House - 621-1225

Mary's House - 275-0820

Youth Focus - 375-8333

Greater Piedmont Teen Challenge - 292-7795

. ADS and

Caring Services

Alcohol Drug Services of Guilford County has probably placed more crack
abusers in Caring Services than any other residential facility in the area.
It's unclear, though, whether the close relationship will continue.

The two will be competing with each other for about $3 million in county
money as the result of mental-health reform legislation enacted by the
General Assembly in 2001. Each has been designated as a lead agency in
separate groups of agencies offering mental health and substance abuse
services in the Triad.

In the past, most people in the area needing care have turned first to ADS,
where they received an evaluation and perhaps detoxification, counseling,
short-term residential care and/or outpatient care. Some were placed in
long-term residential care settings, such as Caring Services.

Under the new arrangement, Caring Services will also be performing some of
those functions, along with other agencies in its group. People seeking
help for crack addiction, or another substance abuse problem, may choose
between ADS and its group (or collaborative, as it is called) or Caring
Services and its group.

"The idea was to give people a choice," said Joe Fontin of The Guilford
Center, which will oversee the new arrangement, and determine how the
county money will be disbursed.

- - Staff report

Residential care

Caring Services has 72 beds in six houses. Although the program is for
abusers of substances in addition to crack, Yates said about 98 percent of
those receiving care there said crack is their "drug of choice."

Each addict at Caring Services gets an individualized recovery plan and
participates in 12-step meetings such as Narcotics Anonymous, Yates said.

Fees are $85 a week, paid after participants find a job, and they are
expected to find a job. They stay at Caring Services as long as they need
to stay, Yates said. For most, that's about a year and a half.

Crack is so addictive that even after a year of treatment only 60 percent
to 80 percent remain off the drug, said Joe Fontin of The Guilford Center,
the county's department for behavioral health and disabilities services.
After 90 days, the success rate is 40 percent to 60 percent, similar to
that of recovering heroin addicts.

Other residential care facilities in Guilford County include 12 Oxford
Houses, part of a nationwide nonprofit, in which recovering addicts govern
themselves and support each other; and Delancey Street Foundation, where
participants operate moving and landscaping businesses and have a yearly
Christmas-tree sale. Others, such as Youth Focus and Teen Challenge, have
residential programs for young people who abuse drugs, including crack.

Faith-based recovery

There are also a number of faith-based residential programs, including
Christian Counseling and Wellness Center in Greensboro and Mary's House,
where women recovering from addiction live with their children.

The largest faith-based recovery program in the area is Malachi House,
which houses 80 to 90 men, about 75 percent of whom are addicted to crack.
They pay a one-time fee of $250 to participate in a year long regimen of
chores and classes that Malachi's director, the Rev. Cliff Lovick, a former
crack addict , describes as a "Christian discipleship program."

About 20 of the men came to Malachi House from prison. They and others
receive job training, remedial education, GED classes and counseling. All
must agree to complete a

14-course program in character building, theology and Bible study.

Recovering crack addicts there praised the program.

"I owe my life to Malachi," Joel Graves said.

However, Fortune at ADS said he tries to avoid placing addicts in
faith-based programs because some of them have religious requirements that
are "too rigid."

"What if I'm Jewish?" said Daniels, the street outreach worker who tries to
get addicts into treatment. "What if I'm Muslim?"

POEM: AN ADDICT'S DREAM

Susan Mills has a friend who has been in and out of drug treatment for his
crack-cocaine habit for at least 10 years. She still has this poem he wrote
in 1993:

Recovery must start or I'll tear apart

Not only my body, but mind and soul

This terrible drug is taking its toll .

If only this poem can symbolize hope

I might not die as if hung from a rope

You see, the problem is larger than life

These days I think I should die by my knife

It's sickening to think about my sweet sorrow

But hopefully now I can live for tomorrow.

Community effort

Residents who have seen family members crippled by crack say the entire
community should come together and make certain there are enough beds, and
that they should be in a facility that can treat crack addicts properly.

Dorothy Brown, president of the Ole Asheboro Neighborhood Association, said
Guilford County should have a place large enough to accommodate all addicts
who want help, and it should be able to meet all their needs.

"It ought to have everything - medical, counseling, job training, education
- - anything and everything they need to give them a chance at life again,"
Brown said.

Paul Nagy would agree with Brown. Nagy, director of the Duke Addictions
Program at Duke University Medical Center, said crack addicts should be
treated holistically. Nagy, a consultant to T he Guilford Center, points to
TROSA, or Triangle Residential Options for Substance Abusers, a two-year
residential treatment program in Durham, as a model for other communities.

The 300 substance abusers in TROSA - many of them crack addicts - receive
counseling, health care, job training and education assistance, as well as
room and board. But they don't have to pay for it, except with their own
sweat. Each participant is expected to work in one of TROSA's "sweat
equity" money making ventures. They include a catering company, a masonry
business and a commercial moving company. The businesses provide $3.6
million of TROSA's budget of $6 million . Donations of items such as
furniture, shoes, blue jeans and toilet paper make up a lot of the rest.

TROSA works, he said. It gives participants a sense of self-worth while
providing them a supportive "safe harbor" for two years.

Any community would do well to consider establishing a similar program,
Nagy said.

"Crack addiction is a tough, tough, tough thing to beat. But the cost of
not treating is much more than the cost of treating it."