KAUAIANS: LACK OF ADDICTION TREATMENT MAJOR PROBLEM

As Kaua'i Mayor Bryan Baptiste, county anti-drug coordinator Roy Nishida, and
KPD Chief George Freitas, talk with 400 other officials at the Hawaii Drug
Control Strategy Summit, Lieutenant Governor Duke Aiona Jr. released the
results of the "Talk Story" program that he initiated throughout the state.

Like the rest of the state, those surveyed on Kaua'i are most concerned with
how drug and alcohol abuse has affected the downfall of the family unit and
increased domestic violence in the home. Those in Kaua'i surveyed gave answers
similar to the results around the state on what to do next; they believed that
more organized youth activities would be the greatest help curbing the drug
epidemic.

One area where Kaua'i residents' opinions differed from the average is the need
for drug treatment. While folks from Oahu who answered the survey felt more
police presence and community organization would curb drug use, those surveys
taken from the "Talk Stories" in Hilo, Kona, Maui, and Kaua'i put increased
drug treatment as their first or second priority to slow down drug use in their
community.

One of the man reasons for this could be the lack of treatment center options
on Kaua'i and the Big Island. At present, no in-patient and only two
out-patient treatment centers are available: Hina Mauka Treatment Services, a
partially state-funded program that offers out-patient treatment on Kaua'i, and
has an in-patient program on Oahu; and Ke Ala Pono Recovery Center, which is a
completely privately funded out-patient program, paid usually through a
patient's health insurance.

In the past, the problems of getting an in-patient treatment center were "part
funding, part [trained] people able to do it, and part community support," said
Dr. Gerald McKenna of Ke Ala Pono in a phone interview from O'ahu, where he is
attending the summit.

At present, he said, there is plenty of community support, and funding is
becoming available. However, "we need to get people who have experience,"
especially in adolescent treatment, said McKenna.

Phil McLaughlin, program coordinator of Hina Mauka, agrees.

Securing the "money, land, and building is a major problem, but the main
problem is keeping it running," said McLaughlin. "You need 'x' number of people
just to keep it going."

For example, McLaughlin said, to keep an in-patient treatment center going, you
need to provide meals, staff 24 hours a day, doctors and nurses. A state
- -funded program is required by law to have a certain ratio of personnel to
clients, he said, and since the rate of clients changes daily, it is difficult
for an in-patient program to maintain enough counselors on a daily basis.

And the lack of certified counselors is a problem that McLaughlin consistently
feels. "It's hard to get qualified, certified counselors here," although there
are a number of people on island in training, he said.

"We have more students and per-diem people than we do staff now," as an
out-patient center, he said. "We're doing what we can with what we got."

Ke Ala Pono has a little more leeway, said McKenna. They are able to continue
out-patient treatment for an indefinite length of time, "even after the
insurance runs out," he added.

While out-patient treatment can work for some chemically dependent people,
usually those with a supportive family, some living skills, and a job,
in-patient treatment is more successful with those without a place to stay or
something to occupy their mind during the rest of their day, McKenna said.

But in-patient treatment centers without complete state funding are dependent
on insurance companies, he said. Most insurance companies give a patient two
30-day treatments for a lifetime, but that depends on the company. Some
companies can stop payment after three or four days, or even force a center to
apply for re-authorization on a daily basis, he said.

"There is discrimination against chemical dependency and some psychiatric
disorders," said McKenna. "Chemical dependency does not get parity."

While chemical and alcohol addiction is recognized by all doctors as a disease,
and relapses occur just as they would with a patient with cancer, insurance
companies are not required to pay for treatment for relapses as they would for
another disease, said McKenna.

There are not enough programs to treat addiction on Kaua'i, said McKenna.

One solution for those without homes who need treatment would be transitional
houses, said McLaughlin.

These houses are for those just out of jails or treatment centers which "are a
place where they can feel safe," he said. "They can keep their stuff safe, and
they don't have to worry" about people using drugs or alcohol around them.

The houses, also called "three-quarter houses," usually contain a number of
people trying to stay sober. They are required to remain sober as a term of
their lease.

"There's too many [people just out of jail or treatment, or in treatment] on
the beaches trying to get by," McLaughlin said. "The house can't be where
there's people using."

McKenna said that the first priority on the island should be an adolescent
in-patient treatment facility using the disease concept of addiction. The
disease concept, he said, is when chemical dependency causes a change in a
person's brain, causing them to behave in a different way.

The 12-step programs, Alcoholics Anonymous and Narcotics Anonymous, are also
based on the disease concept. "The 12-step model is the best road to recovery
over the long haul. It is people trying to live their life honestly," McKenna
said.

"We need trained people who can make dual diagnoses [for addiction and mental
illness]: a psychologist who has input; and an addictionologist," he said.

"The last thing we need is a bad adolescent program," he said. Kaua'i needs a
place with an "approach that has been proven effective."