ANTIDOTE FOR ADDICTION SITS ON SHELF

Drug-Abuse Treatment Often Proves Effective, But It Is A Low Priority

Though drug abuse is raging out of control in Eastern Kentucky, a special
commission says the state ranks 44th in the nation in spending for
mental-health and substance-abuse treatment.

And although several studies show that Kentucky could save money by paying
more to treat drug addicts, there appears to be little hope of changing a
pattern of neglect, experts say.

The "Kentucky legislature has not determined that substance abuse is
deserving of big dollars," said Louise Howell, the executive director of
Kentucky River Community Care, a community mental health agency that serves
eight counties in Eastern Kentucky.

A University of Kentucky study that's due to be released soon suggests
that, as a result, the state is missing out on a way to ease the damage
that drug abuse does to communities. The study followed 900 clients a year
after substance-abuse treatment. It found:

. In the year before treatment, about 66 percent of the clients had
committed crimes. In the year after treatment, only 21 percent did.

. The costs of the crimes committed, including injuries, property damage,
the costs of arresting people and other expenses, were estimated at $11.9
million in the year before treatment, and just $3.4 million in the year after.

. The number of clients reporting daily use of drugs such as Lortab and
OxyContin dropped 71 percent in the year after treatment.

. The number of clients who held full-time jobs increased 27 percent in the
year after treatment.

Nearly every expert agrees that treatment is the best answer to Eastern
Kentucky's drug problem -- but it's clear that there's far too little.

Waiting lists are long at the 17 existing residential treatment centers for
adults in Kentucky, five of which serve Eastern Kentucky.

The need is clear. Parts of Eastern Kentucky ranked the highest nationally
per capita in distribution of narcotics from 1998 through 2001, according
to an analysis of federal data by the Herald-Leader. Those narcotics begin
as legal medicines, but many are diverted into illegal sales and abuse,
according to the federal Drug Enforcement Administration.

People addicted to such narcotics are typically sicker on admission to
treatment than people who abuse other drugs, said Scott Walker, director of
substance abuse treatment for Mountain Comprehensive Care in Prestonsburg.

Such clients need long-term residential treatment, Walker said.

But "if you call today, you couldn't get in any program in the state," said
Mike Townsend, who oversees Kentucky's public treatment centers for the
state Department of Mental Health and Mental Retardation Services.

"That's a real problem for someone who's in dire need of treatment,"
Townsend said.

At Kentucky River Community Care, "the demand far exceeds the supply," said
Howell, who estimated the center is treating about half the people who need it.

The state's substance abuse division has about $40 million this fiscal year
to spend on treatment. Of that, about two-thirds comes from federal
block-grant dollars and Medicaid, Townsend said.

The rest comes from DUI fees and other sources, including clients'
payments, which are determined by an income-based scale.

"We are going to need more revenue if we are going to keep the existing
programs going," Townsend said. "We are not expanding programs right now.
We are cutting back."

Back through the system

People convicted of minor drug crimes, such as possession of controlled
substances, are frequently given probated sentences. But with few treatment
options available, they become prime candidates for cycling back through
the system.

Fred Yaden, a 20-year veteran who supervises state probation officers in 13
Eastern Kentucky counties, said he sees the same people all the time.

"Now I'm into their kids, and, in a few cases, grandkids," Yaden said.
Treatment is needed, he said, "because we haven't won the war the other
way, have we?"

There's a similar shortfall in the state prison system, where a lack of
treatment for most offenders who need it helps create "a never-ending
cycle" of repeat crimes, said Rick Purvis, director of the division of
mental health for the Department of Corrections.

Purvis estimated that 60 percent of the prisoners released in a given year
need treatment, which would have been 4,220 inmates for the 12 months that
ended last June. But only about 880 inmates got treatment, Purvis said.

Part of the reason for that disparity is that prisoners have to ask for
such treatment, and few do -- even though the state Parole Board frequently
encourages inmates to use it. But the state is also hampered by a lack of
beds for treatment, during which inmates are segregated from the rest of
the prison population, Purvis said.

The prison program's total budget in fiscal year 2000 was $822,222, mostly
from the state General Fund, and Purvis estimated it has increased by 5
percent each year since.

Treatment has become a priority to Ishmon Burks, secretary of the state
Justice Cabinet and formerly head of the state police.

Burks said he used to think the best response to the drug problem was to
lock up offenders. He still favors that approach for dealers, he said.

But now he takes a broader view with regard to drug addicts, emphasizing
education, community involvement and treatment.

"I think treatment plays a big part in all of that," Burks said.

It costs $17,669.65 a year to incarcerate an inmate in a state prison.
Residential treatment costs range from about $2,400 to nearly $2,800.

"The math is pretty simple on that," Burks said. "It's common sense."

Matching resources with needs

The Kentucky Agency for Substance Abuse Policy, or KY ASAP, was created in
2000 to help local groups in all 120 counties develop plans to reduce
smoking and drug and alcohol abuse. One goal is to bridge the gap between
communities' needs and resources.

"We do not have all the resources to fund all the needs of our
communities," said Larry Carrico, executive director of KY ASAP. "Treatment
needs are always more than we can provide."

KY ASAP has no money for building new treatment clinics. But local boards
can get money to help prevention programs at schools, or to supplement a
treatment program.

Through two funding rounds so far, certified boards covering 75 counties
have been awarded $3.2 million.

The funding agency is now working with 21 boards covering 29 counties but
will not have the money this year to award funding to all 21.

Of its initial $5 million in funding, the agency had to give back $1.5
million because of the state budget shortfall, Carrico said.

Little likelihood for more money

A state commission that was set up in 2000 recommended that Kentucky
increase the amount it spends on mental health and substance abuse. The
panel of lawmakers and experts recommended raising Kentucky's spending
enough to take it from 44th nationally to 25th over the course of this decade.

Sheila Shuster of the Kentucky Mental Health Coalition, a member of the
commission, said that would take $25 million a year for 10 years.

The good news is that after the 2002 General Assembly, spending on mental
health programs was increased somewhat -- though none of the commission's
recommendations for substance abuse treatment were adopted, said Townsend,
the treatment center director.

"There is no question that Kentucky spends too few state dollars on mental
health and substance abuse programs," according to the commission's report.

This year looks just as bleak, said State Rep. Mary Lou Marzian, D-Louisville.

It will be impossible to get new money in this General Assembly session
"unless the legislators take a hard look at themselves," Mar-zian said, and
raise the state cigarette tax, which is the second-lowest in the nation.

But Marzian said because the state has underfunded substance abuse
treatment for 30 years, she's not optimistic.

"There's no long-term vision," Marzian said. Making hard choices and taking
tough votes is "what we are supposed to do."

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