SUBSTANCE ABUSE TREATMENT CENTERS ON KAUA'I CAN'T FILL ALL THE GAPS

Many involved in the fight against drugs on Kaua'i agree there are gaps in
the process from law enforcement to treatment and follow-up care.

Those who need drug treatment have some options on the island, "intensive
outpatient treatment" being the most common plan.

Kaua'i's three centers offer outpatient services, which consist of group
sessions and counseling, check-ins and meetings. A detox center is available
at Mahelona for alcohol and "street drugs" like crystal methamphetamine, the
drug of choice these days.

Hina Mauka and Ho'ola Lahui Hawai'i receive state funding, while Ke ala Pono
is a private practice. Depending upon the facility, family sessions may also
be required.

About half a dozen inpatient/residential facilities are located on O'ahu,
but for people without medical insurance or who can't afford thousands of
dollars for treatment, space is very limited.

A grant from the Alcohol and Drug Abuse Division of the state Department of
Health pays for two patients a month for Kaua'i patients at the Kane'ohe,
O'ahu-based Hina Mauka Recovery Center. Inpatient treatment goes for 30 days
followed by several months of outpatient follow-up. Health insurance plans
generally pay for such treatment, as well as outpatient care.

"There seems to be a waiting list, always," said Andy Anderson, Hina Mauka
chief executive officer. Many of their 45 beds are sometimes empty - not for
lack of people to fill them, he said, but because people can't afford
treatment.

Treatment costs the state about $4,500 for 30 days, but self-payments are
more, depending on if medication or additional health care is needed. The
same ADAD grant pays for outpatient treatment through Hina Mauka, which can
cost about $2,500.

To get accepted to inpatient treatment, a person must meet certain criteria
on an assessment. Basically, the person has to be doing drugs and is in need
of detox or more help than outpatient treatment can offer.

Prospective clients have to jump through hoops to get help, said Phil
McLaughlin, certified drug abuse counselor (CDAC) and certified substance
abuse counselor (CSAC), at Hina Mauka. If these hoops last longer than a
week, it seems as though a person has to use drugs again or be bumped down
to the bottom of the waiting list, McLaughlin said.

Joan Reid, staff RN at the Samuel Mahelona Hospital's psychiatric unit, said
that their detox beds are available to those who go through Hina Mauka or
receive an assessment from the state DOH Kauai Mental Health Division.
People may also go to the Wilcox Memorial Hospital's emergency room, but
they have to receive an assessment, available only during the week.

Methamphetamine-detox patients are given as few drugs as possible, and are
usually over the detox phase in four days. When patients finish the program,
Hina Mauka will take them as an outpatient client, or inpatient if a bed is
available.

Outpatient treatment center also requires an assessment. Depending upon the
result, the inpatient treatment center requires a psychiatric evaluation,
because drug abuse leads to mental illness such as depression, paranoia and
sometimes schizophrenia, McLaughlin said.

Details from the Kauai Mental Health Division, state DOH, were not
immediately available.

Dr. Gerald McKenna, a clinical psychiatrist and specialist in addiction,
founded Ke ala Pono, the only private practice center on the island, in
1989.

McKenna is an associate professor of psychiatry at the John C. Burns School
of Medicine at the University of Hawaii at Manoa.

"We believe the longer someone's in treatment, the more likely they'll
recover," McKenna said. Adults and adolescents can go to as many sessions as
they need, as long they pay their insurance co-payment for each meeting.

Using education and group sessions, people determine what actions they need
to take to recover.

One idea shared by treatment centers is that family members must also learn
about addiction and recovery. "This is a family disease," McKenna said.

"We need safe places for people to live and get treatment," said Mardi
Maione, CSAC, and head of the Kauai Drug Free Coalition since 1997. After
the halfway house Serenity House closed its doors on Kauai, people had
nowhere to go, Maione remembered. She suggests that private, federal and
state grants could be used to open more treatment options on the island.

One type of facility, called a therapeutic living environment, would offer
treatment, counseling, and residents would be able to stay for months at a
time instead of the common 30 days, and learn basic skills as part of
getting back into the mainstream, Maione said.

Kauai could also benefit from a clean-and-sober house (formerly known as a
halfway house), where people who are in recovery would live in the house
together, without substance abuse counselors or other drug treatment.

"People who are addicted to drugs are not bad people, they are sick," she
said. "The things people do under the influence would never happen if they
were sober," she added. "When you take the drugs away, the behavior changes,
and it's usually for the better."

The idea was echoed by McLaughlin, "The majority of society and the majority
of other people who could help a bit punish them for not getting better and
staying better," he added. He said generally, the view of the non-addict is
"punish the addict," while the addict says "why are you punishing me, I'm
sick."

The coalition last year printed up thousands of resource lists in bookmark-
and business-card sizes, the point being that families and friends of
addicts would know who to call on the island for help. The card is
distributed at outpatient treatment and is available in such centers and
clinics. If a person receives any level of care, Maione said, they hear the
message and know where to get help if they want it.

Maione has also come to Mayor Bryan Baptiste for assistance. While the Kauai
Drug Free Coalition has completed major steps in coordination, Maione says
that many counties in the United States have the benefit of a full-time
substance abuse program that works to get outside funding for the community.

Baptiste said he would look into appointing someone to such a position at a
Jan. 10 session among about 50 community leaders, drug prevention organizers
and others.

He has met with private funding sources to see what can be done here and
State Sen. Gary Hooser and U.S. Representative Ed Case, have promised to
look into community programs and funding options. Governor Linda Lingle has
said she will help get funding for a residential treatment center on Kaua'i.

Maione said that even if a residential treatment center were opened on
Kauai, it would not have enough staff members with credentials recognized by
insurance companies, funding sources and the accreditation board. Kauai has
about a dozen people with such credentials, and the state certification
process can take upwards of two years.