MOST DRUG TREATMENT PROGRAMS AREN'T ADEQUATE, ADVOCATES SAY

Susan Rook believes if she had been released from drug treatment when her
insurance ran out, she would have relapsed.

The end result, given the extent of her drug abuse, would have been her
death, she said. Rook is a former Cable News Network anchor.

She is currently public affairs director for Step One Substance Abuse
Services in Winston-Salem, N.C. Rooks spoke at the Addiction Studies
Program for Journalists in Canada in June. Rook was hosting "TalkBack
Live!," a show that had been created for her on CNN, when she overdosed in
March 1996. "Inpatient (care) was very important to me for several
reasons," Rook said. "I was very sick, and then once I detoxed I was really
ragged physically, emotionally and mentally," she said. "The value was that
I was in a safe environment while I was very, very, very vulnerable. That
gave me a bit of 'clean time' so that I could even hear the idea of
sobriety/recovery and then choose it." After 28 days of inpatient
treatment, CNN gave Rook two months off work, which gave her time for
psychiatric therapy, dental work and medical care to help her physically
recover from the effects of the abuse. Some insurance companies will pay
for only five days of inpatient treatment for substance abuse, while three
months of inpatient care might not be enough, some say. The cycle of
addiction Steve Moore, a certified social worker and a program coordinator
for the UAB Addiction Recovery Program, said people tend to see drug
addiction as black or white. "We have a tendency to look at the problem of
drug addiction as being on drugs or off drugs," he said. "That makes the
substance be the problem and its absence be the solution.

That's just not true. If it were, I could cure addiction by locking people
up for long enough. "The person's response to mood alteration itself is the
problem.

Now that we understand addiction to be a brain disease, much like other
diseases, we can start seeing how people relapse," Moore said. When a
person is faithfully taking his high blood pressure medicine but his blood
pressure gets high anyway, someone might look at that patient and say that
the medicine didn't work right or doctors weren't aggressive enough in
treating the problem. "It's only with addiction that we blame the patient
for the relapse," Moore said. Rochelle D. Schwartz-Bloom has developed a
model to show the cycle of addiction.

Schwartz-Bloom, who studies how drugs affect the brain, is a professor at
Duke University Medical Center's Department of Pharmacology and Cancer
Biology in Durham, N.C. With acute drug use, the initial use of a drug, the
user gets feelings of pleasure from the drug, so he learns to use the drug
again to get that same feeling.

When the user develops tolerance to the drug, he needs more of it to get
the same high, which creates chronic drug use. Once he becomes dependent,
he experiences withdrawals if he stops using for a few hours or days. If
the user is able to quit for longer periods of time, such as days or years,
he could still experience cravings, but long-term abstinence is necessary
for the addict's brain chemistry to attempt to return to its original state
and for the addict to make changes in his behavior so he doesn't start
using again, Schwartz-Bloom said. If the addict relapses, he immediately
returns to acute drug use, and the cycle begins again. Once an addict is
through the short-term abstinence stage, the acute withdrawal, he may
experience other symptoms in addition to cravings, including difficulty
thinking clearly, emotional problems and problems with physical
coordination. "All this we believe is due to changes in the brain," Moore
said. "Once they get off drugs, they're doing what they're supposed to be
doing and they're still not feeling good," Moore said. "The persistent,
false belief of addiction is that 'Chemicals make me better.' For addicts,
the chemical was the solution, not the problem.

Even if it did horrible things to them, it may be their solution." Moore
said the frequency, intensity and duration of treatment all affect a
person's changes of fighting his addiction. "Research shows the longer you
keep people in a structured environment, the better they do," Moore said.
Most insurance companies pay for three days of inpatient treatment for
detoxification, and then some pay part of the costs of inpatient treatment
after that. "It's not the fault of the insurance companies," Moore said.
The law The insurance section of Alabama state law doesn't require
insurance companies to pay for drug abuse treatment.

The law requires minimum treatments be available for the mentally ill
(Section 27-54-1), but that section of the law specifically excludes those
addicted to alcohol and drugs.

Another section of the law focuses on treatment for alcoholics (Section
27-20A-1). "Most times when you have mental health or substance abuse
issues, the Code doesn't mandate treatment except in sections 54, 20A and
27-1-18," said Elizabeth Bookwalter, assistant counsel for the Alabama
Department of Insurance. Section 27-1-18 deals with mental health issues.
The law doesn't allow families to commit addicts for treatment, either.

Just about the only way a person can be coerced into getting treatment is
to be arrested. "If you walk in and see a family member shooting up
OxyContin and you bring him to the hospital, you can't have him locked up
for psychiatric treatment," Moore said. That situation is different in
other states, such as Florida, he said. The Alabama Code may be searched on
the Internet at http://alisdb.legislature.state.al.us/acas/ACASLogin.asp .

The solution?

Herbert Kleber is one of those who believes longer equals better drug abuse
treatment.

The first director of Demand Reduction in the Drug Czar's office under
former President George Bush, Kleber is a professor of psychiatry at
Columbia University and the director of the Division on Substance Abuse for
the College of Physicians and Surgeons and the New York State Psychiatric
Institute. Rook received medical and psychiatric care during her recovery.

Kleber said the combination is critical to gain any sort of improvement.
"Between one-quarter and one-half of substance abusers also have
psychiatric disorders," Kleber said. "Untreated depression and anxiety
disorders are common causes of relapse.

Withholding psychiatric treatment from a depressed, substance-abusing
patient would be like withholding penicillin from a drug abuser with
pneumonia." "The brain of a drug addict is no longer like the brain of a
normal person in the same way that the brain of somebody who is depressed,
has an anxiety disorder or maybe even who has epilepsy is not the same as
the brain of a normal person," Wake Forest School of Medicine professor
David Friedman said. "If you believe it's a brain disorder, then the moral
solution (to the problem) - put them in jail - is ridiculous. It makes much
more sense to put them in treatment." Scientists who see addiction as a
brain disorder believe addiction should be treated with psychotherapy to
change behavior and medicines to alleviate withdrawal symptoms, if
available. Therapy helps hold a person in substance abuse treatment and
helps bring about the behavioral changes a person needs to give up drug
abuse. The public generally doesn't consider treatment a priority for
addicts, and public officials - those who generally have the power to
affect policies - are skeptical about it, Kleber said. Politicians
sometimes see drug treatment for offenders as being easy on criminals.
"Treatment is not a liberal or conservative approach, but a cost-effective
one," Kleber said. "Numerous local, state and national studies have
demonstrated the cost effectiveness of treatment.

In general, a dollar invested in treatment saves $4 to $7 elsewhere in the
health and criminal justice system." Addiction not only affects the addict
and his employer with poor health and lost time from work, it also affects
the children, who can suffer abuse and neglect, and society, which
sometimes ends up paying the cost of those problems. Society also usually
has unrealistic expectations about treatment, expecting one treatment for
substance abuse to "cure" an addict.

Given the chronic, relapsing nature of addiction, sometimes an immediate
goal of treatment is to see improvement, or less use of the drug, Kleber
said. No one treatment is universally effective.

A variety of treatment approaches are needed because of the differences in
the types of people who become addicts and the differences in the types of
addiction. A drug such as alcohol creates a great physical dependence, and
a person abstaining from alcohol can have physically dangerous withdrawals.
Medicines can help alleviate those withdrawal symptoms, which increases the
addict's resistance to relapsing. There are medicines to help ease addicts
off most drugs, such as methadone for heroin, OxyContin and other opiates.

There are also medicines to make an alcoholic sick if he drinks while he's
taking it. There is no medicine to help fight crystal methamphetamine
addiction, Kleber said. Another treatment option is residential therapeutic
communities, where the patient receives therapy while living among other
recovering addicts, particularly criminal addicts. While only 30 percent of
those who enter residential therapeutic communities complete the program,
studies have shown that 85 percent of those who complete it remain
drug-free for at least two years. Whatever the treatment, it must be
tailored to the patient.

Careful assessment of the addict's needs is the first, and most important,
step in finding a treatment program that works, Kleber said.