Series: Part 4 Of 5

RECOVERY FROM ADDICTION CAN BE A TOUGH CLIMB

Elmer isn't sure why he first shoved a needle into his arm some three
decades ago. Maybe it was a combination of boredom and stress. Maybe it was
environment.

"It was Vietnam and everybody was doing it," said Elmer, a combat veteran
of the Army's elite 101st Airborne. "I started right off the bat with heroin."

After his discharge, Elmer said he managed to hide his addiction from his
employers at Kennecott and other mines throughout the West. "A good
junkie," he said, "can hide it pretty easy."

But as the addiction deepened, his secret was eventually exposed. He lost
job after job. He lost his wife and four children.

"Things got so bad I was living under bridges. I was down to owning a
knapsack and working day jobs, stealing, whatever it took to get some dope."

After hitting bottom 2 1/2 years ago, Elmer, a skilled carpenter, began the
long journey back to respectability. He now drives every morning from his
Tooele home to a Salt Lake methadone clinic where he pays for his own
treatment. He has his own car, a steady job and a repaired relationship
with his children, and he is paying taxes.

"I will admit it," he said. "I have tried dope again and it's not the same.
Clean is so much better."

For many, the descent into addiction is an indescribable hell. But the
climb back out can be even worse.

Pain so agonizing that death seems a viable solution. And then there's the
despair.

"You wake up in the morning and just want to die," said Joshua, a
25-year-old addict in the early stages of recovery. "You want to quit, but
you know you can't. Every junkie would quit if they just had the chance."

Joshua got his chance. A Salt Lake man found him begging for spare change
and became his benefactor, paying for his treatment at a private clinic.

He was lucky. Roughly four out of every five addicts in Utah cannot get
into treatment even if they wanted to. Public treatment programs are full,
and most addicts are destitute.

"I stole for drugs," smirked one former addict. "I guess I could steal for
money to pay for treatment."

Some get financial help from their churches to pay for treatment, others
have understanding employers and there are a handful of private foundations
that help.

But those programs reach only a tiny fraction of those wanting help.

Currently, more than 20,000 Utahns are in government-supported treatment
plans, and an estimated 2,000 more are paying for treatment themselves at
private clinics. That still leaves about 80,000 Utahns who need treatment.

If they abide by the law, their turn in a treatment center may never come.

"It's getting to the point that to get public treatment in Utah you have to
commit a crime and have it (treatment) ordered by the court," said Pat
Fleming, director of the Utah Division of Substance Abuse, the state agency
that distributes federal and state money for addiction treatment.

Curled in a fetal position in a hospital emergency room, Steve Davis came
to an inescapable realization: The medical community has an inherent bias
against addicts.

Davis had been fighting an infection most of the previous day. And when he
went to Discovery House for his daily dose of methadone, part of his effort
to kick his addiction to painkillers, the clinic called 911.

He arrived at University Hospital by ambulance about noon. By the time he
left at about 6 p.m., he had seen one student doctor, "and all she did was
come in a couple times to apologize that no one had seen me yet."

Davis can't prove it, "but anyone who was there could easily tell I was
being neglected. I managed to come out once and beg them to do something.
It's like they forgot about me."

Why? Davis believes a urine sample taken when he first arrived tested
positive for methadone. "I can't help but think that changed how they were
going to handle me," he said. The nurses finally told Davis they couldn't
figure out what was wrong and to come back for more tests."

"I was dehydrated and had thrown up the methadone, so by then I was going
through withdrawals besides being sick from the infection," Davis said.

He did not know it at the time, but Discovery House called the hospital,
offering to bring up a replacement dose of methadone. The hospital told the
clinic there was no need, that everything was fine.

"They didn't make the slightest attempt to help me and sent me home with
some morphine, which is like giving me aspirin."

(A hospital spokesman said he couldn't discuss any particular case or
course of treatment but noted that hospital policy is to provide care
without discrimination.)

For thousands of Utahns, the physical addiction is only part of the battle.
There is also the unshakable weight of a stigma that has stereotyped them
as social dregs, criminals or worse.

They are branded losers who have only themselves to blame for their plight.

"People see drug addicts as the bottom of the barrel," said Jana Merkley,
former director of a Salt Lake methadone clinic. "It was OK that Grandpa
was an alcoholic. They knew how to deal with that. But they don't know how
to deal with drug addiction."

That social stigma can be a beast more merciless than heroin. And it
attacks just as addicts are coming to grips with their addiction and
seeking to make amends.

"People still see addiction as a moral failing," Fleming said, "so we have
stigmatized an entire population. We fear they will steal from us or hurt
us or hurt themselves."

And fear, Fleming said, has become an excuse to rationalize discrimination.

Recovering addicts all have horrific stories of prejudice and abuse to tell
- - of being given spurious medical treatment, of being fired after they told
their employers they were in recovery, of taunting by law enforcement
officers all too familiar with their past misdeeds.

One recovering heroin addict recalls how he went to a Salt Lake emergency
room with an abscess so bad the doctors considered amputating his arm. The
doctor assigned to the case took out a scalpel, sliced the abscess and
pressed out the infection - all without anesthesia.

"I was screaming, and he just kept telling me, 'You did this to yourself.
It's your own fault.' " he said.

Another addict, now in recovery, recalled hearing nurses talk openly about
why they were working to save her life when she was obviously trying to
kill herself. "It was like I wasn't even in the room, or maybe they thought
I wasn't human," she said.

Fleming has heard the horror stories, too, and he doesn't doubt there is
some merit to the complaints.

The irony, he says, is that doctors and nurses are some of Utah's worst
abusers of opiates - painkillers, mostly. And they should have more empathy
for the disease than anyone.

Fleming believes the prejudice against addicts is rooted in a huge public
policy debate that divides the medical and treatment communities.

Doctors and nurses, by and large, have not embraced the shifting perception
that "addiction is a disease and needs to be treated like a disease," he
said. And it can be treated with a combination of counseling and legal
drugs that block the euphoric highs of illegal drugs. But therein lies the
paradox. Prescription drugs that treat addiction are rarely covered by
health insurance plans.

And decisions about what is and is not covered are being made by doctors
who sit on insurance company advisory boards, not by experts in addiction
treatment.

The traditional approach to drug addiction - one covered by many insurance
plans - is costly, often involving 30 days treatment at a hospital. Once
the 30 days are up, the patient is released with little follow-up care.

Relapses under those approaches are often inevitable.

"The health insurance companies complain the programs are too expensive and
they don't work," said Angela Smart, a programs administrator with the
state Division of Substance Abuse. "And they are right. That type (of
program) doesn't work."

Those involved with treatment say drug addiction is a chronic disease
usually requiring a minimum of six months treatment, sometimes much, much
longer. Some addicts are in treatment for years.

Experts say addiction treatment is not about checking someone into a
hospital. Rather, treatment invariably works better when patients are
sleeping in their own beds, going to work every day and receiving daily
support from family, friends and church.

That approach is also far cheaper than inpatient hospital stays.

But the current system simply isn't set up to look at the problem that way.
State officials estimate 70 percent of addicts could and should be treated
in outpatient programs like Project Reality and Discovery House -
outpatient programs that fall outside the scope of many medical insurance
plans.

Fleming believes Utah's health insurance community can and must come to
grips with the addiction epidemic that is infecting every social and
economic group in the state. And society simply cannot afford it without
the private sector stepping into the treatment void.

"There has to be parity in insurance coverage," Fleming said. "We just
can't treat (with government funds) all the people who need it."

Paula never saw herself as an addict. At least not at first.

A mother of three working as a supervisor at University Hospital for the
past 20 years, she was just treating a bad case of hemorrhoids. Doctors
were more than willing to treat the pain with pills. One even wrote her a
prescription to last an entire year.

"It was the day I woke up without pain and still craved the pills I knew I
was addicted," she said. "I tried to stop, but I just got so sick I thought
I would die."

Over the next several years, Paula scammed pills from doctors and emergency
rooms. When that wasn't enough, she took to buying them on the streets at
$5 a pill. She mortgaged her house and sold her car, all for a
20-pill-a-day habit.

Paula, now 60, has been clean for 4 1/2 years. Her employer still doesn't
know about her addiction. "I can't tell them. They wouldn't understand,"
she said. "There is an attitude that we did this to ourselves, and we
should pay the consequences."

Tomorrow: Addiction and spirituality.