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Little Room for Recovery

By Amy Goldstein
Washington Post Staff Writer
Monday, September 23, 1996; Page A01

Loretta Dorsey sits on a crate in a downtown Washington alley, waiting for the back door to a small, private drug treatment program to open at 5 a.m. Stretched out around her are the shadowy forms of men and women, some dozing on their plastic crates, some huddled in blankets despite the moist warmth of the night.

People line up for treatment Clean and Sober Streets opens its door to new clients only a few times each year. Dorsey knew that if she wanted the program to help her shed her cocaine addiction, she had to arrive early enough to be one of the first 40 people in line. She has been waiting since 11:30 p.m.

As 5 o'clock approaches, the alley is filled with people -- many of them homeless, all of them poor -- who have been prodded into the line by social workers, parole officers or sheer weariness with their addictions. By the time the door opens and then closes again less than two hours later, Dorsey will be one of 41 taken inside. A few who arrive too late will be told there is no more room.

Turning away drug addicts and alcoholics is a new, uncomfortable role for Clean and Sober Streets, which relies on private donations to treat and shelter addicts on a shoestring. A year ago, it was rare for more than 20 people to show up at a time. But the line in the alley tripled last winter and has remained swollen even in the summer, when fewer drug addicts customarily ask for help.

They are crowding private places such as Clean and Sober Streets because they are being shut out of publicly funded treatment services in the District, which has lost much of its ability to help drug addicts and alcoholics in the last several years. Government-sponsored drug treatment in Prince George's County has declined sharply, too.

The number of people admitted each year into programs in Prince George's has been halved since the start of the decade, while the number of people the District's programs can treat at a time has diminished by one-third since 1994. Services have withered in both places because of deep cuts in local subsidies. Meanwhile, the state and federal aid they receive has remained relatively stable.

In the District, local expenditures on treatment have decreased by nearly one-third since 1992, because of budget cuts that have had a particularly severe effect on health services, such as addiction services, that rely more heavily on local funds.

The cuts in Prince George's have been even deeper. The county's appropriation for substance abuse services have decreased from $2 million at the start of the decade to $180,000 this year, as part of broad cutbacks in public health programs driven by the county's property tax limit.

The net effect is services that are "understaffed, underfunded, unable to meet the demand," according to Michael C. Fuller, director of the Prince George's health department's division of addictions.

Subtler but important changes in drug treatment services have taken place elsewhere in the area.

In virtually every suburb, publicly funded treatment agencies have curtailed expensive residential care as a way to avoid turning away clients as money has become tighter. At different times during the last few years, local appropriations for treatment in Anne Arundel, Fairfax, Loudoun and Prince William counties have been cut, although less severely than in the District and Prince George's. Montgomery County is the only local jurisdiction in which the number of people admitted to publicly funded programs has grown consistently.

Helping drug users and alcoholics wean themselves from addictions is not a historic role of public health agencies. But in the 1970s, public treatment programs proliferated in Washington and elsewhere in the country, as health officials embraced the idea of protecting families and communities from the devastating effects of drug addiction among people who could not afford private treatment. State and local governments began to provide or pay for detoxification, individual or group counseling sessions, residential treatment services, halfway houses and -- more recently -- programs based in prisons and jails.

Access to treatment widened again, this time with generous federal help, in response to the surge of crack cocaine use in the late 1980s. More recently, however, drug treatment has evolved into a poor relation among social policies, less popular than law enforcement as a drug-control strategy. "Years ago, the drug abuse problem itself warranted money," said Eric D. Wish, director of the University of Maryland's Center for Substance Abuse Treatment. "Now it has to be tied in to decreasing crime."

Even in the current climate, the erosion of treatment services in the District and Prince George's has been especially severe. The effects are tangible.

Parole and probation officers in Prince George's are frustrated because it takes three months to get clients into the treatment program in Cheverly, the program closest to where most offenders live, even when they have been ordered into treatment by the courts.

At D.C. General Hospital, patients admitted into the substance abuse unit -- itself strained by staff and budget cuts -- must sign a form that says they understand there may not be any place for them to continue their recovery when they are discharged a week to 10 days later.

The director of a substance abuse hot line in the District sponsored by Catholic Charities has had to devise creative ways to keep callers motivated until treatment becomes available. Darryl Colbert tells and retells the story of his own recovery and has developed a buddy system. "I put [callers] with someone else who is waiting . . . so they won't feel they are the only one," Colbert said.

Unlike in the District and Prince George's, there remains little or no wait for outpatient programs in most Washington suburbs. And most jurisdictions have preserved their methadone programs for heroin addicts. Anne Arundel has eliminated the use of county money for all other kinds of outpatient treatment in order to give methadone to more people as heroin use is increasing and AIDS is spreading among intravenous drug users.

Nevertheless, even those treatment services that have been relatively stable now are under growing pressures. Throughout the area, more residents with drug and alcohol addictions are turning to public agencies for help. That is in part because people with private insurance are discovering new limits on the kind and length of addiction services that their plans will cover.

At the same time, public treatment services may be hampered by impending changes in Medicaid, the government health insurance program for the poor and disabled. Maryland, Virginia and the District are preparing to place more Medicaid patients into managed care arrangements that will exert more control over their health care. None of the three has defined yet what treatment will be insured.

So far, the Washington area has been relatively immune from the recent reins on federal help.

Nationwide, grant funds that are available for innovations in treatment through the federal Center for Substance Abuse Treatment have been cut annually for the last three years. This year, they have been slashed by more than half. The center's larger program of bloc grants to states has had no budget increase for two years.

Locally, however, the few treatment initiatives that have begun lately have been spurred by federal help.

One federal effort to curb drug trafficking began last year to supply the area with $3.3 million to treat people who have been convicted repeatedly of drug-related crimes. Another federal grant is providing $16.5 million to the area over three years to treat low-income women with drug addictions who are pregnant, homeless, or infected with tuberculosis or the AIDS virus.

Although local health officials welcome the help, they say such initiatives are limited in their usefulness because they are restricted to important but narrow groups of addicts.

"As we lose money, the money we get back doesn't have the flexibility of the money we lost," said Roger Biraben, who supervises drug treatment as Loudoun County's mental health services director. None of the recent initiatives is designed to help teenagers, he noted, despite new evidence of escalating drug use among teenagers nationally.

It is unclear how many people with alcohol and drug addictions live in each Washington area jurisdiction. But the number of people arrested on drug-related criminal charges suggests that the most severe drug problems exist in the District and Prince George's, the jurisdictions in which the reduction of services and subsidies has been deepest.

In Prince George's, the staff for the county's addiction services has been halved since the start of the decade. The county has closed a hot line, an intensive outpatient treatment program, a program for teenagers and their families, and an innovative program to treat drunk drivers that has been emulated elsewhere.

It takes several months to get into even the methadone program -- the one Prince George's program spared from cuts -- because the demand is great and the turnover slow. "The doors don't open for you to get help," said Lonnie Ladson, 41, of Landover, a heroin user who waited six months before he started to get the daily doses of methadone. Many people he knows have given up trying to get in. "Every time you call, they say there is a waiting list," Ladson said. "Nobody wants to hear that, especially when they are sick."

The shortage of treatment has redefined the job of outreach workers such as Ronnie Johnson, who combs Prince George's County's most drug-affected neighborhoods. Years ago, he used to lead people right into treatment. Now he dispenses condoms to try to slow the spread of AIDS, along with small pamphlets listing the telephone numbers of county treatment programs that usually are full.

"Have you tried recently?" Johnson asks a man he has known for years named Angel, who is standing in the median along Central Avenue in Capitol Heights holding a sign that says: "Please help. I a.m. hungry!! God bless you. Thank you very much."

Angel, 38, wears jeans and high-heeled sandals, his hair pulled into a sleek ponytail, his tapered fingernails coated with chipped gold polish. He says he has used heroin and cocaine for 20 years.

He has tried occasionally and without success to get into the county's treatment programs or programs at D.C. General and Prince George's Hospital Center. "I get tired of the complications and just give up," he tells Johnson.

Johnson urges Angel to call again, pressing the pamphlet with phone numbers into his hand. "You got to try. You got to stick with this."

Finding treatment in the District can be even harder. The city has cut its detoxification unit, a prerequisite for many other programs, from 85 beds to 35. And it has eliminated 700, or nearly 40 percent, of its spaces for methadone clients.

Karrick Hall, a 28-day residential program run by the city on the grounds of D.C. General, used to house 100 people at a time. Now it has enough staff to treat only 16. Jasper Ormond, director of the District's Addiction, Prevention and Recovery Administration, said that his budget contains the money to pay more workers but that he has been unable to push through the city's bureaucracy a contract needed to hire the additional staff members.

Such limits on the District's ability to offer help is why the line has been growing in the alley outside Clean and Sober Streets.

The eight-year-old program, in the basement of the Community for Creative Non-Violence shelter at Second and D streets NW, takes no government money and keeps no waiting lists. It simply takes in as many people as it can on the mornings every few months when it opens its door.

They are people such as Vince Fisher, 40, an Army veteran who lives off East Capitol Street and works sometimes for a building contractor. He had called the VA Medical Center and had been told that its inpatient drug treatment unit had closed earlier in the year.

And Bernard Jackson, 42, who has been in and out of the Lorton Correctional Complex for 15 years and was released on parole in May on the condition that he get drug treatment. He had called the National Institutes of Health, which sent him a pamphlet listing programs that turned out to have long waiting lists.

And Dorsey, the 38-year-old woman who arrived outside Clean and Sober Streets at 11:30 p.m. after four months of telephoning other places that were full or were unaffordable for someone with neither health insurance nor a job.

"When doors are closed in your face," she said, "you feel you have no choice but to go back to using."

Photo above: Eddie Locke, 28, left, waits outside Clean and Sober Streets at 4:30 a.m. When the doors open at 5 a.m., the program will be able to accept only 41 people. Photo by Michael Williamson, Washington Post.

© Copyright 1996 The Washington Post Company

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