The chairman of the D.C. Council's health committee fulfilled a promise to focus on one of the city's most pressing health problems by holding a hearing at the District's formerly down-at-the-heel Detoxification Center -- the place where thousands of addicts go to start turning their lives around.
Yet David A. Catania was the sole council member listening when men and women who know the issue from hard experience sat down to testify last week. In nearly four hours of discussion, they and others had kudos for the striking cosmetic changes that recently improved the center in Southeast, as well as questions about the changes to come in treatment services.
Before the microphone in the center's dining room and group therapy space -- newly painted a cheery yellow -- the senior deputy director of the Addiction Prevention and Recovery Administration acknowledged that it would be another six months before the agency would near his goals for it. But Robert Johnson assured Catania (I-At Large) and the audience that the "train wreck" he had inherited 18 months earlier was now back on the tracks and moving forward.
The administration does not fill a narrow, special-interest role in a city where one in nine residents has a drug or alcohol problem. Substance abuse "touches everything," Catania said. "Health issues, human services, child and family issues, criminal issues, employment issues."
Past and present clients at the center concurred. A tearful Sheila Gaskins, now "90 days clean and sober," haltingly recounted losing a child because of her struggles with crack. "I really wanted to stop using to get my child back," she said. "I wanted to stop, but I couldn't stay stopped."
Carlos Vaughn offered an unvarnished description of his heroin addiction and homelessness. "My lifestyle on the street was spiraling down," he told Catania. "I needed a timeout. . . . I came here to find out what's wrong with me."
The system, though, can erect barriers. "When I arrived at detox, there was no one who spoke Spanish," Juan Hector Fuentes recounted through a translator. He nodded at doctors without knowing what they were asking about him or his drinking problem, and he sat in therapy sessions and was just as clueless. "The only person whom I met and spoke Spanish was the cleaning staff," he said.
The Salvadoran restaurant worker appeared as a representative of other clients at Neighbors' Consejo, a nonprofit organization that in 2004 opened the city's only inpatient bilingual substance abuse treatment program. And after Catania told Fuentes of the Spanish-speaking counselor and receptionist hired at the 80-bed detox center since the summer, the clinical director of Neighbors' Consejo, Athena Viscusi, said the staff remains inadequate. She said many Latinos wait hours and then leave without being seen.
"In a 24/7 facility, one full-time [counselor] is just a little bit," she said.
The Addiction Prevention and Recovery Administration has other corners to turn, too. The executive director of Second Genesis, which runs treatment programs across the region, testified that the organization had received administration certification in 2003 so District residents could be referred there. No one has been, despite city officials' call for more choices and access to care.
Johnson, the city detox center's director, promised that a system to quickly authorize contracts and procurement -- taking advantage of the health department's autonomy in those areas to cut red tape and delays -- would be in place before the end of the year.
Streamlined certification and new billing systems also will be in use; District officials expect approval before 2006 for Medicaid reimbursement for substance abuse treatment, which should allow expanded services. All changes matter far beyond mere bureaucracy because they will enable the agency to move more quickly and smartly to support initiatives or address needs.
"There's a lot of desire to get started," Johnson said.
Catania's staff put maps to the detox center in council members' mailboxes before last week's meeting. He said he'll do more than that for a follow-up hearing at the center in May. Colleagues won't just get a notice and directions to 19th Street and Pennsylvania Avenue SE, he announced: "We are going to put a few of them on a bus and have them come over."