Treatment on Demand

Mike Steindel (CLaw7MAn@webtv.net)
Sat, 17 Jul 1999 18:00:53 -0700 (PDT)


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Community Profiles: San Francisco & Louisville7/15/99
San Francisco

Fewer than one-fourth of the estimated 23 million Americans who need
substance abuse treatment receive services (1993 study by Brandeis
University's Institute for Health Policy). Many of these people won't
admit that they need help. But for others, the services they need may
not be available in their communities. And many are stuck on the end of
long waiting lists.

Two years ago, community leaders in San Francisco set about trying to do
something about the substance abuse problems in their city with the
establishment, by the city's board of supervisors, of a strategic plan
for a substance abuse "treatment on demand," or TOD, system. A 1996
study by the city public health department's Community Substance Abuse
Services (CSAS) reported some troubling figures. 

Adding together health-related costs, lost economic productivity,
criminal-justice costs, and a variety of others, the report concluded
that untreated substance abuse cost the city $1.7 billion in 1996 alone.

CSAS Director Charlie Morimoto says the intent of the TOD system is to
take a broader view of the community's treatment needs-of populations
not being reached, gaps and duplications in service-and plan
accordingly. "We want to know: what are the target populations, what are
their needs, and what are the proper strategies for intervention?" he
said.

While it may sound uncomplicated, the notion of identifying
substance-abusing groups and their needs is "a different form of
thinking," Morimoto says. Another unconventional idea is to consider
"wraparound services" that might be appropriate for a given group. For
example, he says, methamphetamine users often need help for gum disease. 

Many services for a full TOD program are not yet in place, says
Morimoto, who estimates that he needs an additional $2-3 million to
"ramp up" for operation. But political opposition, even in liberal San
Francisco, is still an impediment. "The homeless population is
increasing," 

Morimoto says. "It's getting worse." The more politically popular
response to a growing number of public inebriates, meanwhile, has been
to establish anti-vagrancy laws.

"But everywhere I turn the data are there," he says. "Treatment works.
It raises the quality of life. We've just got to put a public face on
that data."

Louisville

In Louisville, Ky., operators of a homeless shelter turned their
attention to substance abuse problems after concluding that it was an
inherent and intractable part of homelessness. In 1989, a group of
doctors and their county professional organization created the Jefferson
County Medical Society Outreach Program, Inc. to operate the shelter and
provide health screening for the homeless people who came through its
doors. 

Three years later, the group turned its focus to alcohol and drug
addiction, and according to the center's program engineer, Chris
Fajardo, "they decided they wanted to do more than a Band-Aid."

What they came up with was an extensive and unique self-help program
that has drawn the attention of a half dozen cities interested in
emulating it. Emphasizing that The Healing Place is not a treatment
facility, Fajardo defines it as "a mutual self-help recovery program."
Besides offering Louisville's homeless people a place to eat and sleep,
it offers a variety of recovery programs.

Fajardo, himself in recovery for 32 years, says that recovery rates for
men and women who pass through The Healing Place are 62 percent and 64
percent, respectively, after one year. In all, he says, 600 men and
women who have passed through The Healing Place are in recovery.

One of the keys to the shelter's success is its linkage with the
Louisville area medical establishment. Half of physicians' dues to the
County Medical Society go to The Healing Place, but other doctors
contribute money and volunteer work as well. Last year, doctors,
dentists, and other health-care professionals contributed $1 million
worth of free medical service to the shelter, according to Fajardo.

But the other secret of The Healing Place's success, he says, is its
emphasis on peer influence. 

"The guy who meets you at the door may be someone you drank with,"
Fajardo says. "The guy who serves you food may be someone you did crack
cocaine with. You see that and you might be thinking, "If he's
bright-eyed and bushy-tailed, maybe I can be too."

Fajardo says that The Healing Place is not a replacement for treatment.
It's a complement.

"But I do believe that what we're doing here in the homeless shelter is
a critical part of the solution," he says. "We're seeing more and more
people being pushed out of health care. An increasing number of people
who can't get service are ending up in places like this."

Source: www.jointogether.org





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