Treatment providers struggle to patch safety net

by Amy Kingsley

Representatives from Guilford County’s substance abuse treatment community, a patchwork safety net for the thousands in the Greensboro area afflicted with addiction, gathered May 24 for presentations by successful program administrators from around the state.

The forum organizers aimed to give Guilford County treatment providers ideas for strengthening their own programs and to create awareness of referral options. The speakers represented Triangle Residential Options for Substance Abusers (TROSA), Healing Place of Wake County, Freedom House in Durham and PORT Adolescent Substance Abuse Program in Greenville. The Guilford Center, the county’s largest provider of mental health services for the uninsured, and the Guilford County Substance Abuse Coalition planned the event, which took place at Kress Terrace.

Despite reports revealing a steady increase in substance abuse and documentation of its negative effects on the community, several Guilford County drug treatment facilities operate below full capacity. A number of roadblocks stand between those suffering from addiction and the treatment they need, said Joe Fortin, the program coordinator for dual disorder services at the Guilford Center. The elimination of 135 positions from the Center by the year’s end is likely to make these problems worse unless existing providers can expand local programs, he added.

‘“Some folks are going to be slipping through the cracks unless some money is found,’” Fortin said.

According to coalition research, a number of the county’s homeless residents and those involved in the criminal justice system have already slipped through the cracks. More than 50 percent of the homeless population and 60 percent of those in Guilford County Jail suffer from substance addiction, according to the assessment.

Guilford County law enforcement agencies recorded an increase in drug-related arrests twice the national average during the study period. At the same time the county arrested three times as many people per capita for drug offenses as compared to the national average.

The community is also dealing with the health consequences of substance abuse, which include increased incidence of sexually transmitted disease and higher risk of stroke. The county rate for primary and secondary syphilis in 2003 was 8.8 compared to a statewide average of 1.8. The three-year average of rate of new HIV reports is 29.8 compared to 21.7 for the state.

Researchers conducted an inventory of treatment facilities that found plenty of beds available for medical detoxification and short-term inpatient treatment. The report recommended better coordination of existing assets and the development of long-term support housing.

Representatives from TROSA explained that program first, a course of treatment notable for its length. The full TROSA program lasts two years and includes vocational training, education and a 12-step recovery model.

Chris Budnick from the Healing Place spoke next about his facility, which targets members of the homeless community in Durham. The Healing Place is also a wet shelter, which means they take overnight residents who have been drinking or abusing drugs. Greensboro currently has no such facility.

‘“You can’t expect people to sober up and then come back to the shelter the next night,’” Budnick said.

The wet shelter model also allows intoxicated individuals the opportunity to interact with the facility’s medical staff and long-term residents in recovery. Ninety percent of the detoxification center staff has gone through the program, Budnick said.

The Freedom House in Chapel Hill has a number of diverse facilities housed on a single campus. Halfway houses, residential treatment and 12-step recovery groups all occupy the main campus, allowing abusers access to several treatment options.

Greensboro and Guilford County lack long-term treatment facilities like TROSA and Freedom House. Wheaton Casey, the drug court supervisor for Guilford County, said that many of her clients, some of whom are treated by Alcohol and Drug Services, prefer to leave the county for treatment.

‘“It’s easier for them to stay clean if they are away from their usual crowd,’” Casey said.

All the programs that presented, including PORT, a substance abuse treatment program for adolescents, have medical and psychiatric services available to their clients. Proper treatment of dual-disordered patients, those with substance abuse disorders and another mental illness, can play a crucial role in whether they stay sober, Casey said.

‘“We have a lot of bipolar clients,’” Casey said. ‘“If they’re not on their meds, they’re going to self-medicate.’”

Right now the drug court coordinates treatment at Alcohol and Drug Services and the Guilford Center for those clients. Casey said she is unsure how mental health reform will impact their ability to deliver comprehensive service.

The drug court program, which runs a minimum of one year, is comprehensive. Clients undergo treatment, drug screenings and probation meeting several times a week. Casey has referred clients to TROSA and other long-term treatment unavailable locally.

Drug courts have proven successful. A 2002 National Justice Institute study reported a 27.5 percent recidivism rate for clients within two years of graduation. Felons confined to prison have a 60 percent chance of committing another offense within three years, according to US Department of Justice figures.

The Guilford County Substance Abuse Coalition is one of the best-funded of such groups operating around the country, said member Graham Reaves. The resources they have marshaled will be sorely needed in the months to come, he said.

‘“This community is a leader in providing a moral and compassionate base for treatment,’” said moderator and consultant Paul Nagy. ‘“It is so important in this, the greatest time of change and challenge.’”

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