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Fighting addiction a lifetime process

Fighting addiction a lifetime process :: Local News :: Post-Tribune.

Fighting addiction a lifetime process

January 13, 2009

Whether county efforts to dam up drug problems work, it’s at least worth a try, literally.

The average cost of treating an addict is about $1,500, Adam Brooks, a researcher for the Treatment Research Institute, said. That’s compared to the $11,500 an addict costs a community through loss of taxes, unpaid hospital bills, crime and more.

But throwing money at a solution isn’t the answer, experts say.

That means officials need to track treatment data to see what works. Groups need to work together and share results.

The focus can’t be on just rehabilitation either, officials say. They suggest the county look at prevention programs in place and new ones implemented elsewhere.

Then there are the problems that come with addiction — many addicts don’t have a job or higher education, and often have money problems that keep them from finding a place to live or paying for legal help. Leaving those needs unanswered is like trying to treat a diabetic with just insulin and no change in diet, officials say.

The county also needs to embrace the philosophy that a relapse is not a failure or a reason to give up. It’s part of the recovery.

“People panic because they think it should be all or nothing,” Rocco Schiralli, executive vice president of programs for Porter-Starke Services, said.

How to chart progress

Part of the county’s current problem is a lack of data that would explain just how bad the problem is, Schiralli said. Many of the numbers can be found; they’re just scattered among various counseling centers, medical offices and county programs, he said.

Porter-Starke Services is working with groups to collect that data in one document that would be available to everyone. Using that data is just as important, though.

“Before you start throwing money, you have to make sure it’s something worth throwing money into,” Schiralli said.

Not all programs are created equal. One program might prove to be helpful but might drain the county of funds. Instead, Schiralli said, the county needs to look at the cost per addict served.

The data, then, will create a baseline everyone can check to see if a program is worth the money.

The collaboration shouldn’t stop there, though, said Brooks of the Treatment Research Institute. If the medical community came together and created a list of standard questions to assess addicts, it would help normalize the system and give the community an even better idea of what was working.

He compared it to how doctors take a patient’s heartbeat as a basic standard of telling if someone is healthy.

That’s not the only way the general medical community can help, according to a 2007 study by the National Quality Forum that found the best treatment programs known to be effective. The study said doctors and other medical professionals should be trained to ask questions about drug use for every examination, no matter the patient.

The idea is that doctors can then identify drug addicts as well as help get them into treatment, according to the report.

The collaboration effort isn’t important for just locals, though. More and more grant programs are learning that putting money into anything and everything just drains their pockets while having little effect on users, Schiralli said. Now, grant groups want to see results before they give to a treatment program.

“You have limited resources,” he said. “How do you spend it?”

If the county wants to stretch its dollar even more, it could look toward Delaware, Brooks said. The state set up a program that turned its contracts with addiction treatment providers into a merit-based system. Each contractor worked with the state to set a goal as to how many patients it could serve. The contractors got paid for serving at least 80 percent of that goal, along with how long they treated each patient.

If the contractor didn’t meet the goals, though, payment was deducted.

The program was rated a success. When it started in 2001, the contractors served had about 54 percent of capacity filled. By 2006, they were up to 95 percent, Brooks said.

Prevention plays a role

Getting addicts to stop using drugs isn’t easy, though, and experts say it’s a lifetime process, just like treating any other chronic disease. Prevention, however, can stop the problem before it starts, if done right.

In 2007, the Porter County Substance Abuse Council spent about $16,000 for the Red Ribbon Week. However, that program — as well as Drug Abuse Resistance Education, aka D.A.R.E. — has never been shown to be effective, Schiralli said. A study of local high school students reflected national studies: Students don’t buy into the program because it’s “too general, too simple,” Schiralli said.

Harold Holder, a senior scientist at the Prevention?Research Center at the Pacific Institute for Research and Evaluation, said some school programs do — but not on their own.

“The problem with education-based prevention is there’s no sustained effect,” he said.

Instead, community policy needs to come into play. That can range from changing planning codes so there can only be so many alcohol sellers per person in the county or working with bars and restaurants to train and enforce waiters to cut off alcohol to someone who’s had too much to drink, Holder said.

A study of several communities that took similar steps saw the rates of drunken drivers decrease by 44 percent, Holder said. The point is not to try to prevent addiction but to prevent behaviors that lead to addictions.

“We don’t actually know much about preventing addiction,” he said.

Other issues

Some programs the county has already implemented, specifically the drug court and methadone clinic, have had success elsewhere in the United States treating people. The National Quality Forum study said methadone and other similar drugs should be offered to anyone recovering from an opiate.

The county can’t just focus on treating the addiction, though, Brooks said. Programs that don’t focus on other issues affected by the addiction — such as education, jobs, legal matters and other problems — often end up seeing the addict start using again.

“When you’ve lived as someone with an addiction, you’ve deteriorated almost every area of your life,” Schiralli said.

The county is addressing some of these issues but it needs to do more, he said, such as provide more housing and financial support.

Porter County can only get to that part if it treats the users first, though. If the majority of people don’t want help, then, is there no other option?

Not necessarily, Brooks said. A new program, Community Reinforcement and Family training, trains families and friends on how to approach a user to get help. The theory teaches using support and leverage to induce people to seek treatment. Brooks said the technique works on about 60 to 70 percent of addicts.

Even if the person goes to treatment just to please others, they can still be successful, Holder said. The main factor in recovering from drug addiction is how long one is in a program — not whether the person wants to be there.

Relapse to be expected

The main thing to remember is that what looks like failure is actually just part of helping people, Schiralli sad.

“A relapse is expected; not a sign of failure,” he said.

That’s important to keep in mind because if people emphasize that a relapse means an addict fails, it will just make the entire process more expensive, Brooks said. If addicts feel they’ve messed up, they’ll likely get further sucked up in drugs to deal with feelings of shame. That will lead them again back to all their costly habits — stealing, medical bills, etc. — and intense and costly treatment if they ever go back to it.

If everyone looks at a relapse as part of treatment, though, addicts will feel more comfortable in going to professionals for help sooner, Brooks said, and will avoid many of those costs.

While the efforts Porter County has taken might not show results now, that doesn’t mean they won’t. Addiction is a chronic illness, Brooks said, and the only way to treat it is to prepare for the long haul.

Contact Teresa Auch Schultz at 477-6015 or tauch@post-trib.com. Comment on this story at http://www.post-trib.com.

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