Pubdate: Wed, 29 Nov 2000
Source: Vancouver Sun (CN BC)
Copyright: The Vancouver Sun 2000
Contact:  200 Granville Street, Ste.#1, Vancouver BC V6C 3N3
Fax: (604) 605-2323
Website: http://www.vancouversun.com/
Author: Frances Bula, Vancouver Sun
Series: Searching for solutions - Fix on the Downtown Eastside
http://www.mapinc.org/thefix.htm

LOOKING FOR TREATMENT

It eats up millions of dollars, but addicts wanting to quit still face
waits and must deal with a system in which one hand doesn't always
know what the other is doing.

Get treatment. That's the mantra everyone chants these days as people
talk about how to solve Vancouver's drug problem. That's the theory.
Then there's the practice.

At the battlefront on the practice side, there are people like Iain
Jardine-MacIntyre, a drug and alcohol counsellor who works in two of
the Vancouver/Richmond health board's downtown clinics -- one near
Granville, the other across the street from Oppenheimer Park. Every
day, when someone walks through the door saying, "I want to clean up,"
it's Jardine-MacIntyre's job to pick through the maze of potential
dead-ends to help that person -- from the shortcomings in that
person's capacity to sustain the will to change, to the deficiencies
in B.C.'s vast but completely uncoordinated and patchy treatment system.

"I don't suggest anything until we agree there's a problem," said
Jardine-MacIntyre. "I ask what they want to do about it."

The next step is to figure out how much that person is using and what.
Finally, he has to factor in how stable that person is: Is it someone
who could stand a month-long wait for a treatment bed or someone who's
going to disappear if there's no detox bed tonight?

If he's dealing with a high-functioning middle-class alcoholic, he
might choose to send him to Pacifica. In the meantime, he doesn't have
to worry about finding that person a place to stay.

If it's a native person, Round Lake, which is more geared to First
Nations culture, might be better. And with some completely
street-oriented addict who's been through four or five treatment
centres already, he'd look for something that might offer a different
approach.

But that's only the beginning. Addiction counsellors like
Jardine-MacIntyre don't have the luxury of a system like, for example,
Frankfurt's, that has all the pieces linked. There, someone who went
into one of the city's four drug-resource centres might initially
start by just using the safe-injection rooms. But the individual would
also have the opportunity to get help from the centre's medical
clinic, social workers, counsellors, homeless shelter or referral clinic.

If a person in Frankfurt was asking for treatment, a centre social
worker would line up a place in a detox that would afterward be linked
to a place at a supported-living house while that person waited for a
treatment spot to open up. Treatment would be 10 months at an isolated
treatment facility, then the person would move into a transition house
near the facility for as long as necessary while making the move to
school or work.

Here in Vancouver, counsellors have to first line their clients up for
detox -- and that becomes critical if they're dealing with someone who
is on the street and needs to get stabilized immediately. Then they
join another line-up to get them into a supported-recovery house while
they're waiting for treatment -- line-up number three -- and then
start again to get them into another supported-recovery house to try
to provide them with extra help and a transition before they're thrown
back out into the world.

The Methadone Program

For Jardine-MacIntyre, the biggest problem these days is the people
they have on the methadone program who are now addicted to something
else, usually cocaine. Because so many treatment programs insist on
complete abstinence -- and they view methadone as a drug -- there are
almost no places for that huge and growing group.

Of the 6,000 people on methadone in B.C., Jardine-MacIntyre estimates
that the vast majority of them have another drug-addiction problem.
The province is planning to expand its methadone program, which will
mean just that many more clients for addiction counsellors.

But there is only one three-bed facility -- in Prince George -- that
will take people on methadone and treat them for their other
addictions. (Harbour Light in Vancouver is considering a pilot with a
few more beds.) There are only two recovery houses in Vancouver that
will provide the pre- and post-treatment support. "So I have a guy in
my office today, what am I going to do? The next spot at Nechako in
Prince George doesn't open up until Jan. 8. And then when he comes
back, where to I send him? Back to the Downtown Eastside on welfare in
an SRO?"

Even the first line-up -- for the detox bed -- proves to be more than
some people can handle. "If you've been on the street in the Downtown
Eastside, your patience is almost non-existent," says MacIntyre.

It can also demand more than rarely found patience. Take Paul Le, or
Phu, as he calls himself. Phu is a 46-year-old Vietnamese man who
spends many of his days on the corner of Main and Hastings, selling
imaginary dope and talking to God, occasionally getting beat up when
people get annoyed with him. Ten days before welfare Wednesday last
month, Phu was broke and desperately dope-sick, sick enough to tell
the Main and Hastings street programmers that he wanted to go into
detox. So someone phoned and he got an appointment.

But he missed his detox appointment two days later because of a court
date he'd suddenly remembered. So then he was told he couldn't call
back for seven days because he hadn't shown up when he was supposed
to.

Two days after welfare Wednesday, detox was long forgotten and Phu was
at the corner of Powell and Gore on his knees, bowing to St. James
church across the intersection and kissing the sidewalk. He didn't
need treatment any more, he said, because God would make him strong
enough to resist drugs.

Finding The Right Treatment

Some might argue that detox and treatment, expensive health items,
should be reserved for those who have the motivation and the mental
health to want detox for longer than 24 hours. But others say that the
system needs to be able to grab people whenever they're ready, and
give them every chance to try detox and treatment as often as they
can, because it frequently takes a dozen or two dozen tries and
failures before people can break through to getting clean. It's not
just their own relapses that are the problem. It's finding the
treatment that works for them.

Shawn Millar, a bright but fragile 37-year-old who's been using crack
for five years, is far more functional than someone like Phu. The last
time he wanted to go into detox, he had the patience to phone Harbour
Light morning and afternoon every night for eight days before he got
in. He's been to two treatment programs so far. He did really well on
the first one, three years ago, right up until they said: And now
you're on your own.

Then he found himself in the worst of the bad rooms on the Downtown
Eastside, staring at cockroaches. Within a week, he'd blown all the
money he'd saved up working at his restaurant job.

The second time he tried treatment, he left the Coquitlam house the
second day, unable to stand the constant talk about fags, spics,
sluts, ho's and the rest. He hasn't found the treatment yet that
works. He gets through life day by day, trying to avoid blowing his
money on crack by getting his aunt to come down and babysit him on
welfare Wednesday, getting a Carnegie Centre worker to walk him to the
pawn shop to put any money he's earned doing community work toward a
guitar he wants, and spending almost every evening at Narcotics
Anonymous meetings. He carries the list of meetings in his pocket.

Does it work?

"No," says Millar. "But I don't know what else to do."

Those who've been through treatment say it can take 10, 20, even 30
times before you find what's right for you.

There are several different approaches out there.

The 12-step programs are the most numerous and the best known. Other
centres use a cognitive or behavioural approach. (Some people, turned
off by the religious overtones of 12-step, use a group-meeting network
that's part of something called the Rational Recovery movement.)

Ultimately, says Jardine-MacIntyre, it doesn't matter which centre of
the many with good track records in B.C. that a person picks. "Almost
any treatment model will work if the staff are empathetic. They
[addicts] need to have the sense the person cares. Then you start to
get a whole other level of trust." 
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MAP posted-by: Richard Lake