Pubdate: Mon, 16 Jun 2014
Source: News Journal, The (Wilmington, DE)
Copyright: 2014 The News Journal
Contact: http://drugsense.org/url/1c6Xgdq3
Website: http://www.delawareonline.com/
Details: http://www.mapinc.org/media/822
Authors: Adam Taylor and Kelly Bothum
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

TREATMENT FACILITIES SCARCE IN DELAWARE

Any Changes Will Come in Phases Because of the State's Financial Constraints.

Right around Christmas, a heroin addict from New Castle County went 
to jail for a month, where she detoxed but didn't receive the 
treatment she so desperately wanted.

When she got out, she couldn't get into Gateway Foundation, a 
state-funded rehabilitation center, which, as the only true inpatient 
drug treatment facility in the state, often has a waiting list and 
other hurdles to admission.

She was turned down for a variety of reasons, said Joe Connor, 
executive director of the Addictions Coalition of Delaware.

So the woman did what most addicts in Delaware have to do to go to 
rehab - leave the state. A rehab in Maryland told her she had to be 
impaired to qualify. So she walked down the block, went into a bar, 
and got inebriated. She came back to the treatment facility, and, 
since she qualified for treatment now that she was smashing drunk, 
was admitted.

"There's something wrong with that picture," Connor said.

Connor, a native Delawarean and a recovering alcoholic, has been to 
rehab a couple of times. He did it the Delaware Way, in virtually the 
only two places he could: in jail and out of state. He was in the 
Crest program at Vaughn prison in Smyrna in 2007 and went to Mirmont 
Treatment Center in Media, Pennsylvania, later that year.

"There's something wrong with that picture too," he said.

This is treatment in Delaware, where the opportunities to get clean 
are as sparse as the heroin is plentiful.

"Treatment options are very limited in Delaware, exceedingly 
limited," Connor said. "If you're a woman, they're even more limited."

Delaware Corrections Commissioner Robert Coupe, whose nephew died of 
a heroin overdose last October, said he's aware of the lack of good 
treatment options on the street. So, while he's trying to modernize 
and improve the programs in the state's prisons, he doesn't want to 
make them so good that judges would sentence men to jail instead of 
probation in order for them to get the help they need.

That already happens with many pregnant female defendants addicted to 
heroin, who get sentenced to Baylor Women's Correctional Institution 
to give their babies a better chance of being born healthy.

"You don't want to design a residential program that will result in 
people getting sentenced to jail just so they can get drug 
treatment," Coupe said. "We need programs so judges don't have to do that."

Hopeful signs

While current options aren't plentiful, there is hope.

Gov. Jack Markell acknowledged the problem in his 2014 State of the 
State Address and said fixing it was a priority.

"It's time for us to put into practice what we already know: 
addiction is a disease. It can and must be treated," Markell told the 
state Legislature in January. "Later this year, I will propose 
changes that better align our resources to fill the gaps in our drug 
treatment system and I look forward to working with you to fill these gaps."

Rita Landgraf, secretary Delaware's department of health and social 
services, and Markell's wife Carla have been reviewing the state of 
treatment in Delaware, with the help of several state lawmakers. The 
reorganization plan will be unveiled in a few weeks, Landgraf said.

The changes will come in phases, because of the state's financial 
constraints and because it takes time to expand programs, which could 
include new facilities and staff.

"We know the demand is high, but our capacity right now probably 
can't match that demand," Landgraf said. "I've got to build the 
capacity of the treatment side."

State officials are working on a website that will be a clearinghouse 
for addiction prevention, treatment and recovery resources. The 
department expects to launch the website this summer, spokeswoman 
Jill Fredel said.

At the urging of New Castle County Executive Tom Gordon, county 
council included $500,000 for a heroin awareness campaign. It was an 
extraordinary step for a county government that was facing an 
operating deficit a year ago, but the measure passed by a unanimous vote.

The money is for the budget year that starts in July, so the ads 
haven't been crafted yet. County officials said they could be similar 
to the "Addiction Does Not Discriminate" billboard campaign currently 
running in New Jersey.

Connor said the proposed changes are hopeful signs.

"Overall, I see more political will to tackle this problem in an 
appropriate way than I've seen in a long time," he said. "At the 
state and New Castle county levels, there is a cohesive group of 
powerful people who want to see real progress."

'It can happen to anybody'

That group includes nurses from Red Clay School District who have 
partnered with the Delaware Division of Public Health to educate 
students about prescription and illicit drug abuse. Their hope is 
that the curriculum, which includes age-appropriate materials, 
worksheets and videos, will eventually be adopted for use in each of 
the state's 19 school districts.

Red Clay nurses were spurred on by Rebecca King, whose daughter, 
Stephanie, lived the horror of heroin addiction and has found peace 
and a sense of purpose through nearly two years of recovery. Her 
daughter's experience has made King a champion for awareness and prevention.

"It can happen to anybody, in any family," she said.

King was part of a group of state and education officials who sat in 
on an end-of-the-year health class last month at Alexis I. du Pont 
High School where drug abuse was the main topic. Carla Markell was 
among those who took a seat between students as they listened to 
health teacher Amanda Mattei talk about the reasons some may 
experiment with prescription and illicit drugs - curiosity, peer 
pressure, the desire to feel good, or the hope of somehow feeling better.

The program focuses on prescription drug abuse, which can be easier 
to get than other drugs - especially if all it takes is reaching into 
their parents' medicine cabinet.

"Maybe their friends are doing it. Maybe they don't think anything 
can go wrong," Mattei said. "Maybe they're self-diagnosing and 
self-medicating themselves."

In the class of 23 students, five shared details of a loved one who 
struggled with addiction to alcohol or drugs, including heroin. 
Markell, who has spoken openly about addiction issues in her own 
family growing up, said the program offers a powerful opportunity for 
stopping a drug problem by not starting it in the first place.

"If I had heard these things at your age, it would have changed my 
life," Markell said.

Mattei said students are eager not only to talk about drug abuse, but 
to understand more about their own feelings. It helps for kids to 
hear that it's not typical to be happy or feel good all the time. And 
it offers a stark reminder that addiction is a slippery slope that 
picks up speed faster than anyone expects.

"Which one of you said you wanted to be a heroin addict? Nobody puts 
that as their goal, right?" she told her class. "Nobody means for 
this to happen. So how does it get here?"

It's not about the heroin

The heroin surge isn't a game-changer for drug counselors when it 
comes to treatment. Their curriculum isn't substance-specific.

Jessica Cirillo, clinical supervisor at Mirmont Treatment Center in 
Pennsylvania, which gets a steady clientele of Delaware residents, 
said the program there teaches complete abstinence from all 
substances based on a 12-step model of recovery.

Heroin addiction does present some unique challenges, however. The 
cravings are so severe compared to other drugs that the flight risk 
for addicts who are detoxing is very high. Because of the stigma that 
is still attached to heroin use, many addicts, especially mothers 
whose mission in life is a caretaker, feel a deep sense of shame that 
they have to take a month away from their children to get better.

But ultimately, the treatment is not focused on the heroin.

"Addiction is about way more than a substance," Cirillo said. "It's 
about obsession and preoccupation that drives compulsive behavior 
despite consequences."

There's a genetic predisposition for drug use in addicts as well, 
which makes them unable to moderate their use.

After an addict detoxes and stays clean for a while, the trick is 
essentially to get them to feel comfortable in their own skin and be 
able to deal with life's stressors without getting high.

"I think addicts want to be anywhere other than in their own body," 
Cirillo said. "They are wired for sabotage and self-harm, even though 
that's not their intention."

Usually, she said, the wiring is related to some form of unresolved 
trauma or low self-worth.

"They have mistaken beliefs that they don't fit in, they don't 
belong, they're 'not part of,' they're not lovable," Cirillo said.

Reachable moment

Terry Horton, the medical director for Project Engage at Christiana 
Care, says addicts and alcoholics come in to the emergency room all 
the time for things caused by their addiction.

The hospital staff knew the patients needed help for more than the 
strokes, broken limbs, high blood pressure and seizures. They needed 
rehab, but didn't know how to talk to them. They couldn't get anyone to go.

"An emergency room visit is a reachable moment, a crisis," Horton 
said. "But we didn't know how to help them."

Horton had an epiphany. Get former addicts such as Chris Anderson on 
board to connect with the patients. Project Engage was born.

It began as a pilot program in 2008 and became a full-time program in 
2011. The recovering addicts, called engagement specialists, have 
seen more than 1,500 people. Thirty percent have entered some form of 
drug treatment, a statistic Horton considers astounding. The doctors 
got virtually no patients into treatment before the program began.

"We used to have a social worker talk to them, ask if they're 
interested in treatment, maybe gave them a bus ticket to get there," 
Horton said. "Nobody went."

Anderson thinks he knows why. The non-addict medical staff simply 
doesn't speak the same language as the patients who need treatment.

Anderson is a former heroin addict who used to roam the streets on 
the Del. 9 corridor just south of Wilmington. He's been clean for 
more than eight years, and is now an engaged father of a 3-year-old girl.

Anderson accompanies the doctors and social workers on their medical 
rounds. In fact, he's a key part of it. When they're done dealing 
with the reason the person wound up in the hospital, Anderson chats 
them up about what caused it.

"What I do sounds simple, but it's an amazing thing," he said. "I get 
to go in, tell them a little about me and build a relationship. Some 
people love to tell their story and open up to a peer, a fellow 
addict. I see them shift. They become amenable to treatment, which 
takes a lot of bravery and courage."

The engagement specialists follow up with the patients after they're 
discharged, because Horton said the "barriers to treatment are ferocious."

It's hard to get in places. There are insurance issues. Sometimes the 
patients need to get into a sober living house and need money for groceries.

"It's like a really ratty rope bridge in an Indiana Jones movie," 
Horton said. "There are planks missing. Our engagement specialists 
are the guides over the bridge and the safety net underneath it."

Project Engage sends its clients to 33 different treatment providers, 
many of them out of state.

"Delaware's resources clearly don't meet the needs in the state," Horton said.
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MAP posted-by: Jay Bergstrom