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Smashed

Funding for substance abuse treatment has plummeted.

The result is a pricey public health crisis.

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BRUCE ELLIOTT
  • Bruce Elliott

We'll call her Alex.*

On a Friday last August, Alex was driving drunk in Colorado Springs. Police stopped her around 7 p.m. and charged her with driving under the influence (DUI). Her blood alcohol content was over .30, more than three times the legal level for driving while impaired in Colorado.

The police officers who pulled Alex over took her to Memorial Hospital rather than jail because Alex came out of a blackout long enough to complain of chest pains.

But the Memorial emergency room was getting full, says Alex, "and they didn't want to have a drunk in a bed that could be used for someone else."

Alex was violently sick with what she believed was alcohol poisoning. She says she was left alone on a gurney in the hallway, and when a doctor peeked around a corner to check on her, a nurse quickly ushered the doctor out.

"That's just a drunk," the nurse said, according to Alex. "You don't have to bother with them."

The Independent can't confirm that statement but can confirm that the burden of thousands of emergency room visits by chronic substance abusers is causing excessive stress on the system. Since 1999, according to the Mental Health Association of Colorado, Colorado hospitals have experienced a 999 percent increase in drug and alcohol dependency encounters.

Alex is one of 2,162 people in Colorado Springs picked up for DUI last year. She counts herself a chronic substance abuser, and she is far from alone.

Along with rampant population growth, substance abuse figures have increased exponentially in Colorado since 1990. Between 1993 and 1999, Colorado's alcohol-related discharges from hospitals increased by 40 percent. Drug-related hospital discharges increased by 50 percent. And during the same decade, alcohol-related deaths increased, from 997 in 1990 to more than 1,200 in 1998.

Damage control

The state's Alcohol and Drug Abuse Division estimates that there are 253,400 substance abusers aged 12 and older in Colorado.

The federal government's Substance Abuse and Mental Health Services Administration's annual survey of drug and alcohol use shows that Coloradans indulge in binge drinking more frequently than folks in 39 other states, with 26 percent of respondents admitting to binge drinking at least once over a one-month time frame. (The same survey showed Colorado first in cocaine use.)

"Substance abuse and addiction is the elephant in the living room of state government," said Joseph A. Califano, Jr., former secretary of the U.S. Department of Health, Education and Welfare, at a January press conference announcing the results of a comprehensive study that emphasizes the critical need for treatment and prevention. The states have it backward, said Califano, spending billions of dollars on damage control rather than addressing the problem up front.

While drug and alcohol abuse have risen alarmingly over the past decade, Colorado has fallen to dead last in the United States in state investment in substance abuse prevention, treatment and research. Barely 6 cents of every $100 spent on substance abuse issues in Colorado is actually spent on treatment, prevention or research.

For people like Alex, these statistics translate to inadequate, fragmented and hard-to-find treatment options. For her sober fellow citizens, they translate to a high portion of taxpayers' dollars being dedicated to cleaning up the mess chronic abusers leave behind.

This volatile combination -- an increase in demand for services with a steady decrease in community funding -- constitutes a public health and safety crisis across the state and right here at home, in El Paso County.

The problem, experts say, is not solely that of the substance abuser. Huge costs in public health and safety, to law enforcement agencies, to employers, to self and family result from every case like Alex's.

In Colorado Springs, for every drunk or drug addict who goes untreated, at least four other people are directly negatively affected.

'The first part is a blur'

On that August night, police officers took Alex to Colorado Springs' only detoxification facility, the Lighthouse, operated by Pikes Peak Mental Health (PPMH).

"Detox is a nightmare," said Alex. "The first part is a blur because of the extremely high blood alcohol content." Eventually, as she became more clearheaded, certain things came to her attention.

Surrounding her, she said, were "scary, smelly, sick, violent, angry people," mostly street people who were "yelling and crying and scared."

"It's scary to be in detox," said Alex, who contends that her experience included being treated as a "criminal element," not as a sick person.

"You are dirty, smelly and sick," she said. "Sick to your stomach. You are humiliated."

In the common areas of the clinic, says Alex, chronic abusers discussed their planned return to detox. Because the Lighthouse is a temporary holding facility, many leave only to return the next night.

Alex was lucky. She was picked up from detox on a late Sunday morning and was taken to her clean, lovely home in a northeast Colorado Springs neighborhood.

There, she says, she could drink in peace. She could afford the $5,000 the DUI eventually cost her. But without continuous follow-up counseling and treatment, she couldn't and wouldn't stop drinking.

"Detox is really just the first step," said Dr. Daniel Segal of the UCCS department of psychology, a specialist in substance abuse issues. "The predominant model in the field is the abstinence model -- get sober, make a commitment to sobriety and get help in therapy. Recovery from substance abuse is a continuous process. People have to change their lives. If they don't get into some kind of follow-up therapy, relapse is imminent."

But before recovery can begin, a chronic abuser must be detoxified, the body cleansed of accumulated toxins. Detox occurs naturally when drugs and alcohol are withheld over a period of time, and the resulting physical response withdrawal can be uncomfortable and dangerous.

Cutting the beds back

Detoxification in Colorado Springs, like many other aspects of substance abuse treatment, has suffered from funding cuts combined with a rising demand for services. Sonia Johnson, director of Acute Services for the Lighthouse says that although PPMH has been providing detox services to the community for 25 years, the last decade has been particularly precarious.

The detox unit currently has 20 beds available, and last year served 3,086 people, or an average 60 per week. Length of stay can range anywhere from one hour to five days. In the late 1990s, the center operated at its current capacity, but found that funding from state, county and city sources were either stagnant or diminishing. The Pikes Peak Mental Health Foundation, says Johnson, "was forced to increase its donations to the detoxification center" and found the increase in costs to be non-sustainable.

In 2001, though demand for services was increasing steadily, Pikes Peak Mental Health reduced services at the center from 24 beds to 10 beds (beds were restored to 20 when the situation reached a crisis point). And without additional funding, PPMH was forced to convert from a medical detox model back to a social detox model -- in other words, patients got shorter stays and less medically supervised treatment.

BRUCE ELLIOTT
  • Bruce Elliott

The impact on the community was felt immediately, says Johnson, and concern from the various aspects of the community directly impacted -- emergency rooms, the city, the county, law enforcement and social services providers -- "reached a new plateau."

"The reason the whole community had to get together a couple years ago was because we had to cut our beds back to what we were funded for," said Johnson. "People were left on the street; ERs were overcrowded and people began to complain. Finally, we all teamed together to come up with a solution."

Pikes Peak Mental Health, Penrose-St. Francis Hospital, Memorial Hospital, representatives of the city and county, the Salvation Army and others formed a task force to address the detox and substance abuse crisis in the city.

The problem, says Johnson, is "that was a temporary fix.

"This is really a community problem. The question is, how are we going to fund it? [Substance abuse] has an enormous impact. What we're trying to do now is move forward and get the community to take notice of the problem."

The news is not good

The task force formed in 2001, under the direction of Penrose-St. Francis CEO Rick O'Connell, and contracted with Behavioral Healthcare Consultants of Boston to conduct an eight-month study of substance abuse and treatment issues in Colorado Springs. The result of that study was a report that was presented to the community, to the City Council and to the board of county commissioners in 2003.

The news was not good.

The system of access and flow of substance abuse services in Colorado Springs was fragmented and difficult to navigate, the consultants concluded.

According to the report, some 50,000 people in El Paso County were experiencing mental health and/or alcohol and drug problems. Related police and fire emergency response costs were exceeding $1 million per year.

Substance abuse-related visits to emergency departments at Memorial and Penrose-St. Francis had risen dramatically over five years, "causing added stress to the delivery of emergency services to the community."

El Paso County methamphetamine lab busts had skyrocketed from practically nonexistent in 1998 to 140 in 2002.

While 27,000 Colorado Springs adults needed substance abuse services during the time of the study, only 2,090 received help through publicly funded programs.

Based on these findings and others, such as the fact that Colorado was one of only three states in the nation that refused Medicaid for substance abuse treatment, the task force determined that its highest priority should be "developing substance abuse services for those without resources."

"Those without resources" included the homeless who were also addicts, those caught in the revolving door of abuse and treatment, those Alex overheard planning their day around the time they would return to detox, those planning their next drink or fix before they exited the emergency room or the detox facility.

"The study showed that we didn't have a detox facility that was supported by the community," said Penrose-St. Francis' O'Connell, "that if you had the money or were insured, you could get care in a treatment facility, but if you weren't insured you couldn't get treatment. The hospitals became the bearer of that burden inappropriately."

The Community Behavioral Health/Detox Project, as it came to be known, devised a solution to the immediate problem, a "continuum of care" that involved medical detoxification followed by intensive outpatient treatment, longer term aftercare, and finally, a stay in Harbor House, a newly founded entity that would provide residential treatment to "those without resources" until they could find their way to employment, housing and sobriety in the community at large.

Dwindling dollars

O'Connell says results of the continuum of care are only now being measured, but a number of those exiting Harbor House have cleaned up their lives and are now employable and able to live self sufficiently.

But the project requires continuous funding that is not forthcoming. Contributions from the hospitals and from Pikes Peak Mental Health were intended to be one-year startup funding, O'Connell explained to Colorado Springs City Council in 2003 when he presented the continuum to them and asked that they contribute to the project.

"The study showed that we were the only community in the country where the city didn't participate," said O'Connell. "The continuum -- detox, outpatient treatment, aftercare, then Harbor House -- has been funded by Penrose-St. Francis, by Memorial Hospital, by Pikes Peak Mental Health and the county. The city pays nothing."

City Councilman Richard Skorman says that O'Connell came to the city during a budget crisis and that the city considered Memorial Hospital's contribution to be theirs, since Memorial is a city-owned enterprise.

O'Connell argues that the city uses Memorial Hospital as an asset when it's convenient. Years ago, before the county helped Pikes Peak Mental Health build the Lighthouse, he points out, the city of Colorado Springs paid El Paso County $650,000 a year "for the county to take care of its drunk tank.

"Now they pay nothing."

Initial funding for the Behavioral Health/Detox Project came from Penrose-St. Francis ($142,560), El Paso County ($209,000), Memorial Hospital ($409,860), State Alcohol and Drug Addiction Division ($700,000), and Pikes Peak Mental Health Foundation ($100,000), and most of that funding has been extended over three years.

"We spent countless hours doing what we said we'd do," said O'Connell. "We have a program that works very well. We only need $225,000 from the city to make it work."

Meanwhile, at the county Department of Health and Environment, spending on substance abuse treatment has plummeted from $1,836,454 in 2000 to $702,670 in 2004. With limited funding, the department continues to provide counseling services on a sliding fee scale to adults, adolescents, pregnant women and other women with special needs.

"I would say that we do anywhere from 15 to 25 new intakes a week," said Michael Plunkett of the Health Promotions Division. "And we may see anywhere from 50 to 75 people per week in follow-up sessions.

"On a yearly basis, we provide counseling services for 640 to 650 people [in the clinic]."

Additionally, the agency's Health Promotions Division offers community outreach programs to some 2,000 people per year, traveling to soup kitchens, community centers and social services agencies offering counseling, prevention and education programs.

"Used to be, when a person showed [at the Department of Public Health], you brought them into the program, and the state reimbursed you for how many people you treated," said Plunkett.

Now, the state contracts with a managed care provider, Connect Care, and individual agencies contract with Connect Care for funding for services.

At the same time the state has turned to a managed care model, $7.4 million of General Fund budget cuts have been dealt to mental health and substance abuse programs since 2001, a 30 percent cut.

Everybody is threatened

Michael Plunkett of the El Paso County Department of - Health and Environment provides substance abuse - services through the Health Promotions Division. - BRUCE ELLIOTT
  • Bruce Elliott
  • Michael Plunkett of the El Paso County Department of Health and Environment provides substance abuse services through the Health Promotions Division.

"The cost is enormous," said Alex, referring to the fallout of chronic substance abuse. "Your family, your job, your friends, the taxpayers of the city you live in ... the cost of just one person's addictive behavior is tremendous, not to mention the threat to everyone's safety."

Before she finally got serious help, Alex ended up living in a car on the streets of Colorado Springs, without a job or a place to live, her connections with family and friends severed.

"I lost everything that meant anything to me, especially my sense of self-respect," said Alex. "I couldn't even bear to look at myself in the mirror."

Bob Holmes, executive director of Pikes Peak United Way and part of the Behavioral Health/Detox Task Force, is working tirelessly to raise awareness of the substance abuse crisis. He argues that the cost to the community of the aftermath is far larger than the cost of effective treatment before the fact.

Holmes is currently heading up a new community initiative, now in its very early stages, trying to determine how to get the word out that these are not just the problems of service providers, but of everyone, and the costs are staggering.

"We want to talk to business people," he said, "and ask, 'How much do banks lose each year that have to do with substance abuse?'

"Look at the cost of fetal alcohol syndrome to the taxpayers and to a school system," said Holmes, a former school superintendent at the Riverhead Central School District on Long Island, New York. "One student who suffers from fetal alcohol syndrome because his mother abused alcohol during her pregnancy can cost taxpayers $100,000 a year for 12 years.

"This problem is costing us millions, tens of millions of dollars every year."

Holmes cites the need for mental health care as the single most glaring deficiency in the community, noting that Pikes Peak Mental Health has told him they "just don't have the money" to provide care to those who are uninsured.

Many who need mental health care and can't get prescription medications turn to other substances and self-medicate. Often, they end up behaving irrationally or breaking the law and land in the county jail.

Lt. Dan Goodell of the Detentions Bureau of the Criminal Justice Center says national statistics show that up to 75 percent of people who commit crimes are somehow tied to substance abuse.

"I can tell you this," said Goodell. "Eighty percent of the people in the El Paso County jail or any other jail in the country are here because of drug and alcohol abuse or domestic violence. Of domestic violence cases, 17 to 20 percent have mental illness and many have co-occurring substance abuse problems.

"In prisons it's the same. They first go through the jails, then to prison. Then they bring [their substance abuse problems] with them when they get out."

'Shoveling up'

While millions of state dollars continue to be poured into building new jails and prisons that house thousands of the mentally ill and substance abusers, funding for substance abuse programs within the prisons has steadily declined. Three years ago, $7.5 million was dedicated toward rehabilitative programs for substance abusers in Colorado prisons; that amount has dwindled now to $4.5 million, a 40 percent reduction in funds. Currently, nearly 80 percent of the prison populations have substance abuse problems, according to Joe Stommel, chief of Rehabilitative Programs for the state Department of Corrections. In July of 2003, said Stommel in an e-mail correspondence, more than 60 substance abuse positions were cut in his division, and 33 were directly laid off.

Two months ago, a coalition of law enforcement, hospital and mental health leaders addressed the state Legislature, urging immediate change in the system that puts substance abusers in jail rather than community treatment centers.

Maj. Gary Darling of the Larimer County sheriff's office and a member of the 18-member Colorado Mental Health and Substance Abuse Summit said that taxpayers would save millions of dollars if funding were increased for such centers.

"It is far more expensive to keep people in jails and prisons than in community-based programs, which have the proper staff and medications," said Darling, citing an average cost of $65 per day to keep someone in jail, compared to $14 a day for Boulder's PACE program, a community treatment center.

A comprehensive national study calls this phenomenon "Shoveling Up," citing the failure of states to provide substance abuse treatment as the great budget buster of the 21st century.

Headed by Joseph A. Califano, Jr. of the National Center on Addiction and Substance Abuse at Columbia University, "Shoveling Up: The Impact of Substance Abuse on State Budgets" shows detailed, state-by-state costs of addiction-related expenses in 16 categories, including corrections and the courts, education, health care, child and family programs and public safety.

The report concluded that in 1998, states spent around $81 billion on substance abuse and addiction, but that for each dollar spent, 96 cents went toward "shoveling up the wreckage of substance abuse and addiction (totaling $77.9 billion), while only four cents went to prevent or treat the growing problem (totaling only $3 billion)."

Timing is everything

Dollars alone won't solve the substance abuse crisis. Personal will is required to shake an addiction.

"Drunks don't usually make a choice to detox for themselves," said Alex. "They are forced to go by family or by police, courts, the system.

"But if someone can reach you at detox, and get you to admit that you need help, then aftercare may work, which is why timing is everything."

Ready availability and access of services are critical to a treatment system that catches addicts at the right moment and provides immediate care and adequate long-term follow-up.

In Colorado Springs, once an abuser has detoxed and made it through the initial aftercare phase, 12-step programs exist in abundance for continued self-help with more than 300 meetings for alcohol and narcotics abusers per week.

But first an addict must get clean, and that requires effort on the part of the addict herself as well as the support of the community.

"[Addicts] need a compassionate, tough, accountable treatment facility that will dry them out from drugs and alcohol and get them on the road to recovery," said Alex. "They need professionals -- therapists, doctors, counselors -- and other people in recovery to be there with support, understanding and a patient, ready, willing helping hand.

"Clean them up, feed them, get them back into some good, healthy living environments. Make them accountable, but do so with patience, understanding and medically supervised treatment. Lots of it. Give them lots of resources, without strings attached. Do not humiliate them or make them feel like lesser humans."

Some states are taking a second look at how their money is invested in substance abuse issues, choosing treatment over incarceration. North Dakota, for example, while spending the least per person of the 50 states on substance abuse, contributes the highest ratio of funding to prevention and treatment programs.

Colorado, meanwhile, has launched pilot drug court programs with the authority to order intensive treatment and defer sentencing for some inmates, shifting a fraction of its emphasis toward treatment but still lagging far behind the rest of the nation in the percentage of funding spent on prevention and treatment.

Alex is living clean and sober now. She has a job. She has mended ties with her family. And she is dedicated to maintaining her sobriety, attending 12-step meetings regularly.

Her hope is that others like her will find a way out of their addictions, before they harm themselves or someone else irreparably. The costs to society and to individual lives, she says, are just too great.

Pikes Peak United Ways Bob Holmes heads up a new - community initiative to raise public awareness of the - crisis. - BRUCE ELLIOTT
  • Bruce Elliott
  • Pikes Peak United Ways Bob Holmes heads up a new community initiative to raise public awareness of the crisis.

"You lose your self-respect and everyone's trust," said Alex. "And it takes years to even begin to rebuild. And sometimes you can't, no matter how much or how hard you work for it."

Holmes believes dedicated community investment in treatment and prevention will pay off.

"I think there's a good chance, with community investment in quality substance abuse and mental health treatment, to get [the worst substance abusers] off the street where they could hurt themselves or, God forbid, someone else."

*Alex is a woman living in Colorado Springs who wishes to remain anonymous to honor the requirements of membership in her 12-step program.

Number of patients who made substance abuse and psychiatric visits to the emergency departments of Memorial Hospital and Penrose-St. Francis in 2000: 8,034

Number in 2001: 9,910

Colorado's rank among 50 states in funds spent on drug abuse prevention and treatment: 50

Amount Colorado spends on prevention and treatment for substance abuse out of every $100 (federal) allocated for substance abuse problems: 6 cents

National average spent per $100 allocated: $3.70

Colorado's rank among 50 states for per capita marijuana use: 1

Number of states that refuse Medicaid for substance abuse treatment: 3, including Colorado

Funding dedicated to substance abuse programs in Colorado prisons in 2002: $7.5 million

Funding dedicated to substance abuse programs in Colorado prisons currently: $4.5 million

Percentage of prison population with substance abuse problems: 80

Number of AA meetings in the Greater Pikes Peak area (Fountain to Monument, including Teller County) per week: 310

Amount of Colorado non-Medicaid funding cut from mental health and substance abuse programs since 2001: $7.4 million

Increase in drug dependency encounters since 1999 in Colorado hospitals: 999 percent

Percentage of committed youth in the juvenile justice system with substance abuse issues: 83

Number of recommendations to Colorado State University from the Alcohol Task Force, designed to curb underage drinking among college students: 43

Percentage of U.S. high school seniors who report binge drinking (consuming five or more drinks in a row): 30

Amount college students spend nationally on alcohol each year: $5.5 billion

Percentage of top movie rentals that depicted people doing drugs, drinking or smoking in 1996 and 1997: 98

Average age girls begin drinking in the United States: 13

If you are seeking help for a substance abuse issue:

Alcoholics Anonymous has a 24-hour a day phone line, 573-5020, or visit www.coloradospringsaa.org to find a list of local meetings.

The Salvation Army runs the New Hope Center, 578-9190.

For detox and crisis intervention, call the Lighthouse Assessment Center, 572-6330, 115 S. Parkside Drive, Colorado Springs. The Emergency Services contact at the Lighthouse is 635-7000.

If you are addicted to narcotics and need help, call Narcotics Anonymous at 637-1580 or visit www.nacolorado.org for a list of meetings.

The El Paso County Department of Public Health and Environment offers substance abuse counseling on a sliding scale basis and offers child care while clients are attending appointments. Call 578-3150 for an appointment.

If you are elderly and need help with a substance abuse issue, call the CU Aging Center, a division of the UCCS Department of Psychology providing mental health services for seniors, at 471-4884. The center is at 1436 N. Hancock Ave.

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