Waiting for Admission to Drug Clinics : Lack of Public Funds Forces Long Delays

With only nine publicly funded beds available to detoxify drug-dependent residents of the San Fernando, Santa Clarita and Antelope valleys--or 44 beds in all of Los Angeles County--addicts desperate for help must wait up to five weeks for treatment.

If they lack insurance or are unable to cover the cost of care, they are told to put their names on a list, call back each day and be patient.

By the time their number comes up, most either have been arrested on narcotics-related charges, have moved and can no longer be reached, or have changed their minds about kicking the habit, caseworkers say.

“The person in that situation is worried about what’s going to happen in the next five minutes,” said Richard Rawson, a research psychologist at UCLA who specializes in cocaine addiction and runs a drug-treatment program in Beverly Hills. “They’re out of control. They forget. They don’t call back.”

‘Missed Opportunities’

Waiting lists, he said, “present a huge barrier to very sick people getting treatment. Maybe they’ll resurface again and reconnect with the system. But a lot of opportunities are missed by not having more beds available more quickly.”

As the drug problem has intensified over the last decade, increasing the demand for treatment programs, the services available to addicts has declined.

Countywide, the number of government-subsidized beds in residential detox programs has dropped 33%, from 66 in 1981 to 44 because federal and state funds have failed to keep pace with inflation.

“If we had 100 beds available for all of L.A. County, it would not be enough,” said Annette Seaton, director of community relations for I-ADARP (Inter-Agency Drug Abuse Recovery Program) in Van Nuys. “Forty-four falls so far short, it’s almost a joke.”

Only once in the 2 1/2 years that she has worked with the program did someone get a bed the same day that help was sought, she said. “More than likely it’s a three-week wait. Three weeks doesn’t sound like a lot--unless you’re dying of drug use, and someone can die in that time.”

Battle Escalated

Between 1981 and 1982, the federal contribution to drug-treatment programs in Los Angeles County decreased from $9.9 million to $7.8 million. It remained steady for the next several years, then began to increase in 1987-88 as the government’s battle against drugs escalated into a full-fledged war.

But the county has never recovered from the 1982 financial blow and is able to serve fewer people today than it did a decade ago, said Rene Topalian, assistant director of the Los Angeles County drug-abuse program office.

“We had treatment on demand,” Topalian said. “We had nobody waiting for anything.”

Today, federal funding for drug treatment, prevention and early intervention in Los Angeles totals $13.5 million. The state contributes $13.4 million and the county kicks in $2.8 million for a total of $29.7 million. That compares with $22.6 million in 1981-82, an increase of $7.1 million. However, that money buys 30% fewer services than it would have eight years ago.

The wait for a bed in a residential detox program can vary from a few hours in rare cases to as long as five weeks. County officials say there are only two facilities with county contracts for detoxifying indigent addicts--the Tarzana Treatment Center, which devotes 14 beds to such cases, and American Hospital in Pomona, with 30 beds.

The slots are divided among the county’s geographic regions, and both hospitals operate on referrals from about 45 community-based social service agencies. Representatives of those agencies maintain the waiting lists and call each hospital daily to check availability.

Special priority lists for pregnant women and addicts who test positive for acquired immune deficiency syndrome are maintained by the hospitals. Nine people were on Tarzana’s list last week when four beds became vacant, administrator Maury Weiner said. All of them had AIDS or had tested positive for the disease.

Two of the first four people to be called were admitted. The other two, on the waiting list less than two weeks, could not be reached.

“That’s a double danger,” Weiner said. “Not only are they in danger of continuing an antisocial existence, but in a sense they’re carrying a death bomb for themselves or others who may come in contact with them through needles or sex.”

High Attrition

Other agencies report similar problems. At Cri-Help, which generally has between 10 and 13 people waiting for detox, three or four drop off the list after the second week, said intake supervisor Robyn Sigler.

Addicts seeking assistance are told to call at designated times each day. If they fail to make the call, if they’re in court, in jail or strung out on dope, they can lose their chance. American, for example, gives clients only 45 minutes to respond once a spot becomes available. After that, the bed goes to someone else.

Augie Maldonado, a recovered heroin addict who works for the Bridge--A Way Across social service agency in Pacoima, knows what it’s like to wait. He did it for two weeks in 1983 when he made the decision to get clean.

“For someone who has made that kind of surrender to have to wait from one day to the next is very frustrating,” he said. “A lot of times you question whether you’re making the right decision. Your inclination is to throw up your hands and say, ‘What’s the use?’ ”

Researchers say there is no data that measures how likely it is that someone waiting for treatment will drop out of the system, but they explain that it is not part of the addicts’ nature to wait.

“I don’t know how many we lose, but certainly it is not an acceptable amount,” said Robert Hubbard, who directed a massive federal study on drug-abuse programs that will be published next month. Addicts, he said, need immediate accessibility to treatment and continuity of services. “If you have a break at any point, you might as well start over again,” he said.

Essential First Step

The county detox program is only one component of a comprehensive network of publicly supported services that includes long-term residential and outpatient care, but drug-abuse specialists say it provides a critical first step to recovery, a gateway to the system that, under ideal circumstances, would be followed by additional treatment.

“The only alternative is to detox in a hotel room or the way alcoholics have been doing it for years and years, going through the sweats and waiting it out with some friends to hold their hand,” said Jim Elliot, American Hospital’s associate administrator. “But medically, there are some real problems with that because drugs do strange things to your body. You’re subject to seizures and all kinds of related illness. You’re physically sick and you hurt.”

In addition to its residential detox program, the county funds 143 outpatient detox slots that primarily serve heroin addicts. Using a formula that divides the space based on population and such factors as overdoses, drug-related arrests and emergency room admissions, the San Fernando Valley’s share is 15 slots.

Although some researchers believe that addicts do not require a residential setting to detoxify unless they abuse multiple drugs--as is increasingly the case--or suffer from other health-related problems, many addicts refuse to consider alternative approaches.

They want to flee their environment and its ready supply of drugs for fear that they will be unable to resist the temptation. “In their mind, there is no way they can stop on an outpatient basis,” Rawson said. “They want to stop, and the idea that they’re going to see a counselor and that it will somehow allow them to stop doesn’t sound like it will work to them.”

Follow-Up Needed

At the same time, researchers say providing more residential detox beds would solve only part of the problem. Addicts need a place to go when they come out of detox, which typically lasts seven to 14 days.

“Even though they’re detoxed, they go back to the same community with the same problems and the same availability of drugs,” UCLA’s Anglin said. “When a handoff does not occur, you get a very rapid relapse. You’ve bought breathing space, but then you lose the opportunity.”

Although addicts generally leave detox with referrals to some type of follow-up program, they typically encounter another waiting list for long-term--30 days to a year or more--outpatient or residential treatment.

As is the case with detox programs, the number of publicly funded, long-term residential beds in Los Angeles County has dropped, from 1,001 in 1981 to 731.

At Cri-Help, which operates a 65-bed, nine-month residential program, applicants wait 90 days for a bed. At Tarzana, which also has a residential rehabilitation program, the wait can stretch from a few weeks to a few months. At American, it runs up to 30 days.

‘Clean and Sober’

“In a six-month program, you’re talking 10 to 12 openings a month,” Elliot said. “To come into rehab, you have to be clean and sober. You have to be detoxed. The problem is that while they’re waiting to get in, what’s keeping them from using? If they cannot use while they wait, why do they need a program?”

The fact is that most addicts use drugs while they wait, experts agree.

A federal study to be published this month by Research Triangle Institute in North Carolina tied the success of treatment to the length of time a person receives care. The most significant changes were among those who stayed in treatment up to a year. There was no apparent benefit among those in treatment less than three months.

Long-term residential programs caused the most dramatic reductions in drug abuse among cocaine addicts, cutting use by about half, said Hubbard, who directed the study. But there are not enough of the programs.

There are, however, a few rays of hope. Earlier this month, President Bush proposed a 50% increase in federal spending on publicly subsidized drug-treatment programs, both outpatient and residential. A welcome beginning, experts said, but far short of the mark.

Grant Sought

Los Angeles County has also applied for a $7.1-million grant from the federal Waiting List Reduction Program. If it gets the money, programs operating below their licensed capacity because of budget constraints will probably be the first to benefit.

Among them is Via Avanta, a long-term residential program in Pacoima for drug-addicted mothers and their children.

Although licensed for 87 beds, Via Avanta can afford to operate only 45, said director Marcellus Robinson. The program has a waiting list that Robinson limits to 20 people. “If you go over that, you lose them,” he said. “It seems to discourage people when you tell them there is a long list. We try not to tell people how long they have to wait,” which is up to four months.

Maldonado, who works at Bridge, knows firsthand what clients forced to wait are going through.

“I can feel their pain and their fear,” he said. “But the bottom line is a sense of helplessness.”