War on Drug Abuse: Lines Are Longer, Funds Shorter

On the front lines--the public treatment clinics to which cocaine and heroin users are flocking in unprecedented numbers--the President’s war on drug abuse in Los Angeles County is not faring so well.

Space is short, dollars scarce and, despite a new outbreak this summer of tough anti-drug rhetoric from Sacramento to Washington, the future looks grim. Budget cuts in recent years have undermined the county’s ability to cope with the treatment demand triggered by runaway drug use among the poor and now the middle class.

While high-priced clinics catering to upscale drug users seem to be opening on every corner, the road to recovery for those who cannot afford five-figure treatment programs is getting longer and longer.

The homeless, the poor and a growing number of middle-class users who lack the money or insurance for private care, now wait up to four months to enter county-contracted clinics, where treatment is free or provided at a reduced fee.

Since 1982, one-third of all publicly supported drug treatment services in the county have been cut because federal and state dollars--which finance 90% of those services--have not kept pace with program costs or needs.

Only 2 Centers for Teens

“The situation is serious. . . ,” said Irma H. Strantz, director of the county’s drug abuse office. “But politically, people don’t feel they can cut services for children or the elderly to free up dollars for some nasty drug abuser. It is simply not high enough on some people’s priority list.”

Program shortages are particularly acute for the homeless, unwed pregnant mothers and adolescents. For example, only two centers, with 40 beds, are available for teen-age drug users in the entire county.

The cuts have come at a time when drug use among the county’s down-and-out is on the rise.

Cocaine, in a new and highly addictive rock-hard form known as “crack,” has never been cheaper or more plentiful on the streets. County heroin use and related deaths are also increasing, according to law enforcement officials.

“It’s not hard to find cheap drugs,” one narcotics investigator said, “and with a little initiative, a guy living on the street can finance a habit real easy.”

Many street users steal or peddle drugs or even sell themselves to feed their personal habits. It is a debilitating cycle that eventually prompts some to seek help, but now help is almost impossible to find.

No longer are public drug clinics the private domain of the poor. Today the poor compete for a precious few public treatment slots with the middle class--the auto mechanics, housewives and even stockbrokers who have fallen to the power of cocaine in huge numbers in recent years but cannot afford to pay up to $20,000 for a six-week recovery program at a private institution.

Middle-Class Addict Favored

County officials acknowledge that when push comes to shove, the indigent drug user is sometimes passed over in favor of the middle-class addict who has the ability to pay for at least some care.

To weary clinic operators, frustrated by failures to keep many poor patients drug-free, middle-class users are a welcome sight. They are better-educated, usually have a shorter history of drug use and generally are more motivated to go straight. In short, officials say, middle-class users often have a head start when it comes to licking drug habits.

“Many of them had something before they discovered drugs--a family, a house and a career,” said Rene Topalian, assistant director of the county’s drug abuse program. “If you know what you’ve lost, you are willing to work harder to get it back. And to a counselor who has been burned, you offer him a candidate that has a good chance to succeed.”

The treatment network, Topalian said, is “badly overloaded.” As a result, he added, “it’s forcing a lot of people to make some hard choices about who to treat first.”

Scores of homeless and poor addicts are learning the new rules of the county treatment game the hard way.

Take one Los Angeles user named Richard, who declined to give his last name. He’s broke and into heroin, a lot of it, and now he wants help. He’s been on a waiting list for a bed at Cri-Help, a public drug clinic in North Hollywood, for two months but realizes that it will be weeks before his number is called.

“I’m using, and I’ve got to get off this stuff soon,” he pleaded recently with a Cri-Help counselor in the clinic’s lobby. “Can’t you pull some strings? Please?”

“I’m sorry,” the counselor replied. “The whole world is using. I can’t help. You have to just keep coming back.”

Budget cuts, particularly on the federal level, are a big reason for the long waiting lists. Since 1982, the county has lost or been forced to reallocate nearly $3 million in federal money for local drug treatment services. Some of those dollars have been channeled into drug prevention and education programs, primarily aimed at schoolchildren. But that has been done, health officials say, at the expense of the street addict who needs immediate medical attention, not pamphlets and lectures.

Early Relief Unlikely

Compounding the problem, the state in recent years has held the line on drug treatment spending. In the fiscal 1986-87 state budget, Los Angeles County would receive about $20.1 million for drug programs--the same amount it received last year. And relief coming any time soon from Sacramento is unlikely, according to Chauncey L. Veatch III, state director of the Department of Alcohol and Drug Programs.

Veatch said the Deukmejian Administration remains committed to fight drug abuse, but warned: “It isn’t always wise for us to presume that government will deliver all the money.” In the future, he said, local government and private business must supply more of the ammunition--the money and manpower--to combat drug abuse and provide treatment programs.

Several bills have come before the California Assembly in the last year that would have provided financial assistance to counties to operate drug abuse facilities, but they have all been defeated.

“The sad fact is that everybody is talking about ‘more treatment, more treatment,’ but nobody is doing a thing about it,” said William Dietch, vice president of Phoenix House, which operates clinics in Venice, Orange County and Turlock in the San Joaquin Valley.

“And now there’s all this talk about drug testing,” he said. “Well where in the world are they going to get the money to pay for all those urinalyses, much less the treatment for all those users?”

‘Drug Use Up Among Poor’

Today, Los Angeles County has 51 beds for drug detoxification, 609 spaces for residential treatment, and can provide outpatient drug counseling for 3,000 individuals at any one time. In all, the county contracts with 62 clinics and hospitals for 4,855 residential and outpatient treatment slots, down from a high of 7,555 treatment slots six years ago.

Strantz estimates that it would cost $13 million to $14 million more just to restore services to 1980 levels, “and that doesn’t even take into account that drug use among the poor has gone up.”

How much it is has gone up is uncertain. Specific numbers about drug abuse among the homeless and poor are hard to come by, officials say, because many of those people rarely stay in one place for very long or make contact with authorities.

Last year, about 20,000 users received some kind of treatment in county programs, and some health officials speculate that three to four times that many people want help but do not know where to find it or simply tire of waiting for a treatment opening.

Middle-class users are also showing up on the county’s doorstep in greater numbers, as a last resort. Many have been treated before but failed to stay clean. And while most employers these days are willing to pay for one round of drug treatment with insurance, it is up to the employee after that.

Corporate Programs

“If you’re on drugs, most companies in corporate America will treat you the full nine yards--dry you out, set you up in one of those country club clinics and see that you get counseling,” said Bernice Caldwell, associate editor of a monthly Chicago-based trade journal dealing with employee benefits.

“It may cost $25,000, but they’ll do it,” she said. “But don’t fall off the wagon because most companies can’t afford to do it more than once.”

Staying clean, however, is a daily struggle for many, especially when the drug is cocaine. It has become the drug of choice from the city’s Southside to Hollywood to the San Fernando Valley, and in its new rock form, it is a particularly difficult addiction to break. Many cocaine addicts require multiple courses of treatment.

“We are seeing more recreational drug users--you know, the type that uses only after hours or on weekends--who try crack and suddenly become serious addicts,” said William Rhodes, an Orange County drug treatment official. “This stuff crack is powerful and dangerous and tough to kick.”

Waiting lists themselves have become the best yardsticks of the dramatic growth in drug usage and the strain it has placed on the county’s 16 residential drug centers, officials say.

Week Before Interview

“Five years ago you didn’t wait more than several days, maybe a week at the most, for a bed,” said Topalian, who has worked in the county’s drug abuse program since the early 1970s. “Now it takes a week just to get an interview to get on a waiting list.”

In the case of one Los Angeles man, it took almost eight months before he was admitted to Cri-Help, a 64-bed facility in North Hollywood. Eighty-seven people, including 27 women, are waiting for space in the agency’s treatment program.

Steven, a 26-year-old mechanic who agreed to talk only if his last name was not used, decided on Jan. 1 of this year that the party was over, so he called Cri-Help. In 15 years of often heavy use, he said he had “pissed away just about everything”--a house, a car and most of his friends--because of his addiction to heroin and cocaine.

“I finally realized that my addiction was a progressive disease,” he said in a recent interview, the day after entering the nine-month treatment program in which he is assigned to one of the 28 beds paid for by the county. All but 12 of the beds are financed by the county or through private donations.

“I realized that I had reached the end of the line,” he said, taking a long drag on a cigarette. “It was either quit or go off the deep end.”

Average Patient

Steven is a typical user in the county treatment system. Based on admission statistics for the first three months of 1986, the average patient is male, single, in his mid 20s with a high school education. He has used drugs for at least four years. Forty-one percent are white, 37% Latino and 20% black. Like Steven, a growing number come from middle-class backgrounds. And most have waited a long time to get into treatment.

So he kept using and waiting and using.

“I wanted off the stuff, but I couldn’t do it alone,” Steven said. “So I kept using.”

Most do, according to Patrick L. Ogawa, acting chief of planning for the county drug abuse office. “They just keep ripping and running,” he said, committing crimes to finance habits.

There is a painful irony in all this, said Van Hayes, assistant director of Impact House, a Pasadena public drug clinic. While the county cannot afford $30 a day to put the addict in a bed, he continues to steal $300 to $400 a day for his habit. “One way or the other it costs the taxpayer,” Hayes said.

Some users never get to treatment. In the last year, five people waiting to get into Cri-Help died before their names reached the top of the list, officials there say.

More Cuts Feared

At the moment, county health officials are scrambling again to save another piece of their drug program. A budget squabble between Gov. George Deukmejian and the Legislature may lead to $29.1 million in budget cuts for county health programs, including $547,000 for outpatient methadone treatment of heroin addicts.

Health officials say the loss of that program, which last year treated 3,300 heroin users, would be a blow to county efforts to contain the spread of AIDS (acquired immune deficiency syndrome). Intravenous drug users, particularly those who live on the street, often swap needles, greatly increasing their chances of contracting or transmitting AIDS, which is transferred through body fluids.

Next to homosexuals, addicts who inject drugs run the highest risk of getting the deadly disease. In Los Angeles County, about 13% of about 2,000 known AIDS patients have been intravenous drug users. Nationally, the number is even higher, with 17% of the 23,700 AIDS cases involving users who inject drugs.

“That methadone program is very important, and to cut it would be a serious mistake,” warned Los Angeles County’s Strantz. “How much more can we lose and still be effective?”

The crush of users trying to squeeze into public clinics has also exacted a toll on those who treat addicts.

‘How Can You Sleep?’

“I don’t sleep well at night anymore,” said Benjamin Perez, a substance abuse counselor with West Area Opportunities, a Santa Monica drug referral clinic. “How can you sleep, when you spent the day telling a mother that all you can do for her teen-age daughter going through withdrawals is put her on a waiting list?”

Beverly Samuels, the intake specialist at Cri-Help, who interviews prospective patients, said she nearly up and quit one day.

A woman was in her office “begging me” to get her daughter into the program, when another woman walked through the front door carrying her son. The boy was on heroin and unable to walk.

“These two women looked at me,” Samuels said, “and I felt helpless and inadequate, none of which I am. But I couldn’t deliver. I felt so small. I broke into tears.”