A serious shortage of treatment centers is making it increasingly difficult to help hundreds of Orange County's worst drug addicts, many of whom must wait up to six months for care after qualifying for the government-funded programs.
Discouraged by long delays and harmed by continuing drug abuse while on waiting lists, roughly half of those promised a bed at the county's two residential treatment centers never show up on admission day.
The situation, county officials and former drug users say, denies help for those who need it most and places many addicts in a frustrating purgatory where drug use worsens, relatives suffer and society continues to pay the price of drug-related crime.
"It's the intent of medical professionals and Congress to get people into treatment right away," said William Edelman, division manager of the County Health Care Agency's drug abuse programs. "For people with insurance in private facilities, that happens, but if you're down and out, rippin' and runnin', the space is just not available."
County officials estimate that there could be more than 20,000 people in Orange County with drug problems serious enough to qualify them for the 15-month regimens at Phoenix House in Santa Ana and Hope House in Anaheim. Hundreds apply every year for the 105 slots at the county-funded facilities, which provide living quarters and an intensive counseling program. Surveys of graduates three years out of the program show that 75% to 80% of them have stayed off addictive substances.
The residential centers exclude pregnant women and those single parents who cannot find someone to care for their children while in treatment. The county has no long-term facility for these addicts, except outpatient clinics.
Officials at Hope House and Phoenix House say that two- to six-month waits are common. In extreme cases, the delay can be a year. The time from acceptance to admission for women is generally two to three months; for men, six months or more.
Marc Corradini, executive director of Hope House, said that so many people are qualified for the programs that if the county ran regular public service announcements on radio, the wait would soon grow to a year.
"If we were aggressive and really advertised, we could easily increase the applicants . . . and have a backlog of six months to a year," Corradini said. "But that's inhumane."
Those seeking admission to the county's residential drug treatment centers are some of the most seriously addicted that the streets can offer. About 43% use intravenous drugs. Most are between 18 and 30 years old with long histories of drug abuse that began in adolescence or childhood.
Broke and unemployed, they cannot afford $100 an hour or $1,000 a day for treatment at private centers, which are in ample supply. Making matters worse, many have criminal records, some so serious that private facilities would refuse to accept them even if they could pay.
"The county must pick up those that fall between the cracks and cannot afford the private sector," Edelman said. "They are often the most difficult cases in the county, and this group is continuing to grow."
Statewide, the situation is not much different. In Los Angeles and San Francisco, it can take a year to get into treatment. Statistics from the California Department of Alcohol and Drug Programs show that in 1989, 2,752 people were on waiting lists at 81 long-term treatment centers funded by counties across the state.
About 85% were on the lists longer than seven days. The same figures show that 4,014 people were turned away from those centers last year because the wait was too long or they could not afford certain services.
"People all over the state say they would like more residential facilities," said Michael Caron, who administers state grants for the Department of Alcohol and Drug Programs. "My sense is that a two-month waiting list is lovely, if you can find it."
Most don't, however, and must endure longer delays for treatment, an often frustrating experience that can discourage some people from waiting for or accepting a slot when it finally becomes available.
To make matters worse, those on waiting lists must check in daily on their own by telephone or risk losing the spot saved for them. Former drug users say that isn't easy for an addict living on the street.
Al, who asked that his last name not be used, said that he was frustrated by the process but still made the required calls to Hope House from jail and Cider House, a Norwalk detoxification center he entered temporarily after a drinking binge.
"I guess I was just tired of getting nowhere," he said. "I knew I needed help and I kept calling no matter where I was or how hard it was. When I finally got in, I couldn't believe it."
But at Phoenix House and Hope House, roughly 50% of those accepted into the programs drop out after waiting three weeks. Many of those who stick it out on the waiting list continue using drugs and risk jail or worse in the interim.
"People get arrested for crimes or simply vanish," said William H. Smith, director of clinical services for Phoenix House. "Most continue to play Russian roulette with their lives and continue doing what they've always been doing--taking drugs."
While Sharlene Woronets, 26, was on the waiting list for Phoenix House, she said she lost her job and began stealing purses--"anything"--to support an 8-year-old addiction to heroin and cocaine. After a two-month wait, a bed opened up for her. At the time she was in the county jail for women in Santa Ana.
"I called and said I needed help, but they said there's a four- to six-month wait," Woronets recalled. "It's depressing. Your desire for help lessens the longer you don't get in. I didn't like being on ice."
The day Hope House accepted Al and put him on a waiting list for treatment he went on the binge of his life to celebrate. It was no small achievement. The ruddy 23-year-old normally drank himself into unconsciousness or snorted enough crystal methamphetamine to go four days without sleep.
Al was high for most of three months--the time it took his name to reach the top of a waiting list. During that time, he was in and out of jail on warrants, had smashed the windows of his father's house and was arrested on a charge of assault with a deadly weapon. By his estimation, he "got heavier" into drugs.
On admission day, Al said, he was still feeling the effects of methamphetamine. He cleaned himself up, though, dropped a little Visine in his eyes and presented himself at the center's front door.
"I really thought they forgot about me," he said.
Meanwhile, parents experience the same frustration and anxiety as their children on the waiting lists. Woronets' father, Eli, said that he worried every time the body of a missing young woman was discovered by police. During the three months that Carol Olds, 31, waited to get into Phoenix House, her mother Altha almost gave up hope.
"I didn't think she'd ever get into a program," she said. "I was tired of dealing with people that were users. Items were missing from my house all the time. I didn't even want my own daughter in the house. It's frustrating there aren't more Phoenix Houses."
County and state officials blame the shortage of treatment centers on rampant drug use, a traditional emphasis on law enforcement rather than treatment, and the AIDS crisis, which is providing more of an incentive for drug addicts--particularly intravenous drug users--to get help.
They also point out that cocaine and methamphetamine use have increased substantially statewide. People addicted to those drugs are often the hardest to treat, which means that they will occupy the limited supply of beds much longer.
Financially, Orange County's drug abuse programs have not had a budget increase in five years, although drug use remains a serious problem. Combined with inflation, Edelman said, it has meant a cut in resources for treatment and education.
But officials say that the forecast for drug treatment looks better than it has for years. The state has promised Orange County $1.3 million, which will pay for new facilities, including 27 more beds for Phoenix House and Hope House. More funds will become available, Caron said, as the state applies for new federal grants provided by the Bush Administration's national drug policy.
Within the next few months, the county also plans to open a long-term residential drug treatment center for pregnant women and for single parents who cannot leave their children. Drug abuse officials are negotiating a contract for the services.
"There are a lot of women in my situation," said Terry Criswell, 29, a recovering alcoholic and cocaine addict who has two children. "It's really tough to find a place. You end up getting discouraged and resort back to your old behavior."
Criswell could not find any facility in Orange County that would accept her and her family, and was eventually admitted to Foley House in Whittier, which accepts pregnant women and parents with their children.
"The lack of a residential program for pregnant women represents a big gap in the county's drug treatment effort," said Len Liberio, a drug program manager for the County Health Care Agency.
Even when funds are approved, opening new clinics and expanding facilities is not that simple. The county- and city-permit processes can take a year or longer, and substantial opposition from prospective neighbors, who fear a decline in property values, must be overcome.
The county has been trying to set up an outpatient clinic in a commercial area in South Orange County, but the owner of the property has been reluctant to grant a lease.
"Drug addicts are social pariahs," Liberio said. "It's the traditional 'not in my back yard' syndrome and the attitude is pervasive in all cities. But once the centers are in, they are good neighbors."
ON THE WAITING LIST: Drug addict endures delay. A16