Aid for Indigent Addicts Failing, L.A. Study Finds

Publicly subsidized drug treatment programs in Los Angeles County are failing to promptly respond to indigent addicts asking for help, according to a new study in which researchers posed as drug abusers.

The researchers placed 100 telephone calls to the county’s drug hot line and various treatment programs, failing 40% of the time to get either an appointment or a place on the programs’ waiting lists.

The researchers said hot-line workers frequently gave out incorrect information to addicts and also failed to properly screen or direct callers to appropriate care.

The study reports that there are more than 2,000 addicts countywide on waiting lists for about 5,200 publicly funded drug treatment slots. These slots include a total of 34 residential drug detoxification beds, down from 77 about 10 years ago.

Researchers said that the wait at some residential drug programs was as long as three months. In some cases, addicts were required to telephone daily to preserve their place on the waiting list.

“Substance abusers desperate for treatment find a tremendous barrier to treatment and competition is keen for the few remaining program slots,” said Michael Cousineau, executive director of Homeless Health Care Los Angeles, a nonprofit advocacy group that conducted the study.

In addition, the chief of the county’s Drug Abuse Program Office, Rochelle Ventura, disclosed that she is planning soon to eliminate $1.4 million from a program designed to reduce the waiting lists at about 10 drug treatment centers. She said the federal government recently stopped funding the program, and the county cannot afford to keep it going.

She said she has respect for the integrity and professionalism of the researchers who conducted the study. She said she has no explanation why so many drug treatment programs did not, at the very least, put addicts on a waiting list when they called for help.

Ventura, whose office tallies the waiting lists each month, corroborated the researchers’ figures. But she cautioned that the figures may not be reliable indicators of the backlog for treatment because not all programs keep lists and, in other cases, the lists may contain duplicate names.

M. Douglas Anglin, director of UCLA’s drug abuse research group, said the waiting lists are “likely an underreporting of the need” for care. He said his office recently surveyed the drug treatment needs of people arrested in Los Angeles County and concluded that “the need exceeds the number of treatment slots by more than a factor of 10.”

He praised the new study for documenting an “overburdened” and “unworkable” drug treatment system in which “it is rare that you get through and get what you need with the first phone call.”

The study comes at a time of continuing debate over the success rate of drug treatment programs and how much funding they should receive. One nationwide study of private and public drug treatment centers, published in 1989, found that 80% of the treated addicts surveyed were still off hard drugs five years after completing treatment.

The Homeless Health Care study estimates that 325,000 people in Los Angeles are frequent drug users, with about 100,000 of them poor or homeless and eligible for care at about 120 publicly funded drug treatment centers. Their ranks include an estimated 15,000 homeless, mentally ill addicts--but the study reported that there is is only one program countywide that caters to their needs.

The study also faulted the county for funding only four programs aimed at treating substance-abusing pregnant women. An estimated 25,000 babies a year are born in Los Angeles with prenatal exposure to drugs or alcohol.

But Ventura said she has recently made such programs her “highest priority,” opening two more this year and laying plans for five others.

Researchers posing as addicts called the county’s drug hot line and 22 drug treatment programs. Each researcher was provided a script describing the story behind the particular addict and a context from which to answer questions.

In one scenario, a researcher posed as a 27-year-old pregnant, homeless, heroin addict with two children. But the receptionist failed to provide the correct information to help her obtain access to one of the county’s 34 publicly subsidized residential detoxification beds. (There were 151 addicts on a waiting list for these beds as of May.) Because of the misinformation, the researcher had to place four calls before she contacted the appropriate screening agency.

“Many actual clients would not have had the coping mechanisms and resources to follow through with these telephone calls,” the report said. “An addict calling for help is similar to an individual dialing 911 in a medical emergency. . . . If this help is not offered or arranged (immediately), the temptation to return to drugs may be too strong to overcome.”

Making appointments was easiest for researchers posing as addicts needing outpatient care and hardest for those seeking residential programs--where the waiting lists were reported for most patients to range from one to three months.

Cousineau said: “It is tragic . . . that people waiting days or weeks for a program slot to open have to continue to use drugs while they wait” in order to qualify as “an active user”--which is an enrollment requirement.

Other hurdles that addicts face in getting treatment range from transportation difficulties to requirements that they produce substantial documentation to prove identity and length of addiction. “One methadone maintenance program required a client to have his Social Security number before treatment would begin,” the report said.

The study found that the supply of drug treatment programs in Los Angeles County has not risen to meet the increased need for care, and in fact has declined since l982.

County statistics show that in l982, 5,200 publicly subsidized slots treated 22,991 clients, while this year, 5,170 slots are projected to serve about 15,000 people. The cost of care has risen over the last decade, Ventura said, so that fewer people can be treated with the same level of funding.

Drug Treatment Programs

This chart shows the number of publicly subsidized drug treatment slots available for indigent addicts in five different programs in Los Angeles County. It also shows the number of people on the waiting list.

NO. OF NO. ON TYPE OF PROGRAM SLOTS WAITING LIST* Outpatient treatment 2,400 181 Residential treatment 758 562 Methadone maintenance 1,852 1,042 Outpatient methadone detoxification 126 344 Residential detoxification 34 151 TOTAL programs 5,170 2,225

* Data provided by Los Angeles County Alcohol and Drug Program Administration. Figures in this category may not reflect the total number of addicts on all program waiting lists because some programs did not provide data.