DURHAM Jeff Stillers’ addiction to alcohol has landed him in emergency rooms, clinics and halfway houses; 20 times he’s gone through about a week of detox at the state’s expense since he lost his home, wife and kids 13 years ago to his alcoholism. Each detox visit costs the state up to $1,600.
Stillers, 52, is living in a halfway house in Durham and works for a scaffolding company. He’s sober – for now.
“I can go to detox tomorrow afternoon, I’d bet you,” Stillers said. “I’d go drink tonight, I get up tomorrow morning and start drinking, and then go up to a cop or whatever and just say, ‘Hey man, look, I need some help.’ ”
Those who work with addicts say that the revolving door approach to treatment is all too common in North Carolina and doesn’t work.
But for those without the funds to pay for long-term treatment with housing, counseling, medicine and rehabilitation, the state’s resources are limited – and shrinking further.
The new state budget sliced funding to three state-run alcohol and drug abuse treatment centers by about $4.9 million each year for the next two years – a 12 percent reduction per year to each facility’s budget.
The three – Walter B. Jones Alcohol and Drug Addiction Treatment Center in Greenville, Julian F. Keith Center in Black Mountain and R.J. Blackley Center in Butner – are the only centers in the state that offer long-term treatment to adult addicts without the financial means to help themselves. Last year, they served about 4,300 people – an 11 percent decrease from 2009, according to a Department of Health and Human Services report.
“There’s no question it’s a substantial hit … These three treatment centers are cut to the bone as it is,” said Mark Ezzell, the executive director of Addiction Professionals of North Carolina.
The treatment centers have seen their budgets cut in the past but never by as much.
More emergency room visits
About 7 percent of North Carolinians in 2012 reported an addiction to or abuse of alcohol or illicit drugs, according to the federal Substance Abuse and Mental Health Services Administration. That’s about 683,000 people.
Over the past 13 years, the state has transferred treatment to the private sector. Now there are about 2,500 private facilities in the state that use donations, and federal and state money to provide detox, or medical treatments that remove drugs from the body over several days; outpatient treatment; and counseling.
But there isn’t enough subsidized care for the uninsured who need to be admitted on a longer-term basis, said Amy Blount, the program supervisor for a methadone clinic in Greenville, part of a chain of private mental health and addiction treatment facilities called PORT Human Services.
As funding has declined and the state treatment centers and private practices have had to turn people away, hospitals have seen a rise in patients entering the emergency room in need of substance abuse care, said Becky Frenia, with CarolinaEast Medical Center in New Bern.
As part of her job, Frenia tries to find addicts treatment when they come into the ER looking for care. “It’s when they get out after the seven days, this is critical for them not going back to drinking again or using other substances.”
In July, 33 patients came to CarolinaEast Medical Center with substance abuse problems, Frenia said. She was only able to place 17. She estimates that about 50 percent of the time she can’t find a treatment center bed for walk-in addicts.
The hospital has always had the problem, she said, but it’s getting worse. CarolinaEast used to have someone working only during the day in the ER on mental health and substance abuse, but now it needs someone there 24 hours a day.
The average length of stay in North Carolina for mental health and substance abuse patients in emergency rooms is 16 hours, up 68 percent from 2010 to 2012, according to the N.C. Hospital Association. Until hospital staff can find a drug treatment center bed, patients wait in the emergency room, taking up beds that could be used by other patients.
“If they’re going through withdrawal or if they have a real physical issue, they (can) be treated,” said Earl Marett, director of the Johnston County Department of Social Services and a former area director of a mental health center. “But they need a lot more than that. They need to work through their problems. And that part is not really available … anymore.”
Remaining in treatment for the needed amount of time is critical to recovery, according to the National Institute on Drug Abuse. Most need about three months to fully recover or drastically reduce their risk of relapsing, NIDA says.
Searching for treatment
Brittany Pippin, 22, goes to the PORT Human Services Suboxone Rehab Center in Greenville three days a week for counseling, companionship and Suboxone, one of several drugs addicts can take to wean them off narcotics.
Pippin tried to detox with PORT before, but relapsed. The last week of June, she decided to enroll in the 28-day inpatient program at Walter B. Jones.
But she wasn’t accepted and was directed to PORT, which offers inpatient detox care for only seven days, followed by outpatient counseling.
“It’s really hard for somebody when they finally get the courage to go get help, and then you kinda get denied of it,” she said. It took two weeks after that to get into PORT’s program.
Pippin hasn’t used drugs for around two months. If someone at PORT doesn’t fare as well as Pippin in outpatient care, the clinics refer them to Walter B. Jones, or an often costly private alternative that offers inpatient care, said Tom Savidge, the CEO of PORT Human Services.
The wait list at Walter B. Jones “fluctuates,” Savidge said. “(Sometimes) the demand is high and … you have to try to keep them in outpatient treatment until a spot comes available.”
Minimizing the blow
Before the final budget passed in July, state senators sought to close the state’s treatment centers. They argued addicts could get adequate care in their communities from private treatment facilities and hospitals.
The governor’s budget proposal came from the opposite direction. He did not suggest any cuts to the centers and has said addiction treatment is a personal priority. The House’s budget kept the state centers open as well but reduced funding by 5 percent. The 12 percent cut was a compromise between House and Senate leaders.
“There was consensus in the House and Senate to ask those facilities to take a much closer look at their operating expenditures, and their staff compensation and the like, and to look and see where they can economize,” said Rep. Nelson Dollar, a Cary Republican and the House’s main budget writer.
The state is still working with administrators at the facilities to decide how to make the cuts, said Julie Henry, a Department of Health and Human Services spokeswoman. The state is also promoting a new tele-psychiatry initiative to bring services to emergency rooms dealing with the mentally ill and substance abusers in rural area.
DHHS denied requests to speak to Walter B. Jones administrators.
“I think this in a way is a wake-up call for the state alcohol and drug addiction treatment centers in the system to do a better job of helping the legislature understand what they do and the role they play in the system,” said Phil Mooring, a former director of Walter B. Jones. “This is a good time for the state system to really step up and be able to say back to the legislature: ‘You’ve got a hard job trying to balance the budget, but this isn’t the place to do it.’ ”
Jeff Stillers, sitting in his halfway house, has his own ideas about what’s needed. Stillers has been luckier than many. He once spent 28 days at Walter B. Jones trying to kick his habit. He calls that short term and said it and the weeklong programs waste taxpayers’ money.
Addicts need a way to deal with the real world once they’re thrust back into it, he said. In his experience, programs that offer housing, structure and a transition from the life of an addict to active employment are most successful, he says.
“I think the reason why I could never stop and stay stopped is I would stop and then have no future, have nowhere to live, back to just me, the clothes, the streets,” he said. “Your days are filled with nothing. So you know how to take care of that, you stay drunk. You drink. You be homeless.”
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