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Rehab For Poor People

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Med time at a Philadelphia clinic. Many states are slashing their treatment programs.
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By Jeff Deeney

03/05/12

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Last week, at a Philadelphia welfare treatment center, an illegal gun transaction between two clients went bad, resulting in the seller pistol-whipping the buyer right outside the detox's front door.

At my detox, like at most others of its kind, the patient's common area is racially segregated. There’s no visible tension, since most of us are still too tired or sick to muster up any energy. But lines are clearly drawn and allegiances clearly stated. I heard the groups talking shit on each other as I walked the room’s perimeter, looking for my niche. Many patients have done jail time, and there’s a prison vibe to how the room segregated itself. It’s ironic that here, too—among those clinging to the bottom rung of society’s ladder—the urge exists to drawn lines, to say that someone else is not qualified to occupy the same space as you.

Many indigent addicts are homeless, having spent years living in “abandominiums,” as the blighted addict squat houses that dot North Philly are dubbed on the streets. These addicts can stay in 'recovery houses,' publicly funded sober houses where they’ll at least get three hot meals and a cot during outpatient treatment, bunking four to a room in cavernous, converted old brownstones that sleep up to 30 at a time. Recovery house quality, like every publicly funded service, varies wildly; the list of the recovery houses Philly addiction professionals keep in their desk is as thick as a phone book.

A small handful of regulated houses qualify for additional city funding, above the welfare general assistance money most residents use to pay rent. Regulated houses are generally decent, with clean and tidy surroundings and strict rules. There are also the unregulated joints, which are basically crackhouses where addicts queue outside the bathroom each morning waiting to bang bags of dope. While visiting a client, one of my coworkers once saw a rat crawl from the drain in the kitchen sink, flop on the floor by his foot and scurry away. Some disreputable houses even provide entertainment, bringing prostitutes from nearby hooker strolls to serve male residents.

Leaving rehab we exchanged numbers (or email addresses among the few who used it). In weeks to come we called one another, gossiping about who was using again. The number of phone calls I got quickly dwindled; after a month nobody was around to report on who got high because by then everyone but me had relapsed. Then one of my detox buddies nearly ran me down in South Philly, his car careening around a corner out of control, heavy eyelids weighed down by heroin. As he blew past me, he shouted something out the window too slurred to be understood. Another detox buddy ran up on me in North Philly while I was working; he was covered in sweat, mid-crack binge, begging me for five dollars to get a blast.

All this may sound discouraging, but public funding for addiction treatment dramatically reduces social costs that otherwise rise exponentially the longer addiction goes unchecked. No matter how tattered the facility, effective treatment can prevent years of incarceration, welfare dependence, foster care placements and expensive medical care for chronic health disorders. And there are recent positive developments in the field; training in proven techniques like motivational interviewing, cognitive behavioral therapy, trauma-informed counseling and peer-based, ongoing community recovery supports aimed at preventing relapse are being integrated into community behavioral health by state mandate.

My own case testifies to the value of publicly funded addiction treatment. For the past eight years I’ve contributed taxes while working as a social worker.  I work mainly with urban addiction and mental health programs that demonstrably improve lives and cut costs. With adequate resources, treatment for the poor and uninsured would be much more effective, using evidence-based practices rather than just rehashing the same NA literature available for free. But when I was an addict, both in recovery and as a social worker, I’ve seen even the hardest of the hard cases recover. It pays to not give up on people.

Unfortunately, many cash-strapped states and cities have taken an axe to their addiction treatment programs. Though they might save some dollars in the short term, they're just ensuring expensive problems in the future. Without public funds to help pay for treatment sick people only get sicker and healthcare costs get costlier. For a healthy society, quality addiction treatment shouldn’t be limited to those with the money to pay out of pocket for luxury accommodations—or to tragic TV celebrities. Where's Dr. Drew when you need him?

Jeff Deeney is a Philadelphia social worker and a writer who is in recovery. His column, "Street Beat," runs biweekly in the The Fix.

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Last February, my oldest friend died of a heroin overdose at the age of 49. He beat me to recovery, and he beat me to death. He also gave a final, drug-alogue interview on my radio show 20 hours before he died.

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