The headlines in area newspapers confirm what we already suspect – the drug and alcohol problem in Lowell grows worse with each passing month. Drug overdoses have tripled in the past two years, and deaths from overdoses have doubled. Based on our experience and the experience of many Lowell House staff and colleagues, here is our top six long and short-term priorities necessary to turn the tide on the current drug and alcohol crisis in our communities.
Institute a combination of stronger and more frequent prevention and diversion programs aimed at adolescents twelve and older.
The best way of addressing our addictions epidemic is to stop it, or at least slow it down before our young people make bad, life threatening decisions. The core school prevention programs should include evidence-based models with success nationwide like Peer-Assisted Learning Strategies and Social Decision Making. There are a number of programs tracked by the Federal government that have a strong evidentiary base. The real key is early education and support for teens who have been identified as “at risk” for developing an addiction problem rather than punitively intervening at the school or legal level. LHI’s two-phase diversion program includes intense psycho-educational programs, individual assessment, and group or individual treatment all done as soon as there is an identified need prior to developing a destructive lifestyle.
The Commonwealth has not funded a true prevention agenda since the early 90s. Funding for these critical prevention services is now the responsibility of cash-strapped towns and cities and, on occasion, a thoughtful foundation or caring legislator. The result has been little progress on prevention and diversion.
Provide more treatment options/Extend time in treatment
People can recover from an addiction. However, treatment for addictions requires more than physically detoxing from a substance. Limiting treatment to short-term solutions overloads our emergency rooms, detox facilities, and mental health hospital beds. Without the right supports in place, individuals cycle in and out of costly services. Recovery happens over the course of a lifetime. It involves learning about your addiction and developing the necessary skills to maintain sobriety, connect to community resources, and address mental, physical, spiritual, and social needs. Case management services, sober housing, social support options as well as medical and mental health resources are a few of the options that would help to sustain recovering individuals over a number of years until they feel fully capable of managing their disease without these added supports.
Programs like the Lowell House Recovery Home and Sheehan Women’s Program help individuals begin this process of recovery. The wait time for residential recovery beds statewide can run in excess of four to six weeks. Without immediate treatment following a medical detox, individuals will relapse and develop a cycle of addiction that can last a lifetime. The Department of Public Health Bureau of Substance Abuse needs to double the number of recovery beds statewide. Addiction needs to be thought of and treated as a chronic disease managed through a lifetime without gaps in the continuum of supports. People with this life threatening disease cannot afford to wait for a recovery bed or develop a new lifestyle without necessary post-detox services.
Adequately fund services
Lowell House has not had an increase in residential rates for eight years. Residential programs still provide a quality service with grossly underpaid staff, little administrative support, and even less clinical support. Our outpatient department runs a deficit in excess of $200,000 annually. Managed care companies, even the ones regulating public insurance, offer inadequate rates, often reimbursing less than 50% of the actual cost of treatment. Insurance companies need to increase their reimbursement rate for substance abuse and mental health treatment services in order for agencies like the Lowell House to continue providing these life-altering services. The solution for residential, day programs and clinical services is simple – pay us what it costs to provide quality services. Chapter 256, supported by the legislature, the court system, and governor, would adjust certain rates to cover actual program and service costs. It’s an important start that needs full implementation.
Provide easier and more timely access to Psychiatry and Medication Assisted Treatment
Approximately 50% of the people we treat for addiction also have a reported conjoint mental health issue, some mild to moderate in nature, others more severe, and all have an impact on recovery. Psychiatry services are necessary for these dually diagnosed individuals to manage their mental health disorder medically while simultaneously treating the addiction. The wait time for psychiatry in the Lowell area is anywhere between four and six weeks; substance abuse counseling can begin immediately. This “gap” of connected and vital services is a primary reason for relapse. The problem is that psychiatry services are so expensive that they often cause large budget deficits in outpatient departments. The Commonwealth can help by increasing the regulation of psychiatry rates and reimbursing clinics with a fair and equitable rate that covers their basic expense for providing this necessary service.
“Medication Assisted Treatment” is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful. Medication assisted treatment (MAT) is clinically driven with a focus on individualized patient care.”(Substance Abuse and Mental Health Administration). MAT is currently difficult to access and even more difficult to sustain over the months and sometimes years it takes to be effective. Integrating primary care services, including psychiatry and clinical nursing, with addictions treatment and adjusting reimbursement rates accordingly is the long-term solution.
Support an effective program designed to help incarcerated individuals re-establish a productive life outside of the prison walls
For the past thirty-five years, we have tried to incarcerate our way out of our addiction problem. The re-entry/relapse cycle is all too familiar. Individuals commit crimes to fund a drug or alcohol habit, they are convicted, serve time and often released back to the community still addicted to a substance. With no source of income, no housing, and an often institutional mentality, successful reintegration into the community is nearly impossible. Individuals are often forced to return to the lifestyle that existed prior to incarceration, commit a crime to sustain their habit and end up back in jail. The cycle is endless and costly in wasted lives, wasted funding and increased criminal activity. The federally funded LEAP program run by the Lowell Police Department began to make an impact by providing coordinated drug treatment, housing, and job training to incarcerated individuals re-entering community life. Unfortunately, this program will end after one year of funding. With dozens of drug and alcohol dependent individuals being released from area prisons monthly to the streets of Lowell without necessary supports, there are plenty of customers for cheap heroin, plentiful pills and always available alcohol. A strong community re-entry program funded by the Commonwealth should be at the top of the Commissioner’s list.
Minimize the impact of cheap, easily available drugs
Despite the best efforts of law enforcement, opiates are cheap and readily available. Highly addictive pain and psycho-active medication, including dangerous barbiturates, are prescribed in large doses with minimal scrutiny. There are no easy solutions to this problem. More extensive, mandatory use of the PMP (Prescription Monitoring Program) combined with educational programs for the medical and dental community would help. Educating consumers about the dangers of prescription medication while providing easy and safe disposal opportunities for unused prescription medication is essential.
Posted on Fri, February 6, 2015
by Bill Garr and Maria Lucci