Several years ago, I stood in an alley about three blocks from my office on a December evening, pleading with Bill, a 62-year-old homeless alcoholic, to let me drive him to a hospital detox unit.
Finally, after much discussion, he seemed to consider the idea. ''OK, I'll go,'' he said, a bit hesitantly, ''But I'm not going without Richard!'' I looked around; the streets were empty. ''Richard who?'' I asked. With a grin, he pulled a half-consumed bottle from his jacket: Richard's Wild Irish Rose.
That was in the old days, when detox -- and treatment -- were still available. As the landscape has changed dramatically on the local, state and federal level, due to cutbacks and market forces, the poor are less and less likely to obtain treatment for drug and alcohol addictions.
Baltimore leads the U.S. in cocaine, heroin and alcohol-related emergency-room episodes per 100,000 residents, according to the University of Maryland's Center for Substance Abuse Research. The center also estimates that 74 percent of heroin-related emergency-room visits in Baltimore are due to the chronic effects of heroin use and request for detox. Nationally, this figure is 47 percent. The lack of available treatment is a likely cause of this situation.
In 1992, the Mayor's Working Group on Drug Policy Reform estimated that 47,800 Baltimoreans abuse illegal drugs and 70,000 abuse alcohol, but that only 19 percent of those in need were able to receive treatment.
I've worked with Harry, a former migrant worker whose affinity for gin causes him to become quite verbose. I always know when he's been drinking because he quotes from the book of Leviticus. It went something like this: ''(Mumble), so sayeth the Lord (mumble mumble).''
Harry has been jailed an outrageous number of times for the same charge, drunk and disorderly. Last year, he was released with the stipulation that he receive court-ordered treatment for his alcoholism.
He continued to come to see me, drunk, murmuring that we had to phone his probation officer. So I did. She informed me that Harry had to call a local health-care provider and make an appointment, in order to not be violating the condition of his release. So we did; the earliest one available was three weeks away.
''What happens if he needs to get treatment before then?'' I asked, thinking warily of the paper bag full of gin I'd convinced Harry to stash in the bushes while we made our calls. ''Well, he'll just have to wait,'' the woman who makes appointments told me.
After Harry had gone, I spoke to the probation officer again to reassure her that we would make an appointment.
''How does your office pay for treatment?'' I asked. ''Oh, it doesn't,'' she replied. ''They have to pay for it themselves.''
But Harry had no insurance and very little income; he was homeless as well. After 30 years of regular drinking, he was supposed to stop suddenly and wait three weeks for treatment? So sayeth the parole and probation system.
Then there is Jack, who has been trying desperately to enter a methadone maintenance program. He has been in my office several times each week and on the phone to programs all over town every day with no luck. The city's hotline for those seeking methadone maintenance told Jack to call back three consecutive Mondays at 10 a.m.
There is no room anywhere, he was told. He has a $40-a-day habit.
Treatment -- and treatment dollars -- are becoming even more scarce. Maryland is facing a $24.3 million loss in block-grant funding due to our state's noncompliance with a section of the Public Health Service Act concerning blocking sales of cigarettes to minors. This cut would represent 47 percent of our state's Alcohol and Drug Abuse Administration funding this year. In Baltimore it would mean a loss of $7,348,516.
This potential loss follows Gov. Parris N. Glendening's January decision to cut the Disability Assistance and Loan program, which provides subsistence-level grants and access to medical care for poor and disabled persons. Approximately one third of substance-abuse treatment in Baltimore is paid for by this program.
The House of Representatives recently approved a welfare-reform bill that would, among other things, declassify addicts alcoholics as disabled persons and eliminate disability income and Medicaid for thousands of persons.
These cuts are short-sighted. What is the potential for treatment to be successful when the patient has no means purchasing any type of housing and no opportunity for rehabilitation and training?
There are philosophical roadblocks as well. When I tried to explain that one client lacked the bus fare to get back and forth to a daily group, the intake worker at the halfway house snapped, ''Well, if he can find the money to drink then he can come up with the money for bus fare!'' This is a common response. People actively seeking treatment face many uphill battles; one of the greatest is a lack of trust.