City drug treatment sites feel strained

Groups say shrinking dollars limit number who can get help

Keeping qualified staff a challenge

Pinch comes as officials push for expanded use of programs

September 05, 2005|By Alec MacGillis | Alec MacGillis,SUN STAFF

As consensus builds that substance abuse treatment is a key to attacking Baltimore's scourge of drugs and violence, those administering rehabilitation programs in the city say they welcome the recognition. There's just one problem, they say: The city's drug treatment system lacks the capacity to live up to the official rhetoric, and dollars for it are shrinking.

Hardly a week passes without someone in power - the mayor, the governor, the police chief - stressing the importance of substance abuse treatment. The Police Department has a new initiative to goad dealers with addictions to seek help, drug courts are sentencing more offenders to treatment rather than jail, and prisons are exploring ways to funnel inmates into treatment upon release.

But Baltimore's treatment system is in no position to handle a new wave of referrals. The city's funding for drug treatment, which comes mostly from Annapolis, has dropped by more than 10 percent over the past two years, according to a tally compiled this summer by the Center for Substance Abuse Research at the University of Maryland, College Park.

After increasing steadily for almost a decade, total federal, state and city funding for substance abuse treatment in Baltimore reached a peak of $60 million in 2003. Since then, funding has fallen to about $53 million, according to the center.

Far from being able to accept an influx of new addicts coaxed into treatment, the city's treatment system is under so much strain that in the past two years it has had to reduce the number of people it serves, the center found. Since 2003, the number of addicts being served annually by programs in the city - a count that likely includes repeat visits - has dropped from more than 25,000 per year to about 22,000 last year.

Meanwhile, waiting lists have remained so long that addicts who have finally decided to seek help are often told by programs to call back in three weeks. For addicts for whom simply making that first call was a major step, such a response can be deeply discouraging and often enough to make them give up.

"I don't want to belittle the money we're getting, but it's not trending up as it was. It's starting to move down, and that impacts the number we can serve," said Adam B. Brickner, the director of Baltimore Substance Abuse Systems, the quasi-governmental agency that oversees drug treatment in the city.

The drop in funding has been caused primarily by reductions in state and federal funding, say BSAS officials. Three federal grants totaling $4.5 million over three years have recently ended, and the city has also seen a decrease of more than $3 million in state funding over the past two years, to about $46.7 million.

State support, some of which originates with the federal government, makes up the bulk of funding for BSAS. City funding, which makes up only a small piece of the pie, has remained steady at about $1.2 million, while BSAS has seen private funding fall from $723,000 in 2001 to $250,000 this year.

Maryland officials dispute that there has been a discernible drop in state support for treatment in the city, and also that there has been a decline in client rolls, which they say their own figures don't reflect. Much of the seeming funding reduction, they say, is due to a bookkeeping change - BSAS is no longer handling the money for a residential program with a statewide clientele that will now be funded directly by the state.

The rest of the cuts in the city's funding from Annapolis are due mainly to reductions in federal grants that are passed on by the state, said Peter Luongo, director of the state Alcohol and Drug Abuse Administration. Funding originating with the state has stayed level the past few years, he said.

But directors of treatment programs in the city said that even level funding from Annapolis isn't enough to handle the demand for treatment, much less an expanded stream of referrals. With such costs as fuel and health insurance sharply on the rise, even flat funding has required them to cut the numbers they can serve, or risk watering down the quality of treatment.

"The state says you have to make a business decision [to make do without increases], but the business decision is that there's a point where the system is going to start serving less people at a time when it needs to serve more people," said Gale Saler, regional director of Gaudenzia, a large treatment center that opened three years ago in Park Heights.

The biggest challenge for treatment programs, directors say, is finding enough money to attract and retain qualified nurses and counselors, the key to effective rehabilitation. Under their existing funding, directors say they can't pay counselors more than about $30,000, not enough to recruit well-credentialed candidates. Turnover among counselors is very high - a huge problem considering the importance of the bond between addict and counselor.

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