The Toughest Job In The City

Q and A

September 25, 2005|By Alec MacGillis | Alec MacGillis,Sun Reporter

Three months ago, Adam Brickner took over as the head of Baltimore Substance Abuse Systems, a little-known agency with a hugely important charge -- overseeing drug treatment in a city with thousands of addicts.

The quasi-governmental agency oversees about 70 treatment programs in the city, with a budget of $53 million and a staff of about 50 at its high-rise office downtown.

Brickner, 44, is a native of New York City and the son of the well-known activist Reform Rabbi Balfour Brickner, who died last month. Since arriving from Denver, where he oversaw drug treatment and prevention, Brickner has been open about identifying Baltimore Substance Abuse Systems' shortcomings and suggesting ways that it could improve.

He discusses Baltimore's drug problem with the studied dispassion of a skilled technocrat, but, as he revealed in an interview with The Sun's Alec MacGillis, he also brings to the field a perspective gained from personal experience.

What were some of the first things that struck you about the city, about drugs here and treatment here as compared to Denver, where you had different drugs and a much smaller budget to work with?

It was night and day. It was so exciting to move here, because the whole community recognized the value of drug treatment. I haven't met a politician yet who hasn't been supportive of this issue in Baltimore and Maryland. They recognize the value of lifting the spirits of the entire community -- that if we can get our hands around substance abuse and addiction, it's not just going to be the Inner Harbor that recovers, it's going to be the entire city that recovers. In Denver we were constantly having to prove to people that treatment was effective.

One of the people who believes in treatment is the governor. When he talks about it, he sounds really committed to it. How does this jibe, though, with the fact there's been level funding for treatment for the past three years? When he's asked about this, he says he wants to see cities and counties getting results first before the state spends more money on them. But people in the field say drug treatment's not brain surgery -- you need quality counselors, and that takes money. How can you show results with flat funding?

He's trying to make sure we're being accountable. There's always things we can do better, but I think at this moment in time we're as accountable as anybody could be.

There are treatment programs in the community that are really struggling because level funding for us means that they can't give cost-of-living increases to their staff, and it's really hard to retain quality people. I've only been here three months, so it's hard to get into talking about the governor's options, or what he or she isn't doing. We've requested more money, and hopefully we'll get it.

You've said you want BSAS to do a better job of helping people who make the first step to get help. Lots of times, when people call up for help here now, the most you can do is give them 10 phone numbers of programs to call -- and they call them and they're put on a waiting list and told to call back in three weeks, and they lose their will. Why is that so damaging?

The front door's so important because of motivation. In the substance-abuse world we talk about "readiness for change." If someone makes that decision -- hey, I need help -- it's much better if they have an opportunity to engage that decision right away and make it happen.

When someone moves from that step where they haven't even thought about changing to wanting to change, we want to reinforce that thought process so they can get positive vibes from it. When someone wants to change and you give them 10 numbers to call, that's a negative reinforcement.

So, what can BSAS do in taking a more authoritative role in making the front door work better and really help people who have made that decision?

We're trying to develop a process, a screen of some sort, where we can ask people some very basic information and try to give them some feedback about where they are in their own addiction and start to offer them a menu of options. Maybe there's a treatment program that's available tomorrow that you can go to. Maybe it's not a slot we can pay for, but maybe it's available to you anyway -- if you have ability to pay, you can pay, or if you don't, we can talk about it.

We want to get to the point where we can at least get them engaged when they make that phone call. Then, if they don't show up or it takes three or four phone calls for them to show up for an appointment, then that's kind of on them, it's not on us. Right now it's like we can kind of be used as an excuse not to engage in treatment: "I tried to call them but they didn't have space available."

Plenty of people are still skeptical about treatment and don't understand why, after spending $50 million a year, we're still talking about thousands of addicts in the city. What's the best response to that skepticism?

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