Alcohol, Drug Abuse Cuts Yield a Moral Deficit

From Asheville Citizen Times written by Bonnie Schell.

Lucy Bickers, LCSW, in her May 30 guest commentary told us that the planned closing of JFK Alcohol and Drug Abuse Treatment Center would result in the loss of 80 beds, 214 jobs and a rise in jail incarcerations and chronic homelessness. Lucy asked us to weigh the moral “savings” to North Carolina of closing an ADATC facility with the gain to those families with appreciable estates who will no longer have to pay estate tax in North Carolina.

The loss is even worse than Lucy’s article indicates. All substance abuse services, which are mostly state-funded, are under attack.

The legislature intends to close all three ADATC’s: Julian F. Keith in Black Mountain, Walter B. Jones in Greenville and R. J. Blackley in Butner, part of former John Umstead Hospital. Lawmakers plan to close 240 beds at a time when there is an acute shortage of beds, and adults in emergency rooms are shackled to chairs and gurneys waiting a placement by the state and the local managed care organization, while a member of the sheriff’s department has to be paid to wait with the potential patient.

If the rational reason for closing these three treatment centers is that they are no more effective according to research than outpatient treatment, then the legislature would be moving the money from closing the three centers to enhancing community outpatient treatment. But the budget doesn’t call for that. The Senate budget bill contains a $28 million cut in state funds for local substance abuse treatment.

The mission of North Carolina’s Alcohol and Drug Abuse Treatment Centers is to provide medically monitored detoxification/crisis stabilization and short-term treatment, preparing adults with substance use and co-occurring disorders for ongoing community-based recovery services. In fiscal year 2009, 70 percent of patients at ADATCs had serious mental illness as a co-occurring diagnosis.

Are ADACTs being targeted because they give priority admission to those with HIV/AIDS, intravenous drug users and pregnant women whose infants run the chance of being born addicted? Are these treatment centers sitting on prime land that can be sold or leased like Dorothea Dix Hospital in Raleigh for another park, condos or Atlanta-style Water World?

Does the far right think that the people who might need ADACTs already have enough entitlements? Not so. Adults with primary chemical addictions do not qualify for disability income and hence are not eligible for Medicaid until late in life, when they might have end-stage liver failure. This ruling, made by the Centers for Medicaid and Medicare, is an out-of-date view of addiction, which research shows to have a genetic, metabolic and trauma causality, not due to sorry character or flabby willpower.

Individuals with mental illness and co-occurring substance abuse treated in the public system already die 35 years before the general population.

Thanks to Obamacare, the cap on behavioral health care services is now the same as cancer and heart trouble for those with private or group insurance who can go to the Betty Ford Clinic or the alcohol treatment centers advertised on TV.

Never mind that on any day in North Carolina more than 700,000 citizens over the age of 12 report being addicted to alcohol or other drugs, including prescription painkillers. Ninety percent will never receive treatment, but we will wring our hands over the increases in driving while impaired, domestic violence, problem gambling, underage pregnancies, underage drinking and the tragedies in the juvenile justice system.

Never mind that UNC Chapel Hill has certified more than 800 peer support specialists, with 332 recovered from substance abuse — who if assigned to a peer with substance abuse can assist that person to a new life, crossing each barrier to sobriety as it occurs.

Peer specialists, used nationally, have been shown to be cost-effective and produce good outcomes, but N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services is not pushing local providers to hire them.

Surely, it must be the case that none of our esteemed legislators has a father, daughter, uncle, ex-wife or cousin or business partner who has ruined his/her opportunities in life with alcohol, illicit or prescribed drugs.

Bonnie Schell, MA, CPRP, ran a drop-in center for persons homeless, addicted and mentally ill in California. She was director of consumer affairs for Piedmont Behavioral Healthcare in Concord. She retired to Asheville in 2012.  She serves on the Board of Directors for NC CANSO.

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2 thoughts on “Alcohol, Drug Abuse Cuts Yield a Moral Deficit

  1. Rich Visingardi

    Do not use the closure of facilities as a means of making available state funds to be used for other purposes– funds (including savings if their are any) must be reinvested back into the folks we are to support and serve. As for SA, its time for a real national conversation regarding de-criminalization as for each $1 spent on the “war on drugs” (which has been lost anyway) a $1 for SA education, prevention, early intervention, treatment, et al is lost. A stance that you favor decriminalization is not a voice of support for drugs but rather support for humanity.

    Rich Visingardi
    Former NCDHHS MH/DD/SA Director (2001-2003)

  2. Great to hear from you, Rich. It is indeed time for a national conversation on substance abuse prevention, early intervention, and treatment. But it also has to happen at the state level, and some states have been much slower to recognize addiction issues with serious and compassionate consideration. Lots of old assumptions have created boundaries that must come down.

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