But as crack exploded out of Harlem in 1985, capturing fearsome headlines across the country, politicians steadily jettisoned treatment in favor of “getting tough.” Mandatory minimums for drug offenses, as well as the notorious crack-cocaine sentencing disparities, quickly became part of the landscape, fueling a huge increase — now more than 2.3 million — in the number of Americans behind bars.
To be sure, legislators are becoming increasingly sensitive to the hangover effect of the war on drugs. In a promising move last summer, lawmakers earmarked $1 million for parolee treatment. Meanwhile, Rhode Island was awarded a three-year $8.3 million federal grant last year to provide recovery services for released inmates. The grant will fund treatment for 475 people in its first year, and 1042 each during its second and third years, says Rebecca Boss, chief of substance abuse treatment services for the state Department of Mental Health, Retardation and Hospitals.
Nevertheless, with 400 people exiting the ACI per month alone, the demand for treatment, says Boss, remains “overwhelming.” The disparity is so pronounced that 40 inmates are being held past their parole dates (some for several months) while waiting for a community-based treatment bed to become available.
While addicts face a host of barriers to recovery, simply getting through the door to treatment, particularly for the uninsured, can be among the biggest hurdles.
In 2006, Rhode Island spent $12.9 million on substance abuse treatment, including $5.3 million in federal funds, subsidizing 581 methadone, 181 adult residential, and 674 outpatient treatment slots, as well as 81 residential treatment slots specifically for women and adolescents. That level of funding, says Boss, has remained static for at least five years, and the demand for these slots overwhelms the supply.
CODAC, the largest provider of state-subsidized methadone treatment, reports a wait of up to six months for one of its state-subsidized treatment slots. An uninsured addict will wait from two to three months before a state-subsidized residential treatment bed becomes available, says RICARE’s Gillen.
To the addicts most in need, many of whom are homeless, such delays pose a severe deterrent to treatment. “If someone’s calling to seek help, they’re not calling to say, ‘I want help in two to three months,’ ” says Gillen. And if a person doesn’t receive help — and is simply told to keep calling every day for the next few months — that moment, he says, is “lost.”
Delays in treatment can be fatal. In 2001, 44 of 52 overdose deaths in Providence were attributed to heroin. A 47-year-old Providence man, who requested anonymity, was homeless and addicted to heroin for seven years. He calls overdoses “so common they don’t even upset people.” He knew addicts, the man adds, who’d simply “watch someone turn blue and leave them to die on the street.”