According to Dr. Alex Etienne, associate medical director of Roger Williams Medical Center’s detoxification unit, half of the addicts he sees are destitute, so Roger Williams frequently has no option but to send them back onto the streets. “So often when it’s time for them to go, the most we can hope for is usually a homeless shelter,” says Etienne, who estimates that this is the case for nearly one-third of his clients.
Even for the insured, notes Butler Hospital’s Dr. Michael Stein, “A patient’s ability to pay remains a major barrier [to treatment].” While Medicaid and RIteCare cover long-term methadone maintenance, Michael Rizzi, CODAC’s executive director, says he’s not aware of any commercial health-care provider in Rhode Island that does the same. Likewise, says another treatment professional, most commercial providers restrict residential treatment to two weeks.
The new face of reform
SAY YES TO CHANGE: Wall believes that an effective response to crime requires greater emphasis
After more than 20 years of seeing inmates cycle through prison, inmates for whom incarceration was a symptom of addiction, ACI director A.T. Wall — like some counterparts across the nation — has become an earnest advocate for treatment.
Thirty-one percent of released inmates end up back in prison within one year — a figure 10 percentage points higher than the national average. As Wall puts it, “If we are serious about breaking the cycle of recidivism, we really need to intervene while someone’s in custody and provide them with substantial treatment.”
But turning the tide after decades of prison expansion isn’t easy. Part of the challenge, says Wall, is that many inmates simply cycle through too quickly to undergo treatment. “Meaningful treatment takes time,” he says, citing research suggesting that six months is the “bare minimum” needed for treatment. “And if we’re really going to be realistic about the process, we have to be considering a year or more of treatment.”
The available programs at the ACI, however, are far briefer. Last year, the majority of inmates enrolled received less than two months’ treatment. Demand for such programs remains fierce: in some situations, inmates face waits of up to three months.
Accordingly, says Wall, the Corrections Department is “looking aggressively for any opportunities to promote substance abuse treatment initiatives,” including a possible partnership with Miriam Hospital to provide certain inmates with methadone treatment pre-release. (Currently, methadone treatment is continued only on an ongoing basis to pregnant inmates and those with chronic illnesses.)
Michelle McKenzie, who directs Miriam Hospital’s federally funded Project MOD, which offers 24 weeks of free and subsidized methadone treatment to released inmates, says greater and more stable funding is needed to improve the situation.