Salt Lake County's detoxification facility is too small to meet the county's need, and those who are the most motivated to succeed in kicking substance abuse are getting the least help, according to a county Alcoholism and Drug Abuse Service Division official.
Errol Remington, treatment and rehabilitation coordinator, said the facility has 39 beds, but needs about 80 to meet the existing need.Several months ago, detox policy was changed to only accept those who are inebriated. "In urban areas, you have to serve agencies doing the control - law enforcement and the courts. They were getting so many people we couldn't serve. We used to use detox as a door into programs and services," Remington said.
"Most who go to detox," he said, "are taken there by the police, which has a couple of discouraging side effects. For one, the public, when it needs it, doesn't get to use it. Second, self-referrals, those the most motivated to make a change, frequently can't get in."
Remington said that from a taxpayer's view, a detox facility is a good investment. It costs $27-30 a day to keep someone in detox, while jail costs about $75.
In 1986, the county awarded a contract for operating the facility to Volunteers of America. At the same time, the unit was changed from a "medical model" to a "social model," a less-expensive model that does not use medications. If someone needs medical help - about 5 percent do - he is taken to a hospital. (A doctor is available several hours a week to conduct the mandatory physical exams, however.)
The bulk of those in detox abuse alcohol. "We are basically dealing with a population that can't afford drugs," he said. "But the younger the inebriate is, the higher the probability of polydrug abuse." The average age in treatment is 38-39, he said, but that average is lowering. Many dual-abusers use cocaine to get high and alcohol to come down.
The staff generally watches those in detox "sleep it off," checking vital signs regularly. Those who seem likely to need special attention are placed where they can be continuously monitored in the receiving center. Others sleep in a dorm-like room.
"We'll fund about a week in detox," Remington said. "Detox works hard to talk people into going onto treatment. If they're successful, referrals are made to treatment houses. So sometimes a person is in detox longer than we will fund. It could be a substance is still in the system, or a treatment house is full and has no bed. Rather than put them out on the street and lose them, we keep them."
There are about 170 beds in the various residential treatment programs.
Homeless inebriates pose special problems, according to Remington. "You are dealing with both rehabilitation and habilitation. Many of these people have no coping skills, they've turned off. Treatment programs have pretty good success, but most who work with the homeless believe they need to be in the system for about 18 months. By the book, we offer about 96 days. In fact, they may be in the system 6 to 8 months if they're doing well. If not, there's pressure to move on and make room for someone else."
Remington said treatment is being recognized as the ideal option by more people, but that Salt Lake County has great need for a halfway house or "something to let people stay in the system for 18 months. Some are trying to address that problem, but there's no money."