The Cost of Getting Clean

As the state and county decrease their support, a detox center keeps cutting back

| June 20, 2013
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- Emily Hamann
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It is around 8:30 in the morning in Eureka. Inside a white Victorian, soft morning light shines through a stained glass window onto the landing of the staircase. Stillness radiates from the walls the way it does when a house is full of people sleeping. In the wood-paneled living room, a motivational tape plays on the VCR.

Ginger Fulcher wanders out of one of the first-floor bedrooms, wearing pajamas and a small smile. She looks like she has just woken up from her first full night of sleep in a long time. "This place," she says, "is one of the only reasons I'm clean and sober and alive today."

This is a detoxification center, where people with drug addictions go to stay for a few days while the drugs clear out of their system. This one, on the corner of 14th and C streets in Eureka, is the only resource like it on the North Coast, and it's in trouble.

 

Essentially, detox is a place for drug addicts and alcoholics to wait to sober up. It is a starting point for people looking to get treatment for their addictions. Detox allows people to escape living with a drug user, living on the streets or staying in other circumstances that can get in the way of getting sober.

David Peters is the director of external affairs at the California Association of Addiction Recovery Resources. He said detox is an important part of the healing process. "It provides a safe way for people to get all this poison out of their system," he said. "In order to quit, you can't just stop." Withdrawals from certain drugs can be rough, and sometimes even fatal. "Alcohol particularly — it is very, very dangerous to detox off of alcohol," Peters said. Alcohol withdrawal can cause anxiety, confusion and seizures, and although not everyone gets ill, people who are older or suffering from other health problems are especially vulnerable. So it's important that addicts have a place they can go to detox safely under trained supervision.

Getting sober, especially for chronic and long-time drug users, is not a comfortable process, according to Eric Davis, the manager of Eureka's detox center. Users of alcohol, heroin and prescription drugs sometimes need a medical clearance from the hospital before detox can accept them. The hospital writes them prescriptions for medicines that can help them come down off the drugs safely. Then they go the detox center. The minimum stay is three days. Davis said that most of the time, the alcoholics just want to sleep. It can be tough to get the heroin addicts to stay for the full three days, because of their gut-roiling symptoms. "They'll puke and they'll get the runs," he said. "[They] can't even get comfortable."

The counselors monitor them periodically, giving them their prescription medicines and checking blood pressure. The detox house is just a house; it's not a medical facility and it can't treat people for medical issues. Anyone who suffers a medical emergency is transferred to the hospital.

People at detox also go through group counseling sessions, one-on-one counseling sessions and Alcoholics Anonymous or Narcotics Anonymous meetings during their stay. "Some come in here so broken they don't even want to talk," Davis said. In his 13 years working here, he has seen it all. Despite that, or maybe because of it, he is quick with a grin and a chuckle. His deep voice gets a little lighter when he talks about the people who have come to detox for help.

Part of Davis' job, and the job of the other counselors at detox, is to help people figure out their next step. They might not even know what their options are. Staffers who are knowledgeable about the local resources can help set each person up with a plan for recovery.

At the end of their stay at detox, people should have a clear head and be ready to enter a 30-day rehabilitation program, go to a safe and sober house or attend a 12-step program like AA or NA. A residential treatment program not licensed for detox cannot take in a client who is still under the influence. So, for people who can't get sober on their own, the detox center is a crucial first step.

The nonprofit agency that runs detox estimates that it costs around $82 for the detox center to house and provide services for each person per night. It charges $15.25 per client per night, but not everyone is able to pay that. "If they don't have it we still take them in," Davis said. Usually staff will write down a client's address, if they have one, and promise to bill them later. When someone inevitably skips out on the bill, that's another hole in the detox center's budget. Even if everyone paid their full co-pay, that would leave another $66.75 per night — or just over $200 per stay — to be funded by someone else. At 650 patients a year, which is how many came through the center last year, that adds up to roughly $130,000. But the county is only giving detox $112,433 for the 2013-14 fiscal year. The center is trying to close the gap by cutting back in small ways, including buying lower cost groceries, cutting back on staff training and delaying maintenance such as replacing aging carpets.

 

The detox center in Humboldt County is run by Alcohol and Drug Care Services, a nonprofit that also runs the Lee Brown C Street, the Bonnie Brown and the J Street Program residential treatment centers, as well as a clean and sober house for families and the Serenity Inn, a hotel that provides clean and sober transitional housing.

Scott Cunningham, the nonprofit's director, sits at his desk at the Serenity Inn, where the main office is located. He is running the numbers on dollars coming in from the county versus dollars needed to keep all the services running. They do not add up.

Alcohol and Drug Care Services gets its money from a variety of sources. It has a contract with the county to offer detox and its 30-day residential treatment programs. It also gets donations and grants from private organizations and programs, and it used to get money from other state and county projects. Proposition 36, for example, passed in 2000 and allows nonviolent drug offenders to go to rehabilitation instead of prison. The state made money available to help pay for serving that new population, and the county passed along the some of that money to ADCS. That money ran out, and funding ended in 2009. The law remains, however, so nonviolent offenders are still among those who need detox and other programs. ACDS also gets money through charging people to stay at the Serenity Inn or at its safe and sober house, which are not government-supported.

Like the Proposition 36 money, other specialized programs and grants have also dwindled over the years, leaving Cunningham struggling to provide treatment. The total budget for ADCS has dropped by about one-third, from around $949,000 in 2008 to $675,000 for the current fiscal year. The county used to provide $576,094 of that, including the contract for detox and residential treatment, the money from Proposition 36, funding for the Serenity Inn through the social services branch's General Relief program and a contract for a homeless shelter in the winter months. The biggest pot of that county money, its funding for detox and 30-day residential treatment, dropped from $416,942 in 2008 to $228,373 this year. "I can't cut expenses fast enough," Cunningham said. "Everything that can be cut has been cut."

Heather Muller, the spokeswoman for the Humboldt County Department of Health and Human Services, attributed the cuts to the loss of money from Proposition 36, which, she said in an email, took $600,000 from health and human services as a whole. The money from General Relief that used to go to the Serenity Inn is now spread among a variety of motels, which Muller said has proven to be more effective. And the county is facing its own financial problems. "It is worth noting," Muller said via email, "that DHHS is facing the possibility of an additional loss estimated at $6.8 million due to state realignment schemes contained in the current budget proposal."

Cunningham's nonprofit used to have an outpatient counseling program, where people with less serious problems could get group and one-on-one counseling before their addiction got out of control. Those counseling meetings were held at a bookstore ADCS used to run that sold 12-step program and other recovery books. It had to give up the bookstore in 2009. The county also cut the contract for the winter shelter; its last winter was 2009-2010. The shelter was another way addicts could start the process of getting into a treatment program. "But that's all those little points of contact that we've lost," Cunningham said.

ADCS had to give up one of its safe and sober houses in February; the property was rented and Cunningham could not afford to pay the expenses. "Way back when," ADCS had 11 safe and sober houses throughout the community. It has let them go one by one, and now has just one left, a place specifically aimed at helping families affected by addiction.

Responding to the continuing cuts, in January the detox center stopped accepting people coming to sober up from methamphetamine and marijuana, which don't carry the major health risks withdrawal from alcohol does. There were far fewer people coming to the detox center from methamphetamine and marijuana, as well. However, this creates a small problem for the Humboldt Recovery Center, a residential treatment facility, which has a lot of people coming to recover from methamphetamine addiction. It used to refer a few people to detox every couple of months. "Recently we haven't been able to use it," said Joel McDonough, the founder and former executive director of the recovery center.

The ADCS detox center was closed for two days in May because there wasn't enough money to keep the lights on and the staff paid. Only two people were staying there for detox at the time and when their stays were up, Cunningham told Davis and the rest of the people working there to go home for a few days. Only 48 people were able to come to detox in May, versus 50-60 in an average month. "Word got out that we weren't open," Davis said.

July 1 marks the beginning of the new fiscal year, and Cunningham has already signed a new $228,373 contract with the county, the same amount it has been since 2011-12. Usually, the money ends up being split about evenly between detox and the residential treatment programs, but this year, the contract specifies that exactly $112,433 of it must go to detox and the rest goes to residential treatment. Money from that contract won't start coming until mid-August.

On June 4, St. Joseph Hospital announced that it would give ADCS $12,530 for the detox center. The hospital does not offer non-medical detox services, and sometimes refers patients to detox to start recovery. "They just need this to help bridge them over," Leslie Broomall, the hospital spokeswoman, said. Cunningham said the money is enough to keep detox "operating on a shoestring budget for about a month."

At the June 10 Board of Supervisors budget hearing, Michelle Hayden, the lead counselor for the men's residential treatment program, brought some of the people who have successfully been through the program to attest to its worth and ask for more funding. Since she began running the Lee Brown C Street program in October, only three out of 30 people have failed to graduate. "I'm returning fathers to their children. I'm returning sons to their mothers. And I'm returning men back to the community," Hayden said.

Muller said that ADCS has not requested any more money. She passed along a statement from Director Phil Crandall, which said "the department's position at this time has to be to maintain current contract amounts until we know more."

"I've always asked for more money," Cunningham replied, when told about the statement. He didn't make a written request, he said, but instead asked a county staffer who he declined to name, saying he didn't want to get that person in trouble. Muller said Cunningham was asked by a program manager to make a written proposal. Cunningham responded, "Nobody ever said anything about putting it in writing." Muller said she hopes the county and Cunningham can meet and work it out.

Cunningham gestures to his desk and explains that he probably has about $25,000 in bills sitting on it. "I'm not even sure we'll make it next year," he says.

 

Back at the detox center, it is almost lunch time. The smell of a home-cooked meal circulates throughout the first floor of the two-story house. Ryan Presley, one of the cooks, is making cowboy stew with tomatoes, beans, onions, noodles and ground beef. Fresh rolls and salad are also on the menu. Three months ago, Presley came to detox here. Now he works at the center.

At the front desk area, a new person is getting checked in. Dawn Tatom, one of the counselors, asks her questions about her addiction (alcohol), and has her fill out paperwork. Then Tatom gives her a toothbrush, toothpaste, comb, pajamas and a towel, and sends her to take a shower. "A lot of these people haven't had a shower in forever," Tatom says. Everything a person walks in wearing goes into a plastic bin in a locked closet upstairs.

Michael Plowright, two days into his sobriety, sits on one of the couches in the living room watching the television. The 49-year-old wears pajamas, an old T-shirt and a green robe. Angel Eyes with Jennifer Lopez is playing on the VCR. This is Plowright's fourth stay at the detox center.

A little later, on the back porch, he sits in an old office chair, his slippered feet resting on the faded wood deck. He lights a cigarette and explains he has come here before to try to recover from both alcohol and heroin addictions. "But I'm primarily an alcoholic," he says.

Plowright took his first drink when he was 6 years old. His parents hosted a lot of cocktail parties and it was his job to run drinks and empty glasses back and forth. He would sneak a couple of sips from glasses he was carrying. "Next thing you know, they're all laughing at this drunk little 6-year-old kid. They all thought it was funny back then."

He got his first DUI at 17. The probation officer told him, "Mr. Plowright, you are an alcoholic."

"I said, but I'm 17 years old; how could I possibly be an alcoholic. I thought she was off her rocker. She was more right than I knew."

He started doing heroin in his 30s when his drinking was becoming a problem with clients at the business he owned, which fixed computer network systems for offices. "It's really hard to be professional when you smell like alcohol," he said. "My customers were starting to notice that I was having a drink at lunch."

He went to detox and was able to give up heroin a few years later. "It definitely wasn't my drug of choice," he said.

He came to detox this time because he was having a hard time with withdrawals when he was trying to sober up on his own. "I was starting to feel like I was going to die out on the street," he said. When he leaves detox, he is probably going to live at a safe and sober house. "But my mind is not exactly straight enough to call them just yet," he said. Before, when he wanted to quit, he would try to get into a safe and sober house, but he had been drinking that morning and wasn't allowed in. "It's really hard to sober up when you're on the street," he said.

 

Last year, 650 people walked through the doors of the detox center. Besides giving addicts a place to sleep and sober up, the center is often the only way people can gain access to all the resources they didn't know were available, like county counseling, local safe and sober houses and residential treatment programs.

Davis estimates that around 75 percent of people who complete their detox go into some sort of program. Last month, 11 people left before the three-day minimum — a sign that they don't intend to follow through. The other 48 people completed detox successfully.

"We love them no matter what," Davis said. "We treat them like family."

If detox isn't available, addicts will be left with the choice to sober up in jails, in emergency rooms, or on the streets. "These guys are like zombies out there," Davis said.

Plowright has tried to quit drinking on his own before and failed. He relapses every time. "When I'm desperate enough to come to detox it's because I can't quit on my own and I can't keep going," he said.

Where would he go if there was no detox? "Move to another town, I don't know ... go to AA meetings drunk until I got it ... Or I'd drink until I died."

Humboldt County is ranked third statewide for the highest incidence of death caused by drugs, although the county's small population makes the comparisons difficult. A study from the California Department of Public Health found that on average from 2009-20011, Humboldt County's drug-induced death rate is 36.7 for every 100,000 people. The statewide average is 10.9.

 

When people's time at detox is up, they get their belongings back from the locked closet on the second floor. If they can, they make their bed with clean sheets for the next people. They sign their discharge papers, and they and a staff member sit together and write an exit plan down on paper, so they don't forget or get confused. "They've only got three or four days clean, so their brain's still in a fog," Davis explains. They change out of their pajamas, robes and slippers and back into the clothes they were wearing when they walked in days before.

"Some are happy; they're grateful. They're thanking us. They're writing me letters," Davis said. Others do not want to leave. They're scared to go out to the real world and face recovery, and they don't know if they can do it.

As they're leaving, Tatom has her own private ritual. "I pray for them as they walk out the door," she said.

Some people, Davis and the staff will never see again. Some will be back. Again. And again. And again.

"That's why it's so important to keep these doors open," Davis said.

There is a sticker on the door that says, "Keep coming back." Tatom explains that it really means "keep coming back until you get it right."

The detox center is full of success stories. Many of the people who work at ADCS came there first as clients with addictions of their own. Hayden is one of them. "People gave me a chance and I was county funded," she said.

In the living room of the detox center is a board with small plaques, each listing a name and an age. When someone who has been through detox dies, a new plaque with another name is placed on the board. There is an asterisk next to the name of each person who died sober.

The asterisks pepper the board sparsely. But each one matters.

Counseling sessions are held in the living room at the Lee Brown C Street treatment center.
Counseling sessions are held in the living room at the Lee Brown C Street treatment center.
- photo by Emily Hamann
Eric Davis, Eureka's detox center manager, smiles for the camera.
Eric Davis, Eureka's detox center manager, smiles for the camera.
- photo by Emily Hamann
A display of pamphlets about drug and alcohol addiction sits in the dining room at detox.
A display of pamphlets about drug and alcohol addiction sits in the dining room at detox.
- photo by Emily Hamann
Counselor Michelle Hayden poses in the living room at the men's treatment center
Counselor Michelle Hayden poses in the living room at the men's treatment center
- photo by Emily Hamann
The detox center is in an old white Victorian house.
The detox center is in an old white Victorian house.
- photo by Emily Hamann
Michael Plowright sits on the back porch at detox.
Michael Plowright sits on the back porch at detox.
- photo by Emily Hamann
Counselor Dawn Tatom checks a new person in to the detox center.
Counselor Dawn Tatom checks a new person in to the detox center.
- photo by Emily Hamann
The door at detox reminds people leaving that they can keep coming back until they are fully recovered.
The door at detox reminds people leaving that they can keep coming back until they are fully recovered.
- photo by Emily Hamann
People who have been through detox get their names on the R.I.P. board after they die.
People who have been through detox get their names on the R.I.P. board after they die.
- photo by Emily Hamann

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