Part 12: Treatment programs

Alcohol addiction confounds officials
December 27, 1999
By Eric Newhouse
Tribune Projects Editor
Montana spends some $8 million a year treating alcoholics, only to watch two out of three return to the bottle.
"It‘s heartbreaking to watch these people drink themselves to death," said Pete Townsend, emergency services manager for Opportunities Inc. "But a lot of people don‘t want to get any better."
There‘s plenty of booze — and trouble caused by it — in Montana. The state ranks ninth overall in the amount of alcohol consumed per person. And state officials estimate that more than 120,000 Montanans have serious drinking problems.
Consequently, treatment centers fill up quickly — often with familiar faces.
In fiscal 1999, 4,450 Montanans were admitted to public and private state-approved inpatient programs for treatment of alcoholism. The majority — 2,350 — had been treated previously, 2,100 entered treatment for the first time.
The state continually spends more and more on the problem, the scope of which frustrates officials. Meanwhile, there are no new initiatives to dramatically change or expand treatment options in the state.
"I don‘t know how to do things differently," Gov. Marc Racicot said during an interview on the issue. "If I did, we‘d do it."
Inpatient treatment
The state‘s main treatment center is Montana Chemical Dependency Center, which institutionalizes and treats about 900 patients a year.
The average cost of treatment is about $3,660, and the hospital is usually close to full with a waiting list 50 names long.
State officials believe the center‘s abstinence success rate is a little better than the national average because its program continually incorporates new strategies.
The center incorporates medical care, detoxification, counseling and intensive education in its regimen.
The result: "We‘ve been seeing fewer readmissions these days and more first admissions," said Roland Mena of Helena, who heads the state‘s substance abuse unit.
There are some drugs, like Naltrexone, that seem to reduce the craving for alcohol, but MCDC generally doesn‘t use them.
"It‘s fairly expensive to use them," Mena said, "and there‘s some controversy over their effectiveness."
Instead, patients are encouraged to eat better, sleep better, talk with other patients and work out their problems with counselors before they go into an outpatient program.
Private treatment
Benefis Healthcare has one of eight private facilities in Montana offering inpatient treatment.
State figures show the average cost of private treatment is $8,250, while it‘s $9,750 for a 30-day stay at Benefis. Many insurance policies cover alcoholism treatment.
The private hospitals had a 42 percent occupancy rate during a three-month period earlier this year.
So far this year, Benefis has treated 110 patients in its detox unit, 74 in its inpatient program, 112 in its day therapy program and 256 who receive outpatient therapy.
At Benefis, the emphasis is on motivation.
"Without motivation, it doesn‘t matter what other resources you have," said Dirk Gibson, supervisor of the Addiction Treatment Center at Benefis. "Without motivation, you have nothing."
One way to do that is by stressing the pleasure alcoholics can find by changing their lifestyle.
Another is by stressing the pain they can avoid by quitting drinking.
A lot of people realize that on their own, said Dr. Dan Nauts, medical director of the Benefis Addiction Treatment Center.
"A majority of the people who quit abusing substances do it on their own without treatment," Nauts said. "Fifty percent of heroin addicts who stop using do so without treatment.
"Motivation is really the key," he added.
One critical aspect is an intensive assessment in which counselors carefully listen to a patient to understand individual concerns, Gibson said.
He cited the case of a retired military officer, intelligent and well read, who kept drinking himself into the hospital‘s detox center.
They worked to find a reason to keep the man from drinking, but couldn‘t. Even death wasn‘t a threat.
But when they told him he was likely to die in a nursing home, unable to control his movements or his bowels, that struck a nerve.
"He called me a month later and said, ‘I‘m ready to make a change,‘" Gibson said. "And he did."
Benefis doesn‘t keep track of its success rate, partly because it can‘t decide what to measure, Gibson said.
"We do ourselves a disservice if our only goal is abstinence," Nauts said. "We need to look at outcomes including health, healthy relationships, staying out of trouble, keeping a job."
Group therapy
Once counselors see the encouraging signs of reform, they send their clients to Alcoholics Anonymous meetings, where people with the same problems offer support.
AA groups may include people who‘ve been through treatment, or those working to overcome alcoholism on their own.
The program teaches addicts that they must turn their lives over to a higher power because alone they are powerless to deal with alcohol.
"AA has a tremendous track record," said Rod Robinson, director of Gateway Recover Center.
There are more than 89,000 AA groups meeting around the world, including 54 meetings per week in Great Falls alone.
A national membership survey found that the average member has been sober for five years. But that doesn‘t reflect the many who fell off the wagon.
AA members tend to men, with an average age of 42.
"We used to require all our patients attend AA, but now we only make those who fit the profile go to AA," Gibson said.
He said counselors will work to find alternative social support systems for teen-agers, Native Americans and women.
Abstinence is elusive
Statistics on even achieving abstinence aren‘t promising.
The National Institute on Alcohol Abuse and Alcoholism studied about 1,700 patients a few years ago. Of the patients institutionalized for treatment and receiving aftercare, only 44 percent managed to stay sober for three months.
And only 26 percent receiving outpatient treatment managed three months of sobriety.
"We can expect a good outcome in about 35 to 40 percent of the cases," said Dr. Richard K. Fuller, director of the NIAAA‘s division of clinical and prevention research.
"Alcoholism treatment helps a lot of people, but there‘s still a lot of room for improvement," Fuller said.
NIAAA‘s mission is to develop and test new alcoholism treatment to allow addicts a better change of recovery.
"We‘d like to improve our outcomes from 35 percent to 50 percent — or even better," he said.
However, Mena views relapse as merely part of the treatment process.
"Each time a person returns to treatment, we don‘t view it as failure," he said. "It‘s all part of a cumulative process of turning someone‘s life around."