Arise closing worries those who work with substance abusers

Those who work with substance abusers say the fallout will be felt across the city — from crime rates to human casualties — with the closing of the 28-day Arise residential program.

The end comes Tuesday with the beginning of the 2008-2009 fiscal year. The Central Virginia Community Services decision was based on the residential treatment’s high cost and low reimbursement.

The board of directors of the Lynchburg Bar Association sent an open letter to the CVCS board of directors, asking that the program be kept alive.

The letter, drafted by Lynchburg attorney B. Leigh Drewry, said that lawyers see the effects of alcohol and drug dependence/addiction throughout society — broken homes, neglected families, foreclosures, illness and crime.

The problem is huge, the letter said, “but it does not mean we as a community can not stop it, nor does it mean Central Virginia Community Services (CVCS) can run and hide from the problem under the pretense it must set aside money for other concerns.”

The trend of closing residential programs is a national one, the letter said. The people needing residential care, the letter reads, “are more likely to be indigent or among the many individuals with inadequate health care, further progressed in their illness, and having fewer recovery resources.”

Lynchburg Commonwealth’s Attorney Mike Doucette sent the CVCS board an additional letter stating his agreement with the Bar Association. In the letter, Doucette wrote, “Many prosecuting attorneys also recognize the pitfalls of discontinuing residential substance abuse treatment.

“We all recognize that the CVCS decision is a financial one and not a therapeutic one. I urge the Board to work in conjunction with local, state, and national governmental figures to find a financial solution to this dilemma,” wrote Doucette, who argued the financial costs from untreated

substance abuse “makes the case for the need for enlightened leadership.”

CVCS is setting up a broadly representative task force to look at alternative housing for people in recovery.

Nancy Cottingham, CVCS executive director, said the hope is to find funding options for alternative housing programs such as Oxford House, a sober living community.

Such programs help people continue their recovery, but do not serve “as a replacement for the Courtland residential program,” she said.

With the changes, CVCS will be able to boost coverage for outpatient care.

According to the Department for Medical Assistance Services, new Medicaid coverage areas for substance abuse as of July 1 include assessment and evaluation, outpatient treatment, crisis intervention, case management, intensive outpatient treatment, day treatmen, and opioid treatment.

The Bar Association letter called for a comprehensive system for substance abuse care, including case management, and suggested that additional financing could come by seeking grants and by adjusting the budget to reflect the mental health or mental retardation numbers within the substance abuse population.

The Department of Corrections District 13 office of Probation and Parole works directly with the societal impact of substance abuse.

“It’s one less option that we have to use before we return someone to court as a violator,” said Mary Basten, Lynchburg chief of probation and parole.

“We have an intensive outpatient program we operate here in-house and Arise has intensive outpatient as well. The next step beyond that would naturally be the residential treatment program, where we would refer the more serious offenders who needed extensive treatment.

“The continuum of treatment for more serious offenders is gone and no other viable options are currently available in our locality.”

Jon Winder, a counselor and a former director of the Arise residential program, is in private practice. In a presentation to the board in May, he cautioned that the closing would have a big impact — “more people occupying the emergency room and hospital intensive care, and even more unfortunately, they will end up in the criminal justice system.”

He said only a small portion of public money goes to substance abuse treatment nationally.

“I know this imbalance in part comes from the stigma of addictions. I do not fault the CSB for this, but certainly we need to re-examine this,” Winder said.

Many local agencies work with people who have addictions.

Rhonda Ford is executive director of Miriam’s House in Lynchburg.

Ford was caught by surprise when the CVCS board announced the closing.

It is not unusual for someone to enter Miriam’s House after coming through the 28-day CVCS program, she said. That meant assurance of nearly a month of clean time — but even then a woman can be very fragile in recovery.

Miriam’s House doesn’t expect instant cures, “because of the nature of the disease,” she said. “We see recidivism in the homeless population” she said, but they’ve also seen successes that continue in their success.

“This is going to impact homeless programs,” she said.

Lisa Dibble, executive director at The Gateway, a transitional program for homeless men, said the closing means that coming into The Gateway, “the people won’t have as much clean time as previously.”

It takes time to build strength, to put a support network in place, she said.

“We feel like it’s going to negatively impact the community,” she said. “People won’t get help who previously did.”

Add to that the precarious state of The Gateway’s budget, which Dibble said has now put it at risk of closing.

The United Way of Central Virginia’s 2007 needs assessment states “the vast majority who are experiencing dependency on alcohol and/or drugs are not receiving needed treatment. The consequences of these untreated conditions reach into every facet of life.”

Mary Read Gillispie, executive director of Central Virginia ASAP (Alcohol Safety Action Program), said that over a year’s time, about 900 to 1,000 people come through Central Virginia’s ASAP program, she said.

Referrals from the courts, dealing with DUI offenders and first-offense marijuana possession cases are screened to determine what part of the program they go into. If treatment is needed, then Courtland Center is a provider that can be used.

Most often people start in an outpatient setting, she said. If therapists say they need more, then the therapist makes the referral for more intensive treatment.

Now the city will likely lack those kinds of referrals.