What's missing are the 400 clients a year that the BASIC staff through therapy, job counseling, day care and other services helped to start on the journey to recovery from lives mapped by despair, crime and death. Asked to comment on John F. Kennedy's assassination, Malcolm X infamously replied, "The chickens have come home to roost," implying that a country steeped in violence will see its leaders murdered. In a similarly ironic vein, New Orleans' empty treatment centers are now roosts for pigeons, the literal and allegorical symbols of the city's neglected outpatient rehab programs, while a growing population of addicts who need treatment are forced to make do on the city's streets.
Mike Duffy, assistant secretary for the Louisiana Office for Addictive Disorders (OAD), says there is a public misperception that the shortage of programs is the result of Katrina. Truth is, he says, there never has been "an adequate amount of treatment on demand." In 2007, OAD provided treatment services for about 58,000 people in Louisiana, but a study conducted before the storm found 318,000 people in the state who needed treatment.
The situation is worse in the Orleans metro area. Many psychiatrists and therapists who have worked with and studied the region's post-storm population have written about the growing number of people "self-medicating" to deal with the stress of life after Katrina. Duffy says his office looked at the reports suggesting an increase in substance abuse and found them to be accurate. "Initially, I was reaching almost 10 percent of the identified need pre-Katrina," Duffy says. "Post-Katrina, using the formula of SAMHSA (the federal government's Substance Abuse & Mental Health Services Administration), we're reaching about six percent."
Orleans, St. Bernard and Plaquemines parishes have a total of seven state-funded substance abuse clinics with outpatient rehab programs. The centers are managed by the Metropolitan Human Services District (MHSD) the administrative entity in charge of publicly funded services for addictive disorders, development disabilities and mental health in the three parishes. Dr. Jerome Gibbs, MHSD executive director, says that his outpatient clinics treat approximately 6,000 people a year. Taking into account OAD's figures, that leaves 100,000 people in need of substance abuse help.
'We are woefully unprepared to deal with these people and the conditions they bring," Gibbs says.
One of the most common conditions among substance abusers is a history of crime. Many of those who enter MHSD's clinics are noviolent offenders referred by the Louisiana Supreme Court's Drug Court. By agreeing to regular drug testing and treatment for their addiction, these defendants avoid jail time and receive other services such as job training and education in addition to treatment. Gibbs says that treatment can last anywhere from six months to a year or more and costs from $1,800 to $5,000, depending on an addict's needs.
Taking into account that the defendant is receiving care and not simply serving time, the cost of treatment compares very favorably with the expense of a six-month stay in Orleans Parish Prison, for which the city pays $4,273. The advantages of treating a person rather than incarcerating him are even greater when the defendant is sentenced to one of Louisiana's state correctional institutions.
According to statistics from the Louisiana Department of Public Safety and Corrections (DOC), the average cost to taxpayers for keeping an inmate in jail for one year is $14,815, with the average length of sentence running 7.6 years. This translates to $112,594 for an average stay in state prison at taxpayers' expense. Add to that the state's 48 percent recidivism rate, and one can double that figure to more than $225,000 as the taxpayers' cost for housing (but not treating) just one addicted inmate.
That figure becomes even starker in light of a study conducted at DOC's induction centers, where incoming prisoners are initially processed. The survey, a collaborative effort between DOC and OAD, revealed that 77.4 percent of those entering state prison required substance abuse treatment and 82 percent of them were nonviolent offenders.
Duffy doesn't dispute that at some point these nonviolent offenders chose to experiment with narcotics and/or alcohol. He adds, however, that addicts quickly lose their ability to choose whether or not to use dangerous substances, noting that many experts consider addiction to be a chronic disease requiring treatment. Unable to stop using, addicts often turn to nonviolent crimes such as petty theft to support their habits. Addiction also can be a contributing factor when addicts commit violent crimes.
'What we have is a public health issue that, if left untreated, becomes a public safety issue," Duffy says.
When the "issue" concerns public safety, individual costs skyrocket. Likewise, so does the DOC budget, costing taxpayers more than $350 million a year to house the more than 37,000 state offenders currently incarcerated in state or parish prisons. The total budget for OAD, which allows for inpatient, outpatient and prevention programs, is $108 million for 2007/2008.
At 803 inmates per 100,000 people, Louisiana leads the nation in the highest per capita incarceration rate.
Oval Miller, executive director of BASIC, offers a therapeutic alternative to imprisonment. Instead of paying nearly $15,000 for a year in state prison, Miller can provide a six-month substance abuse plan that includes treatment, daycare for addicted mothers, job training options and help with housing for a cost of just $4,700.
Before Katrina, Miller says, a client would spend eight hours a day at the center, working with counselors who used cognitive therapy to devise alternatives to using drugs or alcohol. Miller says BASIC had a three-week waiting list, and the center did what it could to bolster clients' resolve once they joined the program.
'That person has to get enough strength here during that eight hours to leave and go home and come back the next day," Miller says as he walks around the offices of the closed center. "You have to give them something."
More than anything else, the program gave its participants hope. Miller says that's one of the most important tools for treating addictive disorders, especially among those living in poor neighborhoods. In communities with rampant crime, high unemployment and drug dealers peddling temporary escape on any given corner, there's not much to break the pattern of what Miller refers to as "hopelessness, lack of purpose and lack of love for self."
When Miller founded the BASIC program in St. Louis in 1983, he recognized that in order for counselors to assist disadvantaged drug abusers from poor areas, they had to first understand who these people were and where they came from. He decided that his program should be culturally specific and focused on the African-American community. The majority of BASIC's counselors and social workers are African American, and many are from their clients' neighborhoods or similar communities.
'Programs can best provide services if we understand the cultural context in which the use or misuse develops," Miller explains. "What's the environment what's it like? What are the job opportunities? What's the educational level of achievement? If you don't understand that, how do you prepare a person to go back to it?"
Gibbs agrees with Miller that cultural competency is critical, and although he considers it a goal for his treatment centers, it isn't something all of his staff can bring to the treatment table. "Many persons in our system," Gibbs says, "don't understand and haven't been trained in the concept of cultural competency."
The St. Louis BASIC program was originally funded via assistance from the Griesedieck Foundation and St. Louis business leaders. Miller realized these private funding organizations would expect results, so he created an alumni association to keep track of his former clients. Graduates of the program continue working on their own recoveries while "sponsoring" new members much like Alcoholics Anonymous does in its program. The center doesn't limit itself to indigent clients; if an addict can afford to pay for treatment, they must do so. Others pay according to a sliding scale, but all go through the program together.
Richard Ager, an associate professor with Tulane University's School of Social Work, says support groups such as those used by BASIC and similar programs can be very advantageous for recovering addicts. "It's an excellent network," says Ager. "If you're connected with them after treatment, you can continue the support and recovery."
The results are impressive. Miller reports that 85 percent of his clients who complete the program are still sober a year later. He gives most of the credit to the efficacy of the initial treatment and the alumni association. In 1986, the BASIC center in St. Louis began receiving federal assistance and today is contracted as a service provider by the Missouri Department of Mental Health.
In 1994, Miller brought BASIC to New Orleans. Mayor Sidney Barthelemy convinced the City Council to donate the arched brick building on South Jefferson Davis Parkway to BASIC. With startup funding from the Lupin Foundation, the center began treating clients. Like the St. Louis facility, the New Orleans center took all comers and received some operational support from the state.
Miller says the state funding halted in 1996 beginning with the administration of former Gov. Mike Foster. Despite having to pay four full-time employees and five part-time employees, the center managed to continue operating on limited funds from its paying clients, but with most of its money coming from the St. Louis alumni association. Faced with the need to cut costs, however, the center reluctantly cut insurance on the building.
Then came Katrina.
'We chose between cutting these clients coming to us asking for help and doing something we knew we should be doing, which is protect the building," Miller explains. "But the bottom line is, even after [the loss of state funding], we continued to provide services."
After the storm, Miller cleaned out the building and began making plans to bring back the center, but the storm-related damage was so extensive and mounting because of the repeated looting that he has had to seek help outside of his organization. One of his efforts has resulted in next week's musical fundraiser, "Back To BASICs," an evening with R&B legend Maze (featuring local favorite Frankie Beverly). The event will take place Friday, Feb. 29, at the Morial Convention Center. Ticket proceeds and various levels of available sponsorships will go toward the local center's reconstruction costs, which are expected to exceed $500,000. Gambit Weekly is among the sponsors of the event.
Miller also hopes that local carpenters, electricians and other skilled craftspeople as well as business leaders will volunteer their services in the recovery effort. He reasons that it makes sense to turn to the community as a whole at this time, especially the business sector, because the effects of drug and alcohol abuse reach well beyond the individual addict, particularly when addictive behavior becomes criminal.
'A guy with a $100-a-day habit has to steal $300 a day to support it because he only gets one-third for whatever he sells," Miller says. "You start adding that up and that's why your jails are full."
Overcrowded jails and prisons aren't the answer, insists OAD's Duffy, explaining that addiction is a brain disorder that must receive treatment. Society cannot "punish addiction out of people," he says. Tulane's Ager agrees. "When we don't cure the problem, are we creating worse ones? If you pay up front, you pay far less."
Last November, Orleans Parish Criminal Sheriff Marlin Gusman, who oversees the city's jails, submitted a $27 million budget to the City Council. He hopes to have more jail space available in 2008. Gibbs at MHSD says he spends somewhere between $4 million and $5 million on outpatient drug treatment centers in Orleans, St. Bernard and Plaquemines parishes combined.
Meanwhile, at the boarded-up BASIC building in Gert Town, the pigeon population keeps growing.