Alcohol program review

A change in leadership at the Alcohol Abuse Deterrent Program presents an opportune time to review the entire program – not only its management, but its effectiveness, safety and value in light of new developments in alcohol-abuse treatment.

The non-profit program’s board of directors recently sent a letter to Terry Yeiter, executive director of AADP since 2000, asking him to step down. Win Rood, the board’s chairman, said the board had lost confidence in Yeiter’s management abilities, including the lack of a sound accounting system for medication distributed by the program.

The rumor mill suggested there was medication unaccounted for and reports of overcharging. Rood said an investigation found AADP actually had more pills than records showed, but they were at a different treatment location.

AADP was established to provide an aversion-therapy alternative to incarceration for repeat drunken-driving offenders. Court-ordered participants take Antabuse, the brand name for disulfiram, which blocks the body’s ability to process alcohol and causes discomfort or illness when taken in combination with alcohol. Last year, AADP administered Antabuse or breath tests to about 1,500 people a week. Offenders are required to pay for treatment.

Questions about the program’s cost have long circulated. According to figures from the 990 form filed with the Internal Revenue Service, Yeiter earned $73,170 in 2006. That amount was down from 2005, when he earned $85,239 in salary and benefits and 2004, when he earned $91,897. Five other AADP employees earned more than $57,000 in 2006, and contracts for medical and legal services totaled more than $319,000.

To its credit, Rood said the board will re-evaluate the organization’s structure. A full audit will be performed.

In its inquiry, the non-profit board should engage in serious self-examination beyond any search for wrongdoing or mismanagement. Certainly, AADP is a less-costly alternative to locking up repeat DWI offenders, but is it the most cost-effective alternative? Do the medical and constitutional questions about Antabuse treatment warrant its continued use? The program has been the subject of legal challenges, and there are questions about the drug’s effect on the liver.

Allen Circuit Judge Thomas J. Felts, who orders some offenders to the program, said that he is re-evaluating the best course for felony drunken-driving cases in light of the developments at AADP but said the program has been doing a good job in spite of the director’s departure.

“We are in good communication about what steps they are taking,” Felts said. “What direction we take will be based in large part on what their audit and investigation finds. It will help me in my determination of where the board should go.”

The judge said the prosecutor’s office and adult probation will also help to determine the outcome. “We’re all partners in this,” he said. “It’s a countywide approach.”

The judge said that none of the options for handling felony cases is perfect, but the goal would be to find the best.

Some state and local corrections systems are turning to the use of technology, including a new ankle-monitoring system that detects alcohol consumption by the wearer. The device is in use in 44 states, including Indiana. Felts said he was at a conference where Indiana University medical school representatives reported high error rates with the system, but he acknowledged that some judges and probation officials in Marion County were pleased with results there.

AADP has served the probation and court system in Allen County for almost two decades, undoubtedly saving lives in the process. But every organization demands review over time. The problems that arose in the deterrence program and resulted in its director’s departure prove the review at AADP is overdue.

source: Journal Gazette Forth Wayne, Indiana

More time needed to evaluate mandatory detox for youth conference

The effectiveness of locking up addicted teens against their will appears to be successful, but more time is needed to evaluate the programs, say officials from the three Prairie provinces that offer the service.

Legislation on mandatory youth detoxification has been in effect in Alberta and Saskatchewan for more than a year, and for almost a year in Manitoba.

"Youth detox quicker than adults and so this isn't treatment, this is simply getting the drug out of their system and getting them somewhat stabilized in order to move on to another treatment," Lorri Carlson of Regina Qu'Appelle Health Region said Tuesday after a session at a national substance abuse conference.

The legislation came about mainly due to pressure from parents of teens who abused crystal methamphetamine and who felt they had no other way to get their children help.

"It was largely parent-driven," Beverly Mageau of Manitoba Health and Healthy Living told delegates.

Since Manitoba's program began last December, Mageau said only about three per cent of the 57 teens forced into detox have reported crystal methamphetamine use. In Saskatchewan, of the 142 teens that have been in the safe house, only 12 reported using crystal meth.

All three provincial programs have found the substances most abused by teens are marijuana, alcohol and crack cocaine.

"It was a big concern, everyone was concerned about crystal meth," Mageau said in an interview.

"We had a lot of discussions and a big crystal meth strategy and maybe that had something to do with it, I don't know, but the result now is crystal meth has not become the problem that was anticipated."

Susan McLean of the Alberta Alcohol and Drug Abuse Commission, which runs the safe houses for youth ordered into detox, agreed, saying the numbers for crystal meth are similar in Alberta.

Between July 2006, when Alberta started the program, to April 2007, 351 youth were ordered into safe houses, and 49 per cent continued treatment voluntarily after being let out.

McLean said further evaluation is needed to find out why the other 51 per cent did not want to voluntarily get further help for their addictions.

All three provincial programs target teens under 18. While the legislation is worded differently, all essentially allow parents and guardians to apply to the court to have their child assessed and ordered into secure detoxification for a specified period. Saskatchewan is the only jurisdiction to allow police to apply for the order.

In Alberta and Saskatchewan, it's up to five days, while in Manitoba it's seven days.

Saskatchewan can have more time to help teens because their certificates, or orders, can be renewed up to three times, for a total of 15 days," Carlson said.

"The longer that they're in youth detox, we find, the more willing they are to go voluntary treatment, so if we see some growth we actually can keep them a little longer."

Heather Clark of the Canadian Centre on Substance Abuse told delegates that they have found some obstacles to the programs.

They include community opposition to having a safe house in their neighbourhood; transporting youth to and from the safe houses; having enough addictions specialists to perform assessments; and high turnover of staff.

A health worker from Nova Scotia told people at the session the legislation is a great idea.

"When I first heard of this a year and a half ago, I cheered. I'm a parent, this makes total common sense to me as a parent," said Blair Gallant of Capital Health in Dartmouth.

"I wish I was in one of these three provinces, where I would have somewhere to turn. In the province I currently live in, I don't.

"My son would just run the streets, which is unfortunate, because a lot of people think he should just run the streets because he has rights," he said to laughter from the crowd.

Clark said all three provinces are collaborating to share information and to evaluate their programs so as to make it better.

"When these facilities first opened, there were a lot of questions, like, OK, does it work? Right now we actually need to learn about our target group, assess them and make sure we have the services in place before we start to ask those questions, and that takes time."

author: Mary Jo Laforest

source: The Canadian Press

Push to help prisoners beat their addictions

Four out of five prisoners have alcohol or drug problems but only a fraction have access to treatment, says outgoing Corrections Minister Damien O'Connor.

The Drug Foundation says a fresh approach is needed to stem drug abuse among offenders, giving them treatment when they first arrive behind bars and keeping it going after they leave.

Speaking at an addiction conference in Auckland yesterday, Mr O'Connor cited research showing 89 per cent of serious offenders were under the influence of drugs or alcohol leading up to their offence, and 80 per cent of inmates have had a substance abuse problem at some point in their lives compared with 13 per cent of the general population.

"Despite the significant relationship between substance abuse and crime, only a small proportion of offenders with substance abuse problems actually receive treatment."

However, the Government was taking the problem seriously, by expanding drug treatment units in prisons, he told the combined Australasian Professional Society on Alcohol and other Drugs and Cutting Edge addiction conference.

A new treatment unit was opened at Rimutaka Prison in Upper Hutt last month and another is due to open at Spring Hill Prison in Waikato in July 2008, boosting the system's capacity to treat about 500 people a year. There are 8000 prisoners nationally.

In a pilot programme, health professionals will work at police stations and in courts to identify offenders with substance abuse problems and help refer them for treatment.

"Currently there is no national framework or standard for court-ordered AOD (alcohol and other drug) assessments, but work to develop this is nearly complete," Mr O'Connor said.

Drug Foundation senior policy adviser Keriata Stuart said the Government had to address the "huge problem" of drug abuse among offenders.

She said more "seamless care" was needed: assessing people when they first entered the criminal justice system, giving them the full range of rehabilitation services and following them up after they left prison.

Prison at least offered a captive market, she said.

"It's not an ideal place to create a therapeutic environment but it is an opportunity - people are very focused on making changes and if they have access to assessment and rehab services and continued support, they can succeed."

The foundation is also pushing for more harm-reduction programmes (including needle exchanges and extending the prison methadone programme to new clients) and more specific interventions for young people, women and other groups.

source: Dominion Post