It’s important that we not blame homeless substance abusers seeking detoxification for the high cost of these services in hospitals.
I have seen many of these “frequent fliers” come into our out-patient programs burdened with multiple psychiatric diagnoses, chronic health conditions like H.I.V./AIDS and hepatitis C, criminal backgrounds and long histories of drug-treatment failures.
April 23, 2007
When an Addict Finishes Detox (4 Letters)
To the Editor:
Re “Revolving Door for Addicts Adds to Medicaid Cost” (front page, April 17):
We applaud New York State’s efforts to reduce costly inpatient detoxification services and improve the overall quality and outcomes of care. It is essential that savings from these efforts be reinvested in effective community-based chemical dependency services.
Housing remains a critical issue, and New York City and State have committed to programs that will build 1,500 units of supportive housing for people with addictions, increase case management and provide detoxification services in homeless shelters.
Yet much more remains to be done to reduce chemical dependency in New York City. We must scale up our use of “brief intervention,” a technique proved to reduce problem drinking, and continue to expand the use of buprenorphine, the first new treatment for opiate addiction in four decades.
Joshua Rubin
Assistant Commissioner for Mental Hygiene Policy
New York City Department of Health and Mental Hygiene
New York, April 18, 2007
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To the Editor:
For homeless substance abusers undergoing detoxification, the transition to a long-term treatment program strongly influences whether they will stay clean.
Fumbling this transition increases the likelihood of a relapse, and in my research this factor is especially significant for the homeless. A return to the chaos of city streets typically lays waste to well-intentioned plans for outpatient follow-up.
In studies of homeless substance abusers from Boston and Birmingham, Ala., one treatment component consistently stands out as essential: a roof. Unless New York assures its homeless a secure environment in which to continue addiction treatment (and commits the necessary funds), the revolving door of detoxification will continue to spin.
Stefan G. Kertesz, M.D.
Birmingham, Ala., April 17, 2007
The writer is an assistant professor at the University of Alabama at Birmingham School of Medicine.
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To the Editor:
It’s important that we not blame homeless substance abusers seeking detoxification for the high cost of these services in hospitals.
I have seen many of these “frequent fliers” come into our out-patient programs burdened with multiple psychiatric diagnoses, chronic health conditions like H.I.V./AIDS and hepatitis C, criminal backgrounds and long histories of drug-treatment failures.
I believe that our treatment programs for this population are too rigorous, all too often reinforcing a sense of failure and despair. Many participants are simply not ready to be abstinent. We need to develop interim models that can meet them on their level and help them to learn about their conditions and develop the necessary coping skills.
Programs like these could allow the homeless drug user to “graduate,” as a way of building self-esteem and a sense of accomplishment that could ultimately lead to abstention from drugs or alcohol.
Howard Josepher
New York, April 18, 2007
The writer is executive director of Exponents, a nonprofit group helping people with drug problems and H.I.V./AIDS.
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To the Editor:
New York State’s heavy use of inpatient detoxification does indeed relate to issues beyond the hospital, such as lack of housing and inadequate management of the transition to outpatient treatment.
But it is critical that the public understand that inpatient detoxification is necessary when a lesser level of care would be unsafe, such as when patients have seizures, histories of delirium while detoxifying or cannot abstain from drugs or alcohol after several outpatient attempts.
When the state’s Office of Alcohol and Substance Abuse Services asserts that 80 percent of patients in medically managed detoxification are “uncomplicated,” it is using the word the way Medicaid billing does. This fails to take into account problems such as mental illness that impede addiction recovery.
Hospitals implicated in this problem must be part of the solution and address the broader system of services that is failing these patients.
Richard N. Rosenthal, M.D.
New York, April 18, 2007
The writer is chairman of the psychiatry department at St. Luke’s-Roosevelt Hospital Center.
