http://thesinkingfeeling.blogspot.com/2006/05/funding-hell.html
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I'll say at the outset that there are good treatments for addiction out there. They save lives, many lives, have saved some lives that I'm particularly fond of. I'm not hostile towards the addictions industry per se, though it is an industry, and one that has direct and violent consequences when it goes bad. I had a re-education in that this week, over lunch with a former colleague.
My friend deals primarily in working inmates out of the system, through transitional living, post-incarceration employment and housing, and, of course, addictions treatment. Most of the inmates that my friend works with are on methadone. Oh, <http://www.opiates.com/opiates/methadone-addiction-detox.html>methadone. Takes the bite out of withdrawal symptoms. Does it so good, a person won't even realize that now they've got a whole new addiction that they never bargained for, and sometimes a worse one: withdrawal from methadone, while generally not as acute as heroin, is more protracted. Methadone really represents an attempt to downgrade an addiction more than treat it. Its dangers aren't well-recognized, have not been well-publicized, and certainly a person looking for help would like to believe the best about the help they're getting. Ideally, a lot of careful monitoring and psychological evaluation goes into methadone treatment. Ideally. In a perfect world. Or even in a world that at least pretended to give a shit.
So my friend explains that she's looking for a job. I ask her why, and she tells me that she just can't do it anymore. She's burnt out. She's having a crisis of conscience, she tells me, and she knows that looking for another job is a cop-out, but she doesn't have the balls to confront the situation head on, and she certainly can't continue participating in it. I ask her what that situation is, and I can tell she's been dying to tell it to somebody, because she talks without pause for five minutes.
One particular clinic that she deals with regularly has an unspoken policy of not treating the patients that get referred to them. Oh, they give the folks their methadone. And they keep them on the same dosage, steady as it goes, no attempts to decrease the dosage, no attempts to find inpatient treatment where such a course would be recommended by their own guidelines, charts that are...not falsified, but bullshitted, shall we say. The rate at which they spit people back into the system, said my friend, nearly paced general recidivism rates, meaning that they had failed at one of their primary purposes as one of many small parts working towards helping those in transition become whole again in a non-institutional environment. They are not doing that. They are, in fact, playing into the exact same games that have kept many of their patients running in a cycle of jail/rehab/jail/rehab for more years than most of them can remember.
Why is this happening?
Very simple, and I had deduced the answer myself even before my friend confirmed it. The clinic gets funded for every patient they treat. Because their clientelle is comprised entirely of former inmates, recovery failures are quite easily placed at the patients' feet, and no one sees fit to question it. Well, that's beautiful. Of course they don't want anybody to get well. That would mean money walking out the door. Even better if the patient's failure means a return to prison. That means they'll be back, a fresh new batch of funding.
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