Thursday, April 30, 2009

Taking Out the Trash

Shortly after I left the full time practice of law to run a chemical dependency treatment center in 2001, a friend asked me if treatment works. I observed that it seemed like 20% of the patients who went through treatment succeeded in staying in recovery after a single rehab experience. 20% of the patients would never recover from their chemical dependencies no matter how many times they went through a treatment program (the so-called "Lost"). The remaining 60% were an unknown. Their likelihood of success depended on the treatment experience, the appropriateness of the program, the skill of their counselors, the support of their families and their ability to deal with their unique personal struggles and willingness to give sobriety a try. For the entire six years I worked in the field as an administrator, the 20/40/20 ratio continued to ring true.

I've been thinking a lot about the lost 20% lately because if we accept the premise as true,
i.e., the Lost are never going to benefit from chemical dependency treatment and learn to live normal, productive lives, then we have to acknowledge in this era of hope with increasingly limited resources that the costs of supporting the Lost are expensive, long term propositions. We also need to acknowledge that it may not be appropriate to allocate resources as we have historically to care, and coddle, the Lost, while so many members of society are, as a result, denied access to remedial resources.

I am mindful of, and have long admired, Hubert Humphrey's observation that the true measure of a society is how it treats its most vulnerable citizens. To be clear, I am not speaking of persons with mental or physical infirmities that make successful chemical dependency treatment or to otherwise function productively in society impossible.

Rather, I am talking about the segment of society that consciously chooses to play the "treatment game", bouncing from program to program as an alternative to accepting the responsibilities of employment, parenting, self-betterment and other
indicia of adulthood. Too often, these Lost fly below the radar of societal scrutiny, relying on commonly held perceptions of the challenges of chemical dependency to avoid being held accountable.

In the past, taxpayers just paid for the Lost to attend one treatment program after another, often with a short hiatus between episodes of shelter in well-intentioned licensed facilities. The financial impact was enormous, but it was a price society quietly paid to warehouse the Lost. Three years ago, my employer received about $2,500 a month for counseling services rendered to each client. Using my 20% rule, at any one time, the treatment center was home to 15 clients who I'd consider part of the Lost. On an annual basis, that amounts to providing treatment for 180 of the Lost. At $2,500 apiece, it cost taxpayers $450,000 a year, effectively wasted, to treat the Lost. $450,000. One treatment center in the "Land of 10,000 Treatment Centers". Wasted.

So, what do we do as a society? How do we justify wasting such vast sums of taxpayer money with minimal likelihood of success when so many programs are being cut or eliminated and so many of the vulnerable adults championed by Vice President Humphrey are going wanting?

I recently posed this question over lunch to a friend who is a former officer of the local N.A.A.C.P. I'll call him "Jeff". His answer was startling, probably because it was not the usual "society cannot give up on those who struggle". Jeff responded that it was like clearing garbage from one's home when its accumulation impairs the living environment: "We have to take out the trash".

The scope of the topic of our concern went beyond the chemically dependent who were incapable of sobriety. It included generations of what are typically thought of as underprivileged residents of the community who are perpetually un- or under educated, employed and/or engaged in self-betterment. Focusing on the Black community, my friend observed that the election of our new president offers a positive role model for today's youth and that the ongoing race card blame game used as an excuse by many of their elders lacks credibility. Jeff suggested that it is time to move on from the chronically chemically dependent Lost and from those
unwilling to make any effort to reside in society as lawful, productive members.

But, of course, moving on has its consequences. To use Jeff's analogy, you still have to deal with the trash left behind. From Jeff's point of view, this requires establishing residential campuses where persons otherwise intent on disrupting society are required by court order to live. Residents would be responsible for maintaining their living quarters, assuring a drug-free environment and not tolerating lawlessness. Residents unable to abide by these guidelines would face jail time as a consequence of whatever conduct landed them in the residential campus in the first place. Eventually, the scufflaws would age to the point that they are not a threat to society as a whole or to themselves, and society will have survived to a clean start.

I cannot conceive of any cooperative effort by law enforcement, the judiciary, civil libertarians, social services and willing taxpayers that would allow the creation of such a system. The liberal in me fights the idea that we've sunk so far that intelligent men like Jeff, long involved in the Black community, see no viable alternative to the current situation or to the residential campus concept besides building more jails.

I am back to my original dilemma. I believe that we have a responsibility as a society to help those who cannot help themselves. But, what do we do with those who choose not to seek to partake in economic recovery? What do we do with those who have given up on themselves and choose the comfort of an artificial high to making the effort to live drug-free? As with the classic philosophical debate about the lifeboat carrying 7 people that can only sustain 6, we have some choices to make.

Government and philanthropic financial resources are increasingly precious at the same time they are in increasing demand. It simply makes no sense to deny services and support to persons with legitimate needs because we continue to throw money at others who are making a conscious decision to be wards of the state. Maybe cutting the latter group from support is a form of "tough love". But what then?

I have no answers today. I merely pose the question and ask that we keep in mind the billions of dollars that are wasted as governments and charities are being played for chumps. There are so many worthwhile programs that have done so much good for so many people. I witnessed the successes repeatedly during my six year stint in the social service community. The dilemma is not with the program participants who strive to achieve success. The problem is with the faux participants who park themselves at the public and philanthropic trough with no real desire to use the opportunity to make a difference in their lives.

What do we do? I welcome your comments.

1 comment:

Kari said...

Very thoughtful essay, Sam! You ask excellent questions. At what point are we allowed (or allow ourselves) to move on from a group of people that clearly don't want our help other than to extract whatever they can get from us to serve their own purpose? I think they are here in this earth to teach us something about ourselves--Not to give up on people? To know when to give up? To make choices consciously and with our whole heart no matter what the ultimate choice?