Alcohol & Substance Abuse

Juneau is getting a new kind of apartment building. The Housing First Project in Lemon Creek is built to provide safe, affordable housing to the city’s most vulnerable homeless individuals.

The outside of the building looks mostly finished, but inside the apartments are still bare plywood and studs. Each of the 32 efficiency apartments is small – about as big as a row of three parking spaces. Each one will have its own private bathroom and a small kitchen area.

Workers broke ground for the facility in May, but the concept has been in progress for over four years.  Almost a dozen organizations and agencies have been involved. The Glory Hole, Juneau’s downtown homeless shelter, is managing the project. Mariya Lovishchuk is the executive director of the Glory Hole.

“I am just so excited to be standing in this building right now and, like, actually have a floor and walls and windows and not just, like, an idea in my head,” said Lovishchuk. “That’s really, really awesome. And also I can’t wait — like, I can’t wait to see people in here.”

Lovishchuk said the future residents will be the most at-risk chronically homeless individuals in Juneau, as measured by a vulnerability survey. Lovishchuk said this building will be a place for people to live who have had trouble with other housing programs.

“They end up getting evicted because there are rules about drinking,” she said, “And people are not able to follow those rules and so they get evicted because of that, or people have to participate in treatment and people fail out of that housing because treatment has not worked for them even though they’ve tried, like many of our clients have been to treatment programs, you know 20 times in their lives with no success.”

The Housing First approach does not require treatment or sobriety as a condition of housing. Services and treatment for residents will be available in the building, and will include medical exam rooms and a space for mental health counseling.

Supporters of housing first say that having a stable place to live makes it easier to address the underlying causes of homelessness.

The transition to housing can be rocky for people who have been homeless for a long time. The Housing First facility in Anchorage, Karluk Manor, has found it challenging to track down people on the waiting list and help them adjust to the housing facility. They have placed restrictions on visitors and certain types of alcohol.

The Juneau Housing First Project still needs about a million dollars, which it plans to raise with capital grants and local support through the Juneau Community Foundation.

Lovishchuk expects that facility will be completed in May and the first residents will be able to move in by early summer.

In 1964, the U.S. surgeon general released a report on the health impacts of smoking, and it shaped the public and government’s attitudes toward tobacco for years to come. On Thursday, another surgeon general’s report was issued, this time tackling a much broader issue: addiction and the misuse and abuse of chemical substances. The focus isn’t just one drug, but all of them.

Though little in the report is new, it puts impressive numbers to the problem, and some surprising context: More people use prescription opioids than use tobacco. There are more people with substance abuse disorders than people with cancer. One in five Americans binge drink. And substance abuse disorders cost the U.S. more than $420 billion a year.

Dr. Vivek Murthy, who is closing in on his second year as surgeon general, told NPR’s Steve Inskeep Thursday on Morning Edition that he hopes putting all the data together will help Americans understand that these problems share a common solution. And it starts with kids. Their conversation has been edited for length and clarity.

Interview Highlights

On the prevalence of substance abuse in the United States

An estimated 20.8 million people in our country are living with a substance use disorder. This is similar to the number of people who have diabetes, and 1.5 times the number of people who have all cancers combined. This number does not include the millions of people who are misusing substances but may not yet have a full-fledged disorder. We don’t invest nearly the same amount of attention or resources in addressing substance use disorders that we do in addressing diabetes or cancer, despite the fact that a similar number of people are impacted. That has to change.

We now know from solid data that substance abuse disorders don’t discriminate. They affect the rich and the poor, all socioeconomic groups and ethnic groups. They affect people in urban areas and rural ones. Far more people than we realize are affected. It’s important for us to bring people out from the shadows, and get them the help that they need.

On the economic impact of substance use disorders

The impact this is having on the health and well being of our country, as well as our economy, is quite staggering. These substance use disorders cost over $420 billion a year in the form of health care costs, lost economic productivity, and cost to the criminal justice system. We measure numbers like this for other illnesses, too, and the cost for substance abuse disorders far exceeds the cost of diabetes.

On shifting views of substance disorders

For far too long people have thought about substance abuse disorders as a disease of choice, a character flaw or a moral failing. We underestimated how exposure to addictive substances can lead to full blown addiction.

Opioids are a good example.

Now we understand that these disorders actually change the circuitry in your brain. They affect your ability to make decisions, and change your reward system and your stress response. That tells us that addiction is a chronic disease of the brain, and we need to treat it with the same urgency and compassion that we do with any other illness.

The opioid crisis has certainly received a lot of attention, and it is certainly tearing apart families and costing us in terms of lives lost and health care dollars. But in terms of actual cost, we lose the most lives and suffer the most costs from alcohol related disorders and alcohol related addiction. In 2015, about 66 million people reported that they’d engaged in at least one episode of binge drinking in the previous month. That’s a pretty astounding number. And in 2015, roughly 28 million people reported that they had driven under the influence of drugs and alcohol.

On what we can do to curb the addiction epidemic

There are prevention strategies and treatment strategies that can address multiple substance use disorders. Some of these programs are school-based, college-campus-based, and community-based, some online and some in person. Many — particularly the school-based programs — teach children how to manage stress in a healthy way, because stress is one of the reasons people turn to substances like alcohol, illicit drugs and prescription painkillers. The programs also teach them about substances of misuse, and teach them how to refuse tobacco and alcohol and other illicit substances when they’re offered.

The problem that we have right now is that we’re not implementing many of these evidence-based interventions.

While we’re calling people’s attention to some pretty stark statistics, I also want to recognize that there are reasons to be hopeful. All across our country we have examples of communities that are starting to step up and implement prevention programs and treatment programs. And peoples’ lives are changing as a result of that. We’ve been dealing with substance disorders for centuries. What’s different now is that we have solutions that work.

On continuing this work under the Trump administration

People on both sides of the aisle state clearly and in unequivocal terms that substance use disorders are a problem that we have to address now, because they are tearing apart our communities. So I am hopeful that we are all on the same page when it comes to addressing this crisis — and addressing it urgently. I’m looking forward to working with the next administration to do so.

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

Inpatient treatment programs for heroin and opioid dependence can be so difficult to get into in some parts of the country that drug users who want to quit are voluntarily asking judges to lock them up — just to guarantee they’ll get help.

In Massachusetts, that’s happening via a 46-year-old law that was designed for family members to commit their loved ones to a locked facility when they are deemed “a danger to themselves or others” because of drug or alcohol abuse. But as more people struggling with addiction are actually requesting this sort of lock-up, some are questioning whether “voluntary” court-ordered commitment for treatment of substance abuse is a good idea.

On a bench outside a Springfield, Mass., courtroom recently, a 33-year old man looked more alert than you might expect for someone coming off a heroin binge. He’d previously been clean for two months, he said, but couldn’t maintain it.

“Now I’m probably doing two bags,” he said, “and it’s getting me high as a kite.” He still very much wants to quit, he said. NPR agreed not to disclose his name.

The man said he’s been spending $1,000 a week on heroin, scaring his family and scaring himself. They’re all worried he’ll overdose. That’s why, even though it would mean giving up his liberty for up to 90 days, he was in court that day to ask the judge to lock him away — inside a treatment program that he wouldn’t be allowed to leave, far away from his dealers.

“If I don’t do this, I’m going to lose my freedom eventually anyway,” he explained. “Eventually, I’m going to get enough charges to the point where I go to jail anyway.”

Massachusetts is one of 38 that allow civil commitment for substance abuse.

“Basically, it’s a good way to get clean,” the heroin user in Springfield explained. “Because, if you try getting into these five- or six-day [detoxification programs], it takes forever. It takes a month to get into the place, and if you don’t have the right insurance, they don’t want you.”

Officially, under the law, you’re not allowed to ask for your own commitment. Someone else — a close relative, a probation officer or emergency room doctor, for example — must petition the court on your behalf. But if youagree not to oppose that sort of petition, the judge is likely to approve it.

In the Springfield courtroom of Judge Michele Ouimet-Rooke, that day, the man requesting to be committed stood tall, respectful of the judge.

His sister was the official petitioner. A forensic psychologist testified that the man was, indeed, a danger to himself and others because of his heroin use. Then his attorney spoke.

“My client is in agreement to go to the treatment program in Brockton,” Maria Puppolo, told the judge. That facility is the Men’s Addiction Treatment Center in Brockton, Mass., a locked-down, privately run intervention program, exclusively for men who have been mandated to go there by the civil courts.

“He understands the seriousness of his addiction and he wants to get the help,” the attorney added.

The judge agreed.

“Very good, sir,” Ouimet-Rooke said. “I do find there is a basis for the commitment.”

As a court officer led the man away in handcuffs, the man smiled at his family and looked relieved. That same afternoon, the judge committed three other heroin users to detox programs, all of them willing.

In most such cases, these drug users hope to be assigned to a privately run treatment center like the one in Brockton. But if there’s no room there, some men will end up at a more bare-bones program at the state prison. (Women who are committed to mandatory treatment in these civil proceedings in Massachusetts go exclusively to privately run treatment centers.)

This year, about 8,000 people will be committed to substance abuse treatment in Massachusetts, officials estimate — that’s up 40 percent from five years ago. It’s not clear how many of those commitments are voluntary.

Jennifer Flanagan, a Democrat and Massachusetts state senator representing Worcester and Middlesex, led an investigation in 2014 into this trend — partly to understand why people addicted to drugs were trying to get committed. She says she found that many just couldn’t find or afford treatment outside the courts.

“If you’re an addict and you finally decide, ‘Today is the day I want to go,’ you may not necessarily go through the hassle of calling every place and trying to get a bed, and calling your insurance company,” Flanagan says. It some ways it’s easier just to ask a judge for voluntary commitment, she says, “because you’re mandated a bed.”

That’s a bed in an inpatient program that the state has to pay for if insurance doesn’t — and the length of treatment is often longer than most insurance policies would cover. While Flanagan calls that a “misuse of the system,” others say that’s what the system is for.

Judge William Mazanec III presides over the Greenfield District Court in Greenfield, Mass. He considers it part of his job to help some people who have become physically and emotionally dependent on opioids — people who see the courts as their last resort in being able to quit the drugs.

“They’re asking for me to use that process to force them into a situation where they can’t just walk out of treatment,” Mazanec said. “You have a window of opportunity where they’re recognizing this. You have to act quickly.”

Still, the process doesn’t always run smoothly. Sometimes drug users want to find out where they’re likely to be sent — a private treatment center or a prison program — before agreeing to go. If it’s prison, because there aren’t enough beds open at the private center, some try to stop the commitment process after it starts.

That puts court officials in a bind — and frustrates some state officials, including Flanagan.

The law was designed, Flanagan said, “to get someone out of imminent danger. If you’re in danger, you’re in danger.”

In the past year, more detox inpatient facilities have opened up across Massachusetts, and that may reduce the requests for civil commitment. But advocates for people battling substance abuse say that until someone can reliably pick up the phone and get help right away, the courts will remain a key part of the treatment chain.

Copyright 2016 WFCR-FM. To see more, visit WFCR-FM.

A 23-year-old woman suffered minor injuries early Friday morning after she was reportedly pinned between two cars near Harriet Hunt Lake.

The lake is approximately 10 miles north-northeast of Ketchikan.

The woman was standing near a parked vehicle at about 3 a.m. Friday when another vehicle backed into her, pinning her between the two cars, according to the online Alaska State Troopers dispatch.

The driver of the vehicle was a Sitka woman, also 23.

Troopers say the driver left the scene.

Witnesses reported she was intoxicated at the time of the incident.

The driver later was contacted inside city limits, arrested and charged with driving under the influence.

Troopers say additional charges may follow.

The injured woman was treated at PeaceHealth Ketchikan Medical Center.

The state has officially handed over control of the Ketchikan Regional Youth Facility, which closed this fall, the city council learned Thursday night.

The detention facility was built to hold up to 10 juveniles.

It had been underutilized in recent years and with state budget cuts, the Division of Juvenile Justice decided to close it.

The building is on city of Ketchikan-owned property, and the terms of the lease stipulate that the property will revert to the city if the state stops operating the facility.

Knowing it would be getting the facility, the city solicited proposals for the building, and only received one.

Gateway-Akeela wants to use the building as a sobriety center and safe house for people who need to sober up, City Manager Karl Amylon told the Council on Thursday.

“Essentially, what Akeela wants to do it apply for a recently announced state grant that would be $1 million a year for a three-year period to implement this type of facility, which would serve not only as a safe house, but also as — my term is a portal — to more extended treatment,” he said.

Gateway-Akeela provides mental health and substance abuse services in Ketchikan.

The grant would allow them to run it as a detox facility, as a short-term residential substance abuse inpatient center, or as a “sobering” center, Gateway-Akeela Director Director Joel Jackson told the Council.

That third item is what they’re interested in implementing.

“What it is, is a place where, according to the proposal, they could be there for three to 14 hours,” Jackson said. “So, someone who is intoxicated – doesn’t have to be alcohol, it could be anything – could come in on their own, could be brought in by police, could come from the hospital, a family member. They would be monitored, assessed, and we hope to tie them into the services that we already have.”

Amylon told the Council that there would be a more detailed presentation about the proposal for the next meeting, which has been rescheduled from Nov. 17 to Nov. 21.

Also Thursday, the Council approved a motion to pay $2,500 for a borough-run shuttle that will bring people from downtown up to the Ted Ferry Civic Center during the Winter Arts Faire, set for Nov. 25 through the 27.

The Council also agreed to waive the rental fee for use of the Ted Ferry by Southeast Conference, which will meet in Ketchikan in fall of 2018.

The number of grandparents who are raising their grandchildren is going up and increasingly it’s because their own kids are addicted to heroin or prescription drugs, or have died from an overdose. For some, it’s a challenge with little help available.

In 2005, 2.5 million children were living with grandparents who were responsible for their care. By 2015, that number had risen to 2.9 million.

Child welfare officials say drug addiction, especially to opioids, is behind much of the rise in the number of grandparents raising their grandchildren, just as it was during the crack cocaine epidemic of the 1980s and ’90s. An estimated 2.4 million people were addicted to opioids at last count.

Caseworkers in many states say a growing number of children are neglected or abandoned by parents who are addicted. That has forced them to take emergency steps to handle a growing crisis in foster care — and often to turn first to grandparents for help.

“Obviously, the numbers have grown because of the current national opioid epidemic,” said Maria Moissades, who heads Massachusetts’ Office of the Child Advocate. “You’ve got grandparents who thought they were going to spend their retirement fishing and traveling. Now they’re raising [as many as] five grandkids.”

Federal law requires that states consider placing children with relatives in order to receive foster care and adoption assistance. And grandmothers and grandfathers often are the first — and best — choice when state and local caseworkers have to take a child out of a home and find someone else to take custody, said Angela Sausser, executive director of the Public Children Services Association of Ohio, a coalition of public child safety agencies in the state.

“When we are seeking caregivers for a child, you want to see who that child has relationships with,” Sausser said. “You’re removing them from their [nuclear] family. To minimize the trauma and help them feel some normalcy, you obviously want to seek out whoever is closest to that child.”

In some instances, caseworkers say, grandparents are also struggling with addictions.

In Ohio, for instance, the opioid epidemic has grown so large that caseworkers sometimes have a hard time finding any relatives who can step up, said Kim Wilhelm, protective services administrator for Licking County (Ohio) Department of Job and Family Services.

For every child in foster care who has been placed with a relative, another 20 children are being raised by relatives outside the system, said Jaia Lent, deputy executive director of Generations United, a Washington, D.C.-based family research and advocacy group.

Many grandparents face a host of emotional and financial challenges in their renewed parenting role. And there are often few state or local resources to draw on for help.

Twenty-one percent of grandparents caring for grandchildren live below the poverty line, according to Generations United. About 39 percent are over 60 and 26 percent have a disability. And because many are not licensed in the system, they are not eligible for the same services and financial support as licensed foster parents.

“Can’t y’all make it easier for grandparents? That’s my request,” said Dot Thibodeaux, president and founder of the grassroots support group Grandparents Raising Grandchildren Information Center of Louisiana.

“Most of us are on Social Security,” she said. “When the family grows, the Social Security does not. You have to make do with whatever you were getting, and that’s kind of hard.”

State help

A handful of states are trying to help. In Louisiana, state lawmakers in June voted to establish a grandparents’ council in the governor’s office to study remedies for those tasked with raising grandchildren.

In New Mexico, lawmakers voted in February to set up a task force to study the issue and recommend concrete policy changes that could help grandparents, from legal and financial help to food and housing assistance.

A bill lingering in the Massachusetts Legislature would provide grandparents caring for their grandchildren with property tax relief. And Georgia lawmakers considered bills that would make it easier for grandparents to take grandchildren in their custody to the doctor or to enroll them in school, but failed to pass them.

The growing trend and the problems it can cause are being noticed by Congress too. In May, U.S. Rep. Danny Davis, D-Ill., introduced a bill that would, among other things, make it easier for grandparents caring for children to receive Temporary Assistance for Needy Families. It’s lingering in committee.

In September, U.S. Senate inaction effectively killed a bill that would have provided federal funding for substance abuse programs for families with children at imminent risk of entering foster care. The bill also would have allowed states to waive foster care licensing standards for grandparents and other relatives.

Barriers to help

Grandparents — especially those who don’t become licensed foster parents or legal guardians of their grandchildren — face a host of emotional and legal challenges in getting help.

Many of them often don’t want to apply for legal custody because that would mean taking their own children to court. Or if they apply for welfare, the state could try to make their own children, who may already be struggling with addiction, pay child support.

Licensed foster parents have access to services and can get financial assistance with everything from medical care to a clothing allowance. But to qualify, grandparents would have to go through a lengthy process and meet certain requirements.

To be a licensed foster parent, for instance, states have specific requirements about square footage and bedrooms for each child. This makes sense if a child is being placed with a stranger, but creates barriers for grandparents who may need to accommodate multiple grandchildren in their homes, Lent said.

Although Louisiana offers financial subsidies to help grandparents with the costs of raising children, few apply because they are unaware of the help. Others don’t qualify because they make too much money — even if they earn very little, Thibodeaux said.

“You almost have to be on the streets,” said Thibodeaux, who serves on the governor’s grandparents’ council.

Some child welfare advocates say that what’s needed is more help for “kinship care” — relatives taking in and raising the children who’ve been neglected.

“Everyone agrees that kinship care is the right thing, but there’s no money to pay for it,” said Moissades, the Massachusetts child advocacy official.

But there could be a payoff if some help was provided grandparents who aren’t part of the foster care system. According to analysis of foster care payments by Generations United, grandparents and other relatives raising children save taxpayers $4 billion each year by keeping the children out of the foster care system.

A multigenerational problem?

Back in the 2000s, some states passed legislation establishing “kinship navigator” programs that serve as one-stop shops linking grandparents and other relatives with services such as counseling, housing assistance and short-term financial help.

With these programs, other grandparents raising children often served as the “navigators” to advise on how to get help with everything from legal advice to parenting skills.

But in some states, budget crunches have made funding for some of these programs unstable, Lent said. In 2008, Congress passed the Fostering Connections to Success and Increasing Adoptions Act, which included competitive grants for kinship navigator programs. Some states used the money to create new programs, but not all are available statewide. Some states, including Florida and Ohio, have federally funded navigator programs that cover part of the state.

Today Connecticut, Delaware, New Jersey, New York and Washington state still have statewide, state-funded programs.

Child welfare workers say that more federal funding is needed if every state is to have a navigator program and offer services statewide.

Isabel Barreiro, of the Children’s Home Society of New Jersey, which is contracted by the state to serve as a kinship navigator in Central New Jersey, said she’s often limited in how much she can do to help her clients.

For example, she said, many of her clients live in public housing. Sometimes multiple grandchildren can be dumped on a grandparent’s doorstep, which forces her to try to find a bigger place to live. Barreiro said she doesn’t have the ability to make a bigger apartment magically appear.

State child welfare agencies have some power to intervene with housing, she said.

“Child protection services needs to do a better job of really stabilizing these families,” Barreio said. “Don’t place a child with a 60-year-old grandmother who’s in Section 8 housing, and not help her.”