Drug- and alcohol-rehabilitation centers in Alaska are starting to feel the pain of state budget cuts, with most clinics facing increased caseloads and others discontinuing some services altogether.
A looming fiscal gap prompted Gov. Frank Murkowski to slash about $130 million from the budget this year through line-item vetoes.
The state also drew about $400 million from its savings account, the Constitutional Budget Reserve, last session to balance the budget, and governmental department heads are looking to reduce administrative costs.
Department of Health and Social Services Commissioner Joel Gilbertson reorganized his department in March, combining the Division of Alcoholism and Drug Abuse with the Division of Mental Health and Developmental Disabilities to create the Division of Behavioral Health.
In addition to cuts on the administrative side, the Legislature more than doubled the amount that drug and alcohol rehabilitation centers must pay in order to receive state money.
On Aug. 20, Murkowski signed Senate Bill 124, increasing the match treatment centers must pay from 10 percent to 25 percent. Programs with receipts under $30,000 were exempted.
The cut saved the state about $1.6 million. But considering that Alaska has the highest alcoholism and substance-abuse rates in the nation, some substance-abuse advocates have criticized the move as "penny-wise and pound foolish."
Treatment programs throughout the state already are running at full capacity, and additional cuts have caused a substance-abuse facility in Wasilla to end its alcohol detoxification program.
On Aug. 1, Nugen's Ranch in Wasilla, about 60 miles north of Anchorage, stopped accepting alcohol detox patients, said Executive Director Karen Nugen-Logan.
The operation also provides long-term inpatient treatment. About 75 percent of its funding comes from state grants, Nugen-Logan said. The rest of the funding is through donations, raffles, client fees, and selling vegetables and livestock from the ranch.
Last year, 209 patients entered into the detox program at Nugen's Ranch, Nugen-Logan said. She said those patients now end up at the Valley Hospital in Palmer, in jail, or are referred to other treatment centers.
"It costs $257 a day per client to run the detox program," Nugen-Logan said. "Now if you shift that cost to the hospital, it's costing a lot more, which doesn't help the bottom line. The other problem that comes into this is in detox you have them three to five days. You can work with them and motivate them into treatment."
Since the unit closed, most clients have been referred to the Salvation Army Clitheroe Center in Anchorage, Nugen-Logan said. Some have been referred to clinics in other parts of the state.
Bartlett Regional Hospital's detoxification clinic, the Juneau Recovery Hospital, already has received a couple of referrals from Nugen's, said Jan Walker, acting clinical director at JRH.
"It's a touchy subject because if they are medically unstable, you don't want them riding on an airplane," she said.
The 16-bed detoxification unit at JRH also is experiencing increased caseloads, and within the last few weeks has put at least two alcohol detox patients on a waiting list. Walker said there is a good chance that people put on a waiting list won't return for treatment.
"With addictions, people are ready to get help and you lose them when you tell them to come back in a couple of days," she said. "If they're actively under the influence and we don't have a place to put them, then they go to jail ... or in the hospital at a much higher rate."
But in May, when the Legislature passed Senate Bill 124, some lawmakers argued that the question of substance abuse is one of personal responsibility, not the state's responsibility.
"We have a bigger issue for us to sell as leaders of this state, and the issue here for me is one of personal responsibility," said Fairbanks Republican Rep. Jim Holm on the floor of the House of Representatives.
"Nobody puts a gun to their head and says you take (drugs and alcohol). ... Conversely, if the state is not responsible for the fact that somebody abuses a substance, it is not necessarily the place of the state to bail people out," he said.
Matt Felix, executive director of the National Council on Alcoholism and Drug Dependence in Juneau, called the budget cuts "penny-wise and pound foolish."
He said it costs about $43,600 a year to keep alcoholics in jail, compared to about $10,000 for good substance-abuse treatment.
"It's a medical condition, and an addiction is not like any other chronic disease," Felix said. "They can become an asset to society. They can start paying taxes. From a humanitarian standpoint, these people need to be part of a community that supports them and their family as well."
Karen Pearson, associate director for the Division of Behavioral Health, said the state is facing tight financial times and all agencies need to live within their means.
She said substance-abuse treatment programs for women and children were held harmless from the budget cuts. Pearson also said the state is working with service providers to help maximize their limited resources.
The division is working with the community of Petersburg to combine the local mental health providers and substance-abuse providers into one administrative unit, she said.
"I don't want to be a Pollyanna and say budget cuts don't hurt - they do," she said. "The merger of the division creates an opportunity at the community level. I think it forces us to look at are there ways to leverage federal dollars."
Pearson said the Governor's Advisory Board on Alcoholism and Drug Abuse will meet in Fairbanks on Tuesday and Wednesday to discuss the consolidations and cuts. Pam Watts with the advisory board said it will take public comments.
"The focus will be on examining how the service delivery system might change to better address the needs of people with co-occurring substance-abuse and mental-health disorders and how the system will adjust to budget reductions," she said.