PROVO — They form a circle with their chairs and take turns addressing the group.
A girl starts, her voice strong and confident.
"My name is Beth, and I'm an addict."
She recounts how she started drinking alcohol and using marijuana at age 12. She graduated to methamphetamine at 19.
She comes to treatment every day to face her drug problems.
"Today I will be the woman God wants me to be," she closes confidently.
"Today is a good day," the next woman says. "I haven't used in the last five days."
The woman, in her late 40s, is getting drug treatment for the first time. She's been using meth for 10 years and marijuana since she was 10.
Each day, men and women come to the Foothill Day Treatment program in Provo's downtown Health and Justice Building, taking the first step in an effort to break a drug cycle that has held most of them captive since their teenage years.
The Utah County Division of Substance Abuse calculates that from 2004 to 2005, almost 1,400 people have been treated for substance abuse.
It's a small portion of the nearly 8,000 in Utah County who need help.
"The situation we're in now, it's nothing new," said Richard Nance, director of the county division. "We've always had more demand for treatment than we were able to provide, given the funding that we get. It's a terrible position to be in."
In 400,000-resident Utah County, the second-most populous county in the state, there are three county government-run treatment centers and three other treatment centers that take county referrals. Six other centers in the region offer detoxification help or general out-patient treatment.
It's a far cry from being enough for the demand, Nance says.
Right now, the county counts 611 people in treatment. There are 349 people on the waiting lists, and all county programs are 100 percent full.
"There are as many people in drug treatment as . . . (there are) in jail," Nance said. "In every level of care, we have waiting lists. Without funding, we're being as creative and lean as we can be. There is more and more happening with less and less money."
Facing the problem
Gayle Seal, treatment coordinator for the Foothill Day Treatment program, one of the out patient services offered by Utah County, spends her mornings needling her clients.
"Why are you sitting here?" she asks a man named Ken. "Are you an addict?"
Ken, slumped in his chair, is struggling. Seal and the group won't let him respond to questions about his substance abuse with answers of "I don't know."
"Does that make you less of a human being if you're an addict?" Seal asks. "You'll never look at change if you can't admit."
She asks the group to identify some of Ken's "thinking errors." Eyes shift to a poster on the wall. The students shout out words and phrases. "Rationalizing," "Silent Power," "Justification," "Intellectualizing."
Ken tells members of the group, whose names aren't disclosed to maintain the confidentiality of the therapy process, he was only into meth so he could sell it for the extra money. He could have quit when he wanted.
The group of addicts doesn't buy it.
"Being an addict is knowing that you are powerless over anything," one girl tosses at him. She knows; she is one.
Scott is another story. Same plot, different characters. Scott started using drugs when he was 20. He lived away from home and worked a graveyard shift making it easy to explain away his lethargic attitude, blood-shot eyes and rapid weight loss.
When his mother finally realized something was wrong, it was too late. Her son had moved from marijuana to heroin and was hooked.
"Nobody's immune," his mother, from Provo, said. "It's not just the underprivileged from the wrong side of the tracks — it's everybody."
Scott's parents began scouring the state for treatment options and ended up driving their son back and forth between a program in Salt Lake City three times a week. They didn't realize how deep the problem was, nor how expensive the solution would be.
"If you don't have the money to walk in the door, you don't go any further," his mother said. "We didn't have the money; we still had six kids to support. We're both educated people with the ability to work, but it doesn't cover it. You can't just shell out $30,000 all of a sudden and even have it not work. There's no refund."
The price tag
"It's so damned expensive," one member of the therapy group said about treatment. "We come from the street. We have nothing. At the same time, hell, I'd pay a million for what I've gotten here, but I don't have it."
Different drug addictions call for different treatment options. There is general outpatient, with daily or weekly meetings. There is also residential treatment, where an individual lives in a facility to get help.
The cost of a long-term residential treatment facility can begin at $1,500 a month — and patients usually stay from at least nine months to a year. Private outpatient options can range from $15 to $90 a session, depending on income level.
Utah County — and most other treatment providers — charge for treatment on a sliding scale, anchored to the federal poverty guidelines and household size. Nearly 90 percent of the county's clients have incomes less than the poverty level, meaning their monthly contributions range from $5 to $22, Nance said.
Even if the client is spending 30 days in the $3,000-per-month residential treatment option — Foothill Treatment Center, next to the Utah County Jail — they might only be paying $17, although it costs the county $85 a day.
Foothill's outpatient services, such as the day treatment program, also function on a sliding scale, and Seal tells her clients if they can afford a pack of cigarettes, they can afford drug treatment.
After the small client fees, the rest of the county's budget for addressing substance abuse comes from federal dollars, at 30 percent; money from state tax coffers, 29 percent; and county funds, 4 percent. Grants, Medicaid and other contributions supply the rest, according to county figures from 2005.
Last year, the county's budget for addressing substance abuse was almost $6.5 million. The county's contribution was $237,000 from tax revenues, and federal matches made up the rest. But the match limit has been met.
"If we throw in more money, there's no match," said Steve White, a Utah County commissioner. "If I could throw in another ($237,000) and get another $6.5 million . . . I'd do it. Based on population . . . we've reached our limit."
Any additional funding will have to come through sales and property taxes, White said. The commission doesn't want to throw a huge tax hike on the back of taxpayers just to increase the funding for substance-abuse treatment. As the funds become available through increased growth, White said they will do their best to create more programs.
The jail also needs its share of budget dollars. In 2005, the county spent almost $13 million on the jail, White said. The cost of sending someone to a Spanish Fork cell is around $61 per day. The daily cost of an intensive outpatient substance-abuse treatment is around $20 a day.
Although treatment is cheaper, finding any funding is a constant battle. And it's a battle that David Knowles, executive director of Summit View, just lost.
Knowles recently had to close the doors of his Provo treatment facility and route almost 200 patients to Salt Lake-based programs and the county after he lost funding from a donor.
"We were pretty much functioning at bare minimum," Knowles said. "We were downsizing over the year, streamlining, doing everything I could to stay open."
Even with donated office space, the cost of monthly operation was around $35,000, and the minimal per-week charge of $40 per person wasn't enough to make ends meet.
"Substance abuse just really isn't a popular thing for people to give money to," Knowles said. "It's largely viewed as more of a personal-problem type thing — not society's problem, and that's not the way it works. We're paying millions of dollars into the criminal justice system to take care of these legal problems that these people are creating because of addictions. We would do well to try and treat them rather than to house them and pay for them that way."
In Salt Lake County, there are close to 36,000 adults who need substance-abuse treatment. And right now, they can't all get it.
"We've got capacity inside our treatment system for about 8,000 adults and 1,400 kids. The gap between the capacity we have and the treatment need is substantial, and I think that's going to be fairly similar in Utah County," said Patrick Fleming, director of substance abuse for Salt Lake County, and the former director of substance abuse for the state.
"What's happening right now in Utah — and it's true all over the state — it's getting . . . to the point that you have got to commit a crime to get into the public treatment system."
Criminal connection
On an average Wednesday, 4th District Court Judge Lynn Davis hears as many as 150 criminal cases. Close to 80 percent of them are drug or alcohol related, he says. Theft, burglary, abuse, rape or even traffic cases can all be tracked back to substance abuse.
While Davis acknowledges the relative safety of Utah County — Provo and Orem, the county's two largest cities, were ranked among the nation's safest in a recent study — it still doesn't change the fact that so many people are being crushed by drug and alcohol addictions — and communities are suffering secondhand.
"There's a misperception that drugs are not a challenge in this area, and they are," Davis said. "There's a major drug problem. It's less than other areas, but if your car is broken into, you can almost be assured it's drug-related. Homes broken into? Burglaries? All drug-related."
After committing a crime, some individuals find treatment for their drug problems through programs in jail. Some get help through a referral to a judicial program called Drug Court. Others find treatment in long-term care after serving time. Still, some continue to struggle, flunking out of programs, falling back into bad habits and returning to court and eventually jail.
"We're saddened . . . to see some return," Davis said. "We had great hope for them. We knew their family, their jobs, their therapy options. You know their lives."
Of the almost 600 individuals in the Utah County Jail from Dec. 1 to Jan. 31, the collective total of drug charges was 821 — second only to traffic charges at 912, according to statistics from the Utah County Jail.
"Society has to face up to the fact that substance abuse is really at the root of a lot of problems, including crime and domestic violence," said Randall Bachman, director of Cornerstone, a treatment center in Salt Lake City. "That's not to say that if you solve the substance-abuse problem you'll eliminate all crime and all domestic violence, but there is certainly a correlation."
Looking for answers
Throwing people in jail isn't a magic solution, however.
"(Treatment) is much cheaper than putting them in jail — and it solves the problem," said Gunda Jarvis, a public defender who works with Drug Court clients. "You can either pay for somebody to go to jail for the rest of their lives, off and on. They don't get a job; they don't pay taxes; they don't contribute to society, and they take away from you. Or (put them in) treatment. If we solve the problem . . . it doesn't come back."
Many people who end up in treatment have already spent time in the jail.
"I was in jail at this time last year, praying to God to help me," said Melinda, one of the members of the Foothill Day Treatment program. "I wasn't living and I wasn't dying. I couldn't be where I was anymore. I made a choice to live — I opened my heart to it."
Melinda started her road to recovery by admitting she needed to change. She had already spent decades as an alcoholic.
Now she's in treatment, planning a sober future.
That personal choice is what makes programs or treatment centers effective and the first step to really making a change, said Utah County Jail Programs Sgt. Robin Wall.
"I see a lot of people who are struggling with drug addiction right now," Wall said. "And the likelihood of a drug user coming back to jail is very, very, very high. You can offer an inmate a program, but all it is is a structure. Going through a program doesn't fix someone's life. They have to recognize their addiction for what it is and what it's doing to their life and want a different lifestyle more than the addiction to drugs."
In the Foothill Day Treatment program, Seal says one-third of her students graduate and never come back. Another third make it about six months before slipping. And the others walk out the door and back into the arms of the drug culture.
Some people find success through help from the OUT On-Unit Treatment — program at the jail. The program teaches 20 men and 20 women in a four-week program about how to break their drug habits. The inmates are added at any time, and they cycle through during the five-days-a-week, eight-hours-a-day program.
"(OUT) helps them see who they really are," Wall said. "It helps them identify their addictions and then gives them some opportunities to publicly acknowledge that, kind of like an AA meeting. Counselors help them just recognize their addiction for what it is, and then they give them some skills that they can use to help deal with that addiction, to hopefully avoid it."
When an inmate has been on good behavior and passed a screening procedure, they can apply for admittance into the program. Even if an individual is court-ordered into the program, they still have to prove that they deserve a chance at in-house treatment.
Within the month, Utah County is planning to double the OUT program's capacity to 80 inmates. They also hope to find someone to conduct evaluations in the jail — a therapy needs-assessment prerequisite to attending any other type of treatment facility.
It's a huge step, but there are other solutions that aren't found behind bars.
"The answer can't be to build more jails," Wall said. "The real answer has to come from the community, where the community . . . addresses drugs before they are even used."
Taking responsibility
On any given Friday, dozens of people fill the benches of a Provo courtroom for their weekly or monthly checkup. Fourth District Judge James
Taylor, who presides over Drug Court, has the individual's file in front of him. He already knows how their weeks have been.
The client, who is working to get over a substance addiction, has been attending treatment sessions and has stayed clean for the past few weeks. The good report means he or she is rewarded with judicial approval and chocolate.
"You are rocking this," he tells one client. "Get a candy bar — we'll see you in three weeks."
"You're doing a great job. Keep doing what you're doing," Taylor tells another client, who tries to hide a huge grin as he reaches into the candy jar for a Snickers.
The Drug Court, first started in 1998 in Utah County, has been a much-needed answer to a growing problem, Taylor said.
"I've seen a lot of misery and grief from controlled substances," Taylor said. "But this is the first time I've ever seen a court program that really makes a dramatic, significant difference."
Individuals with a first-time felony drug charge and a non-violent history can ask to be appointed to Drug Court if the prosecutors agree and the individual promises to play by the court's rules.
The person must maintain full-time employment and stable housing, complete a high school diploma or GED, stay drug-free and not be charged with any additional crimes.
The clients go through four phases. At each phase, they submit to random — and sometimes daily — urinalysis tests to check their status and ensure their cooperation. If the test comes back "dirty," meaning they test positive for drug use, the client gets a quick ticket to jail.
Although most clients approach the podium eagerly and look the judge in the eyes, some walk up slowly with their heads bowed.
"You've made some bad mistakes," Taylor says to one client. "You put yourself in a bad spot. Now you'll be in jail for 30 days waiting for the 30-day suspension to be over."
Because the individual tested positive for drugs, he was placed on a 30-day suspension from his treatment program. To prevent future relapses, he'll spend that time in the Utah County Jail.
The quick praise — or punishment — is what makes the program so effective, clients say.
Nine people recently graduated from the Drug Court in Provo, some having stayed clean for as many as 540 days. They credit their case managers, parents and the Drug Court program for their success, but it really boils down to personal commitment.
Grateful parents who attended the graduation commented about how the program has helped rescue their children.
"He's lost a lot through drugs," one parent said. "But he's gained so much through Drug Court."
Those are the responses Taylor wants to hear. But although there's a 90 percent success rate, the program can only accommodate 80 clients at a time.
"I could double, triple Drug Court," Taylor said. "We could serve three, four, five times as many clients. It's so effective — the choke point is having funding for treatment. A couple of times I've had to say I can't accept referrals (and) the reason had nothing to do with court congestion."
The county pays about $7,000 for a felony Drug Court client for a year. It's cheaper than the $3,000 per month for the Foothill Treatment Center in Spanish Fork and much cheaper than the almost $22,300 for a year in jail. And it's far more productive, Taylor said.
"It's such an effective program. (Legislators say), 'Politically we're in favor ', but when it comes down to funding it, there's some money involved. That's the bottom line. You cannot get treatment without paying for it."
Future steps
The Foothill Day Treatment session closes with the students standing in a circle, arms around each other with their right foot forward. They lean in close and repeat, with Seal, the words of a prayer.
"God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference," they say together.
The group breaks up and goes their separate ways. They will return tomorrow and the next day. And the next. If they are strong enough, someday they won't ever have to come back.
"They leave, and go out to the community," Seal says. "We are able to teach them hands-on, immediate skills to practice, but they have to make the choice to change."
She talks about one woman who made that choice. The pregnant woman stayed clean for a year and delivered two healthy babies. Seal tears up as she talks.
"I am very, very passionate about what I do," she says. "We're not here for the pay."
It's a matter of more people acknowledging the problem and getting involved, treatment providers say.
"I think that the public in general needs to start looking at taking some responsibility," Knowles said. "Practically every family out there in Utah County has been affected by substance abuse in a devastating way. One way or another, everybody's had to deal with it. If we don't (take care of this problem), we'll get to the point where it's too late, and however much money they decide to throw at it, is not going to solve the problem."
One of those steps would be to encourage the private health-care sector to fund more substance-abuse treatment programs for insurance holders, Nance said. He also encourages individuals to write to their elected officials to ask for more funding aimed at drug-abuse treatment and prevention.
"This is a universal issue that affects everybody," Nance said. "And the biggest misperception about substance-abuse disorders is that people don't get better, and treating addicts is throwing money down a rat hole. I know by looking at re-arrests, that's not true. We have a significant impact on people."
E-mail: sisraelsen@desnews.com