The New York Times - October 26, 1986
Linda Martin

Doug did not want to give up his addiction to methadone for the seventh time, but his parole officer insisted.

Anna - only first names were used for this article - begged desperately for treatment. She had traded a heroin habit for an addiction to methadone and crack after she saw her brother, also an addict, dying from AIDS. But the unpredictable combination of drugs was inciting her to attack her children.

In a solemn moment at the end of their recent group-therapy session at the Mount Carmel Guild Narcotic and Rehabilitation Center here, these three addicts put aside their individual agonies to join hands with one another and ask for help "to accept the things they cannot change, to have the courage to change the things that they can and to have the wisdom to know the difference."

This prayer, intoned by recovering addicts everywhere, has a deeper resonance in New Jersey, which leads the nation in AIDS cases among intravenous drug users, according to state Health Department figures.

The number of New Jersey men and women who have contracted AIDS from injecting drugs with contaminated needles has nearly doubled since last October. Yet the figure, 773, would have been higher, state Health Department officials say, if their efforts to instill a healthy fear of AIDS among intravenous drug users had not been so effective.

The state's outreach counselors have drawn hundreds of heroin addicts into treatment in the last two years. However, the program is having serious, deleterious repercussions, experts in drug treatment now say.

Overcrowding of the state's drug-treatment facilities by heroin addicts was the first problem precipitated by the widespread fear of AIDS.

"The message got out not just to the IV users, but to other addicts, too, and it drove them all into treatment at the same time," said Edward J. Higgins, executive director of the Asbury Park-based Jersey Shore Addiction Services.

Outpatient drug-treatment centers filled to 35 percent over capacity. Now they can no longer accommodate or monitor all the addicts who want to kick their habits before it is too late, experts say.

As a result, treatment centers have to cut back on counseling and therapy hours, which prolongs treatment and encourages recidivism.

To curtail intravenous drug abuse, treatment centers are focusing on heroin addicts, experts say, often at the expense of the growing numbers of cocaine users and abusers of more than one drug.

The concentration on heroin addicts is particularly worrisome, Mr. Higgins said, "because the AIDS campaign, ironically, made people accept crack as an alternative to injecting heroin."

Now 40 percent of those admitted to state-licensed drug-treatment centers use some form of cocaine, according to Health Department statistics.

Ray Cubino, director of the Mount Carmel center, predicts "a tenfold increase in crack use over the next three years because so many young users have just begun experimenting with this highly addictive form of cocaine."

The influx of addicts seeking treatment, combined with the commitment to primarily treating heroin abusers, are paralyzing the drug-treatment system and preventing it from adapting to changing patterns of addiction, experts say.

"There hasn't been a change in the state's drug-treatment system for 10 years," said Matthew Martin, chief of drug treatment for the state's Division of Alcohol, Narcotic and Drug Abuse.

Treatment was, and still is, designed to fight heroin abuse, primarily with methadone, an orally administered drug that stops the craving for heroin but is also addictive. More than 60 percent of the heroin addicts being treated in New Jersey depend on methadone.

"Methadone is the worst addiction," said Lillian, recalling her baby's birth. The infant, born addicted to methadone, was "shaking so hard that I had to have the nurse help me hold her," she said.

Still, methadone is the preferred therapy for workers with heroin addicts and, more often than ever before, it is becoming the addicts' preferred drug.

Those heroin addicts motivated only by the AIDS scare to seek treatment are frequently more interested in finding an alternative to injecting than in treating their addiction, experts say. For them, the methadone dispensed by treatment programs is the answer. They use it as a drug, rather than a drug replacement, and have no intention of ever graduating from treatment.

Frequently, these methadone addicts combine methadone with cocaine, either smoked or snorted, to recapture the sensation of a rush.

"I was always chasing after 'Rufus,' the perfect high," Anna said. "I knew I'd never find it, but that did not stop me. So pretty soon, I was doing 20, maybe 25, vials of crack a day and using the methadone to bring me down."

The methadone centers have difficulty monitoring cocaine use through their customary once-a-week urinalyses because the drug passes through the system too quickly. Directors of treatment programs estimate that cocaine abuse among their methadone clients ranges from 25 to 50 percent.

Some researchers say that methadone maintenance programs might actually increase the likelihood that former heroin addicts will try cocaine.

According to Health Department officials, the methadone treatment system should not and cannot be changed. They cite the critical need for effective heroin treatment in a state where there is an AIDS epidemic among intravenous drug users and where it is estimated there are 40,000 heroin addicts.

A more immediate reason to maintain methadone use is the obligation to continue treating those addicts already in treatment.

"You can't just abandon 4,400 people you have dependent on methadone," said Mr. Martin.

Treating dual addictions at the methadone centers aggravates the overcrowding and may take places away from those just coming in, experts say, because addicts who are not placated by methadone require therapy much more frequently.

At Jersey Shore Addiction Services, a successful experimental program to treat cocaine addicts with therapy five nights a week was abandoned when too many addicts sought help. Now the program focuses on methadone and treats 327 heroin addicts, but with government funds for only 250.

Each addict comes in for therapy once a week, and although there are more requests than ever for cocaine treatment, Mr. Higgins said, the addicts usually are referred elsewhere.

Carolann Kane-Cavaiola, president of the New Jersey Association for the Prevention and Treatment of Substance Abuse, said that program directors "don't choose to treat one addiction over another."

"We just decided that our policy was to stand still until we get more money for expansion," said Ms. Kane-Cavaiola, who also is director of the Woodbridge-based Action for Youth.

A cocaine addict requires three to four times the number of counseling hours and urinalyses of a heroin addict, experts say, and so treatment is more expensive.

Treating crack addicts is even more costly because, experts generally agree, they initially need inpatient care.

Both kinds of cocaine addicts remain second in line to heroin addicts for treatment dollars.

When additional Federal funds become available next year, they will primarily pay for expanding existing outpatient hours and staffs at treatment centers, Mr. Martin said.

The $4 million to $5 million expected from the new Federal anti-drug bill will alleviate many of the pressures of overcrowding, he said, but it cannot essentially change New Jersey's drug-treatment problems.

The only new state funds for drug treatment this year was the $1.3 million allocated for AIDS-related drug treatment and prevention. This money is reinforcing the orientation of drug programs toward heroin and away from cocaine treatment, experts say.

That direction may be worsening the long-term prognosis for drug treatment in the state, but it is addressing the overshadowing horror of AIDS in 1986, said David H. Kerr, director of one of the state's most crowded facilities, Integrity House in Newark. Mr. Martin agrees. "In the AIDS area," he said, "we're doing a good job. Otherwise, there is not a lot to be proud of when you look at drug treatment."

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