Audit: Addiction Hotline Drops Calls, Rehab Beds Lie Empty

People who want treatment for their addictions in Santa Clara County often have to wait for the help they need—or resort to an emergency room.

A new audit of the county Department of Alcohol and Drug Services (DADS) shows that people calling into a hotline for substance use and mental health problems will spend up to six hours on hold. Those looking for a detox bed will wait 12 days on average—not for a lack of space, but because of the way the county reserves beds for patients who don’t use them right away.

This means people who need immediate help may turn to emergency rooms—a quick, exorbitant fix for a chronic problem. In 2011, more than 5.1 million people in the US were admitted to emergency rooms for drug-related causes, in lieu of rehab.

The report by Harvey M. Rose Associates, an auditing firm hired by the county, also made recommendations that could save taxpayers $1.2 million a year.

Perhaps the biggest issue, because it marks the front line for people who need help, is the call center. Of the eight people who work for the Gateway Call Center, only four to five field more than 50,000 calls a year. But so many employees don’t show up to work that it compromises countless calls, inflating wait times and prompting more than 25 percent of callers to just hang up.

“In addition to its very limited staff, the division has an absenteeism rate that is nearly double the department’s overall … rate,” the audit states. “In FY 2012-13, eight full-time-equivalent staff used 222 leave days, including sick, personal and unpaid leave. The vast majority of these days were used by four of the eight staff.”

The audit suggests checking staff morale to find out why so many people aren’t coming in to work when they should.

In terms of public access, the beds presented another huge problem. Because of bureaucratic rules around how the county reserves spots for people detoxing from drugs and alcohol, it spends around $358,000 a year for empty beds.

Despite 12-day-long wait lists for a spot at a county detox clinic, an average of 14 beds a day remained empty. That’s because of a department policy that requires providers to reserve them for clients who may not come until days later. The county pays a flat rate for bed space, not matter how much use its gets. Annually, that amounts to $24,467 per residential bed and $44,305 per detox bed, or more than $6.1 million annually for 237 beds.

The audit says the county should come up with a new way to contract bed space that bases payments on actual use. It should also improve coordination with these clinics and require patients to report in for detox within 24 hours of doctor’s orders—72 hours for people coming out of jail who need more time to pick up their meds and reach the clinic.

The department could also see $704,000 a year in savings if it closed its adult outpatient clinic and outsourced the service. The county clinic costs seven times more than those run by subcontractors. Contracting out the youth and perinatal clinic would save even more, the audit says, and should be considered. DADS Director Bruce Copley disagreed with this finding, arguing that the county services cost more because of its justifiably more generous salaries.

Outside contractors provide many of the agency’s services, the audit says, but have little oversight, which means the county has no consistent way to tell if they’ve met their commitments. The department administers $17.4 million a year in contracts to 25 organizations, but fails to measure outcomes.

“The lack of tracking outcome measures prevents the Department from assessing, over time, how the provided services are meeting the needs of individuals and the community,” the audit says. “Inability to assess the effectiveness of programs means that funds may be expended on ineffective programs.”

The department isn’t able to assess the effectiveness of the 180 employees on staff, either. The audit says employees don’t have to undergo regular performance reviews, which leaves management with little idea of how well its staffers are living up to their obligations.

Another program proven inefficient by auditors is the department’s Children, Family and Community Services Division, which treats substance-addicted youth. It lacks policies and procedures, a website and uniform workloads for its caseworkers.

Copley agreed with the audit, for the most part. The report is expected to come up for review at a Board of Supervisors meeting in the next month.

Jennifer Wadsworth is the news editor for San Jose Inside and Metro Silicon Valley. Email tips to [email protected]. Follow her on Twitter at @jennwadsworth.

15 Comments

  1. Deja vu. This sounds just like the Office of Education article.
    Yet another government department set up supposedly to solve one of society’s problems that has now morphed into nothing less than an entitlement program for public employees.
    Get rid of the unions and we will at least stand a fighting chance of getting our government to accomplish the things we mean for it to do. Until then we can expect more debt and dysfunction.

  2. ““In FY 2012-13, eight full-time-equivalent staff used 222 leave days, including sick, personal and unpaid leave. The vast majority of these days were used by four of the eight staff.”

    Were they home gettin’ high…or crashing perhaps?

  3. Take off the blinders, liberals, aim your gaze at something besides the government and you might actually discover the simple solution to this problem.

    From a big picture perspective, the root source of the challenge of providing housing and rehab for addicts is the marked increase in the public’s abuse of these substances. The root source of this abuse is human weakness, a trait that has always been with us, but one that, in civilized societies, has always been mitigated by public censure and criminal penalties — approaches that were both effective and imperfect. Despite the efforts of conservatives, these mitigating factors they have all but disappeared from society over the past decades as liberals successfully rebranded censure as intolerance and incarceration as ignorance.

    The tolerant and enlightened, from Haight-Ashbury to Hollywood, transformed the substance abuser from a pariah to a party animal, and along the way pilloried anyone who dared question their recklessness. Thus, the solution to providing housing and rehab for addicts should come not from a government of questionable competence, but from the tolerant and enlightened community whose new approach to old problems has only made matters worse. Need a room for a stoner? Put an ad in Craigslist for a tolerant and enlightened liberal eager to align his home with his purported beliefs. Need rehab facilities? Get a few liberals together to start a private effort, funded by other liberals. Give ’em a chance to show the world how well their actions mesh with their political and social values. Even if only one in a hundred liberals participated, in this lopsidedly liberal state there would easily be enough beds and rehab dollars to relieve the government of this responsibility.

    If this idea seems ridiculous just remember that animating one’s belief’s — putting one’s money where one’s mouth is, has been done countless times by a wide variety of religious and ethnic groups. So come on liberals, here’s your chance to prove you’re not just a bunch of spoiled, self-centered brats.

    • Fairly incoherent, FinFan. I guess you missed all the mandatory minimum sentencing laws of the past few decades and their awesome inability to improve the rehabilitation of addicts.

      As to liberals demonstrating their political views, they did via a method called democracy. They voted for politicians who favored rehab and then put their money where their mouth was and supported those programs through taxes. The main public outrage with this story will come from the waste, not the rehab. Don’t like it? Well, you too can play that democracy game, but I’d work on your arguments first.

  4. Have you forgotten, Finfan, that is the core belief of liberals that it is the government’s job to solve all our problems? They gladly pay taxes so that they need do nothing; it can be done for them by the government.

  5. You’re right. I skipped right over those mandatory minimum sentences because the issue at hand is addicts, not drug dealers. Why you would intentionally conflate those issues is no mystery: it is what liberals do. The current hand-wringing over incarcerated drug “offenders” would garner much less public support were those inmates correctly identified as what they are: drug “dealers.” But the public’s right to the truth — essential in a legitimate democracy, has been usurped by the liberals’ lust for power.

    As for the “main public outrage” to this story, it will be whatever is desired by those in control of the media. Should they find a way to hang this “outrage” on an elected official targeted for ruin, or link it to overindulged public employees, that’s the way it will spin. Just as you highjacked it for your political purposes, so too will the media.

    Substance abuse equals personal ruin, family tragedy, and social breakdown; communicating that fact through all means available is a public duty. Shame, stigma, intolerance, and confined rehab should constitute the public’s first line of defense, but such measures have no chance when pitted against a ubiquitous entertainment industry that, with hardly a peep from the news media, has spent decades trivializing and glamorizing drug use as humorous and cool. In its quest for riches Hollywood has proven itself more than willing to invite ruin into your home, even at the cost of some of its biggest stars and most vulnerable children. It would be more than fitting to bill them for the damage done.

    • Frustrated Finfan, do you actually know any liberals? Many, myself included, are not at all interested in legalizing drugs. What we are interested in doing what works. Strong punishment, which you seem to indorse, does little to change addicts behavior. I spent a decade supervising non-violent inmate workcrews. 90% of them were there for drug and alcohol offenses. They were petty criminals and not what you would think of as drug dealers. I got to know many of them very well and they are an interesting lesson in the overwhelming power of denial. They may have been incarcerated 3 times for drugs and be under random biweekly urine testing with only one dirty test between them and spending another Christmas in the main jail and THEY KNOW THAT and they still will get wasted one weekend with their ex-girlfriend who stole their money last time they got busted.

      You don’t trust the government to rehab addicts and you demand the addicts be instead subjected to “Shame, stigma, intolerance, and confined rehab”. Presumably administered by the same government. Hate to break it to you but in their current state of mind those addicts just won’t listen. We can barely shame away obesity in normal people, why would you think that we could shame away a meth addiction? You got to get inside their heads and break that drug cycle. Locking nonviolences up hasn’t worked in the past, it won’t work in the future.

      Besides, I thought you guys hated taxes. Do you have any concept of how complex and expensive a secured facility is? You can rehab a whole basketball team’s starting lineup for the cost of one corrections inmate.

  6. Sorry but this is actually a democratic republic. The two characteristics are not mutually exclusive. You are entitled to your own opinions but you may find yourself alone with them come June 3 and November 4.

  7. Sorry, Sopartacus, this is a constitutional republic. The word “democracy” does not appear in the Dec. of Indep. or the Constitution. “Democracy” appears only in speech/witings/blogs by democrats and other liberals; and, sadly, now Finfan. A democracy and a republic are mutually exclusive terms.

    Be that as it may, I agree much more with your analysis of addiction than I do with Finfan’s analysis. The incarceration model for drug addicts hasn’t worked, and cannot work. It is the single major reason for prison overcrowding in California, and probably many other places. Imagine what would happen if we criminalized cigarettes. The person who solves the addiction problem will deserve several Nobel Prizes. On the other hand, you could just let these useless morons die from their addictions.

  8. It seems to me that the gist of the article was how wasteful, dysfunctional, and ineffective the County’s Department of Alcohol and Drug Services is.
    Liberals keep wanting our government to do more to solve what they perceive to be societal problems so they elect people who think similarly who then direct tax dollars toward “solving” those problems. Departments are created. Generous salaries are paid. But do the problems get solved? Or do people just sort of show up to work each day (or not even that as the article details) , go through the motions, collect a paycheck and retire early?
    In general , liberals don’t have a very good sense of the sort of things that government can do. Their poor judgment leads to massive waste of tax dollars that could actually be used to good benefit.
    .

  9. BEMUSED365,

    I used the word democracy in my response because it was used in the comment to which I was responding. That said, democracy is very much a part of California government: its the basis of the state’s initiative process. The great irony is, of course, that the liberals who scream the loudest about democracy show no respect for majority rule when they don’t like the ruling (Prop. 8, 187, etc.)

  10. IAMSPARTACUS,

    Doing what works is a fine goal, but my complaint against liberals is that when it comes to drug use they’ve been doing “what works” best to exacerbate the problem. It was liberals that removed the shame and stigma (long associated with drug use) from the social equation. These were cultural tools that didn’t cost a dime but effectively kept drug abuse at bay in all but the lowest levels of society, yet they were criticized, mocked, and rebranded as intolerance by irresponsible idiots so full of themselves they call themselves “progressives.”

    Unfortunately, the days of using shame and stigma to mold young people and maintain decency are gone. Those tools have been usurped for use against not those who spoil and bring ruin to families and communities, but those who aren’t liberal (Prop. 8 supporters, Minutemen, affirmative action foes, etc.).

    Solving the problem of drug addiction may be beyond our current capabilities but recognizing culpability and calling out stupidity isn’t, and that was the motivation behind my comments. Culture counts, and the feel good/do it cultural message (one engineered by the entertainment industry and parroted in the media and academia) that’s been served up to the last two generations has invited personal destruction to a degree previously unseen. And for that, let’s see you blame Nixon.

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