By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
By Eric Nicholson
If there is still such a thing as a war on drugs in Texas, then one of its last skirmishes is unfolding in the trenches at New Place, a drug treatment center that operates amid a pocket of vacant lots in Old East Dallas.
On this Thursday evening, the addicts shift and twist in second-hand chairs, which are loosely arranged in the shape of a circle inside a bare-bones meeting room. With no cigarettes or coffee to help pass the time, addicts sit, ready or not, for another dose of reality about how drugs and alcohol have taken command of their lives.
Although some people come to New Place voluntarily, this group came here fresh out of options. They are participants in a 2-year-old Dallas County court program called Divert, which is available only to addicts arrested for drug possession who have never been convicted of a felony. Though they haven't been here long, they can already claim one victory: For the first time in years, they realize they have a lot to be grateful for.
There is "Emilio," a welder by trade and the father of two children, one 5 years old, the other 8. He's thankful his kids know that Dad's finally getting sober. "Scott" the hairstylist has learned that, contrary to popular belief, pot isn't harmless. He's glad he's alive. Today "Natasha" got her first paycheck in two years. It came to only $99.05 after taxes, but it's a start. And then there's "Greg," a crack addict and single father who no longer has to smile just to keep from crying.
Emilio, Scott, Natasha, and Greg are first-time offenders. As such, the courts have given them one chance to avoid an extended vacation behind bars. The threat of jail got them here, but New Place offers the best opportunity to help them battle their addictions.
Getting addicts clean is easy; the challenge is keeping them clean. Addicts often relapse because they are bombarded with emotions that they had numbed into oblivion with drugs and drink. Oddly enough, one weapon in the New Place arsenal is a simple piece of paper called a "feelings poster," on which row after row of round faces appear. Each of the faces represents a different emotion, which is printed beneath each drawing to help the addicts learn how to identify and deal with their emotions. They cover everything from "afraid" and "miserable" to "satisfied" and "worthwhile."
When they got here, Emilio, Scott, Natasha, and Greg were strangers. They were sick, they were angry, and they weren't the least bit prepared to discuss their problems with anyone. Natasha speaks for the group when she says, "I was the type of person that would tell you to fuck off in an instant."
But after a couple of weeks of therapy, the group has created an atmosphere that gives them the confidence to share the emotions their addictions have concealed. They still have months to go, and the last thing they need now is an excuse to use. But tonight the state of Texas just gave them a good one.
Unbeknownst to them, they are guinea pigs in a new public-health experiment. On July 1, a managed-care program called Northstar descended on the poor in Dallas, Collin, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties. There has been virtually no publicity about Northstar, but its rollout four months ago marked the biggest change in public health care in Dallas County since the advent of Medicaid.
As part of the experiment, state lawmakers have hired two of the nation's largest managed-care companies, Value Options and Magellan, to control the delivery of health-care services to low-income residents in Dallas who are mentally ill and chemically dependent. Northstar is one of several managed-care "models" being tested across Texas, and state lawmakers are hoping one of them will provide a solution to the problem of rising Medicaid costs without forcing them to factor more tax dollars into the equation.
In effect, the state is injecting a shot of privatization into its veins and hoping that the forces of competition will cure a public-health-care system that ranks as the eighth worst in the nation in terms of mental-health spending and fourth worst for substance-abuse spending.
If it works, Northstar supporters say, these two profit-driven companies will usher in a new era of "managed care" that will cut unnecessary costs, expand services, and improve the mental health of the poor. But if Northstar backfires, critics say, those same competitive forces will drive many mental-health clinics and drug treatment centers out of business. They fear the state will awake like a junkie from its stupor to discover that managed-care companies have made off with their wallet and left the county's mentally ill and addicted on the streets or in jail.
"It's an interesting social experiment," says Dr. Kenneth Altshuler, the chairman of the psychiatry department at UT's Southwestern Medical School and a leading expert on mental-health issues. "But people are at risk when you do that kind of experiment. In the public sector, this has horrific possibilities."
The full impact managed care will have on the state's indigent population won't be known for years, but one thing is certain: Northstar is a risky experiment that the state is intent on carrying out, even if it blows up the lab in the process.