MANATEE -- The process of recovering from addiction differs for everyone, but it often requires months of specialized care and support that cost thousands of dollars for a typically financially drained, bereft population.
And while experts on the heroin overdose epidemic says treatment is one of the best ways to deal with the problem, treatment centers in Manatee County don't have the resources to meet the need.
"We're always full. And there's about a month wait, pretty regularly," said Melissa Larkin-Skinner, chief clinical officer at Manatee Glens hospital in Bradenton. "If people just need detoxification, we try to connect them with another agency to find help that is available. And the concern is they don't have the tools to stay sober."
Manatee Glens is the only treat
ment center in Manatee County that takes state and federal funds, meaning they have beds available to those who otherwise wouldn't have the means to afford treatment. Privately owned treatment centers exist in the county but unless a patient has insurance, those can be exorbitantly expensive.
"The reality of the situation is that if people are using and using and using, they probably aren't working. They probably don't have insurance," Larkin-Skinner said. "So then when they come in, whether by court order or because they walk in on their own, they need to have treatment available to them."
Brandilyn Karnehm, a recovering opioid addict, said getting treatment at places such as Manatee Glens is essential for learning to stay clean.
"They try, but I think there should be more funding for programs for addicts instead of just throwing us in jail. Jail is not rehabilitation or recovery," Karnehm said. "Yeah, you get some clean time, but you don't get any of the tools that you need to stay clean."
Manatee Glens takes addicts in both voluntarily and under court orders -- typically, having them go through inpatient detoxification to get the drugs out of their system; an inpatient residential program for a month of therapy and learning the tools to stay clean; and, finally, outpatient treatment, where they can start a normal life for themselves while still getting guidance through therapy.
Even Manatee Glens is limited on what it can provide to the uninsured. It has 19 detoxification beds, and only seven of those are publicly funded. Manatee Glens also has the only residential program available in the entire county, housing addicts for a month, and it has 14 beds, half of which are publicly funded. They only have enough funding for 2 1/2 outpatient specialists available to the uninsured.
'Doing more with less'
Outpatient costs vary because people's needs are so different. But the state covers enough for about 40 patients per year to receive six months of regular programming at Manatee Glens, the recommended amount for addicts to stay alcohol- and drug-free, according to Larkin-Skinner.
The outpatient staff provided services to 480 uninsured addicts in 2014.
Between county and state funding, detoxification services for 453 were covered in 2014, and Manatee Glens served 510 uninsured. About 590 people seeking detoxification services had to wait for a bed or had to be referred to services at other locations, such as emergency rooms, where the process can be even more expensive to taxpayers.
In the residential program, the state provides enough funding for 105 adults per year. Manatee Glens served 161 uninsured clients in 2014, most of whom sat on a waiting list for a month.
Those uninsured people not covered by government funding in 2014 cost Manatee Glens about $2.4 million in 2014, according to Larkin-Skinner. Officials made up for that deficit with $1.4 million in hospital profit margins, private donations and Medicaid incentives. The remainder had to be made up by reducing administrative costs, which have declined from 15.5 percent of the budget to 8.8 percent over the past four years.
"We're doing more with less," said Mary Ruiz, CEO of Manatee Glens.
Treatment is expensive
Without insurance or state help, Larkin-Skinner said a patient would have to pay $2,000 for a four-day detoxification stay and $10,500 for four weeks in the residential program. Since very few could afford that, Manatee Glens officials have to look for other funds available to help addicts, and sometimes have to turn them away completely.
Keeping the treatments affordable is essential to convincing addicts to seek treatment.
"Cost was never an issue for me," said Karnehm, who was mostly covered by charity care provided by state and local funding. "I think I paid for the outpatient, but it was like $2 per day. It was very affordable.
"And that's what irks me, too," the recovering addict pointed out. "A lot of people say, 'Oh, I can't afford treatment, I can't do this.' Well, they have state funding. ... It's a system so people can actually afford it."
Karnehm went through the works at Manatee Glens: the detoxification, the residential program and the outpatient program. It was there that she learned the tools to stay clean through individual therapy and group therapy.
She learned there to avoid people, places and things that she associated with using.
"I would relapse because I didn't listen to suggestions, but as soon as I got out of rehab I would want to show my friends I was clean, so I would go back to the people who were using and try to say, 'Hey, look we can live a better life,' and they'd say, 'Shut up and take this,'" Karnehm said. "You have to do everything in your life differently."
Without Manatee Glens, Karnehm isn't sure where she would be right now.
Ruiz says they need more funding, and they need it soon. The annual budget for the center, which includes both addiction and behavioral health treatment, is $29.2 million, with 36.8 percent of that funding coming from the state and 10.7 percent from the county in 2014-15. Ruiz said she didn't seek more from the county this year because she's hoping to ask for more as the indigent fund runs out.
"We're struggling with funding in a lot of areas, and the struggle is getting very, very serious," Ruiz said. "We're buckling under the load."
Without additional resources, Manatee Glens can't offer more beds or treatment than they already do, or officials would risk going under completely. And they haven't seen enough funding to increase addiction treatment capacities in years, even as the economy has picked up after the state Legislature slashed their funding during the Great Recession, leaving Florida 49th out of 50 states in behavioral health funding and 35th in addiction funding.
"I believe this county would be devastated if Manatee Glens and all the treatment services we provide were no longer here. It would have an incredibly negative impact on the community," Larkin-Skinner said. "People would be in the ERs more, and they're already incredibly busy and on bypass often, and more people will be in the jail. Both of those are way more expensive than what we're doing."
Heroin creates challenges
Ever since the pill mill crackdown, Larkin-Skinner said she and other Manatee Glens officials have watched the heroin problem explode. In order to address detoxification and treatment adequately, she said they'd have to more than double their publicly funded beds. And though they try to meet the need and help people however they can, they have had to turn some away.
Funding from the state to Manatee Glens and other behavioral treatment centers was cut just a few years before the pill mill crackdown occurred.
And though Ruiz said she warned that shutting down the pill mills would mean repercussions involving heroin and other illegal drugs, the problems remained unaddressed.
"Our funding was cut just as the need for our services skyrocketed," Ruiz said. "As they went through the pill mill shutdown, they never once put another dime in treatment funding."
Kate Irby, Herald online/political reporter, can be reached at 941-745-7055 or at firstname.lastname@example.org. Follow her on Twitter @KateIrby.