Used and Abused

On November 10, 1996, Denise Marshall was the graveyard supervisor at Arapahoe House's drug and alcohol detoxification facility in Wheat Ridge. When she'd arrived at 10 p.m. the night before, the facility already housed eighteen clients in various stages of intoxication. By the time Marshall's shift ended, at 7:30 the next morning, four others had appeared, drunk or stoned, needing to dry out. It was a light load for Detox West and a staff--four counselors, including Marshall--that could absorb up to twenty new admissions in a matter of hours.

Marshall recognized one of the new clients. "He was what we call a 'frequent flier,'" she recalls, a habitual drunk who was a regular visitor to the detox. As she sat at her desk and began filling out his paperwork for admission, the man became hostile, throwing about his belongings in a growing rage and then, suddenly, lunging at her. His punch had a tremendous impact--he'd gripped a roll of quarters in his hand to amplify the force--and a second later she found herself spitting out a broken tooth. The police were called, and the man was whisked off to jail.

Working in a detox is risky--drunks are unpredictable--and Marshall knew when she signed on five years ago that there might be hazards. But this was far from the first time that she'd been injured, and the incident infuriated her. "This facility is not a safe place to work," she scribbled in that night's shift report.

"Of course, Arapahoe House will find a way to blame this on the supervisor, I'm sure," she added.

And, she says, the following day she was reprimanded by her superior, who reminded her that she was not to send any more clients to jail. The reason, as Marshall well knew by that time, was money. Jefferson County pays Arapahoe House's west-side detox to take in all of the drunks picked up by the county's law-enforcement agencies. The operative word is "all": If the detox refuses to accept one--even if it is because he is violent or threatening--Arapahoe House is penalized at a rate of $150 per refusal.

"We expect them to handle these people--that's their business," explains Tom Giacinti, director of Jeffco's Department of Community Corrections, which administers the contract with Arapahoe House. "I mean, if they're drunk, they aren't going to be real violent."

Less than a week later, Denise Marshall was on the graveyard shift when the man who'd assaulted her showed up again.

Her choices were slim. She could admit the man and hope he wouldn't be violent on this particular night. Or she could send him back to jail, risking the wrath of her bosses. "And I had been getting increasing pressure from my supervisor not to send people to jail," she recalls.

So instead, she got creative. She ordered the man sent to another Arapahoe House detox, this one in Englewood, where the facility didn't have a penalizing contract with the local police. She warned the staff there that the man would be arriving. They alerted the police, who quickly carted him off to the Arapahoe County jail when he showed up.

Marshall, who quit her job at Arapahoe House late last month, estimates that during particularly bad stretches, she would resort to that maneuver three to four times a week. "I had a thing worked out with some of the supervisors at the other [Arapahoe House] detoxes," she says. "It was an unwritten agreement. It was the way we got around getting injured."

At other times when she felt pressure to admit drunks that she thought were too out-of-control or threatening for Detox West, Marshall improvised a less complicated solution. "When they told me I had to keep a violent person, I'd call the police and say, 'I'm opening the door now and letting him walk out,'" she says.

"When you're put under pressure to do something that threatens your safety or your job, you problem-solve," she explains. "I did it to keep myself, my staff and my clients safe."

It didn't always work. During her five years at Arapahoe House, Marshall says that violent clients broke her hands twice, gave her several black eyes and yanked out hunks of her hair.

Marshall isn't alone in her concerns over the safety and well-being of Arapahoe House workers and clients alike. A number of former and current counselors and supervisors say the contract with Jefferson County has forced them into making snap choices between their personal security and their job security. They have their own stories of violence and danger at the Detox West facility. The stories, many of which can be verified through written staff reports and other documents, range from instances of benign neglect (harried counselors dispensing medications without prescriptions, not monitoring clients' vital signs as they dry out) to actual sexual assault and battery.

These workers have expressed their frustrations at being given few, if any, tools to handle their responsibilities toward the intoxicated people in their care. For instance, they point out that there is no medical staff on site to watch over clients who can show up with complex medical problems and who can suffer sudden seizures during withdrawal.

They complain that the twin policies of not locking the detox facility--giving very drunk clients the freedom to walk out if they choose--and directing staff not to touch or restrain clients have led to numerous dangerous predicaments: Drunks weaving through traffic on busy Wadsworth Boulevard, stumbling outside into subzero temperatures, or harassing neighbors.

But worst of all, the workers say, they have been forced to put their own safety at risk because of monetary considerations.

It wasn't always that way. Detox West was born in the late 1980s, when Jeffco decided it couldn't continue providing detox out of a county building in Lakewood. "We just didn't have enough space for it to expand, which it obviously needed to do," recalls Giacinti. Meanwhile, Arapahoe House was looking to grow beyond its Englewood facility, so it opened a west-side facility at 4643 Wadsworth Boulevard and signed a contract with Jefferson County.

Detox West takes in anyone who needs drying out--drunks who walk in on their own, who are brought in by a friend or relative, or who are referred by local social service agencies. But counselors there say up to half of the facility's business comes from "police drops" covered by the contract with Jeffco.

Under the agreement, the county pays Arapahoe House $418,000 a year; in return, Detox West agrees to "admit all intoxicants to its facilities delivered to Arapahoe House by any law enforcement agency that has jurisdiction in Jefferson County except those with medical conditions." Two years ago, after Jefferson County officials complained that Detox West was refusing too many drunks, the $150 penalty provision was added.

Executives at Arapahoe House, Colorado's largest nonprofit substance-abuse company, insist that Detox West meets its clients' and employees' needs as well as possible, particularly given the obstacles of low staff pay and shrinking government funding for detoxification programs. The facility, they claim, is not unusually dangerous.

Michael Kirby, Arapahoe House's CEO, points out that in 1996 and 1997, "we had over 16,000 'episodes of detox' [and] only three incidents of workers' compensation were related to any kind of physical assault on a staff member by a client.

"The decision to refuse service," he adds, "rests with the shift supervisor [and is] based on specific criteria, including safety--not dollars."

But something has gone wrong at Arapahoe House's Detox West. In 1997 cops responded to the facility an average of 2.4 times every day of the year, making it the busiest single response site in Wheat Ridge.

Like many people who choose to do social work, and particularly those who decide to work in substance abuse, Denise Marshall, who looks like a smaller Bette Midler and projects the same take-no-shit attitude, was prompted to join the field by a combination of professional interest, altruism and personal experience.

"I used to be a paramedic, and it seemed like 85 percent of what I was treating were drug- and alcohol-abuse cases," she explains. "After a while, I thought I'd like to get into a field that addressed those problems before it became a matter of life and limb."

Marshall started as a volunteer at Arapahoe House's Detox West on January 4, 1993, working for free for six months. She was hired as a counselor that summer. On the day she marked her one-year anniversary at the facility, her mother died as a result of years of alcohol abuse.

Marshall was soon promoted to shift supervisor, a job that placed her in charge of as many as five counselors and support staffers. During her busy overnight shift, she also oversaw the care and feeding of up to three dozen drunks and strung-out drug users. That meant shouldering responsibility for monitoring vital signs, dispensing prescription medication, diagnosing addictions, keeping an eye out for dangerous withdrawal symptoms such as seizures, providing meals and maintaining safety and discipline among clients.

When she quit a month ago, Marshall was earning $7.84 an hour.
For social workers, drug- and alcohol-detoxification programs are among the most difficult and least satisfying places to work. Most clients don't want to be there. Drunk or high when they arrive, patients can be dirty, belligerent, uncooperative or even violent. Transients and indigents use the facility as a flophouse. Others are brought in by cops because the police don't know what else to do with them. People who are simply intoxicated have committed no crime--Colorado rescinded its public drunkenness laws 25 years ago--but they are often too incapacitated to be out on their own and so end up in detox.

Once they have sobered up, most people in detox choose not to enter long-term treatment programs, so counselors rarely experience the satisfaction of watching a person turn his life around. In fact, the main qualification for the job seems to be bottomless patience and a tolerance for abuse that is endless. "I signed up to help people," says Dano Martinez, who worked as an Arapahoe House detox counselor for ten months in 1996 and 1997. "But all I was was a mini-jailer."

As a result, detox workers are among the lowest-paid staffers in a profession that traditionally does not pay much. Helping keep salaries low is the fact that detoxes don't generate much private money; insurance won't cover a drunk's drying-out period unless it is medically required.

Yet detox clients can lead to money, since many of the longer-term treatment programs are covered by insurance. "Detox is the starting point," says CEO Kirby. "It's the cornerstone of what we do. When things work well, we're able to motivate people to get into treatment, or to simply go to AA. We believe in rehabilitation."

That rehabilitation is not cheap. Arapahoe House is the largest, highest-profile provider of such services in the Denver area. In addition to its three detox centers, the company operates nearly a dozen residential and out-patient substance-abuse treatment centers for teens, adults and families. The company spends $13 million a year keeping all of its programs humming.

Most of the money comes from taxpayers, but some is collected at Arapahoe House's many fundraisers, which are attended by some of the city's top socialites. A smaller amount comes from daily fees assessed to clients. The company charges an extravagant-sounding $295 per night for detox. But most times that assessment exists only on paper.

Given the demographics of the drunks and junkies who come through the door, the $295 bill is rarely collected in its entirety. "We average about $50 per person," Kirby says. "Detox is a service that loses money or that barely breaks even."

And lately, money has gotten even scarcer. The largest single outlay of cash to all of Colorado's detoxes comes from the state Alcohol and Drug Abuse Division, which until recently paid facilities a fixed amount of money for each client. In 1997, however, the state decided to give managed care a shot: Instead of paying detoxes for each client served, ADAD now paid one check to cover a year's worth of detox.

To reach the figure of how much money each detox received, ADAD conceived a brutal formula. It took the number of clients served in 1995-96, cranked it up by 10 percent, then subtracted 10 percent of the total amount paid the previous year. "We wanted more bang for our buck," explains Bruce Mendelson, a researcher for ADAD.

According to Kirby, the new funding recipe cost Arapahoe House $264,000 last year. "For a business like ours, that is a tremendous amount of money," he says. "We have cut every expense that we could. But we have dealt with it in a very responsible manner."

In the rapidly changing world of managed care, though, last year's budget cuts are the least of Kirby's worries. This year ADAD is expected to add a punishment provision to its substance-abuse treatment contracts. It will penalize detoxes that don't meet targets of a certain number of clients treated.

For Arapahoe House, this means that if the company's three detox facilities do not serve a total of 7,982 clients this coming year, the company will probably have to pay a fine. The amount has yet to be determined, says Mendelson.

While detox facilities all have essentially the same goals, not all programs operate the same way.

In addition to Arapahoe House, two other Denver-area entities offer detox services: Denver Cares, which is part of Denver Health and Hospitals; and the Aurora Emergency Treatment Unit, or AETU, a nonprofit division of the for-profit Aurora Behavioral Health Hospital, which opened in 1995.

While all three bill themselves as "social detoxes"--that is, facilities that don't provide intensive medical treatment for abusers while they dry out--their staffing is markedly different.

Denver Cares assigns a nurse to each shift, who evaluates new clients, oversees monitoring of their vital signs and dispenses any necessary medications. AETU is housed inside Aurora Behavioral: Summoning a nurse is an internal phone call away. "We dial three numbers--3-6-0--and a nurse will be here in minutes," says detox director David Arthofer. "It really helps when our clients have seizures."

Arapahoe House used to staff its shifts with nurses, too, but eliminated the positions five years ago. "Whenever we tried to be a hybrid medical detox, we realized we just couldn't do it," Kirby says. "We're not as richly funded as Denver Cares."

The abrupt change in staffing came in late 1993, shortly after Marshall got her full-time job. She says the elimination of nurses marked a sharp turnaround in the facility's quality of care. "Arapahoe House used to be a great place to work," she says. "The beginning of the downfall came when we got rid of the nurses."

Esther Strickland is a former Denver cop who worked as a day-shift supervisor at Detox West for two and a half years before quitting last month. After the nurse positions were axed, she says, the responsibility for medical tasks such as taking clients' vital signs and assessing their health risks was picked up by detox counselors--most of whom, Strickland adds, have no medical training and sometimes have no more than a high-school education.

And the counselors do those tasks only when they can find the time. "Following admission, blood pressure and pulse will be taken 2 hours after admission, 4 hours after admission, 8 hours after admission, and 12 hours after admission," a 1993 internal Arapahoe House memo titled Monitoring of Client Vital Signs instructs counselors.

But "that's absurd," says Anita Ducolon, a former counselor and supervisor at Arapahoe House's Detox East who now works at the Aurora Emergency Treatment Unit. "It's just absurd. There were times when I would come to work on a Sunday and there would be forty clients, and me and one counselor. So if a client wasn't obviously sick, you would just fake it--make their vitals up, put what their last reading was. We all did that. We had to."

Similarly, say workers, although they're supposed to counsel detox clients during their stays in Arapahoe House, such counseling is rare to non-existent. "We used to have group counseling sessions for people in detox," says Deborah Pollack, another day-shift supervisor who quit this summer. "But that stopped over a year ago. When you're processing forty people, you don't have the time. It's like a meat market."

"Clients want referrals," says Ducolon. "They want hand-holding, to tell you their life story. But there just isn't time. It's a zoo."

"What do you get for your $295 [at Arapahoe House]?" asks Pollack. "You get a bed. Possibly a meal. And you might get somebody who possibly has time to take your vitals."

At times, she says, the sheer number of clients housed at the detox lowered treatment expectations to base levels. "You want a warm body at the end, not a cold one," Pollack notes.

Adds Strickland, "Most people would be far better off just going home and sleeping it off."

According to former and current employees, Arapahoe House procedures for dispensing some prescription drugs are similarly loose. For example, the appropriate medical situation in which to give clients the prescription sedative Tranzene is described for counselors in a simple handout.

"We weren't supposed to give it out without a prescription," says Ducolon. "But it was done." Clients frequently arrive with their own Tranzene, Ducolon and other workers explain, then leave it behind when they exit, giving the staff a ready supply to dole out to new clients.

Kirby concedes that there have been problems in the past regarding the drugs but says that new policies will correct them. As of late last month, non-medical staff members are no longer permitted to give out drugs unless a client arrives with a valid prescription. "We're tightening up where things had slipped," he says. "There may have been cases where there was sloppiness around the use of Tranzene."

Having poorly trained or under-educated workers performing professional tasks also has caused less serious concerns at Arapahoe House. An internal Arapahoe House memo dated April 28, 1997, for instance, admonishes counselors not to use amateur-sounding descriptions such as "Clients are dead drunk" and "Client is acting like a jerk" when writing in their official medical charts.

Such conduct doesn't surprise Pollack. "I had been working there two days when I was handed an intake packet," she recalls. "I said, 'But I don't know what this is about.' They said, 'Wing it.'" After a few more days, she says, she was being required to make a professional diagnosis of the extent of new clients' alcohol addictions--a medical assessment that could end up on a patient's permanent record.

The differences among Denver's detoxes aren't only staff-related. There are also crucial philosophical differences that in turn lead to wide discrepancies in protocol. As director of behavioral health services for Denver Health and Hospitals, Dr. Ed Casper oversees the operation of the detox program for Denver Cares, which treats just under 6,000 clients a year. He says his facility practices an aggressive approach to taking responsibility for the people who are checked in.

For example, Casper says, once a client enters the building, he may not leave, even if he wants to: The doors are locked. "His well-being is our responsibility," Casper points out. If a drunk becomes violent or threatening, he is quickly removed to one of six "isolation rooms," where he can vent in private, without harming himself or anyone else.

Arthofer, the director of the AETU detox, says his facility locks its doors after 4 p.m., although he admits that "if someone is persistent enough, he will find a way to leave."

Arapahoe House takes an even less controlled approach to its clients. Kirby, who wrote his doctoral dissertation at the University of Colorado on the benefits of de-institutionalization of the mentally ill, says that philosophically, he doesn't believe in either locking up clients or sequestering them if they become violent. "We don't want to cross that line from being a detox to becoming a jail," he explains.

Indeed, by policy, Arapahoe House counselors generally are not permitted to have any physical contact with clients. (According to Kristine Payne, who still works at Arapahoe House, workers recently were told that if clients became unruly, counselors would be permitted to use one of three specific holds.)

Instead, if a client's behavior gets out of hand, workers are expected to defuse the situation by talking to him--a strategy that Kirby insists is more than adequate. Every detox worker, he says, is required to complete a three-day, in-house training course that teaches how to do this.

"Verbal de-escalation works wonderfully 99.9 percent of the time," Kirby says. And in those few instances where it doesn't work, he adds, counselors are trained to call the police.

According to Dan Griffin, public information officer for the Wheat Ridge police, police responded to Arapahoe House's Detox West 884 times in 1997. That number, he stresses, does not include the instances when police simply dropped off a drunk or when the detox called to inform the cops that someone had run away from the facility.

Arapahoe House workers say the no-lock, no-touch policy often leaves them powerless to do their jobs safely. In fact, they claim, there is an inherent contradiction between the detox's policies and the law.

Many people are brought into a detox on what is called an "emergency commitment," a legal document in which a professional--usually a cop or a detox supervisor--attests that the drunk is incapacitated enough to be a danger to himself or to others. Once the drunk makes it inside, the detox takes over responsibility by presumably providing a safe environment in which he can dry out.

"But you're talking about doing this at an unlocked facility," Marshall points out, "and one with no security."

Those conditions have caused tensions between Detox West and its neighbors.
"We've considered moving because of Arapahoe House," says Steve Balog, owner of a small business two doors away from Detox West on Wadsworth Boulevard. "We've probably had the Wheat Ridge police here an average of fifty times a year.

"The problem," he continues, "is that their drunks end up lying here in front of our door. They apparently don't have enough staff to keep an eye on everyone there, and so some leave. When they come here, many times they're still drunk, still high. One guy walked into our store bleeding from his foot. He got blood all over our carpet. They approach our customers asking for a ride or for change. I know we've lost customers because of Arapahoe House."

In an effort to address the problem of runaway clients, a few years ago Arapahoe House installed security cameras at the Detox West facility. But "they're useless," says Pollack. For one thing, the cameras don't always work. For another, they're pointed at the facility's doors--when most clients escape through the building's unlocked windows.

Even when the detox staff manages to spot someone escaping, the image simply provides visual confirmation of what has always gone on. "Since we can't touch people," says Strickland, "if we happened to see someone leave on camera, our security system entails a counselor going outside and saying, 'Yep, he's going north.'"

Last summer, two young men walked away from Arapahoe House. They were captured four blocks away, after a woman spotted them trying to steal her car and called the police. "That set off a number of calls to me," recalls Ken Siler, a Wheat Ridge city councilman who represents the district in which the detox is situated.

After touring Arapahoe House and meeting with administrators, Siler noted that clients were able to leave undetected through windows and the back door. Late last year he convinced Wheat Ridge officials to pony up $8,500 to pay for alarms to be installed on both. The work was done this past spring.

Both Siler and Kirby contend that is the most that can be done: Clients who are bent on getting out of Arapahoe House will always be able to leave one way or another. Once they do, the staff has been instructed to call the police immediately.

Whether the cops will have the time to do anything about it is another matter. "It depends on the call load," explains Griffin, the Wheat Ridge police spokesman. "I don't want to say that we don't care. But it's a pretty common occurrence. If we had to mount a manhunt every time that happened, we'd be doing that all day and nothing else. So usually what we do is put out what we call a 'BOLO'--a 'Be on the lookout for' bulletin."

Far more worrisome than a few harassed neighbors is how the no-lock/no-touch philosophy can put detox clients themselves at risk. On more than one occasion, Marshall says, she had to race out the door and, despite company policy, tackle a drunk person before he or she staggered into the heavy traffic racing up and down Wadsworth.

"2350 hours; man with [blood alcohol level] of .247 escaped through front door and was running into traffic," reads a shift report from last July.

Another, from late May 1996, has a more harrowing description: "Client bolted for door and ran out across Wadsworth. [Two counselors] went to see which direction she was headed. Client [began to] run southbound down the middle of Wadsworth. Staff tried to persuade her to get out of the street..." A southbound semi-truck barreling over the rise in the road slammed on its brakes as the woman darted into its path, "missing the client by inches.

"Client then darted into northbound lane," the report continues. "Another truck slammed on brakes. Client climbed into passenger side--truck left with client."

Marshall says she knows of at least one drunk client who was actually hit by a car; he wandered into traffic on Wadsworth last summer after checking himself into Detox West, getting lost in the hectic intake shuffle and finally leaving in exasperation. Marshall, who visited him in the hospital, says he suffered "massive internal injuries."

"They say we're just supposed to let them go," she says. "But I can't do that." In fact, one night last year Marshall became so frustrated with one "extremely intoxicated" woman who twice ran into heavy traffic that she tied the client to a chair with a sheet. She was suspended from work for a week for violating company policy, Marshall says.

Inside the facility, the drunks still face hazards--particularly when they're underage. "We hate it when we get a kid in," says Strickland, "because we have to watch them all the time. We can't provide a safe environment."

State law requires that adolescents entered into substance-abuse treatment must be separated by "sight and sound" from the general adult population. Denver Cares accomplishes this by simply checking the boys and girls into Denver General Hospital whenever they show up for detoxification services. "Adolescents can't be in the same facility; they must be in separate facilities, with separate staffs," Casper explains. "At least that's my understanding of the law."

Detox West has no separate facilities for girls. When they are admitted, they stay with the general women's population. As a result, Strickland says, if she happened to be working when a social service agency called with a girl appropriate for detox, her first response was to try to talk the agency out of it.

"A couple times someone from a county social services department would call when I was supervisor, saying 'We have a thirteen-year-old girl to send to detox,'" Strickland recalls. "And I'd tell them up front that we had no way to protect them, no separated facilities."

Pollack says that at times she simply kept the girls in her own office through the entire shift rather than placing them with the rest of the women.

The precautions didn't always work. Detox West has a single smoking facility that also contains the building's only television. "At night we tried not to let clients smoke outside, because they'd split, so everyone went into the same room," recalls Strickland. One time in the TV room, both Strickland and Marshall recall, a drunken man began pawing a fifteen-year-old girl, shoving his hand up her shorts. She complained to counselors, who called the police. Because the girl refused to file harassment charges, the police said they couldn't arrest the man.

Although Detox West does have a small, separate room for adolescent boys, it is directly off the men's room and out of sight of staff offices. "All someone has to do is open the door and he'd have access to a room of drunken, passed-out teenagers," says Strickland.

It's happened. "One night we heard this disturbance, and so we ran out to see what was going on," Marshall recalls. She quickly filled out an emergency commitment form to get a drunk client out of the facility.

"Client is clearly a danger to himself and others," the April 1997 report reads, "as evidenced by threats, and by his going into the adolescent room with his pants and underwear down to his knees and jumping on the adolescent in his bed."

Although Kirby says Arapahoe House's detox centers receive very few adolescents in need of immediate drying out, he acknowledges that its facilities may be inadequate. "Keeping them separate is a statewide problem," he says. "We try to keep them separate. We do the best we can."

But for all the harm that can come to clients at Detox West, what really angers former and current employees are the constant--and unnecessary, they say--dangers workers face there every day.

Detox West is the only one of Arapahoe House's three detox facilities that has a service contract with the county in which it's located. At the start of the agreement with Jeffco, violent or threatening drunks were simply sent back to jail with minimal fuss. "When I first started working there, it was no big deal," Marshall recalls. "You just wrote out a form called 'detox refusal.' You'd fill it out and send them back."

But the number of refusals soon began to cause tension between the county and Arapahoe House. "The issue that began to come up over a period of time was that they were being selective about the people they took," says Jeffco's Giacinti. "There's a tolerable level of refusals. But it's not very high. Some people are really obstreperous, and the counselors would prefer not to deal with them. But this had gotten out of hand."

Several counselors even admit that, early on, the refusal policy may have been abused--sending an intoxicated man back to jail just because he insulted a staffer in a foul mood, for instance. The solution, crafted in 1996, was twofold: Instead of a simple refusal, detox workers now had to fill out an emergency commitment form. And every time Detox West refused a client, for whatever reason, Arapahoe House would be docked $150.

"And suddenly," recalls Marshall, "I started getting a lot of pressure not to send people to jail."

Kirby says the new clause was a way to get the problem of too many unnecessary refusals under control, and adds that Jeffco still permits ten refusals per month before assessing the fine. (The contract, however, contains no such provision.) "The intent behind it was not to push Arapahoe House into taking people who are inappropriate," he says. "But detox is inherently a situation where you have intoxicated people who don't want to be there. At what point do you call the sheriff?"

The answer, at least to Arapahoe House executives, seemed to be: Not as often as Detox West was dialing the cops. "We started having meetings every week," recalls Adrienne Nimmo, a counselor who worked at Detox West for ten months before moving to Texas in July 1997. "They would tell us we were sending too many people back to jail, that it was costing us money. We weren't supposed to send anybody to jail unless they actually assaulted us. We had to wait for an injury."

The new clause created increasing tension between staffers concerned for their safety, and their bosses. "We had 19 [emergency commitments to jail] in March and 18 in April," reads one 1996 memo from Arapahoe House management to Detox West supervisors. "This is too high and needs to be reduced."

Indeed, conversations with both Casper of Denver Cares and AETU's Arthofer suggest that, for whatever reason, Detox West does have an unusually large number of incidents where staff have reported feeling threatened or in danger. While AETU has the luxury of calling in more hospital staff if things at the detox get out of hand, Arthofer says the frequency of such incidents is "rare."

Yet Marshall insists each Detox West episode staffers complain about is legitimate. "I worked my butt off to keep my staff and my clients safe," she says. In fact, she notes, she continued to call the police even after her job evaluations sank because of her insistence on refusing clients she saw as threatening. "Denise is slow to adopt to new procedures, i.e., limiting ECs [emergency commitments] to jail," reads an October 1996 assessment.

When the number of Detox West refusals remained high, Arapahoe House administrators tried to push more "de-escalation" training as a solution. In a January 1997 memo that noted an increase in the number of clients sent back to the Jeffco jail, one company official urged counselors to take more classes.

Many workers, though, remained unconvinced that staff education was the answer. "The people we send back to jail are not those who can be de-escalated," says Marshall.

In a March 1997 memo to Arapahoe House's director of human resources, an assistant supervisor stated his predicament: "The writing of ECs poses a dilemma for Detox West supervisors," he noted. "Because Arapahoe House must pay Jeffco $150 every time a client is sent to jail on an EC, the minimizing of this expense accrues to the benefit of Arapahoe House and reflects financially on management. Our dilemma is that...ECs can generate adverse consequences, endangerment of ourselves and our clients if we don't use them, and [an administrator's] criticism if we do. How many is too many?"

"Economically," adds former supervisor Strickland, "it's a great incentive for the company to pressure employees not to send people to jail. When we do, they say it's unnecessary and that we're losing money, and you won't get raises, or we'll have to shut down."

Kirby denies that the $150 penalty clause compromises security. He says the amount of money Arapahoe House loses each quarter for refusing intoxicated dropoffs from Jefferson County is "nominal"--and certainly not a sufficient sum to force him to compromise safety at Detox West. "We're always looking to improve security," he adds.

Shift supervisors, however, claim the pressure to keep the number of refusals down led them to try anything--even if it was frowned on by their bosses--to maintain a safe facility. While Marshall shipped violent or threatening clients to other detoxes and let others walk out the door, Pollack says she sent unruly clients to Denver Cares, which has isolation rooms. When her strategy was discovered, she adds, she was told to stop.

Workers say they've tried to find above-board solutions to ease the friction. "We asked for a security guard long ago," says current Detox West staffer Kristine Payne.

Adds Marshall: "We've asked them to hire an off-duty officer, because sometimes a uniform alone will stop these things before they start. But Arapahoe House won't do it--too expensive."

Kirby disputes that charge. "We really haven't talked about hiring a security guard," he says. "The staff has never raised this with us. But if that's something they feel strongly about, we'll consider it."

Frustrated by the increasing tension over the issue of safety, among other things, this past January Arapahoe House's 57 detox counselors narrowly voted to unionize and join the Communications Workers of America. Arapahoe House and CWA union representatives are currently in negotiation to approve a contract.

Wages are a major issue. At a starting salary of $6.19 an hour, Arapahoe House detox workers say they're underpaid even in an industry known for penny-pinching. AETU's Arthofer agrees. "That's subhuman," he says. "With the kind of work you're talking about, that's ridiculous."

But the bigger issue, the workers say, remains security--for both clients and staffers. Strickland, who now works at a LoDo substance-abuse clinic and is studying for her master's degree, hopes the union can help.

"For now, Arapahoe House detox is not a safe place to work," she says. "For anyone."

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