Why Arapahoe House Is Ending Detox Services
Inside Arapahoe House Thornton, a residential treatment center. Additional images below.
Earlier this week, we explored a lawsuit filed by a couple picked up by police officers at Mile High Stadium while inebriated and placed in a Denver CARES detox facility against their will. Lawyer Elisabeth Owen, who represents the pair, argues that Denver CARES and the Denver Police Department are essentially colluding as part of a moneymaking scheme that would only be legal if individuals voluntarily submitted to detention — and that definitely wasn't the case with her clients.
Representing a very different angle on these issues is the announced intention of Arapahoe House, a nonprofit that specializes in drug and alcohol treatment, to stop providing detox services to three major metro-area counties (Adams, Arapahoe and Jefferson) and twenty local hospitals, among other entities. CEO Mike Butler says this move is being made in part because running a detox program costs far more money than it brings in and involves little actual treatment.
This last admission echoes claims made in the Mile High Stadium suit; the plaintiffs say that for the $325 each of them was charged for Denver CARES detox, they got little more than a cot to lay on and access to food and some Gatorade. Unlike attorney Owen, however, Butler sees detox services as vital even if, as he concedes, the majority of people "do not want help." Indeed, the CEO stresses that he and members of his staff are eager to assist their client counties and hospitals in finding other organizations to take over the task by June 30, 2017, when Arapahoe House will cease detox operations — and he's hopeful that these outfits will hire some or all of the approximately sixty employees who will otherwise lose their jobs once the program ends.
"We're a 41-year-old operation," Butler says, "and we've been focusing on providing treatment and services for those who suffer from substance-abuse disorder. Our mission is to help individuals break the cycle of addiction and improve their lives. That's really what drives all the programs we have, and over the course of decades, we've developed over twenty programs that we offer individuals suffering from various addictions."
Butler notes that these programs "are treatment-based, providing deep therapeutic help for individuals," with one exception: detox. "That's a public-safety service," he maintains. "We're providing a safe environment for individuals to stay and be cared for while they're detoxing. There's very little treatment involved and the majority of individuals who come through detox have no interest in moving to the next level of care."
By Butler's estimate, detox represents "about 20 percent of what we do and 20 percent of our staff. But it was significantly underfunded. We were losing large amounts of money on it, and it was not treatment-based but public-service-based. So like many nonprofits faced with limited fundraising opportunities and finite dollars, we made the decision to direct our resources to our core mission — those programs that help patients break the cycle of addiction."
This move will impact plenty of folks. By Butler's estimate, Arapahoe House's detox arm has around 14,000 admissions per annum, representing approximately 10,000 people. He explains the difference between these numbers by pointing out that "70 percent of them we never see again, because they may not even have a substance-abuse problem. They got drunk at a Broncos game, they stayed late at a party, they had one too many drinks. The other 30 percent come back another 4,000 times."
Out of the overall total, Butler continues, "a number of people are brought in by police and a number of them we pick up at hospitals. They'll call us, say they have an intoxicated individual who doesn't need medical detox, they need social detox, and we'll go and pick them up and bring them back" to one of three Arapahoe House detox facilities, located in Wheat Ridge, Commerce City and Aurora.
When asked if admissions are voluntary, Butler offers a complex response. "It's not illegal in Colorado to be publicly intoxicated," he says, reinforcing a key point in the aforementioned Mile High Stadium complaint. "But if an individual is arrested on a DUI, they may not be taken directly to jail, and we provide services for them in detox. And an individual may be brought to us by police because they're found on the street and deemed to be unsafe — because police officers feel it's necessary. We'll admit those people, but here's the distinction: None of our facilities is locked, and a patient can leave our facility if they choose to at any time. Now, there are consequences to that if they were brought in by police and charged; if they leave, they'll probably be re-arrested within hours. But we don't have a lock-down facility. We have a hands-off policy, so we never touch a patient with any kind of restraint."
He adds, "There's a wide breadth of people we serve. Some do come to us on their own and self-admit and say, 'I need to detox.' But the ones police bring in, that's between the police and the individual. We're there simply to provide care, and if they choose to leave, they can."
If these descriptions of detox at Arapahoe House make it seem as if it's relatively cheap to provide, Butler begs to differ. "We receive approximately $2.5 million less in funding than it costs us to deliver these services. You have to keep in mind that we have three locations open 24 hours a day, seven days a week. They're never closed, and they're staffed for three shifts a day. We house individuals, we feed them and care for them. It's very expensive to deliver this public-safety service, and we've been subsidizing it for a number of years. We've worked very hard internally to consider varied options about how we can deliver this service more efficiently with the funds that are available, and the reality is, we cannot."
Given this economic scenario, the counties and hospitals may have a tough time finding another nonprofit willing to pick up where Arapahoe House leaves off. That's why Butler hosted a stakeholder meeting on December 20 "to facilitate a discussion around, 'Okay, here's a big statewide challenge. How are we going to move this forward?' And we have six months to work purposefully to find another provider or group of providers."
He's confident this chore can be accomplished before June 30, a date that he portrays as hard and fast. "There's an opioid epidemic racing across the country, and Colorado is one of the leaders of substance use and abuse," Butler says. Every day, he goes on, "we have to turn away individuals when they're at a point in their recovery where they want help and they're coming to us. We cannot get them into our treatment fast enough, so that's driving our decision to shed this very important and critical public-safety service and focus on our treatment plans. We need to focus on the people who want help, unlike the majority of people in detox."