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By Brian Stimson of The Skanner News
Published: 10 September 2009

Admittedly, Kevin Scott has not led the most sympathetic life. Now in his 50s, Scott has been living on the streets and using heroin and cocaine much of his life. So when Scott was referred to an innovative drug treatment program run by Volunteers of America, he'd just come off a five-month heroin binge.
The year-old program was designed for people on parole and probation: for people like Scott, the 'frequent flyers" of the criminal justice system. Scott said he was one of the petty criminals on the Portland Police Bureau's "Dirty 30" list, and also a client of Project 57 – two programs that targeted Old Town's most prolific quality of life criminals.
Before his latest relapse, Scott had been living in Central City Concern housing.
"I came to them and told them I needed help," he said. "After a month, they got me in."
After detoxing by himself, Scott says he arrived at Volunteers of America's Recovery Support Program feeling positive about changing his life.
But in less than a week, Kevin Scott's past lifestyle habits had caught up with him--
almost snatching away not only his recovery, but his life.

For the past year, the Portland Police – led by Officer Jeff Myers –
Multnomah County Community Corrections, the Central City Concern and Volunteers of America have coordinated to provide longtime addicts and offenders a different kind of substance abuse program, says Pam Kelly, division director for rehabilitation services for VOA.
Located in the Salvation Army's Harbor Light building on West Burnside and S.W. Second Avenue in Old Town, the VOA's Recovery Support Program takes 12 men into supervised housing for three to four months. (The Salvation Army is not affiliated with this program.) As well as supervised housing, the men are fed and taken to classes and treatment sessions. Unlike other programs, Kelly says clients do not immediately jump into full-time treatment sessions. She want the men to begin getting used to living without drugs in the shared housing before they begin addressing some of their other longstanding problems.
In treatment, alongside 12-step programs, they are encouraged to find different ways to spend their time and have fun as well as opportunities for job training. It's all free of charge.
After the initial supervised housing period, the clients are then moved into dry housing provided by the Central City Concern and continue to attend day treatment sessions for the next six months.
"They're given as much supervised, clean time as possible," Kelly said.
An alumni program is starting to take root in order to provide both newcomers and past graduates a place to reinforce their new-found lifestyles. For many, Kelly says, it's the first time in years they've experienced such long periods of sobriety.
New habits must be learned. Kelly says the VOA provides lifestyle training to help erase the years of street survival habits that have little bearing in the real world.
"They really like being in this program," Kelly said. "They're not locked in. I'm amazed at how receptive clients have been."

On Aug. 9, after nearly a week in the program, Scott found himself in an ambulance heading to Legacy Emmanuel hospital. His mother, Loretta, called the ambulance after he spoke to her on the phone. He was suffering from a fever, lingering effects of heroin detoxification, and what was likely a case of dehydration. Not long after he reached the hospital he suffered a seizure.
"I couldn't consume (anything) no food, no drink, I couldn't participate," he said.
Scott is upset about his rapid collapse, saying the RSP facility's directors ignored his requests to go to a hospital. Kelly said that simply isn't true. She said program directors asked Scott on several occasions if he needed to go to the hospital, but he said no, blaming his ill-feelings on heroin withdrawal.
Every client is required to go through a medically supervised withdrawal, and most clients go to the Hooper Detoxification Center. Scott says he was turned away because the facility was full, so he simply went cold turkey.
"He hadn't been fully honest about the extent of his addiction," said Alexa Heinicke, of VOA. "The detox process can be long and subtle."
Steve Mattsson, Hooper's manager, says his facility sees about 30 people a day trying to get into medical detox on their own. Triage nurses look for the worst cases of withdrawal. They end of admitting about 10 people a day to the 54 bed facility. A waiting list is made for the rest and it's their responsibility to come back until they're admitted, Mattsson says.
"If they don't, there are plenty of people to take their place," he said. Most of those admitted to Hooper detox – 45 percent – are alcoholics; another 45 percent are opiate addicts; the other 10 percent are qualified as "other drugs." Often, alcoholics are admitted first because severe alcohol withdrawal can cause deadly seizures, Mattsson says. Opiate addiction, on the other hand, is horribly unpleasant, but rarely deadly.

Scott's week in the hospital is an illustration of the challenges faced by both treatment providers and those receiving treatment. Working with the chronically homeless who suffer from addiction disorders means working with people who largely don't value their health and haven't seen a doctor regularly.
A main point of Scott's criticism is that the center doesn't have a nurse on site.
"I'm afraid somebody's going to come through and they'll find someone in their bed dead," he said.
Kelly said a full-time nurse is expensive and unnecessary. She said situations such as Scott's are actually quite rare, although it's common for clients to feel miserable and unwell after a long period of addiction. Both supervisors at RSP are trained addiction specialists.
"It's not unusual for someone to say 'I don't feel well,'" Kelly said. "He wasn't appearing to be in acute medical distress."
Kelly said VOA has a non-emergency medical transportation company on call and will also not hesitate to call 911 for medical emergencies. They also have a medical director on call.
Despite Scott's week-long hospitalization and his lingering concerns about the incident, he is now back in the VOA program – a program that he says is helping him get free of his longtime addictions and behaviors. He may be voicing criticisms of RSP's medical supervision, but he also says he is glad to be back. He likes the group of guys he's going through treatment with and he respects the program directors, he says. Rather than blaming anyone for his problems, Scott is busy looking for solutions.
"It's my problem," he said. "I put myself in that position."

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