Delvertis Duke doesn't rely on foxhole prayers anymore.
"You know how you get caught and say, 'Oh God, just help me this one last time,' and then go right back to it,'" said Duke, 55. "That's a foxhole prayer. I don't do that now."
Duke can say that and mean it.
He's been off drugs for three years after being addicted to heroin and cocaine for three decades. Duke battled drug addiction since the age of 22, when his experiments with marijuana and alcohol morphed into heroin and cocaine. Finally clean, Duke is married and started a home rehab business called God's Skillful Hands.
"I could put up cabinets, cut in the sink," Duke said proudly. "I could put it all in — ceramic floors, bathrooms. I could do everything by scratch."
A former member of the Undertaker Vice Lords gang, Duke has come a long way from his days of using, then selling, drugs on the streets to support his habit. He recognizes that his redemption came from an unlikely place: jail. Duke cycled in and out of jail and prison six times, with his first stint being in the federal penitentiary in Oxford, Wisconsin in 1991.
Things changed two decades later. In March 2010, Duke was caught with a bag of heroin that got him 37 days in Cook County Jail. This time Duke had had enough. Detoxing in jail wasn't the best option, but it seemed like the only way to get clean.
"It feels like I got the flu more than the flu," he recalled. "I feel like I'm finna die. Stomach turning, upside down. Then when you get 15 to 20 days in, you start feeling better. Then you ask God to help you out."
He bargained with God that if he got through it, his hustling days would be over. Jail for Duke saved him.
"When I got out, I didn't look back," he said. "My focus is living a normal productive life."
Duke's path to sobriety follows that of many low-income people who cycle in and out of incarceration because of drug addiction.
In Cook County jail, 75 percent of arrestees routinely test positive for illicit substances when they enter, according to Treatment Alternatives for Safe Communities, Inc. (TASC), which provides case management for people leaving jail. According to 2012 data from Substance Abuse and Mental Health Services Administration (SAMHSA), 40 to 51 percent of people in drug treatment for marijuana, methamphetamine and PCP were referred through the criminal justice system. Only 7 percent of all drug treatment referrals came from a healthcare provider.
"What does that say about how we're handling substance use disorders in our society?" asked Daphne Baille, TASC's director of communications. "We're saying that when it becomes a criminal justice problem, that's when we are addressing it. We are not addressing it when it's showing up in our doctor's offices."
But President Barack Obama's signature health care reform legislation could offer new hope for destitute people like Duke who previously found jail their best avenue out of addiction.
The Affordable Care Act greatly expands access to health services, including substance abuse and mental health treatment. That's especially true for low-income, single childless individuals living in states that expanded their Medicaid programs under the law. Illinois is one of 27 states to do so.
More than 622,000 Illinoisans signed up for health care under the law. And, of that, approximately 405,000 people enrolled in the state's expanded Medicaid program. But as Obamacare's open enrollment period begins, many treatment providers say hurdles still exist that could impact those needing care. Treatment facilities could see a significant impact.
Capacity, stagnant reimbursement rates, and Illinois' arduous move to HMO-like managed care for its Medicaid system may limit beds or slots, adding to already-long waitlists for drug treatment.
Sally Thoren, executive director of Gateway Foundation Chicago West Treatment Center in North Lawndale, is hopeful the law will result in more access to treatment for many people.
"The best part about the ACA is the fact that it recognizes and requires insurers to cover mental health and substance abuse," Thoren said. "That's a huge accomplishment [since] that wasn't always the case."
Medicaid expansion under Obamacare gives people the ability to seek care, but it does not necessarily guarantee access to care.
For example, Gateway offers several outpatient, as well as residential treatment services, city and statewide for adults and youth. A federal rule limits the size of such adult treatment programs to 16 beds.
Gateway's North Lawndale site at 3828 W. Taylor has 100 beds — 16 of which are adult Medicaid beds and another 18 are for youth. The remaining beds are for private insurance patients. While more people are eligible for those Medicaid beds under Obamacare, it does not increase the number of licensed and certified Medicaid treatment providers, or the number of Medicaid beds in treatment facilities.
Thoren said that for every bed in her facility, there are three to five people waiting for admission.
Stagnant Medicaid reimbursement rates also impact capacity, said Eric Foster, chief operating officer for the Springfield-based Illinois Alcoholism and Drug Dependence Association (IADDA). Addiction treatment providers have been reimbursed at the same rate since 2006, even though the cost to provide care has gone up, Foster said.
Medicaid reimburses group and individual counseling at $22 and $15 per hour respectively, on average. Obamacare does not change that, though the state has proposed a possible 3-percent rate increase for addiction services in its FY2015 budget.
Next week, managed care concerns and treatment-on-demand services under Obamacare
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