On Tuesday, Sept. 24, the city of Juneau is set to lose a valuable resource for treating individuals in our community suffering from drug and alcohol addiction. After decades of operation, Rainforest Recovery Center, the only intensive inpatient drug and alcohol treatment center in Southeast Alaska, will close. Unfortunately, contrary to what some may believe, there will be no program in Juneau able to fill the void in addiction services that the closure of Rainforest Recovery will leave us with.
To better understand the impact of this decision, one needs to appreciate the different levels of intensity in chemical dependency treatment. We must also understand that individuals need to be placed in programs with the appropriate levels of care to ensure that individuals have safe and successful addiction treatment.
In order to optimize treatment outcomes, the American Society of Addiction Medicine(ASAM) has outlined four levels of care which are necessary to treat the spectrum of chemical dependency related illnesses. Level 4 is inpatient hospitalization, which is done at Bartlett Regional Hospital, while levels 1 and 2 are handled through various outpatient services at our local clinics and doctors’ offices. Level 3 is clinically managed residential services, with level 3.5 being high-intensity residential services, and level 3.1 being low-intensity residential services.
Currently, Rainforest Recovery is the only 3.5-level program in Southeast Alaska, with the next closest 3.5-level programs in the Anchorage area, which have waiting lists of 90+ days. Not only do 3.5-level programs provide more intensive addiction treatment, they have the staff and expertise to address individuals’ concurrent withdrawal symptoms as well as any coinciding mental health issues and medical needs.
Gastineau Human Services (GHS) is the only 3.1 residential program currently operating in Juneau. One of the latest proposals, in the wake of Rainforest’s sudden closure, is to transition all residential services to Gastineau’s 3.1 level of care. Unfortunately, the majority of patients that I see in the emergency room seeking help for drug and alcohol addiction have needs that go far beyond the care capacity of a 3.1-level facility. Therefore it will be dangerous and medically irresponsible to refer these individuals to this lower level of care.
The way clinicians determine the appropriate level of care for an individual is to perform an ASAM assessment. For individuals suffering from addiction, this assessment explores six different dimensions of current clinical conditions as they relate to their treatment needs, which are as follows: 1 — Acute intoxication or withdrawal, 2 — biomedical conditions or complications, 3 — emotional, behavioral or cognitive conditions, 4 — readiness to change, 5 — relapse or continued use potential and 6 — Recovery/Living environment. After assessing these six dimensions, the clinician determines the appropriate level of care that an individual needs, then placing them in a program that meets their unique needs. For example, if an individual presents in the emergency room with withdrawal symptoms, they will initially be placed in the hospital (level 4) and subsequently transferred to an intensive residential program (level 3.5) for ongoing care. It is medically inappropriate to transfer such a patient to a lower level of care (level 3.1) as these programs are not set up to safely and adequately treat said patient. In other words, transferring individuals from a level 4 to a level 3.1 would be akin to offering Juneau Residents an aspirin when they present in the ER with a heart attack, rather than sending them to Anchorage or Seattle for a heart catheterization.
How does our community move forward at this time? First, we must all realize the necessity of having a 3.5-level addiction program operating in our community. While I greatly appreciate Gastineau Human Services and their willingness to expand their services, there is much work to be done in order for them to provide 3.5 level of services. This work will take months, if not years, to complete. This means that many of our residents needing addiction services at the 3.5 level will have no appropriate care options in Juneau. Given this reality, our only safe and viable option is to demand that our city-owned and operated hospital immediately reopen Rainforest Recovery Program, and to remain so until the time comes when another agency is willing and able to provide quality intensive, clinically-managed, residential services.
Having had long conversations with the hospital administration I know their response will be something along the lines of “..but we just can’t get staff to run the program,” which is unacceptable. I understand it is difficult, especially after Covid, to recruit and retain qualified healthcare professionals in Juneau. This problem is an administrative challenge (and responsibility) and should not be an excuse for failing to provide such essential services to our community. In my opinion, this sort of response is as unacceptable as saying the emergency room needs to be closed 12 hours a day because we cannot get nurses to cover shifts.
I am proud to call Juneau my home and honored to have spent my whole career practicing medicine in this beautiful community. One thing that has always impressed me is how we Juneauites go the extra mile to help each other out in times of need. At this moment, one of the most vulnerable portions of our population, those needing help dealing with the ravages of drug and alcohol addiction, desperately need all of us all to step up, speak up, and lend a hand. So, I encourage all to reach out to our city leaders, Assembly members, hospital board members and hospital administration, and demand that they do not forget our fellow citizens struggling with addiction. As a health care provider and community member, I urge all reading this to reflect and consider the vital importance of reopening Rainforest Recovery Center for our community, if we wish to continue as just that; a healthy community.
• Lindy Jones is an emergency department doctor and board member at Bartlett Regional Hospital.
