Care programs range from free to ultra-expensive

Photos by Sergey Shayevich, The Arizona Daily Star Kids at Funtasticks Family Fun Park whiz past substance-abuse counselors Deborah Brook, left, Wendy Pipentacos and Scott Somers. There is head-over-heels fun for kids during visit to the Funtasticks park. Wendy Pipentacos and Scott Somers watch trampoline acrobatics.

Got a kid on drugs? Want help? Bring your wallet, a court order, or proof of insurance.

Coming clean can cost as much as $18,000. A month.

``It's $650 a day for inpatient care,'' says Ben Weber, primary therapist for adolescents at Cottonwood de Tucson.

Cottonwood also offers an intensive outpatient program that costs $400 a day and runs from 8 a.m. to 8 p.m. daily for 21 to 30 days.

Getting insurance companies to foot those kind of bills is getting harder and harder, says Dennis Noonan, lead therapist for Cottonwood's adolescent unit.

``You have to prove medical necessity,'' says Noonan. ``Companies will say, `Have they done anything dangerous in the past week?' We'll say, `Well, no.' And they'll say, `Let them out. Now.' ''

Patients are free to leave at any time. Because of the cost, the center gets few juvenile court referrals unless the offender's parents have insurance that will pay for the treatment, says Noonan.

In a year's time, Cottonwood will see about 250 kids, says Weber. As for gender, it's usually about even, boys to girls, though he's recently seeing more boys.

``The adolescents here are all poly-substance abusers,'' says Weber. ``Adolescents will do whatever offers escape.''

Cottonwood uses the 12-step program pioneered by Alcoholics Anonymous, though Weber admits, ``We're lucky if we get through the first step at the end of 30 days.''

It's a real problem, he says, for adolescents to admit they're powerless in the face of drugs.

``The one we really work on is how has your life been impacted by drugs?'' says Weber. ``But we don't hammer it in their faces. We let the kids come to their own conclusions.''

The center does that with something called the body wrap.

``We get kids down on the floor on a piece of paper, and others will draw their outline,'' Weber says.

``We ask them to list all their feelings on one side of the body. On the other side, we ask them to list all the drugs they've ever done.''

The result, says Weber, is to increase the kids' awareness of how they're self-medicating their feelings with drugs.

Patients also build a time line, outlining the various traumas in their lives, and whether they're linked to drug use.

A four-day program encompassing families also is included for both programs, as are various challenge exercises, such as rock climbing.

After treatment is done, the facility will recommend some sort of follow-up, ranging from more therapy to going to AA meetings.

``This is not a 30-day quick-fix,'' says Weber. ``We offer them the tools to use for life. It's up to them to use them.''

La Cañada program

But it's a small group - six boys, three girls at a time - designed for notch groups not covered by insurance, including the Arizona Health Care Cost Containment System, or AHCCCS, which covers the state's medically indigent.

The program, which is run through a partnership between CODAC Behavioral Health Services and the Arizona Children's Association, is in its second year. Funding comes through tobacco tax money.

Most of the patients are ordered into treatment through Pima County Juvenile Court.

However, there is no ``lock-down.'' And once in a while, kids will take off.

``We do try to talk them out of it,'' says resident coordinator T.K. Estes.

La Cañada is one of only two inpatient homes in the state to which Pima County Juvenile Court regularly sends its drug offenders, says La Cañada Program Coordinator Bob Solis.

There's an eight- to 10-week waiting list for boys, one to two weeks for girls, Solis adds.

The center uses a 12-step treatment model, combined with cognitive therapy.

``We work on solutions instead of what happened in the past,'' says CODAC Executive Director Neal Cash.

Families also are included, with a family session during one week of the 30-day stay.

Family visits continue at the CODAC facility during the four months of follow-up sessions that the teens also undergo.

Seven Challenges

``We're not hassling them. We're not in their faces telling them, `You're in denial. You're going to die,' '' says Steve Barcanic, team leader for the Seven Challenges program used by PACT/Providence.

Developed by Tucson psychologist Robert Schwebel, Seven Challenges eschews the more traditional 12-step program, particularly its demand that users admit they're powerless.

``We attempt to empower kids from the inside to change their behavior,'' says Barcanic. ``When kids come here, they're looking for someone to battle. We disarm them. They relax, become more open.''

The center offers two programs. The newer one, called BASIC, is for kids who are just beginning to experiment. It meets for two hours a week.

The more intensive program, for kids who are heavy drug users, meets four times a week for eight weeks. There's also a four-month follow-up component.

Parents of heavy drug users also meet once a week at the center - with their kids and separately.

``We get people from all walks of life,'' says Seven Challenges therapist Wendy Pipentacos. ``We'll get the button-down dad and the hippie mom. The walls come down.''

Every Friday, the kids have an outside activity, ranging from rock climbing to eating at a nice restaurant.

``For some of these kids, ordering from a menu is a risk,'' says Seven Challenges counselor Deborah Brook. ``They've never done that before.''

Total cost of the intensive eight-week, 32-session program is $2,560. The center offers a sliding scale fee to lower-income parents. It also serves a variety of insurance companies, as well as AHCCCS.

The Mark program

``We get sweet kids in here. They give us a song and dance, leave treatment, and they're back to using. But the kids who are in more pain, who have suffered the natural consequences, seem to do the best in the long run.''

Seventeen years ago, Leggio started the Adolescent Family Counseling Agency, which was the first inpatient substance-abuse care unit for adolescents in Tucson.

From there, he went on to form the inpatient substance-abuse unit at Tucson Psychiatric Institute. Eleven years ago, he started The Mark.

``I saw the need for an intensive outpatient program,'' says Leggio, whose current program is a minimum of nine weeks, plus six months of follow-up.

Although most kids have not yet developed a physiological dependence on drugs the way adults have, they may need a longer cycle of treatment, says Leggio.

``Adults have had 10 or 20 years of consequences, kids only a year or two. They're saying, `Hey, I'm getting loaded and laid. Why should I quit?' ''

The Mark uses a variety of approaches to answer that question, says Leggio, depending on whether ``it's a 13-year-old female out on the streets or a 17-year-old male who's mouthing off.''

One constant does stand out in treatment, however.

``It seems like somehow these kids need to have a spiritual commitment, to pick a higher power,'' says Leggio. ``They can't do it alone.''

Parents are heavily involved with the treatment and are required to come to the twice-weekly meetings - the same as their kids.

``You can't just drop them off at the center,'' says Leggio.

He also acknowledges that treatment sometimes fails. ``Some kids may have to fall more than once. And some parents may have to let them.''

Cost of the program is $1,800 for nine weeks. About 10 percent of its kids come through juvenile court.

Springboard program

The 90-day residential program costs $400 a month and is not covered by insurance. Some of the girls are referred by juvenile court, but most come through private referrals, says intake counselor Janet Stone.

``We use the 12-step program, the Bible and a belief foundation in Jesus Christ as the cure,'' says Stone. ``We make it clear upfront we are a Christian program.''