His name is Justin. He’s a heroin addict. He’s been sober for 42 days. And he's 16.

“They say I’m doing pretty good,” he said.

It’s nearing the end of his first stay in one of Laredo’s few drug treatment facilities. With earnest brown eyes outlined in dark, long lashes and rosary beads dangling from his neck, Justin vows he’s done with drugs and won’t be back. But, the odds are against him. Drugs are abundant in border communities. Poverty is rampant. Substance abuse treatment is scarce.

For starters, getting treatment is an economic problem. Justin is among the perversely fortunate few who land in state-funded treatment after a run-in with the law. His single mother, who works 12-hour days to support Justin and his two siblings, could hardly afford private treatment — even if she could find it.

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Texas has a serious dearth of licensed chemical dependency counselors. More than 60 counties in the state, including 13 counties on the border and in the Far West, have no drug abuse counselors at all. Patients must travel hours to treatment facilities isolated from family and the support systems they need to stay clean. It’s also a matter of geography and culture. In Laredo and other border communities along drug trade routes, narcotics are cheap and plentiful. Add to that concerns about deportation in many mixed citizenship status homes, and the obstacles for some border residents who need addiction treatment can become mountainous. 

“The problems just keep compounding,” said Luis Flores, executive director of Serving Children and Adolescents in Need (SCAN) Inc., which operates treatment facilities in Laredo.

Cautionary but common tale

Justin started smoking pot when he was 13. He wanted to be like his big brother, an addict who at 23 is now an intravenous heroin user. “He was a role model to me,” Justin said.

He moved quickly to snorting coke with an uncle who lived in his house — an uncle who is now serving time. By age 14, Justin was inhaling heroin, and he said he planned to switch to needles before a judge sent him to rehab. He got busted trying to lift bottles of cologne from a store in the mall. “I used to wake up and think, ‘OK, what am I going to do to get money?’” he said.

Justin’s quick transition from marijuana to hard narcotics at such a tender age is not uncommon in border communities, said Jane Maxwell, a senior research scientist at the University of Texas at Austin’s Center for Excellence in Drug Epidemiology, who compiles an annual report on substance abuse trends in Texas. “It has to do with availability and where drugs are coming from,” Maxwell said.

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Youth in border communities are more likely to report using tobacco, cocaine and Rohypnol — the so-called "date rape" drug — than their peers in nonborder areas of the state, according to Maxwell’s June 2009 report. Nonborder youths more often reported using drugs like marijuana, alcohol and Xanax. At state-funded treatment clinics, patients from the border were often younger, more likely to be unemployed, more likely to be homeless and more likely to have a history of injection drug use.

Drugs are also cheaper on the border, according to the report. A gram of cocaine costs about $50 in El Paso, compared to as much as $80 in Dallas and $100 in Houston. An ounce of black tar heroin costs about $1,000 in El Paso, compared to as much as $2,400 in San Antonio.

Abuse problems on the border, Maxwell said, are made worse by the lack of treatment available. “What’s out there is good, but the resources are scarce,” she said. There are only 32 state-funded rehab beds to serve adolescent men in a 20-county region that spans from Laredo to Brownsville to Corpus Christi, said Michael Benitez, a licensed chemical dependency counselor at the Rio Grande Valley Council. There are six beds for adolescent women in that region. To get one of those few rehabilitation beds, a patient usually needs to go through detox first.

“The biggest challenge is getting detox services for adolescents,” said Benitez, whose job is to find treatment resources for youth who are sent to him by Laredo probation officers and those who come to him just plain desperate for help. The closest detox center to Laredo is two-and-a-half hours away in Corpus Christi. Addicts come to him broken and crying, sometimes homeless and destitute. Asking them if they can find transportation to a detox center 140 miles away, Benitez said, he feels stupid. It doesn’t take long to purge heroin, Benitez said, but it’s a herculean task for an addict to stay clean on their own for three or four days. “Sometimes the only resort is getting them locked up,” he said.

In 2007, nearly three-quarters of all Texas counties were designated by the Texas Department of State Health Services as health profession-shortage areas for mental health workers. While the paucity of professionals is a statewide problem, it is even more pronounced on the border, especially in rural areas. Rural border areas had just 24.3 licensed professional counselors for every 100,000 residents. Urban regions, by comparison, had 65.5 counselors for every 100,000 residents.

Sue Gallego, border coordinator for mental health substance abuse services at DSHS, said some of the same factors that make drug abuse so prevalent on the border make it difficult to get and keep mental health professionals there. With some of the highest high school drop out and teen pregnancy rates in the state, the border is short on educated workers. Those who graduate from high school and want to obtain the higher education needed to become a counselor usually have to leave the border, and many don’t return. Anyway, the pay is low. On average statewide, a licensed chemical dependency counselor makes about $15.55 per hour. The national median salary is $17.10. “A lot of it comes down to the almighty dollar,” Gallego said.

For that small salary, counselors on the border must work in dangerous environments, as drug violence in Mexico worsens and threatens to spill into Texas communities. Year after year, El Paso is ranked among the safest places to live in the nation, but across the river in bloody Juarez about 300 people every month die in a savage drug war. Dr. Chilo Madrid, executive director of Aliviane, Inc. in El Paso, had to install new security measures this year at his treatment facilities. He’s trying to make the counselors feel safe after gunmen mowed down 18 people in a Juarez clinic with the same name. “Being a drug treatment counselor these days is hazardous to your health,” he said.

As the violence continues, Madrid said, more and more of his counselors are turning to hospitals and law enforcement for work. Several have become probation officers, where they still work with addicts but go to the office armed. “We are living in a trauma-induced environment here,” he said.

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Stuck on the border

Fortunately for Justin, when his probation officer sent him to get treatment, a bed was available in Laredo. Many addicts, though, have to travel hours from home to find the next available treatment bed, and that poses its own set of problems. U.S. Border Patrol checkpoints dot just about every road between Laredo and the rest of the United States. In bicultural border communities, often some family members are legal residents and others are not.

For families with mixed status, those checkpoints can be a barrier to help, the state health department’s Gallego said. Even if the addict can pass the checkpoint, if the family member who has transportation cannot, the patient may not be able to get to a treatment center in Houston, San Antonio, Corpus Christi or El Paso. And, Gallego said, family members are a crucial part of the recovery process. If they can’t pass a checkpoint to get to their loved one in treatment, a critical piece of recovery puzzle could be lost.

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Dire need for dollars

In a January report to legislators, the Texas Drug Demand Reduction Advisory Committee recommended more investment in border substance abuse treatment. More money, they said, should be devoted to recruiting and retaining counselors. “The spillover of the Mexican drug wars into Texas and its impact on that region is significant,” the committee wrote. “Significant harms combined with workforce shortages suggest the benefit of targeting border areas.”

In the 2008-2009 biennium legislators spent more than $357 million for substance abuse treatment and prevention and for drug enforcement statewide. The Texas Department of State Health Services asked for an additional $70 million for additional treatment and prevention efforts in the 2010-2011 biennium. Legislators approved none of that request.

The continuing lack of resources leaves counselors like Luis Flores at SCAN and Michael Benitez at Rio Grande Valley Council scrambling to find treatment for youths like Justin who come to them in tears, arms swollen from thousands of needle injections, budding lives in tatters. Because of the overwhelming demand, kids like Justin get just a couple of months to get through treatment before they are sent home. “In 60 days, we’re beginning to understand where they’re coming from,” said Carlos Briseño, program director and counselor at the SCAN recovery center in Laredo where Justin is getting treatment. “They’re just beginning to open up about their problems. ... At that point, it’s time to let them go.”

With too little time to give kids the treatment they need, Briseño and his colleagues sometimes feel like they work in a recycling center. “We see many returns,” he said. “They’re going back to their same environment.”

Justin was set to go home in just a few days, back to the same home he came from just across the street from the treatment center. His heroin-injecting brother still lives there. So does his 2-year-old sister, his mother and his grandmother. He wants to set a better example for his little sister, to get a job and help his mom, to finish school and one day become a dentist. He knows it won’t be easy. “Everywhere I go there’s drugs,” he said, “but I want to stay clean.”

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