Program director Marti Strum talked with Joyce Johnston, chemical dependency counselor, who helps operate the 24-hour helpline.

Marti Strum, director of the St. Francis Medical Center for Recovery, standing, met with parole officers of the Missouri Department of Corrections Board of Probation and Parole to discuss drug awareness.

Successful treatment of substance abusers requires patients to do only one thing: Change every aspect of their lives that contributes to use.

"We want them to look at themselves and what they have control over, what they do not have control over and look at alternatives to deal with their problems," said Marti Sturm, program director for the St. Francis Center for Recovery in Cape Girardeau.

But before patients reach the stage where they learn skills in handling their drug and alcohol addiction, they first have to accept their problem, something many are steadfastly unwilling to do.

"You have to break through the denial phase and teach coping skills," said Jack Selener, residential coordinator at the Gibson Center in Cape Girardeau.

"A lot of patients have lost family; a lot have given up promising futures and careers; isolated themselves from friends; and eventually start developing health problems. Denial allows people to cope with these losses and allows them to think they're still OK."

Whether a private outpatient program like the St. Francis operation or a community agency like the Gibson Center, the goal is to teach coping skills to those dealing chemical dependency.

An important component of treatment is getting patients' families involved as their own behaviors have a big effect on the outcome of treatment.

"We have heavy family involvement because chemical dependency is a family illness," Sturm said.

While patients examine their behaviors that contribute to their problems, the families think of ways they may have enabled the abusers to drink or use drugs by perhaps looking the other ways or making excuses.

"If you don't get the family involved," Sturm said, "first, they don't understand the disease process and second, they don't know how to help the person when they get home. They keep doing the same thing and this person is trying to do something different."

Family impact of both addiction and sobriety has yielded increased public awareness to the issues.

"I think basically society is better educated about substance abuse," Selener said. "In the '70s it was kind of a hidden secret."

He added, "There is a sense that almost every family is touched by use and now people are beginning to take the enlightened approach that this is a disease and it is treatable."

Treatment generally involves 12-step programs such as those used by Alcoholics Anonymous and Narcotics Anonymous. The programs provide a clear path for the abuser to follow toward recovery.

That recovery, however, is ongoing. Those who continue with follow-up care after initial treatment generally are less likely to relapse.

As long as patients are serious about controlling their addiction, they can start making progress when they stop ingesting substances.

At the Center for Recovery, a 20-day intensive outpatient program, Sturm said "significant" progress can be made during that period by teaching patients to get rid of guilt and understanding that treatment, though not easy, is possible.

After about three or four days, according to Dick Decker, executive director of the Gibson Center, you can see a difference in the patient's physical appearance, once they detoxify and begin eating a nutritional diet. Gibson's program entails a 30-day stay at the facility, although it also offers outpatient services in Perryville, Sikeston and Charleston.

"We encourage sleep, rest, nourishment and getting the chemical out of their systems," Decker said.

Although use of highly addictive crack cocaine has been taken off in recent years, alcohol abuse still remains the No. 1 drug of choice.

Of the patients currently at the Gibson Center, for example, 60 percent are there for primary addiction to alcohol, compared to 15 percent for marijuana, 10 percent for crack, 7 percent for methadone and 8 percent for others. Also, a solid majority of those who are primarily addicted to something else, also has drinking problems.