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How to Drastically Increase Success of Addiction Treatment

Despite all of society’s efforts, drug abuse and addiction are still serious problems in the modern world. The answers to the problem aren’t easy to come by, but there are many intelligent people working on providing them. Professor M. Douglas Anglin is one of the most respected addiction and treatment researchers in the country, having conducted research in the field since 1972 -- providing him with over four decades of experience. He was the founding director of the UCLA Drug Abuse Research Center and currently serves as senior advisor at the Department of Psychiatry and Biobehavioral Sciences at the university. Professor Michael Prendergast, director of the Criminal Justice Research Group at UCLA, investigates drug treatment strategies in the criminal justice system and helps to evaluate treatment programs throughout California. The Fix caught up with these two experts to see what they thought about the state of addiction treatment and how society’s drug issues can best be rectified.

The Civil Addict Program

When Richard Nixon initiated the “War on Drugs” in 1968, Anglin was just beginning his graduate studies in addiction. Soon afterward, he became involved with the Civil Addict Program, which had been operating in California since the early 1960s. The premise of the program was that drug offenders should be offered inpatient treatment at minimum security prisons before being released on parole under the support of parole officers who would regularly drug test them and try to help them avoid relapse. If they did relapse, they’d be sent for further treatment at a rehab center for three to nine months. The “civil addict period” established by the program was seven years, which Anglin explains reflected “an understanding of the entrenched nature of drug addiction.”

Later on, many of those enrolled in the program were released on writs of habeas corpus, which enabled the researchers to investigate the effectiveness of the program. By comparing those who were released to those who remained in the program, they established that the program was effective, especially from a cost perspective. However, Prendergast points out that the program became less successful after the ’80s and ’90s, when treatment became more lax and the results became less convincing. The program still exists but is rarely used.

Anglin, when asked if treatment should be offered to first-time drug offenders, responded, “It should be the first option, the second option and the third option … you needed to swoop in and provide more substantive interventions in the face of relapse as opposed to more punishment.” He pointed out that 70 percent of the budget still goes into criminal justice, leaving just 30 percent for treatment options and interventions.

Do Drug Courts Work for Drug Offenders?

Drug courts are another way to provide an alternative to prison for drug offenders, and today operate in virtually every state in the U.S. Most steer offenders into treatment such as AA (or NA) instead of prison time. The results are mixed, according to Anglin, but he points to the standards set down by the National Association of Drug Court Professionals as being an example of how to allow drug courts to have a reasonably positive effect overall. Prendergast suggests that the biggest issue is the limitation placed on the offenders they can accept, with restrictions meaning they serve a relatively small proportion of drug users. He says they’re an important tool but currently too small in scope to make a significant impact.

Importance of Return on Investment

Overall, the two put forward the argument that, while treatment-based interventions are more effective, they are still underused. One way Anglin tried to make progress was by introducing the concept of “return on investment” into the discussions of how to handle drug offenders. On that basis, expanding rehabilitation programs that help people overcome addiction and not re-offend makes more financial sense than punishment without treatment that results in a high rate of recidivism.

Prendergast suggests that the main problem with this approach is that it isn’t always the same department that spends the money that sees the return on investment. For example, if the department of corrections provides and pays for treatment, it would see returns on the investment if re-offending were reduced, but other positive, cost-effective results like an increase in employment wouldn’t directly come back to the department. In short, they’re less likely to see the approach as being as cost-effective. He concludes, “As a result, it can be a little tricky sometimes.”

Treatment Is the Way Forward, Not Punishment

Anglin and Prendergast put forward a strong argument for treatment of drug offenders as opposed to punishment, in terms of both cost-effectiveness and reducing rates of drug abuse, but it’s consistently hampered by poor implementation of the strategies. For example, drug courts appear to be effective, but they are unable to handle enough of the people in need. Similarly, the Civil Addict Program was showing promise but was sidelined in favor of providing treatment in prisons. However, the number of drug offenders treated in prison is still a paltry 12 percent to 15 percent. It holds potential but isn’t being supported nearly as much as the demonstrably ineffective strategy of punishment without treatment. As Anglin puts it, “In other words, it’s still a drop in a bucket.”

Posted on March 27th, 2015

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