Is America Ready to Expand Drug Addiction Treatment?

Posted on December 17th, 2009

Officials say that America is shifting its war on drugs to focus on treatment rather than incarceration for drug offenders, but many are questioning whether the nation is ready to follow through.

David Crary of the Associated Press writes that numerous studies conclude that treating addicts—even in extended residential programs—costs substantially less than incarcerating them, so states could save millions amidst ongoing budget constraints.

There is also a huge need for addiction treatment. According to federal data, 7.6 million Americans needed treatment for illicit drug use in 2008, but only 1.2 million—or 16 percent—received it.

But even with the prospect of saving millions on prison terms and court costs, there hasn’t been a surge of fiscal support for expanding drug treatment. Crary writes that California’s latest crisis budget, for example, strips all but a small fraction of state funding away from a successful diversion and treatment program that voters approved in 2000.

"It’s easy to talk a good game about more treatment and helping people," said Scott Burns, executive director of the National District Attorneys Association. "But it smashes head on into reality when they don’t put their money where their mouth is."

The appointment of treatment expert Tom McLellan as deputy director of the White House Office of National Drug Control Policy in April was seen as part of a shift of priorities for the drug czar’s office.

McLellan said he sees greater openness to expanding treatment but also deep misunderstanding or ignorance about scientific advances in the field and the need to integrate it into the health care system.

Most Americans, he suggested, have an image of drug treatment formed from the movies—"cartoon treatment" involving emotional group encounters—and are unaware of a new wave of medications and other therapies that haven’t gained wide use despite proven effectiveness.

"For the first time, it can truly be said that we know what to do—we know the things that work," McLellan said. "But do we have the economic and political willingness to put them into place? If we do, we’ll see results."

McLellan also said that expanding treatment wouldn’t negate the war on drugs.

"Law enforcement is necessary, but it’s not sufficient," he said. "You need effective preventive services, addiction and mental health services integrated with the rest of medicine. You shouldn’t have to go to some squalid little place across the railroad tracks."

There are more than 13,640 treatment programs nationwide, mostly operating apart from the mainstream health-care industry.

Dr. H. Westley Clark, director of the federal Center for Substance Abuse Treatment, said his agency wants states to develop better measurements of programs’ performance.

"The data shows treatment saves money—$1 spent to $4 or $7 saved," Clark said. "If you’re an altruist, making treatment available is a good thing. If you’re a narcissist, it’s a good thing—you’d pay less in taxes."

Crary writes that treatment advocates are closely watching Congress, hoping the pending health care overhaul will expand insurance coverage for substance abuse programs. Recent federal data indicates that 37 percent of those seeking treatment don’t get it because they can’t pay for it, and many end up in prison.

Those who work in the drug treatment field are usually modestly paid, with counselors—many of whom are former addicts—earning less than the $40,000 per year that it costs to keep an inmate in prison in many states.

"Some of the stigma that goes with addiction adheres to the staff as well," said Raquel Jeffers, director of New Jersey’s Division of Addiction Services. "Most agencies are trying to do right—but the field is getting increasingly complicated. The business skills that are needed aren’t always the same skills that make a good clinician."

Yet most front-line counselors win high praise. "People in the field weren’t driven to it by the money or glamour, but often by personal experience or that of a loved one," said Keith Humphreys, a treatment expert from Stanford University now working for the drug czar’s office. "They may not have the fanciest degrees, but they are incredibly caring."

Garnett Wilson served prison time for armed robbery in the 1980s and now, at age 61, has two decades of drug counseling under his belt as an employee of the Fortune Society, which provides support services to ex-offenders in New York City.

"Some of the people who’ve been through it become too rigid," Wilson said. "Preaching doesn’t work. They forget how hard it is to rise above your environment, and they alienate the people they’re trying to help."

Going forward, New York may serve as a test case for the potential to expand treatment programs. Earlier this year, its legislature approved reforms of the harsh drug laws enacted in 1973 under Gov. Nelson Rockefeller, which means that thousands of nonviolent offenders who would have faced long, mandatory prison terms will be diverted to treatment. Despite financial problems, the state is allocating $50 million to treatment programs.

"New York will now treat addiction as a health concern and focus on treating the disease, rather than locking up the patient," said Karen Carpenter-Palumbo, commissioner of the state’s Office of Alcoholism and Substance Abuse.

Carpenter-Palumbo’s office oversees one of nation’s largest addiction treatment systems, with some 1,550 programs serving more than 110,000 people a day. Yet that caseload represents only 15 percent of those needing treatment. An estimated 80 percent of the 60,000 offenders in New York’s prisons have substance abuse problems.

New York stands in contrast to many other states, where the push for more treatment has been undercut by the recession. In California, state funding for a landmark drug treatment program has fallen from $145 million three years ago to $18 million in the latest budget.

The result is that many nonviolent offenders who are supposed to get treatment as an alternative to prison are in limbo. Treatment centers currently have little space for new clients, and experts worry that some offenders on waiting lists will lapse into crime.

"They end up being basically out on the street," said Thomas Renfree, executive director of the County Alcohol and Drug Program Administrators Association of California. "If they can’t get into treatment right way, you’re going to lose some of them."

Renfree says the diversion program had been highly successful—saving up to $4 for every dollar spent and diverting 36,000 people to treatment each year.

"There’s a lot of lip service paid to it," he said. "But even some of those who think it’s a good idea aren’t willing to kick in the resources."

Meanwhile, California’s corrections department has had to slash $250 million worth of rehabilitation services, forcing cutbacks in a drug treatment program that had sharply reduced recidivism rates.

Treatment advocates say their efforts to lobby for scarce funds often lag behind those of law enforcement.

"The treatment community has never been as effective — they’re not as aggressive, not as well organized," said Margaret Dooley-Sammuli, the Drug Policy Alliance’s deputy state director in Southern California. "If those two go at it, fighting for resources, who’s going to win?"

Scott Burns of the National District Attorneys Association said many law enforcement officials are increasingly open to treatment, but not at the expense of their anti-crime budgets.

"There’s always been competition between law enforcement and the treatment community for funds," Burns said. "Legislatures, and to some degree the federal government, talk a lot about how important treatment is, but somehow never seem to fund it at the levels people in the field feel they must have to make a difference."

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