Drug Watch
International
Position Statement
DRUG AND ALCOHOL TREATMENT
Substance
abuse is the number one health problem in America. More deaths, illness, and
disabilities derive directly from substance use than from any other preventable
health condition.1 The
financial costs of substance abuse, according to the Center on Addiction and
Substance Abuse at Columbia University, approach $400 billion annually.
This does not include all the personal life tragedies incurred by the
individuals addicted and the sufferings borne by their families, children, and
friends.2 Almost
30% of all prisoners were under the influence of drugs at the time of their
offense. Furthermore, 70% of all
female arrestees tested positive for drugs, and 30% to 78% of male arrestees in
a sample of 23 American cities tested positive for drugs.3
Drug
treatment has multiple goals: Maintaining a drug-free lifestyle, reducing the
demand for illegal drugs; reducing street crime; changing users' personal
values; developing education and vocational capabilities; improving the user's
overall health; reducing fetal exposure to drugs.
Different
modalities of treatment have been demonstrated to be effective to varying
degrees in achieving to some degree the aforementioned treatment goals.4
Furthermore, significant savings in terms of court costs and imprisonment
are achieved as a result of
participating in drug treatment. Health
care costs are reduced as a function of drug treatment.
For every $1.00 expended in drug treatment, there is a cost offset of up
to $4.00 saved in related health care expenditures.5
By
making treatment more available, making it a priority within the health care
delivery system, and insisting on it whenever possible, the costs of criminal
justice and health care systems that are mushrooming out of control can be
reduced. More importantly, an addicted person can have the opportunity to engage
in a life of recovery and make a positive contribution to his or her community.
An appropriate criticism of the current treatment framework involving criminal
addicts is the "revolving door" phenomenon.
Criminal
addicts often receive treatment as an afterthought but then cycle through the
criminal justice system with repeated relapses.
A
possible alternative to currently available treatment of criminal addicts could
include intensively supervised extended treatment, which also involves an
intensive overhaul of the addict's social and personal factors, while
integrating treatment into the criminal justice system. Thus, criminal addicts
could not use treatment as a means to reduce their sentences. Rather, sentences
would be spent in a treatment environment, and addicts would risk going to
criminal prison or remaining incarcerated if they continue to use drugs.
When
it is said that treatment works6, this doesn't mean that it works in each and
every instance. There are few
medical interventions that work all the time. For some, treatment is a framework
for life that will never be acceptable or applicable. For others, treatment is
embraced and is a successful way of life. Relapse occurs in many of those who
finish treatment, but may often be handled by short relapse focused refreshers.
A great emphasis is now placed on the eventuality of relapse and how to
prevent it.
Some
treatment programs are more effective than others. Treatment is a continuum of
processes, which on one hand can may include only self help measures, and at the
other extreme may be extensive long term institutional processes. It is also
important to recognize coexistent conditions, which reduce the potential long
term effectiveness of treatment. Effective programs must incorporate the entire
family system, relapse prevention, and aftercare subsequent to the primary
treatment program. The effectiveness of treatment should be documented by drug
testing and outcomes monitoring.
Drug
use and addiction is a complex human and societal problem. It must be addressed
from at least a threefold perspective: interdiction, prevention and treatment.
None of these interventions is by itself sufficient, but in combination
they are effective. They do reduce the amount of drugs that are available, they
do prevent initial use, and they do result in addicts becoming drug free.
COPYRIGHT:
Permission is granted to reproduce this article,
provided credit is given to Drug Watch International.
2. Center On
Addiction And Substance Abuse At Columbia University.
Annual Report, 1992.
3. Drugs,
Crime, and the Justice System. Bureau of Justice Statistics. U.S. Department of
Justice, 1992.
4. Evaluating
Recovery Services:
5. "The
Illinois Medicare/Medicaid Alcoholism Services Demonstration:
6. "Invest
in Treatment for Alcohol and Other Drug Problems: It Pays,"
(D
& A Treatment 9/95)
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