Is America poised to shift into a more enlightened phase where treatment of addicts gains favor over imprisonment — this is question that starts a recent AP story (by David Crary published Nov 8, 2009) on changing attitudes about conducting the War on Drugs. The overall cost saving to government, and society of treating people with substance abuse addictions, rather than incarcerate them, and the increasing acceptance of addiction as a mental and biological condition are part of the discussion on this weeks Addiction Podcast, featuring Dr. Darryl Inaba.
Transcript:
CNS: Hi and welcome once again to the addiction radio podcast from CNS. Im Howard LaMere here with Dr. Darryl Inaba. Darryl in the news this week a good story written by an associated press reporter on the shift in perception on treatment of addiction and it looks like it is shifting, if gradually.
Darryl: Well, its such an exciting and inspiring story. Its what weve all been talking about for at least forty years and now in the White House, Tom McLellan, the Deputy Director for the Office of National Drug Control Policy, put in there by Obama, seems to be moving us in the direction, everybody has evaluated to be the proper direction, but nobody seemed to have the courage to really take us — and thats a real focus toward treatment, rather than incarceration and also interdiction investing again in the demand side of the war on drugs rather than the supply side of the war on drugs, and whats so exciting about this, in a funny way is its capitalistic, the way theyre presenting this thing is purely from a capitalistic point of view, that looks at hey, its a lot cheaper and more effective to treat addicts than it is to lock them in jail. Which has been a total failure for all this period of time, so why not invest in seeing if we can actually make a dent in things by providing more access to treatment by individuals and taking the money we can save by not incarcerating addicts and put that into treatment and if that comes to play thats really great; theyre all citing the New York experiments, that New York went this way recently where theyre putting much more emphasis than even Californias proposition did, of putting convicted drug users who are not, or who havent had any kind of violent crime to put them into treatment rather than to put them into jail and theyre looking at that as a test case, but I think that theres a whole wealth of data. I remember the University of Pennsylvania meta-study of over a thousand treatment programs that looked at this issue and all concluded, the outcomes all concluded, that every dollar you spent treating an addict and an alcoholic is going to make money for you in terms of the savings it will bring about, in terms of criminal justice system, social costs and other costs. So why we havent done this before, I dont get it, but now the top drug people in the country are citing the evidence and citing from a capitalistic point of view, this makes sense. Lets start spending money for treatment and less money for incarceration. He quotes, Thom McLellan, does that about sixteen per cent of people who needed treatment last year where able to access treatment. Theres the University of Marilyn study that came up that actually shows it might higher if you look at not only those people who wanted treatment but you also looked at those people who met criteria for this disorder and needed treatment but werent able to access it, that the number might be considerable into five, one in five based treatment, its only one in about twenty or thirty were able to access treatment. So certainly theres a treatment gap in place, theres people who want treatment that need to get into treatment, and pretty much theyre stating that treatment is fairly effective although were only getting fifty per cent of those people who enter treatment, completing treatment, and in some ways thats not good. But when you compare it to treating other illnesses and compare it to recidivism rate of locking somebody in jail for their addiction its a marvelous success story and we shouldnt look at it as a defeat, we should look at fifty per cent who complete treatment in a given year, the other fifty per cent it pretty much plants the seed that this is workable, they need to do something about their addiction and maybe the next time they enter or the next time after that, theyre able to complete and actually do well and stay in recovery. And I think thats what were seeing in treatment programs, that there is a high recidivism rate still is lower than what occurs in treating asthma, treating hypertension, its about on par with what we do, what we get when we treat diabetes, so thats effective in itself. But even with recidivism we have people coming back in for treatment and each time they come back they get something more out of it, and they do better, so Im encouraged that our top drug czar or top drug crime fighters in this country, is really now moving the agenda towards where we say it should have been all along and thats toward the demand side. We should be spending more on treatment and prevention than we do on the international treaties and interdiction and the criminality involving drugs.
CNS: But theyre not talking about stopping it (interdiction), theyre going to continue doing that, but, but just increasing the level of treatment thats available, but Im concerned, even though its a money saving possibility, we are still in a recession and like California slashed its budget for treatment from a hundred fifty million to eighteen million just within the last year, and so even though its going to save a lot of money, you know its kind of a penny wise, pound foolish.
Darryl: Yeah thats a tragedy there, that California has taken their money out of treatment and its pretty foolish again as you say and unwise when the fact is that when we say theyre saving money or making money, were saying that if they pay for somebody in treatment, versus putting that person in jail, that theres a huge difference, that results in the saving to the state. So California if theyve chosen
CNS: Not to mention the person
Darryl: Yeah, not to mention any benefits to society or the person or anything else, but if California is now taking back, that theyre in such financial straits that theyre gutting treatment programs, what are they going to do with their, with their offenders, now are they going to put them back in jail or do they let them roam the street without treatment
CNS: Well, theyre still closing jails too arent they?
Darryl: No, theyre actually not. I have a feeling theyre make, theyre going to actually have more jails now
CNS: Well yeah and we talked about this not too long ago about the difference in the laws being power between the treatment professional, the treatment community, and the prison association and the district attorneys and law enforcement the latter having a lot more practice and a lot more aggressiveness perhaps, by tendency than the treatment community. I dont know if thats fair but
Darryl: Well that it is, but the sad thing about that story is that basically people in law enforcement and guards in prison and the whole probation, they make a lot more money than drug counselors do. You know thats a problem so they make more money they can, they can afford to maybe have more lobbyists and whatever. But the tragedy of that statement is that the article mentions, as well as other people, that substance abuse treatment professionals are severely under-paid and yet they continue to do this because they have their heart, and they have their belief and they like people and seeing people get better but it, I think its an abuse when we have people who are contributing so much to society, who are being paid so very poor and they mention a figure that most drug abuse counselors or what ever make forty thousand or less. Well I want to tell you something man, if counselors here in Oregon made forty thousand theyd so happy and excited and everything. Its not even close to that amount theyre getting paid and theyre only doing it because of what their belief is and their compassion to do something about this so, thats one of the tragedies there in the states and in the governments are laying this issue on the backs of peoples goodness rather than on what they need to do.
CNS: Yeah, that reminds me of the prior presidents pushing or promoting of faith-based initiatives for social service, and certainly there are a lot of religious organizations and similar entities that do, do great work in helping people but it is, its a disconnect.
Darryl: Again, its a wanting to deal with our number one public health problem and our
CNS: Thats the other thing
Darryl: Other issues by not spending any money on it and doing more to promote the banks and promote stocks and promote the trade industry here while the most key important thing that we need to do with our society goes pretty much unmet, or is laid on the backs of the goodness of people and not any kind of organized way of dealing with it.
CNS: Another point, poignant point, that the article made was that treatment is and has been not considered a part of mainstream medicine and that seems to be changing in the last few years, as weve come to understand the chemistry, the neurochemistry much better and more sophisticated targeted drugs are being developed, medications are being developed to address addiction and some of the component parts. But do you see that addiction is being, if, if gradually being more accepted by the medical establishment? And of course what we dont know is about our health insurance reform, which just passed one of the houses, we dont know to what extent any treatment is included in that brand new legislation that weve been debating for months and months and months.
Darryl: You know, we have to look at that, the one thing thats going to help, that later statement you made is that the government did recognize in 2008 that this is a health issue and they passed the Mental Health Parody and Addiction Equity Act of 2008 which is now in place so if the government, I guess they could do this, but if the government themselves were to themselves not honor that and discriminate against substance abuse and addiction and carve that out or even carve out mental health and say thats not part of their health bill, theyd be violating one of their own laws. I guess its not unusual for the government to do that but
CNS: But its still setting a precedent yeah
Darryl: But Id like to see that, how theyd react to that. Now in terms of your former statement, I do see that the medical establishment is much, in a much bigger way, raising substance abuse treatment. But I see a sinister side of that as well I see again the dollar signs and the economics behind that, more than whats the right thing to do and the recognition that this is an actual biological disorder and not a weakness in people, because there is this tremendous development of medication, treatment, paradigms and already theres a statement embracing evidence-based care as the state with Oregon for instance. You have to be, you have to have evidence-based treatment program in order to get any funding or licensing from the state of Oregon to treat substance abusers. So Im sure thats the same across the country and right away, what the medical staff is saying, you arent evidence based unless you include a medical component into your treatment and therefore you know promoting the pharmaceuticals and drug companies and all that. But despite that sinister side, I look at skepticism I always have this healthy skepticism of the way we do things. There is really, really good solid evidence that medical interventions are helping addicts and alcoholics embrace recovery and participate in treatment and do better than they have done in the past. In the past we, we reached the ceiling maybe you know with talk therapy, social mono therapy, and whatever were, you know sometimes as low as ten per cent, some people say as high as thirty per cent. But with embracing these other techniques weve risen it to fifty and more being developed there is a time, I see that we could possibly raise it even more and we can get better chance for people to enter in recovery, change around their lives than we have in the past and thats the good part of it, so I hope that we do see an expansion of, of the medical not only acceptance but the medical involvement of treatment of all addicts and bring them the care that they need.
CNS: Well the more parts that we can bring to bear on the problem the better; theres another article that we will talk about it some other time about the kind of whole-person – mind, body, and spirit approach thats being adopted in some areas.
Darryl: That holistic approach, whats strange is that those holistic approaches are in the track, to become evidence-based, theres a lot of evidence-based research going on to show that mindfulness meditation, hatha yoga, equine therapy and pet therapy and those types of things are actually showing better results when you have them than when you dont have them so thats, thats a whole different dimension that many drug abuse, drug treatment programs have embraced in the past but saying it I found it strange also that the states themselves, the State of Oregon here, they have their own evidence-based accepted practices, they dont ascribe, subscribe to the federal, NIDA or SAMHSA websites that list evidence-based practices which SAMHSA has evaluated and accepted as being viable to add to treatment programs and the State of Oregon sort of snobbishly has their own and they reject some of the things that SAMHSA and NIDA has so where this is all going who knows but one thing is clear Im sure were seeing much more medical involvement in the treatment of drug and alcohol now.
CNS: I think that, that is a good thing. Well Im sure that well get a chance to talk about this more as ever your questions and comments, those of you listening, are more than welcome. Stop by our website which is cnsproductions.com and drop us an email either from the main page or from the podcast-blog page. Darryl thank you very much, talk to you soon.
Darryl: Hey super Howard, great to be here.
CNS: That wraps our pod for today. Thanks for visiting the CNS pod cast. Please check back soon for the next in the series and visit our website www.cnsproductions.com.