Prevention, Drug Treatment And Recovery

Traditionally, U.S. Presidents through the office of National Drug Control Policy (ONDCP) have divided drug demand reduction into two main categories: prevention and treatment. However, the Obama Administration has added a third area: recovery. For the first time ever, in its 2010 National Drug Control Strategy, ONDCP focused on the need to invest in recovery. Treatment for drug abusers usually takes place during a fixed period of time. However, recovery is a lifelong process.

The private sector should foster the development of businesses that positively affect the lives of people in recovery by increasing employment opportunities for them. Residential treatment is a commonly used form of treatment. However, many states are facing a shortage of residential treatment beds. The shortage of beds is especially true for women with children seeking treatment.  In spite of efforts to increase funding for drug prevention and treatment programs, the United States continues to be the world’s largest consumer of illegal drugs.

According to the National Institute on Drug Abuse’s 2009 Monitoring the Future Survey, more 10^th graders are smoking marijuana than cigarettes, because they view cigarettes as more harmful than marijuana. Yet, marijuana smoke contains 50 to 70 percent more carcinogenic compounds, including tar, than cigarettes. Marijuana is much more potent today than in the past. In recent decades, marijuana growers have been genetically altering their plants to increase the percentage of delta-9-tetrahydrocannabinal (THC), the main active ingredient in marijuana. THC impacts parts of the brain, triggering a series of reactions that ultimately lead to the “high” users experience when they smoke the drug. The average potency of tested marijuana from federal seizures more than doubled from 1998 to 2008.

The second most common form of drug abuse in the United States is the misuse of prescription drugs. The Office of National Drug Control Policy views prescription drug abuse as “the Nation’s fastest growing drug problem.”

…from 1997 to 2007, the milligram per person use of prescription opioids in the U.S. increased from 74 milligrams to 369 milligrams – a 402 percent increase…in 2000, retail pharmacies dispensed 174 million prescriptions for opioids. In 2009, that number rose to 257 million prescriptions – a 48 percent increase.

Another dangerous trend by those seeking prescription drugs is the increase in pharmacy violence. For example, an April 5, 2012 press report highlighted a number of high profile robberies of pharmacies across the country. According to the report, since 2006 there has been an 82% increase in the rise in pharmacy robberies, from 385 in 2006 to 701 in 2011. This increase in robberies is attributed to addicts and thieves targeting pain medicine which can reach nearly $80 per pill in street value.

…methamphetamine prevention and treatment programs should be included in the nation’s drug demand reduction efforts not only because of the large number of users, but also because of the enormous costs associated with the drug. Methamphetamine abuse not only ravages the individual user, but also has serious consequences for entire communities. Those injured in the production or use of the drug have overwhelmed hospitals, with average stays that cost 60 percent more than the average patient, forcing taxpayers to pay “well into the tens if not hundreds of millions of dollars.” This problem has significantly increased with the so-called “shake and bake” methamphetamine production method. This occurs in small batches and often in two liter plastic bottles on a widespread basis. Methamphetamine also has a disastrous impact on the environment with five to six pounds of hazardous waste associated with each pound of methamphetamine produced. This results in staggering clean-up costs.

On a more positive note, cocaine use was at the lowest point in a decade with only .6 percent of Americans 12 or older reporting use in 2010.

According to SAMHSA 2010 survey data, 0.2 percent of Americans aged 12 and older used heroin within the past month. Methadone is the most common drug used to treat heroin addiction. SAMHSA describes methadone as a “well-studied, safe and powerful medication when prescribed and consumed properly.”

There are more than 2,000 drug courts in the United States. The first drug court opened in Miami in 1989, offering treatment as an alternative to incarceration. Drug courts are judicially supervised court dockets that handle the cases of non-violent substance abusing offenders under the adult, juvenile, family and tribal justice system.

Drug courts operate under a specialized model in which the judiciary, prosecution, defense, probation, law enforcement, mental health, social service, and treatment communities work together to help non-violent offenders find restoration in recovery and become productive citizens.

“Across studies showing re-arrest differences, the percentages of drug court program participants rearrested were lower than for comparison group members by 6 to 26 percentage points. Drug court participants who completed their program had re-arrest rates 12 to 58 percentage points below those of the comparison group.”

“It is vital that prevention is heavily emphasized, because addiction is a developmental disorder that begins in adolescence, sometimes as early as childhood.”

The reach of drug prevention programs is, of course, directly correlated with the amount of money invested in them. Thomas Babor points out that “societies tend to make a small investment in prevention and, on average, they reap a small return.” Given the current fiscal environment in the United States, the Caucus recognizes that major new, high-cost programs are not realistic right now. At the same time, we realize that greater investment in prevention is fundamental as it will save lives and money in the long term.

When carried out properly, anti-drug media campaigns have the potential to have a significant impact.

“…there has been virtually no public emphasis on prevention or efforts to reduce demand in recent years. Where, for example, are the media campaigns including new media, celebrity spokespeople, pronouncements from senior officials, the public condemnation of drug use in the same manner as smoking or helmetless motorcycle riding? Where is the effort to show the link between drug use and killings in Central America and Mexico, along the same lines as the campaign to stop the “blood diamond” trade? ‘Just say no’ is not an effective approach, perhaps, but at this point, nobody seems to be saying much of anything.”

According to the National Treatment Improvement Evaluation Study, drug treatment can cut drug abuse in half, reduce criminal activity up to 80 percent, and  reduce arrests up to 64 percent. Treatment for drug addiction rests on the science of addiction which since the 1970s has asserted that” drug addiction is a complex but treatable disease that affects brain function and behavior.” According to the National Institute on Drug Abuse, there are three fundamental components that need to be considered in U.S. drug treatment policy:

-        Treatment must be long enough to have lasting results – this means that access and costs must allow for long term care;

-        Services need to fit the needs of individuals in criminal justice populations; and

-        A balance of rewards and sanctions must exist to encourage treatment participation.

Substance abuse treatment funding in the United States was estimated by the federal government to cost $23.5 billion in 2006. This includes $5.1 billion in private insurance and personal funds, $1.1 billion in Medicare, $4.2 billion in Medicaid (State and Federal), $9.8 billion in other state and local public funding, and $3.3 billion from a variety of federal programs. These resources provide treatment for an estimated 2.6 million people annually.

Treatment costs are far lower than those of incarceration. For example, in the case of heroin addiction, methadone treatment costs $4,700 annually whereas imprisonment would cost approximately 24,000.

In Massachusetts, residential treatment providers indicate they have 25 to 30 calls a day for which they do not have a bed available. In Oregon, residential treatment wait time can be up to three months and the waiting list typically has 300 people.

…drug treatment poses several challenges for women (and particularly women with families) because “many treatment programs are designed for and used mostly by men” while many women must consider family concerns that prevent them from seeking treatment as programs for women rarely accommodate their children. Traditional drug abuse treatment programs do not allow for the inclusion of children, posing a dilemma for women between the need for treatment and the need to provide care for their children. Further complications for women seeking treatment arise from the fact that “admitting to a substance abuse problem may lead to involvement with the criminal justice system and the loss of custody of children.”

Drug treatment programs can cut down on recidivism rate and thereby improve public safety and reduce crime-related expenditures. Inmates who either committed a crime to get drugs or were under the influence of drugs at the time of their crime are among the most likely to re-offend. Of the 2.3 million inmates imprisoned in the United States, 65 percent meet the medical criteria to be considered addicted to either drugs or alcohol. The National Center of Addiction and Substance Abuse at Columbia University found that between 1996 and 2006, while the number of adults incarcerated in the U.S. increased 33 percent to 2.3 million, the number of inmates with substance abuse issues increased by 43 percent to 1.9 million. Due to the potentially large societal benefits, it is important to make available the most effective treatment programs for addicted prisoners.

Unfortunately, inmates who are substance abuse-involved continue to be re-incarcerated at greater rates than those who are not abusing drugs. One reason for this is that there is a serious “treatment gap,” where of the 1.5 million inmates who were substance abusers in 200, only 11.2 percent received treatment since admission to prison, according to the National Center on Addiction and Substance Abuse at Columbia University. This is due at least in part to fact that treatment in specialized settings, which is recognized to be more effective, is only available in 16.6 percent of facilities.

“A key to solving America’s drug problem is greater support for and partnership with the huge number of our citizens who have recovered from addiction and who deserve the opportunity to fully rejoin society. The millions of Americans who are in recovery are the most compelling evidence that there is hope for every addicted American in the ongoing process of recovery, individuals not only stop using substances, they reestablish friendships and family ties, become productive and responsible citizens, and very often help other addicted people begin to walk the same path.”

Treatment for drug abusers usually takes place during a fixed period of time, whereas recovery is a lifelong process.

Recent research suggests that while drug abstinence remains an essential prerequisite to a successful recovery program, treating a patient’s substance abuse alone will not ensure his or her recovery. For many individuals, drug addiction is a chronic problem that impacts one’s occupation, familial relations, physical and mental health, friendships, residential status and access to social services. Drug abstinence, while an essential first step in the recovery process, is unlikely to immediately reverse these longer term problems by itself Even after a patient abstains from drug use, he or she may face several practical challenges left unresolved by an acute treatment strategy, such as difficulty securing housing or employment.

Those in recovery recognize the need to address multiple aspects of their lives that have been negatively impacted by drug addiction. One study shows that although “staying clean” ranked first among the concerns of individuals in recovery, these individuals were also concerned about other long-term, “lifestyle” issues – employment, education, vocational training, housing and personal relationships.

The massive demand for illegal drugs in the United States creates both a challenge for public health in our own country and a challenge to security in countries throughout the world that are battling drug trafficking organizations. In spite of efforts to increase funding for drug prevention and treatment programs, the United States continues to be the world’s largest consumer of illegal drugs.

According to the National Survey on Drug Use and Health, in 2009, about 21.8 million Americans aged 12 and older were current (in the past month) illegal drug users, representing 8.7 percent of the population. This represents the largest proportion in the past decade of people aged 12 and older identified as current illegal drug users. This is in spite of years of U.S. investment in drug prevention and treatment programs.