Funding Drug Addiction Treatment Would Cost 1/7 the Cost of the Current Criminal System Focused Policy

Treatment: Effective (But Unpopular) Weapon Against Drugs

Paying for treatment of hard-core drug users is a bone in the throat of middle class taxpayers–and small wonder. Drug abusers are not an appealing group, and the programs themselves largely fail to wean their clients off drugs for good. Nonetheless, say RAND researchers, treatment programs are a sound investment of public funds because they effectively cut consumption–and consumption is what drives the drug trade.

RAND corporation aims to provide policy guidance, driven by data and research, to policy makers. They differ from many others in that they pay more attention to what works than to the interest groups often telling politicians what to do. RAND is willing to take stands that others are not and often propose policies that conflict with the accepted positions held to for decades by interest groups.

When data supports a policy RAND will encourage the use of that policy even if it seems odd – like paying for drug treatment for those breaking the law. Without treatment RAND data shows the government will spend 7 times as much money. But politicians have been resisting spending 1/7 as much money because they fear voters can’t understand that doing so is wise. This is from a 1995 report by RAND:

Treatment is seven times more cost-effective in reducing cocaine consumption than the best supply-control program and could cut consumption by a third if it were extended to all heavy users, according to the study. Such a strategy could also substantially reduce the number of users and the costs they inflict on society through crime and lost productivity.

And RAND doesn’t even factor in the costs of wasted lives, pain and suffering that are aided by good addition treatment help. Some propose we aid drug users with treatment programs because human suffering is something we should reduce when we can. RAND proposes we do so based solely on the hard cash benefits government will gain. It is hard to argue with a program that reduces costs by 86% (6/7).

While we may have made a little progress has been made in getting more funding since 1995, if we have it is a tiny portion of what would be a wise investment. The failure to use addiction treatment progress continues to add to the budget deficits our governments face and the suffering of drug abusers in our society.

Related: Drug Treatment Funding Can More Than Pay For Itself With Reduced Crime CostsImproving Addiction Treatment with The University of Wisconsin MadisonWhat Should Society Do About Drug Addicts That Are Not Seeking Treatment?

Drug Addictions Often Disappear Over Time

This article includes links to many research studies, some linked to below, for the rest go to the full article.

Most People With Addiction Simply Grow Out of It by Maia Szalavitz

By age 35, half of all people who qualified for active alcoholism or addiction diagnoses during their teens and 20s no longer do.

The average cocaine addiction lasts four years, the average marijuana addiction lasts six years, and the average alcohol addiction is resolved within 15 years. Heroin addictions tend to last as long as alcoholism, but prescription opioid problems, on average, last five years. In these large samples, which are drawn from the general population, only a quarter of people who recover have ever sought assistance in doing so (including via 12-step programs). This actually makes addictions the psychiatric disorder with the highest odds of recovery.

If you start drinking or taking drugs with peers before age 18, you have a 25% chance of becoming addicted, but if your use starts later, the odds drop to 4%. Very few people without a prior history of addiction get hooked later in life, even if they are exposed to drugs like opioid painkillers.

These results can give people hope when they, or loved ones, are suffering from an addiction. Treatment helps sometimes but also fails quite often. Even in the case where things are not looking good, there is hope that eventually things may run there course.

Of course, there is a risk, sadly, that before the addiction ends tragedy will strike. So hopefully we can keep researching methods to better treat addiction. But if things are failing (especially for one you love) there may be light at the end of the dark tunnel.

Related: The Success Rate of AA is Only 5-10%How Effective is Drug Addiction Treatment?What Does the Evidence of Treating Alcoholism Show?Combination Strategy to Treat Alcohol Dependence

Vermont to Treat Heroin Abuse as Health Issue Instead of Fighting “War” with Addicts

Vermont Quits War on Drugs to Treat Heroin Abuse as Health Issue

[Governor] Shumlin urged the legislature to approve a new set of drug policies that go beyond the never-ending cat-and-mouse between cops and dealers. Along with a crackdown on traffickers, he proposed rigorous addiction prevention programs in schools and doctors’ offices, as well as more rehabilitation options for addicts. “We must address it as a public health crisis,” Shumlin said, “providing treatment and support rather than simply doling out punishment, claiming victory, and moving on to our next conviction.”

Representative Thomas Burditt… “As everybody knows, the war on drugs is lost, pretty much. It’s time to go down a new road.”

This is one small effort, among many, to find solutions instead of continuing the failed policies used for decades. Sadly those failed policies still dominate the efforts given by governments throughout the USA. The costs to the economy and personal lives of the people is enormous. We need to experiment to find better methods to reduce he harm done to society due to drug addiction.

Related: The Death of Philip Seymour Hoffman Highlights the Increased Use of HeroinPrescription Painkillers Kill More People Every Year in USA than Heroin and Cocaine CombinedDrug Treatment Funding Can More Than Pay For Itself With Reduced Crime Costs

The Miracle That Saved Robert Downey Jr.

It is nice to read about successes in addressing drug addiction and the damage it causes to people. Robert Downey Jr. continues to provide such an example with his long successful career after years of struggles with drug addiction.

Susan Downey: Iron Woman

For a long time, however, it seemed as if that never-grow-up quality was going to land Robert in an early grave. After sauntering into our hearts as the doomed rich kid Julian in 1987’s Less Than Zero and proving himself a comic genius with his Oscar-nominated performance in 1992’s Chaplin, Robert spent roughly five years (from 1996 to 2001) in a long, heavily publicized death dance with crack cocaine, heroin, gunplay, and prison — at one point, even wandering into a neighbor’s home and passing out in a child’s bedroom. By the time he was released from court-ordered rehab in 2002, he was largely considered unemployable in Hollywood and was able to convince producer Silver to hire him for Gothika only by agreeing to have a good chunk of his salary withheld until the film wrapped.

But Robert was not quite finished with what he refers to as his Darth Vader side. “I did meet Darth Vader, for like a minute,” Susan acknowledges, “right after the movie wrapped, and I said immediately, ‘This isn’t gonna work.’ I made it clear that to stay with me, nothing could happen.”

Something about Susan’s ultimatum clicked. Around July 4, 2003, Robert stopped at a Burger King on the Pacific Coast Highway, threw his drugs in the ocean, and decided that he was done for good. “I think he saw what we had,” Susan says. “There was something magical there, something we couldn’t put our finger on. He always says that we became this third thing when we got together — something that neither of us could have become by ourselves — and I think that’s true.”

Success for one individual don’t easily translate to others. It is normally many individual things that all line up to make it work. Robert had been to rehab before and relapsed. Plenty of addicts get ultimatums and relapse. Plenty of people find love and proceed to mess it up. But in this case Robert was able to make a change and has been able to enjoy great success and happiness.

Related: Robert Downey Jr. Rehab SuccessRobin Williams Reflects on Rehab‘Marcia Brady’ Recovers After Drug Addiction

The Success Rate of AA is Only 5-10%

The treatment of drug addiction continues to be difficult. Even finding data on success rates is hard. And analyzing that data is difficult (the data is not straight forward and leaves open many possible questions or criticisms). This study calls into question the effectiveness of a 12-step recovery method to treat addiction.

With Sobering Science, Doctor Debunks 12-Step Recovery

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don’t seem to know that because it’s not widely publicized. … There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It’s not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we’d say OK. But it’s harmful to the 90 percent who don’t do well. And it’s harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it’s you that’s failed.

The reason that the 5 to 10 percent do well in AA actually doesn’t have to do with the 12 steps themselves, it has to do with the camaraderie. It’s a supportive organization with people who are on the whole kind to you and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood, rather than a treatment.

image of the Sober Truth book cover

Dr. Lance Dodes has written a book looking at the data behind the results of AA. The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

Related: Looking at the Evidence of Treating AlcoholismHow Effective is Drug Addiction Treatment?, NIH studyImproving Addiction Treatment with The University of Wisconsin, MadisonMethods Used to Treat Addiction

The Death of Philip Seymour Hoffman Highlights the Increased Use of Heroin

We lost a great actor with the death of Philip Seymour Hoffman. Once again the danger of drug use has resulted in the loss of life. He sought treatment for his addiction but failed to avoid an untimely death.

photo of Philip Seymour Hoffman by Jean Jacques Georges

Philip Seymour Hoffman at the Paris premiere of The Ides of March in 2011 by photo by Jean Jacques Georges

Hoffman death puts focus on heroin’s comeback

Hoffman, 46, was found on the bathroom floor of his New York City apartment with a syringe in his left arm and glassine bags usually associated with heroin. Police say they are investigating substances found in the apartment to determine which drugs were present, but Hoffman has been open about his drug use, which included prescription pills and heroin, and his decades-long struggle to stay sober.

As authorities crack down on clinics that prescribe pain pills by the thousands and pharmaceutical companies change their formulas so the pills are more difficult to abuse, opiate addicts are turning to cheaper and more-plentiful heroin.

In recent years, the number of people abusing prescription pain pills has dropped steadily as heroin use increased. The number of people 12 and older who regularly abuse OxyContin dropped from 566,000 in 2010 to 358,000 in 2012, the National Survey on Drug Use and Health reported in December. The number of regular heroin users soared from 239,000 in 2010 to 335,000 in 2012, the survey found.

The tragedy caused by the abuse of drugs damages millions every day. We have to do a better job of reducing the damage done to society due to the abuse of drugs. Celebrities shine a light on the problem but it is a widespread problem that has an immense impact throughout society.

Related: Russell brand’s testimony on dealing with drug addictionPrescription painkillers kill more every year in usa than heroin and cocaine combined Eminem’s ‘relapse’ explores his drug addition and rehabilitation

The Causes of Drug Addiction are Complex

image of comic panels from rat addiction experiment

Comic panels, by Stuart McMillen, of the rat park drug addiction experiment, see the full comic.

The causes of drug addiction are not simple. Like many medical issues they are a complex interaction of factors.

Drug addiction: The complex truth by Tom Stafford

Many studies have shown rats and monkeys will neglect food and drink in favour of pressing levers to obtain morphine (the lab form of heroin). With the right experimental set up, some rats will self-administer drugs until they die. At first glance it looks like a simple case of the laboratory animals losing control of their actions to the drugs they need. It’s easy to see in this a frightening scientific fable about the power of these drugs to rob us of our free will.

But there is more to the real scientific story, even if it isn’t widely talked about. The results of a set of little-known experiments carried out more than 30 years ago paint a very different picture, and illustrate how easy it is for neuroscience to be twisted to pander to popular anxieties. The vital missing evidence is a series of studies carried out in the late 1970s in what has become known as “Rat Park”. Canadian psychologist Bruce Alexander, at the Simon Fraser University in British Columbia, Canada, suspected that the preference of rats to morphine over water in previous experiments might be affected by their housing conditions.

Rats are smart, social creatures. Living in a small cage on their own is a form of sensory deprivation. Rat Park was what neuroscientists would call an enriched environment, or – if you prefer to look at it this way – a non-deprived one. In Alexander’s tests, rats reared in cages drank as much as 20 times more morphine than those brought up in Rat Park.

As the article notes more research is needed, but there should be more research into the importance of social environment on drug abuse and drug abuse treatment.

Related: Methods to treat addictionHow effective is drug addiction treatment in the USA?Prescription drug abuse in the USALooking at the evidence of treating alcoholism

Prescription Painkillers Kill More Every Year in USA than Heroin and Cocaine Combined

Overdose deaths from prescription painkillers have skyrocketed in the past decade. Every year, nearly 15,000 people die from overdoses involving these drugs—more than those who die from heroin and cocaine combined.

The abuse of prescription painkillers has risen dramatically in the last 15 years; in 1999 4,000 people were killed by these drugs (less than a third of the current numbers of deaths).

Find more information on prescription drug abuse and treatment options from the United States Center for Disease Control.

Related: Prescription Drug Abuse in the USAPrescription Drug Abuse: Pain Killers Can Lead to AdditionDecline in the Misuse of Prescription Drugs in the USA (reported in 2008, was the data accurate?)Brett Favre Overcomes Painkiller Addiction

What Should Society Do About Drug Addicts That Are Not Seeking Treatment?

What to do about drug addicts that are not interested in treatment (yet?) is open to debate. Strict law enforcement would say that the government shouldn’t provide any support to those that are taking illegal action (taking drugs they can’t legally take). And that argument makes some sense. The biggest problem with it is the results of such policies have not been very effective. Society suffers. Should society suffer because taking action to reduce burdens on society can be seen as taking it easy on criminals?

Denmark offers rooms monitored by nurses for drug addicts to use, and crime seems to have been reduced:

Year on year, burglaries in the wider area are down by about 3%, theft from vehicles and violence down about 5%, and possession of weapons also down. “From the police perspective, I can see the benefits,” said Orye. “It feels calmer.”

Critics say that such rooms make it easier for drug users to abuse themselves and send the wrong message. Only five people using Copenhagen’s room have been put on treatment since October.

Petersen, like many others using the room or floating around the courtyard outside, said that she does not want and would never seek treatment. But every day that she comes here to inject she meets health professionals, social workers and people offering treatment in case she suddenly want to rise from rock bottom, say the room’s staff. Petersen might change her mind one day, said Nanna Gotfredsen, a lawyer who campaigned for the room.

Michael Olsen, a local resident who was a key figure in persuading authorities to accept the idea of a consumption room, said that he felt moved to champion the cause when he found addicts taking drugs in his bins, and women urinating in a phone box because all the toilets in the area had been sealed to stop addicts injecting there.

The best strategies for society are not obvious. The last 50 years have not been a very successful period for society dealing with the problems caused by drug addiction. Hopefully we can experiment and find solutions that are better.

I do think we have moved toward more support for treatment for those seeking help to overcome drug addiction and to stay clean. Moving more in that direction seems wise to me.

Related: UK Drug Policy Commission Recommends Decriminalizing Drug UseRussell Brand’s Testimony on Dealing with Drug AddictionHow Effective is Drug Addiction Treatment?2012 National Drug Control Strategy for the USA

2012 National Drug Control Strategy for the USA

The USA has published their 2012 National Drug Control Strategy. The intro from President Obama includes:

Illicit drug use in America contributed to an estimated $193 billion in crime, health, and lost productivity costs in 2007, the year for which the most recent estimate is available. In today’s challenging economic environment, we cannot afford such a drain on our economy and public resources. While difficult budget decisions must be made at all levels of government, we must ensure continued support for policies and programs that reduce drug use and its enormous costs to American society.

Research has documented that substance use disorder treatment is a sound public investment. For example, a 2006 study found that every dollar spent on treatment yielded an average of seven dollars in costs savings. The majority of these savings came from reduced criminal justice system involvement and increased employment earnings. **Benefit-cost in the California treatment outcome project: Does substance abuse treatment‘pay or itself’? Health Services Research, 41(1), 192-213, 2006**

Other studies document substantial cost-offsets in the healthcare domain alone . Another 2006 study reported a net savings of $2,500 per person per year in Medicaid costs associated with treatment, and a State of Washington report found that treatment yielded a con- servatively estimated $252 per person per month in cost reductions associated with medical care and state and community psychiatric hospitalizations. **The effect of substance abuse treatment on medicaid expenditures among general assistance welfare clients in Washington State, The Milbank Quarterly, 84(3), 555-576, 2006 and Washington State supplemental security income (SSI) cost-offset pilot project: 2002 progress report.

In 2010, an estimated 23.1 million Americans (9.1%) aged 12 or older needed specialized treatment for a substance use disorder, but only 2.6 million (roughly 11.2% of them) received it. We need to stop wasting money and lives and costing our society much more over the long term.

In 2010, over seven million people in the United States were under the supervision of the criminal justice system: over two million incarcerated and the remaining five million on probation or parole.

Compounding the significant expenditures on corrections is the fact that far too many offenders return to drug use and reenter the criminal justice system. Among state prisoners with substance use disorders, 53% had at least three prior sentences to probation or incarceration, compared to 32% of other inmates.

Many offenders deal with a chronic substance use disorder—a disease for which too many are inadequately treated. These offenders need effective substance use disorder and mental health treatment while incarcerated and should continue with recovery support services that assist with employment, housing, medical care, and other support upon their reentry into the community.

Related: UK Drug Policy Commission Recommends Decriminalizing Drug UseDrug Treatment Funding Can More Than Pay For Itself With Reduced Crime CostsImproving Addiction Treatment with The University of Wisconsin – Madison