DOES TREATMENT WORK?
If the overwhelming majority of drug users are not addicts then why does everyone keep calling for treatment? Well, while it is true that only some 10-20% of drug users are what we call addicted, of those who come in contact with law enforcement the percentage is much higher. These people are the ones who have developed a problem with their drug of choice. It’s helping them make bad decisions. They fight, steal, rob, and spread disease. They cost the taxpayers money. They often pose a danger on our streets. Putting them in jail is usually not effective because they eventually get released and hit the streets worse than when they went in.
The NY Times recently did an article on the effectiveness of treatment and the money spent on it. State and federal governments spend more than $15 billion, and insurers at least another $5 billion each year on drug treatment services for some four million people. That amount may soon increase sharply since Congress just passed the mental health parity law, which requires that insurers cover mental and physical ailments at equal levels. Many clinics across the county have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.
Treatment certainly is more humane than prison and far less expensive but is it effective? What sort of treatment works? I think the answers will surprise you. The success rates for people suffering from addictions is about the same regardless if they complete a 12-step program, an inpatient program, or just go cold-turkey. Here’s what the The Harvard Mental Health Letter had to say about this surprising fact.
There is a high rate of recovery among alcoholics and addicts, treated and
untreated. According to one estimate, heroin addicts break the habit in an
average of 11 years. Another estimate is that at least 50% of alcoholics
eventually free themselves although only 10% are ever treated. One recent
study found that 80% of all alcoholics who recover for a year or more do so
on their own, some after being unsuccessfully treated. When a group of these
self-treated alcoholics was interviewed, 57% said they simply decided that alcohol was bad for them. Twenty-nine percent said health problems, frightening experiences, accidents, or blackouts persuaded them to quit.
Others used such phrases as “Things were building up” or “I was sick and
tired of it.” Support from a husband or wife was important in sustaining the
resolution.
*Treatment of Drug Abuse and Addiction — Part III, The Harvard Mental
Health Letter, Volume 12, Number 4, October 1995, page 3.
(See Aug. (Part I), Sept. (Part II), Oct. 1995 (Part III).)*
We have seen adult cigarette smoking cut in half during the last decade. Some people needed some form of assistance quitting - “the patch”, group therapy, nicotine chewing gum- but the majority simply made up their minds to quit and did so. These treatments were available for those who wanted them. Nobody was thrown in prison if they didn’t and nobody was forced into treatment.
So just how effective is drug treatment? My colleague in drug policy reform David Duncan, an amazing fellow with a truly extraordinary resume in the field sums it up like this: “
There are a few treatment approaches that have been demonstrated to be effective when properly applied, but most treatment programs don’t use those approaches or use them to a very limited degree and subordinate to a twelve step approach. There has never been any evidence that the twelve step programs work by themselves, but patients who have undergone professional treatment and also attend AA/NA/etc have better outcomes than those who have undergone professional treatment and don’t participate in a twelve step group afterward. Whether this is due to the twelve-step program or would be true of any aftercare support group has not been tested.
A number of studies have shown that coerced treatment and voluntary treatment are equally effective. A few studies that have looked at the impact of patient motivation have shown that the degree to which a person wants to stop using has virtually no impact on how likely they are to succeed. I would say that for those addicts for whom it is enough, no treatment is ever needed and they just quit; for those who need treatment, their desire to stop is not a significant factor in success or failure.”
So it seems that some sort of treatment can help some drug users so clearly it should be available to them. It is significantly less expensive than incarceration and doesn’t automatically come with a lifetime criminal record. That means that those that do benefit can go about getting their lives back on track.
There is no easy fix for the drug problem. The crime problem is another matter - legalize and regulate these drugs and the drug dealers are out of business overnight. The problem of drug addiction is a more complicated one but it clearly needs to be treated as a public health issue, not a criminal justice issue.
Comments
Leave a Reply
