With the White House announcing a new focus on treating addiction as a disease rather than a moral failing, those of us who have dedicated our lives to addiction treatment are once again hopeful that this will result in a shift in attitude about treatment versus punishment. In 2009, the Obama administration said that it would no longer focus on the punitive "War on Drugs," but in 2011, evidence from LEAP, an international organization of criminal justice professionals, suggested that government policies had produced more rhetoric than results. My hope is that this will be the year we truly take steps to change the War on Drugs to the Fight for Addiction Treatment.
Drugs are a worthy enemy, but the way we have chosen to combat the nation's drug problem has focused on the low-hanging fruit -- drug users -- far too often. Drug war incentives are alive and well while access to treatment for those with mental illness and addiction, especially those without resources, has declined dramatically. This short-sighted approach means more people with mental illness who cannot access treatment will turn to drugs to self-medicate, and more addicts who want help will find there simply aren't beds available.
Drug courts, which offer treatment in lieu of incarceration, have been successful at producing positive outcomes and low re-arrest rates. According to the Department of Justice Bureau of Prisons, incarceration in federal prison costs roughly $25,000 whereas treatment in a drug court program costs $900 to $3,500 per year on average. Yet many states and counties are cutting funds for treatment. When budgets are cut, mental health treatment seems to end up on the cutting room floor.
More Fully Address and Destigmatize Mental Illness
A significant number of substance abuse disorders can be attributed to self-medication of untreated, underlying mental illnesses such as anxiety, depression and personality disorders. Rather than just focusing on the substance abuse (often the symptom), we should be putting more resources into treating mental illness (the underlying cause).
The Mental Health Parity Act was a step in the right direction. This piece of legislation requires group health plans of employers offering mental health coverage to provide the same benefits for mental health disorders as they do for other medical conditions. While the act encourages people to seek mental health treatment early on and sends a message that mental illness deserves the same treatment as other chronic health conditions, a number of gaps remain.
Ironically, since the Act was signed into law spending on mental health has plummeted, even though studies show that every dollar spent on treatment yields five to 10 times the savings in health, criminal and educational costs. The failing economy, high unemployment rate, and growing number of soldiers returning from Iraq and Afghanistan have fueled the demand for treatment, yet cuts to state and local programs are making it even harder to access needed mental health care. Instead, health care costs continue to rise, fewer Americans have health insurance, and only about 2.5 million of the 23 million Americans that need substance abuse treatment receive it. Recent changes to policy that would allow states to determine what health insurance must cover will mean politics (and lobbying) will often determine who gets treatment.
It is now widely accepted among addiction specialists that addiction is a disease similar to heart disease and diabetes. The American Society of Addiction Medicine recently confirmed this fact, describing addiction as a "primary, chronic disease of brain reward, motivation, memory and related circuitry." This means that people abuse drugs not because they are somehow flawed, but because changes in the brain make it extremely difficult to feel normal without drugs.
Since we've recognized that addiction is a chronic disease similar to heart disease and diabetes, now it's time to start treating it that way. People need access to long-term treatment, even if they cannot pay for it themselves, and to be treated with compassion and respect rather than blame. We do not punish people who have a second heart attack by denying treatment; why do we punish those who relapse with an addiction by denying further treatment?
Government can play a role by refusing to use the lives of people suffering from addiction as pawns in political games. Calls to drug test people who apply for benefits yet not provide them with options to get help might make for great sound bites, but this is terrible public policy. Ignorance about the true nature of addiction fuels these self-righteous stands by politicians.
Corporations can also play an important role in destigmatizing addiction and mental illness. A company that terminates a skilled employee because they have a mental health condition should instead receive incentives to provide the employee with the treatment they need to be productive. If corporations started firing people because they have heart disease, diabetes, or cancer, we would be outraged.
In 2011, the War on Drugs turned 40. In 2012 it's time to focus on the real problems and implement solutions. If we are to wage any type of war, let it be a Fight for Addiction Treatment -- one that knows its true enemy and fights only those battles that are calculated to produce results.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction and mental health treatment programs that includes the Promises Treatment Centers, The Ranch outside Nashville, The Sexual Recovery Institute, and The Recovery Place. You can follow Dr. Sack on Twitter at http://www.twitter.com/drdavidsack.
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