How long does it take for a paradigm shift to become policy? For the United States, it took 102 years to change our ideas around substance abuse and pass the Comprehensive Addiction Recovery Act (CARA). In 1914, the federal government enacted the Harrison Narcotic Control Act, the first comprehensive legislation to address substance use and abuse in our country. It was a pivotal act, as it addressed what we now know is a disease, as criminal acts. The legislation focused on enforcement of laws regarding the sale and distribution of substances and treatment and prevention were not addressed.
The Harrison Narcotic Control Act paved the road for Prohibition and the War on Drugs. The latter helped lead to the prison industrial complex, over-incarceration in the U.S., sustained institutional racism, the revolving door of recidivism, a lack of accessibility to quality community-based treatment and ineffective substance abuse treatments for “offenders.”
Fast forward to 2011, The American Society of Addiction Medicine issued a new definition of addiction characterizing it as a brain disorder, a disease:
Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors.
This declaration, along with the growing bipartisan recognition that our country is not winning the war on drugs, cannot financially sustain the incarceration rates, and an opioid epidemic that does not discriminate based on race or class helped fuel legislative support for CARA.
On July 13, this historic piece of legislation passed in the Senate with bi-partisan support after clearing the House last week. It went to President Obama’s desk for signature, and he agreed to sign this comprehensive bill aimed at increasing resources for prevention and recovery. Specifically, CARA is the most expansive federal legislation to date to address addiction support services by focusing on: prevention, law enforcement strategies, prevention of overdose deaths, expansion of evidence-based treatment including Medicated Assisted Treatment, and support for those in, or seeking, recovery.
This legislation is commendable not only because it was passed by Congress with strong bipartisan support during an election cycle, but because it acknowledges the disease of addiction and that we cannot arrest or incarcerate our way out of this problem. Funding from CARA will help support evidence based prevention and treatment programs, and increase access for the life-saving medication, Narcan.
Moving forward, the programs and policies that evolve from CARA will need to be continuously and comprehensively monitored to ensure evidenced based practices are sustained and appropriate quality improvements and enhancements are added. As practitioners and policymakers, we must also recognize the potential collateral consequences, and be prepared to address them as they arise. For today, let’s celebrate this step in the right direction with the passing of CARA and the potential lives saved.