The hot-button topic in our current election cycle is the economy. Basically, finances seem to be the sole focus of nearly every campaign. And why not? With unemployment rates hovering in the 8 percent range, our nation's financial situation is a major issue. But almost as many Americans suffer from a serious mental illness as are unemployed, and there are many more people dealing with addiction than are unemployed. Even in an economy-driven election -- perhaps especially in an economy-driven election -- politicians should be paying attention to these facts. After all, whether it is a debilitating mental illness such as bipolar disorder or a mind-addling addiction to prescription medications, these issues cost our nation serious money. And the amount increases when the problems are left untreated or passed off to the criminal justice system.
The simple fact is that just about everyone knows someone -- a loved one, a friend, a co-worker -- with a mental health or addiction issue. Nevertheless, politicians routinely ignore the need to treat these populations. Perhaps this neglect stems from the fact that addiction and mental illness have historically been viewed as moral failings as opposed to treatable illnesses. Alcoholics were seen as hopeless bums and a drain on society, drug addicts were degenerate criminals to be feared and thrown in jail, and the mentally ill were unfortunate creatures best hidden away in locked rooms or placed in asylums "for their own good." Sadly, even though the medical and scientific communities now possess considerable evidence indicating these once-upon-a-time "facts" have little, if anything, to do with the reality of alcoholism, drug addiction and mental illness, our socio-political system continues to wallow in the see no evil, hear no evil, speak no evil dark ages. Rather than dealing with these problems head on, we choose to either ignore them or use the judicial system to sweep them under the rug.
This unhelpful attitude has, over the last several decades, led to a bevy of unfortunate, expensive and wildly unsuccessful federal, state and local policies focused on interdiction and punishment rather than treatment. And in most respects these moth-eaten "contain and control" strategies persist despite the ever-growing mountain of evidence clearly demonstrating their abysmal inadequacy. Consider, for instance, the tried and truly failed idea that we can "arrest" our way to a drug-free America. Today, there are more than seven million Americans under the supervision of the criminal justice system, with a large percentage of that number in on drug offenses. Yet more people than ever are dying drug-related deaths. However many people we lock up, the ravages of addiction continue unabated.
If we look at the matter objectively, we see clearly that the war on drugs is over, and everybody lost. So why do we continue to address the "addiction problem" primarily through the criminal justice system? Rather than dumping countless billions into a quagmire of policies that we know don't work, couldn't we refocus our efforts and funnel these same resources into improving our treatment methodologies and making that treatment affordable, accessible and without stigma?
One common argument against the above idea is that federal and state governments should not be throwing their limited financial resources at a tiny segment of the population when so many larger, more pressing issues (i.e., the economy) need to be addressed. Of course, this argument fails to recognize that arresting and incarcerating drug users, oftentimes repeatedly, without addressing their underlying issues costs, over time, significantly more money than helping those individuals identify and overcome their problems through proper treatment. And the financial costs don't end with arrest and incarceration! The number of work-days lost to addiction is incalculable, costing employers millions, perhaps even billions. And what about the healthcare system? Medical expenses for an untreated alcoholic are triple those of a nonalcoholic.
Furthermore, as mentioned earlier, addicted and/or mentally ill people are hardly a "tiny segment" of the U.S. population. It is thought that approximately 12 percent of Americans suffer from alcohol or drug addiction, and approximately 5 percent suffer from a serious mental illness. (A "serious mental illness" is an emotional or psychological disorder resulting in a functional impairment that substantially interferes with or limits one or more major life activities.) And these numbers take into account only the individuals directly affected by the disorder. We should also consider the millions of children, spouses, parents and friends who are indirectly affected.
Nevertheless, most jurisdictions determinedly perpetuate policies of interdiction, arrest and incarceration -- probably because seeming "soft on crime" is a good way to lose votes. Thus, resources for dealing with addiction and mental illness have become highly politicized, with policies that sound good to the voting population winning out despite their well-documented lack of success. Happily, not all is doom and gloom on the political front. Earlier this year, in April, the Obama administration released its thoughtful, informed, and progressive 2012 National Drug Control Strategy, building nicely on the president's initial Drug Control Strategy introduced in 2010. Basically, the administration's policy is grounded in three research-based premises that are now widely accepted in the addiction treatment community:
1) Drug addiction is not a moral failing; rather, it is a preventable and treatable chronic brain disease.
2) People can and do recover from addiction.
3) Criminal justice reforms are needed if we truly want to stop the cycle of drug use, crime, incarceration, release, more drug use, and re-arrest.
In part, the president's policy focuses on the two most current drug-related challenges: the prescription drug epidemic, and the millions of people who need substance abuse treatment but do not receive it. If it is followed through -- and that's still a big if -- the new approach will respond to the aforementioned two challenges by diverting nonviolent drug offenders into treatment, and expanding overall access to treatment. For instance, the Affordable Care Act will force insurers to cover drug addiction treatment as they would any other chronic disease. Overall, the new policy is a revolutionary and long-overdue shift in the federal approach.
Unfortunately, addiction and mental illness have (as usual) been placed on a back burner in the current presidential election, with state and local races following suit. Campaign speeches and advertisements are focused on the economy, while the ongoing issue of treating rather than ignoring and/or incarcerating a large, constantly growing and needful segment of our population remains unaddressed. Until this attitude of political neglect changes, we're likely stuck with the current jumble of antiquated laws that do more harm than good. Thus, the individual suffering of millions of people -- not to mention their friends and families -- will continue, as will the unwarranted funding of numerous failed drug control strategies. Yes, the new National Drug Control Policy is a significant step in the right direction, but at the moment it's a lone beacon of light that most politicians are choosing to ignore in favor of "vote grabbing" topics.
David Sack, M.D., is board certified in addiction psychiatry and addiction medicine. As CEO of Elements Behavioral Health he oversees a network of addiction treatment centers that include Promises, The Ranch, The Recovery Place, and The Sexual Recovery Institute.