 Dealing With Addiction
By Barry McCaffrey
As a nation we have made enormous progress in our efforts to reduce drug use and its consequences. Our diverse drug prevention and education campaigns have been successful. While America's illegal drug problem remains serious, it does not approach the emergency situation of the late 1970s, when drug abuse skyrocketed, or the cocaine epidemic of the 1980s. In the past 15 years, we have reduced the number of illicit drug users by 50 percent. Just 6 percent of our household population age 12 and over was using drugs in 1995, down from 14.1 percent in 1979. Cocaine use has also plunged, dropping 30 percent in the past four years. More than 1.5 million Americans were current cocaine users in 1995, a 74 percent decline from 5.7 million a decade earlier. Cocaine is on its way out as a major threat in America. In addition, drug-related homicides are down by 25 percent. Most of our largest companies have effective drug-free workplace programs. And our towns and cities have formed more than 3,500 community anti-drug coalitions -- the one in Miami reducing drug use by 50 percent. It is clear that when we focus on the drug problem, drug use and its consequences can be driven down. But the consequences of illegal drug use remain unacceptably high. Currently we have 3.6 million Americans who are addicted to illegal drugs. Of those, 2.7 million are hard-core addicts who consume 80 percent of the illegal drugs in America. There is no doubt that substance abuse is our biggest national health problem. During the decade of the 1990s, illegal drugs have killed more than 100,000 people and cost more than $300,000 million in health care, prison incarceration, accidents, and litigation. Tobacco kills another 400,000 a year. Alcohol kills more than 100,000. Between 13 and 24 percent of Americans suffer from substance-abuse disorders sometime in their lives, making this the most prevalent of all psychiatric disorders in the United States. The most alarming drug trend is the increasing use of illegal drugs, tobacco, and alcohol among youth. According to a study conducted by Columbia University's Center on Addiction and Substance Abuse (CASA), children who smoke marijuana are 85 times more likely to use cocaine than peers who never tried marijuana. The use of illicit drugs among eighth graders is up 150 percent over the past five years. While alarmingly high, the prevalence of drug use among today's young people has not returned to the near-epidemic levels of the late 1970s. Still, we cannot stand idly by and allow drug use by our children to continue to rise. We are not content with the current domestic demand for illegal drugs, and our government will not tolerate its continuation. We are absolutely committed to reducing drug use and its disastrous consequences. Each year our federal, state, and local governments spend more than a combined $30,000 million on counterdrug programs, and treatment is the centerpiece of our counterdrug strategy. No Magic Bullet There is no question that effective treatment programs can put people in a position where they no longer suffer from addiction, where they are not involved in street crime, where they are less likely to be a victim of AIDS. We can intervene successfully in these situations. And that's the kind of thing we're trying to organize for those who are suffering from addiction to cocaine, heroin, methamphetamines, and other drugs. No magic bullet can eradicate drug abuse overnight, but treatment does bring sustained reduction in drug use. Drugs purport to be an "instant" answer -- whether to boredom, anxiety, frustration, thrill-seeking, or pain. By contrast, the solution to the drug problem for the individual and the country is anything but instant. We can make headway against this difficult problem by adopting a long-range approach that demands patience and perseverance. The metaphor of a "war on drugs" is misleading. It implies a lightning, overwhelming attack. We defeat an enemy. But who's the enemy in this case? It's our own children. It's fellow employees. The metaphor starts to break down. The United States does not wage war on its citizens. The chronically addicted must be helped, not defeated. A more appropriate conceptual framework for the drug problem is the metaphor of cancer. Dealing with cancer is a long-term proposition. It requires the mobilization of support mechanisms -- human, medical, educational, and societal, among others. To confront cancer, we must check its spread, deal with its consequences, and improve the prognosis. Resistance to the spread of both cancer and drug addiction is necessary, but so is patience, compassion, and the will to carry on. Pain must be managed while the root cause is attacked. The road to recovery is long and complex. For women and men of all ages, regardless of the drugs, we have found that treatment works when it is structured, flexible, sufficiently long, and integrated with other forms of rehabilitation. Drug addiction was once viewed exclusively as a moral problem or character defect. Today we understand it to be a chronic, recurring illness with personal and social underpinnings. Drug addiction produces changes in brain chemistry, but treatment can help restore chemical balance and give patients a chance to regain control of their lives. In conjunction with treatment, addicts need job training, relapse prevention, supervision, psychological support, and medication where indicated. Equally important are aftercare transitional treatment, self-help groups, and community support. All of these treatment approaches contribute to recovery and long-term abstinence. The National Treatment Improvement Evaluation Study (NTIES), a five-year study conducted by the National Opinion Research Center at the University of Chicago, found that the percentage of patients reporting use of illicit drugs dropped by approximately 50 percent during the year after treatment compared to the year before treatment. The study also documented that violent behavior was reduced from 49.3 percent to 11 percent, and that reports of arrests went down by almost two-thirds. These results held for methadone and non-methadone outpatient treatment, and short- and long-term residential and correctional treatment. We have found that drug treatment lowers medical costs, reduces accidents and worker absenteeism, diminishes criminal behavior, and cuts down on child abuse and neglect. Following treatment, recovering users require less public assistance, are less likely to be homeless, contract fewer illnesses (including sexually transmitted diseases), and are more productive. A 1994 study by the Rand Corporation demonstrated a cost-benefit ratio of seven-to-one for drug prevention and treatment compared to supply reduction. In other words, for every dollar not spent on drug prevention and treatment, we would have to spend $7 on reducing the supply of drugs. The question is not whether we can afford to pay for treatment. Rather, how can we afford not to? The message of treatment is clear: people whose lives have been ravaged by drugs can become productive citizens once again, restoring their dignity, reuniting their families, and strengthening society as a whole. Drug Control Strategy Provides Direction The National Drug Control Strategy is America's main guide in the struggle to decrease illegal drug use. The strategy provides a compass for the nation to reach this critical objective. Developed in consultation with public and private organizations, it sets a course for the nation's collective effort against drugs. The 1997 strategy proposes a 10-year commitment supported by five-year budgets so that continuity of effort can help insure success. The strategy addresses the two sides of the challenge: limiting availability of illegal drugs and reducing demand. Our first priority is to set our own house in order. To that end, one-third of the U.S. federal counterdrug budget -- $5,000 million -- has been dedicated to demand reduction programs. Fifty-five percent -- $8,000 million -- goes for domestic law enforcement. The first three goals of the 1997 strategy call for educating America's youth to reject illegal drugs as well as alcohol and tobacco; increasing the safety of citizens by substantially reducing drug-related crime and violence; and reducing the health and social costs of illegal drug use. Under the last initiative, reducing health and social problems, the strategy focuses on helping the 3.6 million chronic drug users in America overcome addiction. Chronic drug users are at the heart of America's drug problem. They comprise about 20 percent of the drug-using population yet consume over 80 percent of the supply of drugs. Chronic users maintain drug markets and keep drug traffickers in business. The willingness of chronic drug users to undergo treatment is influenced by the availability of treatment programs, affordability of services, access to publicly funded programs, family and employer support, and the potential consequences of admitting a dependency problem. The strategy seeks to reduce these barriers so that increasing numbers of chronic users can begin treatment. Programs capitalize on individual motivation to end drug dependency. We are also increasing research efforts to treat those addicted to cocaine. While methadone exists for the treatment of opiate addiction, pharmacotherapies for cocaine dependency do not exist. Since addiction is particularly devastating for the poor, who lack economic and family safety nets, we encourage treatment programs that address the special needs of these populations. States, communities, and health-care professionals are encouraged to integrate drug prevention and assessment programs in prenatal, pediatric, and adolescent medical clinics. Drug testing and employee assistance programs also reduce drug use. The McDonnell-Douglas Corporation found that such programs returned $3 for every dollar invested through reduced absenteeism and medical claims. The share of major U.S. firms that test for drugs rose to 81 percent in January 1996. Our challenge is to expand these programs to the small business community that employs 87 percent of all workers. Drug Courts Offer Alternative to Prison Also of particular concern is the relationship between drugs and crime. In major American cities up to one half of all homicides are drug-related. As many as two-thirds of individuals arrested for serious crimes test positive for illicit drugs. Unless treatment programs are readily available in prison, particularly the federal justice and state prison systems, we are doomed to a cycle of arresting people, incarcerating them, and eventually sending them back out into the streets and back into a life of crime. So we are encouraging drug treatment and education for prisoners, expanded use of "drug courts" that offer incentives for drug rehabilitation in lieu of incarceration, and integrated efforts to rid criminals of drug habits. The coercive power of the criminal justice system can be used to test and treat drug addicts arrested for committing crimes. And alternative judicial processes such as the drug courts, have demonstrated that they can motivate non-violent offenders to abandon drug-related activities and lower recidivism rates by giving them by sentences that do not involve incarceration. More than 200 drug courts around the country and community programs like Treatment Accountability for Safer Communities are already helping non-violent offenders break the cycle of drugs and crime. There's no question that if major cities like New York, Miami, and San Diego can reduce the impact of drug addiction on street crime, which they have, then there is hope for all of us. But Americans are especially concerned about the increased use of drugs by young people. Today, dangerous drugs like cocaine, heroine, and methamphetamines are cheaper and more potent than they were at the height of our domestic drug problem 15 or 20 years ago. Our children also dropped their guard when drugs faded as a pressing problem in the late 1980s and early 1990s, and first-hand knowledge of dangerous substances became scarce. According to the Partnership for a Drug-Free America, there has been a 20 percent reduction in the number of public service announcements carried by television, radio, and the print media since 1991. Consequently, disapproval of drugs and the perception of risk on the part of young people has declined throughout the decade. As a result, since 1992, more youth have been using alcohol, tobacco, and illegal drugs. A disturbing study prepared by CASA also suggests that adults have become resigned to teen drug use. In fact, nearly half the parents from the "baby-boomer" generation expect their teenagers to try illegal drugs. Forty percent believe they have little influence over their teenagers' decisions about whether to smoke, drink, or use illegal drugs. But this assumption is incorrect. Parents have enormous influence over the decisions young people make. In fact, the first priority in the prevention effort must include parents, teachers, coaches, ministers, and youth counselors. Youngsters and adolescents listen most to those they know, love, and respect. The 50 million Americans who used drugs in their youth but have now rejected illegal drugs must also participate in this national prevention effort. We know statistically that if we can keep a young person between the ages of 10- and 21-years-old from smoking, abusing alcohol, or using illegal drugs, then the chances of that person becoming one of the 3.6 million people currently addicted to drugs approach zero. You normally don't start using cocaine in your last year of law school, or start using methamphetamines in your first job. And we know that when we get organized at the community level, when we get involved with educators, and when we give children positive options in their lives -- less of them, by enormous numbers, become involved in addictive behavior, even when their family circumstances are dysfunctional. Drug education and prevention are the centerpiece of the national drug strategy. Key strategy initiatives being undertaken to decrease drug use among young people include keeping drugs out of areas where children and adolescents study, play, and spend leisure time; having schools offer both formal and informal opportunities for changing the attitudes of students and parents regarding illicit use of alcohol, tobacco, and drugs; and increasing the number of drug-related public service announcements carried by the media. Communities and community anti-drug coalitions are also part of the prevention effort. The community-based anti-drug movement in this country is strong, with more than 4,300 coalitions already organized. These coalitions involve partnerships between local groups and state and federal agencies to reduce drug use, especially among young people. Such groups have the ability to mobilize community resources; inspire collective action; synchronize complementary prevention, treatment, and enforcement; and engender community pride. I'll conclude by saying that we must also continue to oppose efforts to legalize marijuana if we want to reduce the rate of teenage drug use and prevent American youth from using more dangerous drugs like cocaine. According to research conducted by CASA, marijuana is a gateway drug. Children who smoke it are 85 times more likely to use cocaine. Marijuana is listed under the provisions of the Controlled Substances Act because of its high potential for abuse and because there is no currently accepted medical use in the United States. In response to anecdotal claims about marijuana's medicinal effectiveness for things like glaucoma, wasting illness, and the management of pain, we are funding a comprehensive review of the drug by the National Academy of Science's Institute of Medicine. Addressing drug abuse is a continuous challenge; the moment we believe ourselves to be victorious and free to relax our resolve, drug abuse will rise again. We must continue to do all in our power to prevent that from happening.
|
