Drug treatment advocates in a divided house

The Times’ Nov. 10 article on lengthening drug-addiction treatment presents a thoughtful report on substance-abuse programs that extend past the 30-day norm. The article relies on studies and interviews with treatment providers who explain that longer-term programs result in fewer people relapsing than the shorter 30-day option.

But does a user who relapses after undergoing treatment necessarily mean that his or her program isn’t successful? While we appreciate the valuable point that drug treatment takes time, there are other moral and strategic questions being debated fiercely in our community. The very nature of treatment is changing, along with shifting public perceptions about what addiction is and how best to address its associated problems. Most of all, elected officials need a complete picture of the modern treatment landscape to see how society can best support people with drug addictions.

“Treatment” for most people has nothing to do with the expensive, for-profit centers described in The Times’ article. Quality treatment-on-demand that goes beyond the do-it-yourself 12-step model or compulsory 28-day detoxification programs should be available to everyone. Unfortunately, incarceration or insurance plans that refuse to pay for treatment tend to get in the way. On the national level, however, there is a glimmer of hope: President Bush recently signed into law legislation that requires employers to provide mental health insurance benefits comparable to their medical coverage.

But lawmakers across the country still have a long way to go. Even though treatment has been proved to cost less and work better than incarceration in reducing addiction, crime and recidivism among drug offenders, close to 500,000 people in the U.S. are behind bars tonight thanks to drug offenses.

The two biggest points that create divisions among both treatment advocates and the public are the usefulness of criminal sanctions or the threat of jail as a treatment compliance tool and the requirement of total abstinence for people in treatment and recovery.

One camp -- usually made up of law enforcement, prison guards and “tough love” types -- thinks the threat of imprisonment for dropping out of programs or relapsing is needed to get people to comply with the terms of their treatment. It is common for many in this group to believe that total abstinence is the only answer for people with addiction problems. In a nutshell, they believe that drug-addicted individuals are not motivated on their own but need threats and coercion to comply with their treatment programs.

The other camp believes that substance abuse should be handled as a health issue, not as a criminal one. They don’t believe jail is the answer when someone relapses or continues to struggle with addiction. Instead, they believe relapse is common and expected for people seeking recovery and that incarcerating someone who slips up is unnecessary and harmful. They also want to focus on reducing the harms stemming from drug use, even if that use is ongoing. For example, someone who injects drugs is better off doing so less often and using sterile syringes to avoid contracting HIV. As a result, treatment advocates claim, public safety will improve -- and there is evidence to support their claim.

Relapse happens. While we know that drug treatment is more humane and more effective than prison, it is not a silver bullet. Many people, such as Steve Owens -- who was featured in The Times’ article -- will quit, relapse and then need continued support to quit again. As The Times’ article points out, between 40% and 60% of people relapse after drug treatment, according to the National Institute on Drug Abuse. But what constitutes successful treatment is being challenged and is moving out of the black or white, all-or-nothing realm. For example, complete sobriety is not the only positive outcome of treatment. Maintaining employment, lessening the risk of overdose and a reduction in drug use are all signs that one’s treatment program is working.

According to several polls, the majority of Americans support treatment instead of incarceration for many of the people who are struggling with drug addiction. That’s the good news. In our advocacy, we must be clear that treatment does not mean only one thing and that there are different philosophies and strategies. We should stop focusing on expanding abstinence-only programs that are closely linked to the criminal justice system and instead try to deliver help where it’s most needed -- and we must use approaches that are grounded in empirical evidence.

Isaac Skelton and Tony Newman are, respectively, publications director and media relations director for the Drug Policy Alliance (drugpolicy.org).