Rehabilitation: Way to Conquer Crack

There is no magic pill to cure the wrenching addiction caused by crack cocaine. There is not even an equivalent to methadone, the narcotic palliative that suppresses the longing of heroin addicts for the drug that has them hooked. Rehabilitation offers the best hope as America looks for a way out of this social and human quagmire.

If drug treatment is the answer--and that is the consensus of our recent Op-Ed page series, “Drugs: America Looks for the Way Out”--what is the question? There are many. How many Americans need it? How much does it cost? Does it really work? And, perhaps, the question most on the minds of politicians: Does a buck spent on drug treatment pay off with a reduction in crime?

An estimated 860,000 Americans regularly use cocaine, according to a 1988 survey of households by the National Institute of Drug Abuse. That number excludes large groups of users--inmates, the homeless and people already in drug treatment programs. Other estimates put the figure as high as 2.2 million cocaine-addicted Americans.

The budget debates on how to deal with such numbers boil down to prisons versus prevention and cops versus treatment. Beefed-up law enforcement is the historical response to higher rates of crime. But the numbers prove that more cops, courts and prisons can’t provide the whole cure.

Even the nation’s top cops--including Los Angeles Police Chief Daryl F. Gates--are beginning to call for additional rehabilitation. Out-manned and out-gunned on the streets, big-city cops are beginning to view the drug problem as more than a law enforcement nightmare. And they are right.

It costs about $71,600 in salary and benefits to put another cop on the streets of Los Angeles. Police can help stop drug abuse, but treatment costs less and does more good.

Getting people to admit they need help is often half the battle. When drug abusers want to go straight, are highly motivated and ready to change, they should get help quickly. But at the moment they get help only if they can pay.

Celebrities and other wealthy drug users can check into private, for-profit residential facilities that charge from $6,000 to $12,000 for 28 days of treatment, plus after-care. Research shows that residential facilities offer the greatest hope of success. But, at those prices, only the well-to-do or employees of companies with excellent health insurance plans can afford to stay 28 days and longer, or to go back again and again until they’re able to control their craving.

No such help is available to the most vulnerable drug abusers: Poor city kids must be patient--very patient. The wait for an opening in some places can last longer than it takes a woman addict to deliver another crack baby.

Drug treatment on demand can save such babies, and their parents. It is costly, but not as costly as the millions of dollars involved in caring for drug-addicted babies from their tortured cradle through disabled adulthood to an early grave. Because of the cost in human terms, and to taxpayers, child-bearing women deserve first priority in government-supported programs. In those cases, drug treatment makes the most sense financially.

Residential treatment is a good investment because it removes users from an environment where cocaine is easy to come by and from friends who consider crack a seductive companion. The optimal commitment is for at least 16 weeks, often followed by months of warding off relapses; the average addict suffers five relapses. Even when drug abusers learn to abstain, their cravings--triggered by a memory, a dream, a wad of money or a familiar face--may never go away. Through effective treatment, however, users can develop the will to resist drugs and master the secrets of staying clean. It may cost a lot--roughly $14,000 per year in public, nonprofit treatment centers--but it’s more than worth it.

Drug rehabilitation is expensive, but not as expensive as building new prisons and running them at double the capacity. Tight government budgets and huge deficits demand spending priorities. But nearly 80% of the men arrested in large cities test positive for drug use, according to a study by the National Institute of Justice published in December. Those numbers demand attention.

The prison climate--structured, highly disciplined and, in theory, largely free of drugs--could be conducive to successful rehabilitation. But few jails or prisons provide systematic drug treatment. That’s a wasted opportunity.

Prison officials blame this failure on tight budgets that are being further squeezed by overcrowding, overtime wages and the cost of housing more dangerous criminals. Politicians blame voters who cast their ballots for more jail cells. But dollar-for-dollar, serious investment in drug treatment would do more to cut down recidivism and street crime.

Treatment--specifically residential programs--showed dramatic reductions in drug use and a significant decline in predatory crime, according to researchers who tracked more than 10,000 drug users in 41 residential and outpatient treatment programs nationwide for five years. The federally funded Treatment Outcome Prospective Study--the largest long-term study of treatment effectiveness--was done by the Research Triangle Institute in North Carolina.

An unusual and detailed cost-benefit analysis found that, in most cases, the benefits of providing treatment were substantially higher than the costs. According to “Drug Abuse Treatment: A National Study of Effectiveness,” the published report of the TOPS findings: “Virtually all economic measures show that the burden of crime and other economic consequences of drug abuse are lower after treatment than before.”

After drug treatment, crime-related costs declined significantly--for victims and the criminal justice system including cops, courts and prisons. Those encouraging findings--although based on drug use before crack put an intense and very addictive high within reach of anyone with as little as $5--are very persuasive arguments that the best investment of scarce public dollars is drug treatment.

Drug abuse costs billions of dollars and drains productivity from every segment of society--from boardrooms and courtrooms as well as street corners. Drug rehabilitation, accessible for all who need it, is the best government can do to reduce the public and social costs--that is, unless this nation is willing to build a prison in virtually every neighborhood.

Benefits of Drug Treatment

Virtually all economic measures show that the burden of crime and other economic consequences of drug abuse are lower after treatment than before. Source: “Drug Abuse Treatment: A National Study of Effectiveness” by Robert L. Hubbard et-al.