Investing in drug abuse treatment: a discussion paper for policy makers.

The available research is quite clear on these points: • Education does not correct drug dependence: it is not simply a problem of lack of knowledge. • Consequences of drug use (e.g. hangovers, loss of job, arrest, etc.) appear to be important stimuli leading to entry into drug abuse treatment. • Very few addicted individuals are able to profit from a corrections-oriented approach by itself. Relapse rates are over 70 per cent from all forms of criminal justice interventions. • Addiction is not simply a matter of becoming stabilized and getting the drugs out of one’s system. Relapse rates following detoxifications are approximately the same as those following incarceration. Based on these findings, drug abuse is best treated by combinations of continuing outpatient therapy, medications and monitoring, with the goal of retaining drug abusers in that treatment/monitoring regimen to maximize and maintain the full benefits of treatment. Recent pharmaceutical research has produced effective medications for the treatment of alcohol, nicotine and opiate dependence and has identified promising candidate medications that will provide even more assistance to physicians in treating those illnesses. From this, one must conclude that drug and alcohol dependence are treatable medical illnesses. While this paper compares addiction to other chronic illnesses, there are many differences. One of the most prominent differences is the impact of the disease on the family and society. The major focuses of most treatments for other chronic illnesses are symptom remission and return of function for the benefit of the patient. This has also been true for many addiction treatments, which has left much of society with the view that the major goal of addiction treatment is simply to make the patient feel better-not something those who have suffered from the crime, lost productivity and embarrassment of addiction are eager to do. The perspective taken here suggests that addiction treatment providers must broaden their responsibilities and focus on such socially important goals as: • Working with employers and social welfare agencies towards the goals of returning to—or finding—work; • Working with criminal justice agencies and parole/probation officers towards the goals of keeping the patient from returning to drug-related crime and incarceration; • Working with family agencies and families towards the goals of returning to, or taking on, responsible family roles, especially parenting. These are the addiction-related conditions that most affect society and reduction or elimination of them are what society expects from any “effective” intervention. This paper concludes that substance abuse treatments can and should be expected to improve the public health and social problems of patients and that there are methods of organizing the structure and delivery of care to achieve those outcomes