Can Addiction Treatment Reduce Demand for Drugs?

In a speech by President Obama shortly before leaving office, he said: “For too long we’ve viewed drug addiction through the lens of criminal justice. The most important thing to do is reduce demand. And the only way to do that is to provide treatment—to see it as a public health problem and not a criminal problem.” Many of us cheered his recognition that that drug use, abuse and addiction should be moved out of the criminal justice framework. But, his idea the way to reduce demand is through treatment is problematic to say the least.

The first of several problems is finding people to treat addiction. The Affordable Care Act has exploded the number of people covered for treatment, but we haven’t near enough providers to serve them. Based on a professional study, a Pew report states: “The number of psychiatrists, psychologists, counselors and social workers available to treat every 1,000 people with SUD” averages 32 per state. We don’t know how many we need, “but experts agree the current workforce is inadequate in most parts of the country.” Indeed they do. In a review of 2016, President Ball of the Center for Addiction and Substance Abuse (CASA),  complained about the “staggering treatment gap” due to the shortage of adequately trained treatment professionals. And, he said: “All providers need to be better trained in addiction.”

Without a workforce able to successfully treat most drug addictions, reducing demand through treatment is not going to happen. And, there is another reason.

Earlier last year, Carl Hart of Columbia University pointed out that most drug users are not addicts.  They don’t need treatment and treatment would be of no effect on their use of drugs– or the demand they represent. Hart is a neuroscientist and has specialized in drug abuse and addiction for nearly two decades. That’s without counting the years of his youth when he, himself, was using and dealing drugs in one of Miami’s most violent neighborhoods.  Today, he and a colleague update a college level textbook each year. That book is now in its 16th edition. He knows the subject.

Hart argues this idea that”drug addiction is a health problem that requires treatment” is exactly the wrong way to look at the use of drugs in the United States. “Politicians today, whether Republican or Democrat, are comfortable with saying that we don’t want to send people to jail for drugs; we will offer them treatment.” But “the vast majority of people don’t need treatment. We need better public education, and more realistic education. And we’re not getting that.”

Hart argues we have become way over-panicked about addiction. It affects, at most, one quarter of drug users, including users of cocaine, heroin and meth. Those who do become addicted are treatable and most of those end their addictions without treatment. Hart thinks we should stop acting like Chicken Little (Remember: “the sky is falling!”?) and deal with the overdose problem in large part with educational initiatives.

I think he would agree with my contention that people can be taught to use their drugs responsibly. Those who have difficulty with that could benefit from coaching and monitoring, important features of the reform system I propose in Kill the Drug Trade.

That system could rid any  city or region where installed, of the corrupting influence of illegal drug sales. It would bring adult users into a program that assures they have the drug knowledge they need, including how to quit drugs when they are ready to take that step. No longer subject to the dangerous additives of such killers as fentanyl, and others, their risk of overdose and death would drop. And all users would get the education Hart says they should have.

In her introduction to the  2016 Report of the Global Commission on Drug Policy the Chairperson states: “The vast majority of people use all these substances in a reasonable way.” They use them for relief of various mental and physical issues and some for religious and ceremonial rites. A small minority are vulnerable to addiction and those need special help. I contend that a tolerant system, one that allows addicts the time and space to develop in their own way is what we need to crack the problems of addiction and abusive use.  Learning responsible use is, in my view, a first and important step on the path that leads toward quitting drugs—which nearly all addicts eventually do.

Treating the addicted is a worthy goal but it would not shut down the underground market delivering unsafe drugs into the hands of teens and preteens all over the U.S. That business produces hundreds of thousands of newly addicted young people each year. The real way to end that is through the toleration of adult use—putting illegal dealers out of business.

© All rights reserved to Dave Finch 2/23/2017

For more information about the reform I advocate (I call it the TCC Solution) visit the Reform Drug Policy Project.

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