VOLUNTARY OR NOT, DRUG TREATMENT WORKS (1/2)

The Sun's recent editorials on addiction in Baltimore (June 27-28) suggested
that "voluntary" addiction treatment is a "philosophy" that must prove
itself before it merits further funding (June 27-28). But treatment is not a
philosophy and its efficacy is already proven.

Drug addiction treatment has been evaluated many times under rigorous
condition similar to those the Food and Drug Administration (FDA) uses to
evaluate new medications. Many studies have shown unequivocally that
treatment reduces crime, drug use and the spread of HIV.

Given the money it saves the health and criminal justice systems, treatment
more than pays for itself.

Making treatment available through the criminal justice system is a
promising approach -- and one that has been available for decades. However,
rigorous research comparing "coerced" to "voluntary" treatment has been
lacking. The data available on this comparison is not conclusive.

But such comparisons overlook the obvious: The real difference is not
between coerced and voluntary treatment, but between no treatment (which is
the usual situation today) and any treatment (coerced or otherwise).

Thus citizens should focus on making treatment available to all who would
benefit.

Finally, The Sun incorrectly suggested that Baltimore's low
treatment-completion rates, compared with those in other parts of the state,
indicate that treatment somehow doesn't work in Baltimore.

But completion rates are a poor measure of success. Large and sustained
improvements have been shown for patients in treatment, whether or not they
complete the program.

And given the variation in socio-economic status, drug-use severity and the
types of treatment across jurisdictions, it is unfair to compare Baltimore's
outcomes with those in the rest of the state.

Baltimore's concentration of poverty has enormous impact on expected
treatment outcomes for all chronic disorders, including addictions. The
large proportion of city addicts receiving methadone also affects the city's
completion data unfavorably.

Dr. Robert Schwartz, Baltimore

The writer is director of the University of Maryland School of Medicine's
Division of Alcohol and Drug Abuse and a board member of the Baltimore
Substance Abuse Systems Inc.