WHY SHOULDN'T SOCIETY TREAT SUBSTANCE ABUSERS?

Drugs: Let's Get Past The Moral Outrage And Use Available Solutions To Help
Addicts And, In Turn, To Help Everyone.

Imagine a debilitating disease for which there are effective
treatments. Imagine that this treatable disease costs society $110
billion a year. Can you imagine not using the treatments? It seems
unfathomable, but that often is the case with the treatment of drug
addiction.

Addicts are frequently denied treatment that would not only improve
their lives, but also would improve our own lives by cutting crime,
reducing disease and improving the productivity of employees and the
economy.

People are polarized on the issue of treatment: They are either strong
advocates for treating addiction or they hate the idea. People debate
with passion whether treatment works or not, which approaches are best
and whether treatments such as methadone simply substitute one
addiction for another.

From my observation post, the core of the issue cannot be simply
whether drug treatments are effective or not, since there already is
abundant scientific data showing that they are. In fact, research
shows that drug treatments are as, or more, effective than treatments
for other chronic disorders, such as forms of heart disease, diabetes
and some mental illness.

The central issue for many people is whether addicts should be treated
at all. I frequently hear people ask: Do they really deserve to be
treated? Didn't they just do it to themselves? Why should we coddle
people who cause so much societal disruption? Shouldn't they be
punished, rather than treated? Even many people who recognize
addiction as a disease still get hung up on whether it is a "no fault"
illness.

Science has brought us to a point where we should no longer focus the
drug treatment question simply on these kinds of unanswerable moral
dilemmas. From a practical perspective, benefits to society must be
included in the decision equations. The very same body of scientific
data that demonstrates the effectiveness of treatments in reducing an
individual's drug use also shows the enormous benefits that drug
treatment can have for the patient's family and the community.

A variety of studies from the National Institutes of Health, Columbia
University, the University of Pennsylvania and other institutions all
have shown that drug treatment reduces use by 50% to 60%, and arrests
for violent and nonviolent criminal acts by 40% or more. Drug abuse
treatment reduces the risk of HIV infection, and interventions to
prevent HIV are much less costly than treating AIDS. Treatment tied to
vocational services improves the prospects for employment, with 40% to
60% more individuals employed after treatment.

The case is just as dramatic for prison and jail inmates, 60% to 80%
of whom have serious substance abuse problems. Science shows that
appropriately treating addicts in prison reduces their later drug use
by 50% to 70% and their later criminality and resulting arrests by 50%
to 60%. These data make the case against warehousing addicts in prison
without attending to their addictions.

Successful drug treatment takes a person who is now seen as only a
drain on a community's resources and returns the individual to
productive membership in society. Best estimates are that for every $1
spent on drug treatment, there is a $4 to $7 return in cost savings to
society. This means that dwelling on moralistic questions, such as who
deserves what kind of help, blocks both the individual and society
from receiving the economic and societal benefits that can be achieved
from treating addicts.

It is true that the individual initially made the voluntary decision
to use drugs. But once addicted, it is no longer a simple matter of
choice. Prolonged drug use changes the brain in long lasting and
fundamental ways that result in truly compulsive, often
uncontrollable, drug craving, seeking and use, which is the essence of
addiction. Once addicted, it is almost impossible for most people to
stop using drugs without treatment.

It is clearly in everyone's interest to rise above our moral outrage
that addiction results from a voluntary behavior. If we are ever going
to significantly reduce the tremendous that price drug addiction
exacts from every aspect of our society, drug treatment for all who
need it must be a core element of our society's strategies.

Alan I. Leshner Is Director of the National Institute on Drug Abuse at
the National Institutes of Health.