TREATING THE TREATMENT

If drug treatment is a critical factor to reducing crime, relieving
overcrowded jails and ending destructive cycles of addiction, why are
we doing such a lousy job? In a sobering new study, a task force
convened by the N.C. Institute of Medicine concludes that fewer than
one out of 10 people who use illegal drugs in North Carolina receive
state-funded help. Even worse, those who do receive state help aren't
getting their money's worth -- or the taxpayer's -- the report says.
The treatment tends to be inadequate and out-of-date. The task force
says the state's system of drug-abuse treatment needs a new look and
a new philosophy: to consider addiction an illness and a brain
disorder and to deal with it through treatment and follow-ups. The
report took 14 months to complete and is authored by a panel of
people who should know the topic best: doctors, scientists,
drug-abuse-treatment facility managers, lawmakers and individuals who
are personally coping with addiction.

Expert opinions

The report's recommendations are thoughtful, well-conceived and
wide-ranging. They include shifting the state's drug-treatment model
to "recovery-oriented care"; creating statewide and local plans for
substance-abuse prevention; increasing the number of drug-treatment
courts; and investing in new training for drug-treatment
professionals. Some of the ideas will spark a prickly debate among
lawmakers (ban smoking in all public buildings, "including, but not
limited to, restaurants, bars, and work sites"). Others only cost
good judgment and common sense (do not lower the legal drinking age
below 21). But most would not be inexpensive, calling for an
estimated $100 million investment over the next two years. Even in a
good times, that would be a lot of money. These are not good times.

More problems, more money

In light of the teetering economy, the state is projected to see a $2
billion, or more, budget shortfall this year and lawmakers are
grappling with the need to make deep cuts. Given the magnitude of
budget shortfalls this year, can the state afford to provide more and
better drug treatment?

Many say it can't afford not to.

The report estimates the direct and indirect costs of drug and
alcohol addiction to total more than $12.4 billion a year in North
Carolina. "You can cut back on treatment, but you end up paying in
cops, hospitals and broken families," an addiction expert, David
Friedman of Wake Forest University, told The News & Observer of
Raleigh. That kind of thinking persuaded the Guilford County
commissioners to fund a new drug-treatment facility on West Wendover
Avenue in High Point -- the only county-funded drug-treatment
facility in the state.

The 56-bed center, which provides residential treatment for alcohol
and drug abuse, has had its problems since opening last year. In
2008, it briefly was not allowed to admit new patients after being
cited by state inspectors for regulatory violations and fined $1,500.
It has since addressed the violations, is accepting patients and
represents an important first step in a comprehensive drug-treatment
approach that should pay long-term dividends. Whether the center's
current operator, Missouri-based Bridgeway Behavioral Health, is the
best fit remains to be seen. But the concept behind the facility is
sound. Meanwhile, even the president and CEO of the Institute of
Medicine acknowledges the tough funding climate for statewide
reforms. "It's always difficult to ask for money in a tight budget
year like this," Pam Silberman said a recent interview.

One step at a time?

The study suggests paying for the drug-treatment makeover with
increased excise taxes on beer, alcohol, wine and cigarettes. State
lawmakers also have cited the so-called "sin taxes" as one way to
raise desperately needed new revenues.

But they don't envision the money solely for drug-treatment
initiatives. There is, however, a viable alternative. Silberman says
the task force's top recommendations could be phased in incrementally
for less than one-fifth of the costs, or about $21.3 million, over
two years. Those priority recommendations include setting up pilot
community prevention programs whose effectiveness would be measured
objectively and scientifically. That approach is well worth
considering, given the huge impact and high costs -- in human and
monetary terms -- of substance abuse in the state. "The point is,"
Silberman said, "we pay for it anyway."