Pubdate: Sun, 05 Sept 1999
Source: Boston Globe (MA)
Copyright: 1999 Globe Newspaper Company.
Contact:  P.O. Box 2378, Boston, MA 02107-2378
Author: Alan I. Leshner
Section: page D4
Note: Dr. Leshner is the director of the National Institute on Drug Abuse
at the National Institutes of Health.


More than 4 million Americans are addicted to drugs, and fewer than half of
them have received any treatment. Many of the remaining millions have
actively sought treatment but have been turned away for lack of programs
and resources. The consequence of this severe nationwide shortfall in
resources is unnecessary devastation for the addicts, their families,
employers, and communities.

Consider these facts:

Lost work-force productivity due to drug abuse costs the nation at least
$14 billion annually, including losses due to unemployment, impairment,
absenteeism, and premature deaths. On the other hand, research shows that
treatment increases the likelihood of employment by 40 percent or more.

Crime related to drug addiction costs the nation an estimated $57 billion
per year, not including victims' and law officers' medical costs. However,
research has shown that addicts who undergo treatment are 40 percent less
likely to be arrested for violent or nonviolent crimes.

Addicts who receive appropriate treatment in prison are 50 to 60 percent
less likely to be arrested again during the 18 months following their
release. According to several conservative estimates, every $1 invested in
addiction treatment yields a return of $4 to $7 in reduced crime and
criminal justice costs.

Drug abuse treatment reduces injection drug users' risk of spreading HIV
and other infections by as much as 60 percent, and abstaining addicts do
not need costly emergency room treatment for overdoses.

Making high-quality drug addiction treatment widely available can alleviate
much of the devastation caused by drugs in the United States. However,
treatment receives relatively little support from the public. Why? The
underlying problems are a lack of understanding of the true nature of drug
addiction and failure to recognize the effectiveness of its treatment.

The prevailing perception is that drug addiction is simply willful and
defiant antisocial behavior. This leads to the attitude that addicts do not
deserve help. And if a treated addict relapses to drug use, the fall is
attributed to bad character.

These might have been defensible points of view 30 years ago, based on what
was then known about addiction. However, modern science has since shown
them to be completely off the mark.

Most untreated addicts cannot resist abusing drugs, even in the face of
severe negative health and social consequences. This compulsion comes about
because prolonged drug use causes structural and functional changes in the
brain. With modern brain-imaging techniques, scientists actually can see
these dramatic alterations in brain function.

For some people, the fact that voluntary drug abuse precedes addiction
means that addicts do not deserve treatment. This same logic would suggest
that we should not offer treatment to people with many other chronic
diseases, almost all of which involve a combination of vulnerability and
choice. In hypertension, for example, there is an underlying vulnerability,
but the impact of the disease depends on diet, exercise, and whether one
chooses to work at a stressful job.

This does not mean drug addicts should be absolved of responsibility for
their actions. On the contrary, the addict must actively participate and
comply with treatment regimens if the outcome is to be successful.

Many treated addicts relapse, but it is wrong to conclude that treatment
has failed, or that the addict is incorrigible. Most addicts, like most
patients with asthma or hypertension, gain control over their disease
gradually, often over the course of many treatment episodes. Drug abuse
treatment should be judged by the same criteria used for other chronic
disease interventions: Will it help lengthen the time between relapses,
ensure that the individual can function fully in society, and minimize
long-term damage to the body?

A variety of studies from the National Institutes of Health, Columbia
University, the University of Pennsylvania, and other institutions have all
shown that drug treatment reduces use by 50 to 60 percent. This success
rate is not ideal, but it is comparable to - or better than - the results
of treatments for many other chronic diseases including diabetes,
hypertension, cancer, depression, and heart disease.

Moreover, medical research is making addiction treatment better all the
time. Science is equipping treatment providers with more and better tools
to tailor treatment to individual patients' needs, as determined by his or
her choice of drug (or drugs), the addiction history, as well as concurrent
diagnoses, such as HIV/AIDS or depression, and environmental factors.

The conclusion is inescapable. As much as one might deplore the addict's
initial decision to take drugs, it is clearly in everyone's interest that
we rise above our moral outrage and offer treatment to all who need it.

A variety of recent proposals suggest that the country may at last be ready
to abandon discredited, self-defeating ideas about drug addiction. These
proposals would increase financing for more treatment slots, expand the
breadth and usefulness of treatment research, equalize health insurance
coverage for drug addiction treatment when compared with other medical
treatments, and expand treatment for addicts involved in the criminal
justice system.

The sooner these proposals move forward, the sooner the national nightmare
of drug addiction will abate.

Alan I. Leshner is the director of the National Institute on Drug Abuse at
the National Institutes of Health. 
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