Addiction - Article VI

By: Michael Stone, MD, Addiction Medicine Specialist,
Director, Cornerstone of Southern California

I had decided to write about why we should treat people with addictions and was into the first few paragraphs when I came across a great article written by Alan I. Leshner MD, director of the National Institute on Drug Abuse at the National Institutes of Health. I decided to provide you with a verbatim copy of his statement on this subject. Enjoy.

Why Shouldn't Society Treat Substance Abusers?

By Alan I. Leshner

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 areas, 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 the point where we should not longer focus on 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 community.

A variety of studies from the National Institutes of Health, Columbia University, the University of Pennsylvania, and other institutions all have shown the drug treatment reduces use by 50% to 60%, and arrests for violent and nonviolent criminals acts by 40% or more. Drug abuse treatment reduces the risk of HIV infection, and interventions to prevent HIV are much less costly then treating AIDS. Treatment tied to vocational services improves the prospects for employment, with 40% to 60% more individual 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 voluntary behavior. If we are ever going to significantly reduce the tremendous price that 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.

MICHAEL STONE, MD, Addiction Medicine Specialist
Cornerstone of Southern California
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Incidental Medical Services (IMS)

On January 1, 2016, Chapter 744, Assembly Bill 848 was enacted authorizing adult alcoholism or drug abuse recovery or treatment facilities that are licensed by the Department of Health Care Services (DHCS) to provide IMS. AB 848 amends sections 11834.03 and 11834.36, and adds sections 11834.025 and 11834.026 to the Health and Safety Code to allow licensed residential providers the option to apply to DHCS for approval to provide IMS in their facilities.

IMS are services provided at a licensed residential facility by a health care practitioner that address medical issues associated with either detoxification or the provision of alcoholism or drug abuse recovery or treatment services to assist in the enhancement of treatment services. IMS does not include the provision of general primary medical care. IMS must be related to the patient's process of moving into long-term recovery.

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https://www.samhsa.gov/medication-assisted-treatment

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