By David Joel Miller.
Did you think drug treatment programs were designed to treat addiction?
Drug treatment efforts in the United States are generally not about treating addiction. If we really cared about reducing addiction we would be doing things differently.
There has been a fair amount of criticism surrounding drug treatment programs and why there are so many people who have been through a treatment program and still use drugs. The reason this situation looks so bleak is that the majority of these programs were never designed to treat addiction despite what the program may be called.
Addiction is not the only area where programs are designed to do one thing despite being sold to the public and called by a name that implies they are supposed to solve that problem.
Having angered half the world with my posts on prayer and the role of spirituality in recovery I might as well anger the rest of the world with some comments about the defects in our political system.
Most drug treatment programs are not meant to get addicts off drugs!
Does that surprise you? It is only very recently and among a very a small number of people; that addiction, alcoholism and related impulse control disorders like compulsive gambling have come to be regarded as diseases.
The traditional approach to addiction was to consider those people criminals and lock them up until they quit doing drugs. Alcoholics were considered crazy and got confined to psychiatric facility’s called “sanitariums.” The high prevalence of repeat DUI’s (Driving under the influence sometimes called DWI, driving while intoxicated) and rearrests for drug use confirms that more than just locking them away is needed to solve this problem.
Some examples of possible treatments
Methadone maintenance for Heroin Addicts.
Methadone maintenance is not designed to cure addiction. It is designed to reduce crime. The goal in this and most other drug and alcohol treatment programs is now and always has been on crime prevention.
The Heroin Addict with a $200 a day habit has to come up with that money every day or become very sick. There are ways to put the bill off, like getting an advance from the dealer, but that works for a very short time unless you are very, very wealthy. Eventually, you need cash. Drug connections are not charitable institutions, they want the cash.
Many Heroin users resort to stealing to cover their costs, burglary is a common way. To get $200 a day for drugs the addict needs to steal $2,000 worth of property. Fences do not pay retail. In the process of stealing $2,000 a day to cover their drug needs the addict may do $20,000 in damage. They do not care if they break a $1,000 window to steal a $1 item.
Giving the addict a $2 dose of “narcotic replacement therapy” will save as much as $20,000 in burglary and vandalism costs. What shocks me at this point is that the insurance companies are not lining up to fund this kind of crime prevention effort.
Remember that Heroin was discovered back in the 1800’s and has been way out of patent protection for a long time. The only reason it is so expensive is that it is illegal. Doctors are not even allowed to prescribe it for clients who are addicted.
The replacement drug, most often Methadone, is not less addicting but more addicting than heroin. It is also not easy to get off. So the system does not treat the heroin addict. We get them hooked on another even more addicting drug.
Please do not misread this as my arguing for the legalization of Heroin or the end of methadone clinics. Keeping as much heroin as possible off our streets may reduce initial cases of addiction. Putting more Heroin on the streets will likely increase cases of addiction. I also know of many cases of people whose lives were changed by the use of narcotic replacement therapy (mostly methadone.) Some people need that drug to get out of the illegal lifestyle and on to a legitimate job.
What I am pointing to is that this program like so many other government programs is not meant to help the people with the problem.
Drug treatment programs are designed to reduce crime not cure addiction.
Prop 36 or SACPA.
The “Prop 36” program in California which sent tens of thousands of addicts to treatment resulted in a number getting off and staying off drugs. The program has since been in large part “defunded.” The official title of the program was SACPA, short for Substance Abuse Crime Prevention Act. Clearly, the emphasis was on crime prevention, not addiction treatment.
Drunk Driving programs.
Further evidence for this hypothesis comes from Drunk Driving programs. Drunk driving programs do NOT treat alcoholism despite the high number of alcoholics with chronic medical problems who are driving up the cost of medical care for all of us. Programs forbid their instructors from talking about alcoholism.
Drunk driving programs are focused on teaching you how to drink more and still not get a DUI. Things like designated driver programs and spacing your drinks so you can continue drinking, the more the better, and still not get a DUI.
It is possible with the expansion of health care we will get serious about treating addiction, alcoholism and mental health issues. I remain hopeful but skeptical. Past experience has made me that way.
Sorry to spoil your illusions. Drug treatment never was about the addict. But then you are not one of those people who believe in fairy tales like the tooth fairy or that food stamps are meant to reduce hunger are you?
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings, and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books