In drug treatment vs. prison, a political shift in tone

If President Bush has his way, more people like Carolann will find themselves in drug treatment rather than jail.

For five years, cocaine ruled the life of this architectural design engineer, and almost robbed her of her daughter by consuming her energy and affections. She's been in treatment for 11 months and is determined never to go back.

In announcing his national strategy to combat illicit drugs this week, Mr. Bush made it clear Carolann's success story is the kind the White House would like to trumpet as it tries to make drug treatment more widely available and socially acceptable. That effort is the most recent and highest level indication of a shift in thinking about the role drug treatment can play in the overall fight against drug abuse.

For years, advocates have argued that treating addicts was more cost effective and humane than putting them in jail. But for more than two decades, those arguments lost in the political arena to a "get tough" approach that produced increasingly harsh penalties for drug offenders. Although some have argued that approach might help reduce the crime rate, it has also more than doubled the prison population, while draining state budgets.

Now, Bush is making it clear it's time to rethink the role of treatment. "The best way to affect supply is to reduce demand for drugs," he said Tuesday. "We can work as hard as we possibly want on interdiction, but so long as there is the demand for drugs in this country, some crook is going to figure out how to get them here."

Bush has backed up those words with dollars. Drug treatment was one of the few domestic items, other than defense, given an increase in his proposed budget. It's about a 6 percent hike, bringing the total drug treatment budget to $3.8 billion. That could help almost 550,000 people - about 50,000 more than last year.

While treatment advocates applaud the shift in tone, they contend that extra dollars amount to only drops in the bucket compared with the need. In 2000, the National Household Survey on Drug Abuse found that 3.9 million people who needed treatment did not get it. In treatment circles, the accepted estimate is that only 1 in 10 people get the help they need.

"I see too many people who suffer because they can't get it, and it goes far beyond the individual. The families suffer as well," says Terry Horton, medical director of Phoenix House, one of the country's largest drug-treatment organizations.

Public opinion on the issue of treatment has been ahead of politicians for some years. Polls show Americans overwhelmingly prefer giving nonviolent first- and second-time drug offenders treatment rather than jail time. Part of the shift is due to an effort by the National Institute for Drug Abuse (NIDA) to highlight studies that have scientists viewing substance abuse as a medical disease, rather than as a moral failing.

The Soros Foundation has also played a role by pushing referendums in a handful of states that overrode their own lawmakers' get-tough policies.

Last year, California became the second state, after Arizona, where voters passed a referendum by large margins that mandates treatment before jail time. Similar referendums are planned for Florida, Michigan, and Ohio this year.

A handful of states are also increasing drug-treatment options in lieu of long prison terms, despite severe budget deficits. And even in states that are cutting drug treatment to cope with the economic downturn, the rescissions are nowhere near as much as could have been expected just five years ago.

But critics of treatment have long noted - and studies confirm - that more than half of addicts who get help end up using again within a year. And most of the people who need help don't want it, anyway.

The nation's drug czar, John Walters, says that Americans have to change the way they deal with addicts at home and at work so that it's not "only accepted, but expected" that Americans will step forward when they see someone in trouble.

"When a person has a substance-abuse problem, the single biggest challenge after getting treatment is recovery, because it's a lifelong challenge," says Mr. Walters. "We need to work on a change in the climate in our communities, workplaces, and families where we support people in treatment and recovery - don't stand back when they relapse, get them back into sobriety as soon as possible."

Baltimore is one of the best places to look to understand why treatment itself has been rehabilitated. In the late 1990s, it joined San Francisco in trying to ensure that every addict that wanted it had access to treatment. It was modeled on the Nixon administration's push for "Treatment on Demand" back in the early '70s.

A major three-year study of the Baltimore effort has just been released, and the findings show that providing treatment to all comers - even those who drop out - substantially reduced not only substance abuse, but also crime and risky behaviors that could lead to HIV.

Heroin use was down 69 percent after 12 months. Cocaine abuse dropped by 43 percent. And there was a 40 percent reduction in arrests, a 52 percent increase in employment, and a 67 percent increase in legitimate wages.

"The real thing this study shows is that it affects the entire community and taxpayers," says Peter Beilenson, the Baltimore City Health Commissioner. "Even if you didn't care about the individual users, the immediate pay-offs to the community show we should be making a massive commitment to drug treatment nationwide."