There are many dedicated professionals who treat people with addiction compassionately, but the American addiction treatment system on the whole remains highly dysfunctional:
• Research has long shown that treatment that employs confrontation and humiliation increases drug use rather than fighting addiction, but the majority of rehab programs still include these elements.
• Tough-love boot camps, wilderness programs and emotional growth or therapeutic boarding schools — programs aimed mainly at teens who take drugs — remain unregulated at the federal level and continue to use harsh, counterproductive tactics.
• Ninety percent of addiction counselors focus on getting people to attend 12-step programs for addiction, even though they are not the only way to recover and don't work for many people.
• Methadone and buprenorphine maintenance are the most effective treatments for opioid addiction, yet methadone treatment is exiled from mainstream health care and ghettoized in clinics; as for buprenorphine, any one doctor is not allowed to treat more than 100 patients with the drug.
What do these facts have to do with the drug war? If addiction were seen as a disease like any other — not as a problem for the criminal justice system — addiction treatment would have been integrated into ordinary medicine long ago, and the extreme disrespect that many patients still endure would not have been tolerated. Much more treatment could be funded, of course, if the states and federal government combined weren't spending $50 billion annually on law enforcement and prisons.
June 17 marks the 40th anniversary of President Nixon’s declaration of war on drugs, an effort that has cost the U.S. $1 trillion to date. What have we gotten for our investment? Not much that’s good. Drug use in the U.S. has dropped since its peak in 1979, when surveys showed that 54% of high school seniors reported using an illegal drug at least once in the past year; that proportion has bounced up and down since 1988 and has settled at about 38%. But the rate of the most dangerous type of drug use — daily use — has remained virtually unchanged since 1975 for marijuana, cocaine and opioids. The big problem, of course, is that the U.S. insists on treating a medical and social issue as a criminal one. That trillion dollars has been misspent, as my colleague Tim Padgett argueson Global Spin:
Two-thirds or more of Washington’s $15 billion annual anti-drug budget is spent on conventional interdiction, but half should be going to drug rehab and other demand-reducing devices. … Since as early as 1994, research has shown that the societal costs of the drug war, from prison cells to productivity loss, drop appreciably more — 14 times more in one Rand Corporation study — when a dollar is spent on drug treatment instead of on law enforcement.”
But what gets glossed over in that calculation is that our national drug strategy not only fails to improve Americans’ well-being and health, but in many ways endangers it. So to mark its 40th year, Healthland notes the drug war’s 10 worst side effects.