Imagine an actual war being fought the same way as the war on drugs. The army would go out and fight like hell all day, capture lots of the enemy and lots of territory and then at nightfall, turn all the captives loose and retreat back to the original battle lines.
The war on drugs has primarily relied on law enforcement. Let us assume, for the sake of discussion, that this law enforcement war was exquisitely effective in carrying out its mission. What then? There would be lots of people waiting to be processed through the courts and many more who, feeling the heat, would voluntarily want to stop using drugs.
The courts are not capable of handling their current level of cases, let alone a greatly increased case load, so all these new cases would get backlogged. Most of these people can not make bail, so they would remain in jail pending trial. The jails are hardly capable of handling their current load, in fact, many are under court order to reduce their populations. They are doing so through early releases of sentenced prisoners and releasing pre-trial ones on their own recognizance. So much for one of the expressed purposes of arresting them in the first place, that of getting them out of circulation.
Addicts will not seek treatment until they perceive their backs are against the wall. Getting arrested and facing jail time is the most effective way to put a back firmly against a wall. When the system has addicts in this position, they have, in effect, "captured the territory and taken prisoners". Without treatment programs in which to immediately place them, they are either released pending trial, incarcerated until they plea bargain their way out or are sentenced. In all these ways, they remain drug using addicts in or out of jail and so the gains in the war effort are lost and the troops go back to go and replay the same battle the next day.
The other tragedy is that the associates of those that the enforcement system catches start feeling the pressure and many of them, feeling that their backs are very close to that wall, voluntarily seek treatment. In Los Angeles County, the average wait to get into a residential treatment facility is six weeks to three months and even longer for detox facilities. There are only two detox facilities in Los Angeles County that will take people without insurance. If addicts could wait that long without using drugs, they wouldn't need a program, so an even larger opportunity to consolidate the territory won by the war is lost.
The bottom line is that there is no sense in more aggressively fighting a war, if you can't hold the territory! The most effective way to hold that territory is to make sure that there are enough treatment program spaces available to absorb every applicant. This concept is commonly referred to as "treatment on demand". We need to be dedicated to doing everything possible to make sure that all people who want treatment can get it immediately.
The following is a description of specific ways that the goal of Treatment On Demand can be met. Some of the ideas, like the Community Meeting Houses, cost little or no money and can be implemented immediately. Others, like the Residential Programs, will take Federal funding.
There is a need to educate communities, that for very little monetary investment, they can have a major impact on the local availability of treatment for those who want to stop using drugs. The way to do this is to set up meeting houses that can be used by twelve step programs, such as Narcotics Anonymous, Cocaine Anonymous, Crystal Meth Anonymous and Alcoholics Anonymous. These twelve step programs have a proven track record and are supported by the contributions of their members. The only thing that hinders the growth of such groups is the lack of affordable, accessible meeting space.
If the people who coordinate and supervise the meeting space, itself, are also trained to do referrals to other treatment programs for those who need more than twelve step meetings, the value of these meeting houses will be even greater.
A support organization needs to be established to assist local community groups or local governments in their efforts to provide more meeting spaces. The organization should not only committed to promoting the idea of these meeting houses. It should also provide all the necessary technical and other supportive assistance to the community groups or local governments through all the phases of developing their local project, from planning to on-going operation.
Such resources would include: business, governmental and community backing; prospective members for boards of directors; sources for in-kind donations; public relations and advertising support; and start-up seed money, and on-going operating funding.
The Space Available Register has two functions. The first is to compile waiting list statistics from all the treatment programs. This is a very important statistic to demonstrate the need for more programs. The second is to eventually serve as a clearing house with a toll-free phone number that would allow local referral services, who are looking for a treatment slot for their client to immediately be matched with an available one. Since, at this point, there is rarely a treatment slot that is unclaimed, this idea would be put into place later on. The toll-free number might still be useful to encourage treatment programs to report their waiting list statistics.
Federal dollars will be best spent by investing in recovery houses and therapeutic communities (TC's). Recovery houses, where clients stay for up to three months and therapeutic communities (TC's), where stays are usually from 9 to 18 months, are much better values both in dollars and results. Both of these programs are staffed primarily by people who have been through similar programs, with supervision by a mix of professionals and para-professionals.
Recovery houses are appropriate for clients who are already fairly functional in the rest of their lives and just need a breather from all the every day pressures while they learn the 12 steps of recovery. The second part of their treatment will be attending 12 step meetings of one of the Anonymous Programs (Alcoholics Anonymous, Narcotics Anonymous, etc.) while they work and live on their own.
For people who are very addicted to and non-functional without their drugs and/or alcohol, therapeutic communities are a more appropriate choice. They provide a very structured environment in a warm, loving, supportive family atmosphere. They use a lot of behavior modification and emotional therapies. Most of the programs also teach their residents the 12 steps.
Most addicts, whose usage has progressed to the point where it has gotten them involved with the legal system are usually beyond the point where recovery houses will work for them. For these people, it takes at least three months in a program before they stop playing addict games and are ready to learn the lessons necessary to lead a productive substance-free life.
There has been a lot of pressure on TC's over the years to decrease the average length of their programs as a way of cutting costs. This is a serious mistake. For most addicts, nine months is a bare minimum length of stay in the residential program with another six months of gradually reintegrating them into the real world.
Funding is the only missing ingredient to immediately increase the ability of existing therapeutic communities to serve more clients. Most of the TC's in Los Angeles physically have available beds but can not fill them do to a lack of funding. Funding inequalities need to be explored to make sure that available beds are able to be filled. In LA there are usually beds open for HIV infected people all the time, whereas non-infected addicts have about a three month wait.
TC's have been successfully set up in prisons and other locked institutional settings such as state hospitals. They will work well as long as there is a physical separation from the general population of the institution, such as being housed in a separate facility within the prison walls. Utilizing the TC's concept in prisons can go along way towards making the prison experience for an addict rehabilitative rather than that of one that maintains the addictive patterns and increases the level of criminal knowledge.
Here are some cost comparisons for the different types of treatment programs in LA County: 30 day treatment/ detox programs cost between $7,000 (for non-hospital) and $35,000 (for hospital programs)! Therapeutic communities cost $80 per day ($2,400 per month).
Recovery Houses and, especially, Therapeutic Communities ought to be the main-stays of a national treatment on demand policy.
This message has to be kept in front of the public by the use of billboards, public service announcements on television and radio, magazine articles, a monthly newsletter, and appearances on television and radio talk shows. A monthly press release indicating the number of people waiting and the average length of time to get into treatment facilities, both state-wide and nationally, will also serve to focus attention.
The Treatment Now! Councils can, also, conduct public awareness projects at the local level. They also will be the means by which pressure can be kept on the various legislatures.
Research and demonstration projects in the area of treatment need to be encouraged. For instance, the idea of a non-residential therapeutic community, where people participate in a very structured and supportive day and evening program and then go home at night, could be easier to start and much less costly alternative to the residential TC's. Such programs have been tried in the past, but usually as a holding situation for people waiting to get into a residential TC. What needs to be explored is if such programs might be all that is needed for addicts who a safe, non-substance using home to go to at night.
The process of finding grants and seed money for new programs is both costly and frustrating enough that many good ideas are never investigated. A central Federal organization needs to be put into being that will not only coordinate research and development, but will also develop a reservoir of funding from both the public and private sectors that would be available to innovative individual researchers and programs. This would eliminate the need for such people and programs to have to hire full time grant researchers.
Copyright © 1992, rev. 1996, Jason Wittman, MPS, All Rights Reserved