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Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination

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Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination Technical Assistance Publication Series 11 Ann H. Crowe, M.S.S.W., A.C.S.W. Rhonda Reeves, M.A. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fisher Lane Rockville, MD 20857 Foreword of TAP 11: Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except quoted passages from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the author. Citation of the source is appreciated. This publication was written by Ann H. Crowe, M.S.S.W., A.C.S.W., and Rhonda Reeves, M.A., of the Council of State Governements. Contributors to the publication were Thomas B. Kosten, M.D., of the Department of Psychiatry, Division of Substance Abuse, Yale University School of Medicine, and Bert Pepper, M.D., and Jackie Massaro, C.S.W., of the Information Exchange. It was prepared under contract number 270-92-0007 from the Substance Abuse and Mental Health Services Administration (SAMHSA). Roberta Messalle of CSAT served as the Government project officer. The opinions expressed herein are the views of the authors and do not necessarily reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). DHHS Publication No. (SMA) 94-2075 Printed 1994 Foreword The abuse of alcohol and other drugs (AOD) is undeniably linked with economic and personal adversities for both individuals and society. It is estimated that the annual national cost of substance abuse is more than $144 billion. This includes related health and mental health care, social welfare, victim's losses, unemployment and lost productivity, and criminal justice system costs. The immeasurable human suffering caused by chemical dependency is equally disturbing. Family dysfunction and violence, children affected by alcohol or other drugs before birth, homelessness and poverty, accidents, homicides, suicides, and crime are often rooted in the abuse of alcohol and other drugs. The number of persons incarcerated in the United States has doubled since 1980, and much of the crime responsible for this increase is drug-driven. It is estimated that currently 80 percent of criminal offenders are substance abusers. The rates of HIV/AIDS, tuberculosis, Hepatitis B, and other infectious diseases are growing among injection drug users, the homeless, prison populations, and others commonly involved with alcohol abuse or the use of illicit drugs. HIV disease and a variety of other illnesses that are related to substance abuse have affected this country's health care system enormously. In areas where there is the highest rate of injection drug use, the spread of infectious diseases is rampant. This is straining the ability of medical facilities and health care professionals to meet the needs of patients. Health care costs in this country have increased at twice the rate of inflation since 1981. Medical costs are being driven even higher by the incidence of substance abuse-related infectious diseases. Substance abuse is a chronic, progressive, relapsing disorder resulting in physical and psychological dependence on chemical substances. Much like other health disorders, it also can be treated successfully. Effective treatment of substance abuse disorders is essential for decreasing drug use and many of its accompanying problems. Alcohol and drug abuse treatment reduces chemical dependency and thus helps control both the spread and the associated costs of substance abuse-related diseases. Treatment also reduces criminal behavior and increases productive work and social functioning. Considering both the human and the financial burden of substance abuse, treatment for addictive disorders is very cost-effective. Dollars spent for alcohol and other drug treatment not only save lives but conserve financial resources. Outpatient treatment of substance abusers costs only 1/10 as much as incarceration. For each dollar spent for substance abuse treatment services, more than $11 are saved in social costs. For each person protected by AOD treatment from contracting AIDS, a potential of $75,000 in lifetime medical costs are saved. Providing effective treatment services poses extraordinary challenges. Achieving positive results from treatment efforts is not automatic. Major changes during the past decade in treatment for alcohol and other drug addiction have resulted in improvements in treatment procedures, management of patients, and funding mechanisms. However, growing caseloads and limited resources place a tremendous strain on treatment programs. The most constructive outcomes occur with coordination and collaboration among persons and systems with responsibility. Key decision makers from the state legislature, judiciary, and treatment field must communicate and work cooperatively, forging collaborative partnerships to achieve the most effective treatment system. Alcohol and drug abuse treatment professionals provide leadership and expertise for developing and delivering effective treatment programs. State legislative roles involve funding and policymaking, while State court personnel have a key role in referring individuals for treatment and monitoring their participation. All are essential elements in the quest to translate concern about the problems related to substance abuse into positive, concrete results. Readers will find resource information in this document about the problem and consequences of substance abuse, the importance and effectiveness of assessment procedures, and current treatment modalities, as well as issues related to productive treatment programming. To achieve optimal treatment programs, the role and value of collaboration among systems with responsibility for coordination also are stressed. State-level legislative, judicial, and treatment officials are encouraged to use the information provided in this text as a resource in coordinating and developing treatment strategies based on state-of-the art practices and identified needs within their States. Chapter 1–Who Needs Treatment: An Overview of Addiction and Its Treatment Almost everyone has had experience with addictive psycho active substances. Alcohol is a legal substance that is frequently used in social situations by people from all walks of life. Most people consume it occasionally and experience no adverse effects. Nevertheless, it can be addicting, and for those who reach this level of use, there are potential health and social consequences. In addition to alcohol, mood-altering drugs include a variety of illegal and legal substances that are highly addictive and often result in impaired physical, social, and psychological functioning of users. Joseph A. Califano, Jr. (1992), president of the Columbia University Center on Addictions and Substance Abuse and former Secretary of the U.S. Department of Health, Education, and Welfare, reported the following estimates of the numbers of persons abusing alcohol and other drugs in the United States: approximately 18 million persons abuse or are addicted to alcohol; up to 1 million individuals use heroin; at least 2 million are addicted to cocaine or crack; 5.5 million get high on marijuana more than once a week; and 11 million persons abuse tranquilizers and other psychotropic drugs. Because of the addictive properties of these substances, and the related physical, social, and psychological consequences they precipitate, treatment will be required for these individuals to recover from their addictions and achieve abstinence. Those who have not had personal experiences using either socially acceptable or illicit drugs still may have been touched by the effects of these substances. Use and abuse of alcohol and other drugs has far-reaching effects. Family members, friends, coworkers, and others often are affected–sometimes tragically–by those who become involved in substance abuse. In this chapter, the process of addiction–progressing from experimental and social use to dependency and addiction–will be examined. This process also includes recovery for many individuals who receive appropriate treatment interventions. Such recovery means a chance to return to productive roles in society that are not focused on procuring and using alcohol and other drugs at the expense of one's physical health and personal well-being. Recognized as a part of the disorder of addiction is its chronic and relapsing nature. Recovery from addictive illness necessitates sobriety and abstinence, relapse prevention programs, and continuing supportive intervention for those who become dependent on mood-altering chemicals. The majority of persons who use drugs or alcohol from time to time will not need treatment. Those who are not dependent or addicted may be able to decide to stop using chemicals. However, finding a social climate that is intolerant toward drug use will be important for them. The threat of social, legal, or employer sanctions often is significant enough to persuade them away from continued drug use (Office of National Drug Control Policy [ONDCP], 1990b). Treatment is for those who cannot or will not stop their use of alcohol or drugs without the help of a specific program–usually those
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