A New Strategy To Help Addicts
Whether it’s oxycodone or Vicodin, heroin or fentanyl, too many Americans are taking drugs they don't need and that are harmful not only to themselves but also to friends and families who watch their loved ones descend into the crisis of addiction.
Drug use has always been around, but for the last 20 years, it has taken a turbulent turn from a sea of good intention. In the 1990s, patient advocates began promoting powerful narcotics as solutions to treat everything from nasty toothaches to minor injuries, perhaps as a means to curb the cost-curve of health care.
Doctors began over-prescribing long-acting, high-dose narcotics, egged on by aggressive marketing of drug manufacturers. Prevalence made for easy access by "recreational" users.
The outcome: heroin-related overdose deaths have tripled since 2010; 2 million people in America are listed as dependent on or abusive of opioids.
What's more: A large number of users — anywhere between 40 to 60 percent — enter rehab for opiate abuse but drop out very quickly and relapse.
The good news is that despite the widespread uptick in addiction and poor track record of recovery, a number of new resources are available to combat this epidemic.
Sally Satel, an addiction psychiatrist and a lecturer at the Yale University School of Medicine, writes that new programs are offering interesting approaches to ending addiction.
While the situation is extremely serious, there is hope: a developing synergy of tools ranging from new anti-addiction medications to newly developed treatment methods (including those conducted within the criminal-justice system, e.g., in drug courts) to a new openness to involuntary civil commitment in the most serious cases. Call it all a necessary benign paternalism or a carrot-and-stick approach to addressing America’s opioid crisis.
How do these approaches work? For one, by leveraging opportunities to get individuals to stay in treatment — the lynchpin for recovery.
The less time patients have spent in treatment, the less exposure they have had to vital recovery strategies, such as identifying the specific circumstances in which they are most vulnerable to craving and devising strategies for subduing the urge to use. Leverage to keep patients in treatment is therefore necessary.
What types of leverage work? Some promising treatment and rehabilitation models include drug courts.
There are roughly 3,000 such courts, which typically offer offenders dismissal of charges for completion of a twelve- to 18-month treatment program. Critically, the courts impose swift, certain, and fair consequences when participants fail drug tests or commit other infractions, such as missing meetings with probation officers or skipping work-training classes. The sanctions can escalate, depending on the number of infractions committed, ranging from warnings from the judge to community service to more-intensive probation supervision to flash incarceration (temporary stays in jail of one to ten days).
These courts are more effective than conventional corrections options, such as mandatory jail time or traditional probation. According to the National Association of Drug Court Professionals, offenders whose cases are handled by drug courts are one-half to one-third less likely to return to crime or drug use than those who are monitored under typical probationary conditions. On average, nearly two-thirds of drug-court participants graduate drug-free at 18 months.
Another incentive model: payment for staying clean.
A research team from Johns Hopkins offered addicts $10 an hour to work in a 'therapeutic workplace' if they submitted clean urine. If the sample was positive or if the person refused to give a sample, he or she could not attend work or collect pay for the day. Workplace participants provided significantly more opiate-negative urine samples than controls did, worked more days, and reported higher employment income and less money spent on drugs.
These programs offer a new dynamic over the traditional drug war approach. Rather than incarceration as a tool to combat addiction, cultural attitudes are shifting toward focusing on treatment over punishment. But they do require a different type of commanding authority.
"It will work only if we are clear-eyed about the nature of addiction and the demands of recovery," Satel writes, "— an appreciation that inevitably leads us to the virtues of benign paternalism."
What do you think of Satel’s ideas? Do they have merit? Let us know your thoughts!