In April, the American Society of Addiction Medicine (ASAM) marked its 50th anniversary at the 35th Annual Medical-Scientific Conference in Washington, D.C. A congratulatory letter from President George W. Bush was read at the opening of the conference. "Addiction destroys the lives of countless Americans, shatters families and threatens the safety of our neighborhoods," Bush wrote. "Since 1954, your organization has been committed to educating our country's medical community about this issue and improving treatment for individuals suffering from addiction."
Lawrence Brown Jr., M.D., ASAM president, described support of preventive programs, addiction research and efforts to lobby for science-based public policy. Although Brown conceded that political and economic factors often hold sway in policy formulation and implementation, he encouraged ASAM to maintain a scientific base for political activism.
"It is incumbent upon us to appreciate and know the science," Brown said, "and at the same time, to be able to translate that into a manner that our public and our public servants can appreciate."
Several speakers offered perspectives on public policy toward addicts and addictions. Andrea Barthwell, M.D., past ASAM president and current deputy director for demand reduction in the White House Office of National Drug Control Policy (ONDCP), described how the ONDCP advises President Bush in policy formulation and responding to emergent issues.
Barthwell indicated there had been some concern that the Bush Administration would structure the ONDCP around interdiction. Instead, the office was charged with three priorities: "Stopping use before it starts, healing America's drug users and disrupting the market."
The ONDCP was not charged, Barthwell emphasized, to address a "treatment gap" in the United States by increasing availability of addiction treatment programs. While acknowledging that there are waiting lists for admission to licensed narcotic addiction treatment clinics, she argued, "the big problem in this country is waiting for people who have this problem to recognize that they have a problem and get into treatment."
Barthwell quoted John Walters, the ONDCP director, on the many drug users who don't consider themselves drug abusers in need of treatment: "4.6 million of the 6 million people who need treatment don't know it. Health care professionals are a critical tool in reducing the tragic 'denial gap.'"
While the Bush Administration has increased the level of funding for addiction treatment, Barthwell noted, it has not come with a mandate to increase treatment capacity, but to increase the numbers of addicts who achieve recovery. One initiative being undertaken with the Substance Abuse and Mental Health Services Administration (SAMHSA) should increase access to screening, brief interventions and referral to treatment.
She encouraged listeners to support this initiative. "We need people such as yourselves, who are more knowledgeable, to link more thoroughly to the drug treatment system, to help them improve the quality of what's going on across the country."
She also specifically asked for help in educating about the dangers of prescription drug abuse. "It will be a much better outcome if the medical community gets engaged to self-regulate, self-educate and take some responsibility for educating the public, rather than allowing the government to do that for you."
In another session, other speakers argued that the substantial treatment gap should be addressed by policies that affect public funding for treatment as well as private health insurers. Donald Kurth, M.D., chairperson of the ASAM Advocacy Committee and associate professor and chief of addictions medicine at Linda University in California, lamented the inadequacy of current public policies and of access to treatment.
"Our addiction treatment public policy is going backward," Kurth asserted. "Between 1990 and 2000, insurance benefits for addiction treatment decreased by 75%. Is this because the disease is going away? Is this because we've cured it?
"We know that we can treat this disease," Kurth added, "and yet, we can't seem to provide these benefits for the people who have the disease."
Paul Samuels, director of the Legal Action Center in New York, concurred. "There is a huge treatment gap. There are hundreds of thousands of people ... who want treatment for alcohol and drug problems and can't get it."
This gap between the number who suffer with addictive illness and those who receive treatment is unique, according to Samuels. "Can you imagine the hue and cry around the country if there were a quarter of a million people who had heart disease and could not get care?"
These addicts don't just disappear, Samuels stated, but present in the criminal justice system, emergency departments and homeless shelters. "The dysfunctions that are created and the human toll in death and misery are really inexcusable," he said.
He suggested that public policy has not adequately supported treatment systems because too few people know anyone in recovery. Furthermore, the face of the illness remains the addicted who are dysfunctional, disrupt society, commit crimes and appear unable to achieve recovery. He indicated his optimism, however, about current opportunities to affect public policy. These are occurring in part, Samuels said, because of the growing constituency of successfully recovering addicts and their families.
Samuels encouraged attendees to participate in the advocacy process, noting the effect that individual voices and correspondence can make. "Every elected official with whom I have ever come into contact ... keeps track of the letters they get," Samuels said.
He described a grass-roots advocacy campaign that successfully opposed an amendment in the welfare reform bill before the U.S. Congress in 1997. The amendment would have barred anyone convicted of a drug offense from ever receiving any federal benefits, ranging from Medicare to student loans. The campaign succeeded in limiting the amendment to felony drug convictions and involving only the welfare and food-stamp benefits designated in the original bill.
Samuels stated, "We were able to water it down ... and we got a provision that said that states can change the law ... and now over 30 states have modified the law to either eliminate the ban or to let people who go into treatment, or otherwise succeed, collect benefits."