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does treatment work?: A short backgrounder on  the history of drug treatment in the U.S. and a rundown of recent authoritative studies which support its effectiveness.

 

Richard Nixon--the first U.S. President to declare an "all-out war on drugs"-- was also the first, and only, president to recognize the value of treatment as a sound investment of public funds. In June 1971, Nixon requested an extra $155 million to fight the drug war--$105 million of that amount was targeted for the treatment and rehabilitation of addicts. Under the Nixon Administration, Dr. Jerome Jaffe headed up the newly-established Special Action Office for Drug Abuse Prevention (SAODAP). Faced with rehabilitating thousands of Vietnam vets returning home addicted to heroin, Jaffe encouraged setting up nationwide treatment programs. But Nixon's program for treating heroin addicts was dismantled by Ronald Reagan. Nancy Reagan preached the message of "Just Say No" as her husband cut into the federal budget for drug treatment. (see chart on budget percentages going towards treatment and prevention). Law enforcement became the priority, and the few treatment centers that did survive fiscal cuts were overwhelmed by the onset of the crack epidemic.

Recently, treatment has once again come under serious consideration. In the face of the continuing drug problem, extensive research studies have been done into the efficacy of rehabilitation versus incarceration. Measuring the effectiveness of treatment is controversial: it can be calculated both in terms of financial gains for society as well as the user's rehabilitation. Despite variations in research methodologies, all recent studies have shown that treatment is effective.

the studies

Controlling Cocaine: Supply Versus Demand Programs

by C. Peter Rydell and Susan S. Everingham
RAND Corporation, 1994

The 1994 RAND study on controlling cocaine provides a powerful argument for increasing U.S. drug treatment programs.It is often cited in the debate on the effectiveness of the "drug war." This study depicts both past and future trends in cocaine consumption. It also provides the first systematic method of comparing the cost effectiveness of cocaine control programs. The RAND study is a "modeling study": it analyzes the data of other organizations. The study revolves around the central question of how the government can effectively allocate the drug budget. It presents a model that estimates the relative cost-effectiveness of four cocaine-control programs: "source control," "interdiction," "domestic law enforcement," and "treatment."

Three of these approaches are clearly "supply control" programs aimed at stopping the influx of drugs into the country, and commonly associated with law enforcement. The "source-control" program refers to the strategy of attacking the drug supply from abroad (primarily Peru, Bolivia, and Colombia). The "interdiction" approach is aimed at stopping drugs at the U.S. border. The "domestic law enforcement" approach is geared towards the arrest and imprisonment of drug buyers and sellers within the United States. These law enforcement approaches were analyzed and compared to the treatment approach, and the question is asked: "How much would the government have to spend on each approach to decrease cocaine consumption in the U.S. by 1%?" The results show that treatment is overwhelmingly the most cost-effective way of reducing cocaine consumption and its resulting social costs. In brief, the RAND study shows that treatment is 7 times more cost effective than domestic law enforcement method, 10 times more effective than interdiction, and 23 times more effective than the "source control" method.

The RAND report is not available online. To order "Controlling Cocaine: Supply Versus Demand Programs" by C. Peter Rydell and Susan S. Everingham, contact:

RAND
1700 Main Street
P.O. Box 2138
Santa Monica, CA, 90407-2138
Phone: (310) 451-6988

The Drug Abuse Treatment Outcome Studies (DATOS)
The National Institute for Drug Abuse initiated the Drug Abuse Treatment Outcome Studies (DATOS) in 1990. The goal of DATOS is to evaluate the effectiveness of various forms of treatment and identify emerging treatment issues in the United States. The studies on their site are extensive, and focus on shifting public concerns and expectations for treatment. They include advances in research on addiction, and changes in the funding and organization of treatment programs.
The National Treatment Improvement Evaluation Summary (NTIES)

This five-year study assesses the impact of treatment on 5,388 clients in publicly funded substance abuse programs across the United States. It was funded by the U.S. Department of Health & Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). The study found that treatment led to significantly reduced substance use; lasting benefits a full year after treatment; increased employment and income; improved mental and physical health; decreased criminal activity; decreased homeless rates; and decreased at-risk behaviors for HIV/AIDS infections.

The Office of Drug Control Policy on Treatment Outcomes and Evaluations

This site provides a list of federally sponsored treatment studies, most of which conclude that treatment is, in fact, effective. While the resources on this site overlap somewhat with the NIDA and NTIES sites, it contains several reports that are not listed elsewhere.

The General Accounting Office Report Drug Abuse:  Studies Show Treatment is Effective but Benefits May Be Overstated

This 1998 General Accounting Office report resulted from the review and synthesis of the largest and most comprehensive studies of drug treatment effectiveness. While the report did not extensively analyze the methodologies of these studies, it did find that general trend towards reliance on self-reported data may overstate treatment effectiveness. It found objective tests, such as urinalysis, to be more consistent in identifying continued drug use.

California Drug and Alcohol Treatment Assessment (CALDATA)

This watershed study came out of California in 1994. It showed that drug treatment should be viewed as a public investment rather than cost, and that for every dollar that goes into treatment, the public saves $7 in health care and crime costs. The CALDATA study determined that drug abuse costs the state of California $3.1 billion each year, 70% of which is due to costs associated with crime. A total of $1.3 billion is spent on crime victim's medical costs, property damage and lost work time, and $442 million is spent on medical care for drug abusers.

NIDA Guide to Measurement of Treatment Effectiveness:
"Measuring and Improving Costs, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs."

This manual, sponsored by NIDA, is a tool kit designed to assist treatment programs in determining their own cost-effectiveness and benefit. It contains strategies for collecting data and shows how to use the findings to improve your program.


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