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