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Treatment Is More Effective, Less Expensive Than Jail For Drug Offenders, Says Doctors Group


March-April 1998

Drug and alcohol abuse are medical problems that respond to treatment just as well as diabetes and other chronic diseases do, and treatment is less expensive and more effective than incarcerating addicts, according to the public health group, Physician Leadership on National Drug Policy (PLNDP) (Steve Sternberg, "Doctors Want Addicts Cured, Not Jailed," USA Today, March 18, 1998; Associated Press, "Health experts: Treat, don't jail, drug abusers," Dallas Morning News, March 18, 1998; Raja Mishra, "Doctors challenge drug policy," Denver Post, March 18, 1998, p. A1; David Lewis, M.D., "Treatment works -- the truth please," Brown University Digest of Addiction Theory and Application, April 1998, p. 8).

"Stigma is a barrier to those who would otherwise seek treatment, to doctors who would otherwise do more in treating addiction, and to legislators and public health officials who would otherwise do more to make treatment available."

-- David C. Lewis, M.D.
Editor, Brown Univ. Digest of Addiction Theory & Application

On March 17, PLNDP held a forum and press conference in Washington, DC to present its research review on addiction treatment, including its cost effectiveness and comparisons with other chronic illnesses. The group's research is based on an analysis of more than 600 studies. PLNDP is a nonpartisan group of 37 prominent physicians and public health experts, including top health administrators from the Clinton, Bush and Reagan administrations.

The Federal government spends only 20% of its $17 billion drug-control budget on drug and alcohol treatment. A majority of the public believes that jailing addicts is best, according to a Harvard study published in JAMA unveiled by PLNDP. "We've been telling people to `just say no' when addiction is a biological event," said Dr. June Osborn, former chair of the National Commission on AIDS, who chairs PLNDP.

Although many of the 14 million alcoholics and 6.7 million drug addicts in the U.S. relapse after initial drug treatment, the scientists concluded that treatment is the most cost effective way of addressing the problem. According to PLNDP researchers, incarcerating a drug addict costs $25,900 annually. According to Dr. Donald Shepard of Brandeis University, a year of traditional outpatient drug treatment costs $1,800, intensive outpatient care costs $2,500, methadone treatment for heroin users costs $3,900 and residential drug-treatment program costs range from $4,400 to $6,800 a year. Every dollar invested in drug treatment can save $7 in societal and medical costs, said former Assistant Health Secretary Philip Lee. Addiction treatment consistently ranks in the top 10% in cost effectiveness of more than 500 health- and life-saving measures, said David C. Lewis, M.D., editor of the Brown University Digest of Addiction Theory and Application.

Drug treatment can cut crime by 80%, said Brown University addiction director Norman Hoffman. Brown researcher Craig Love studied female substance abusers who were in jail, and found that 25% who underwent treatment were later rearrested, compared to 62% of those released without substance abuse treatment who were rearrested.

Long-term drug treatment is as effective as long-term treatment for chronic diseases, such as asthma, diabetes and hypertension, said Dr. Thomas McLellan of the University of Pennsylvania. One-year reoccurrence rates for such diseases and for addicts consistently are about 50%, he said. Compliance with addiction therapy is similar to compliance with treatment regimes for other chronic illnesses. Fewer than half of diabetics consistently comply with their therapy over a year, as do fewer than 30% of asthma and hypertension patients compared to fewer than 40% of alcohol or drug abusers. "The likelihood of requiring additional treatment within a 12-month period is generally higher for diabetes, hypertension, and asthma than for drug addiction," said Dr. Lewis.

Drug treatment helps society's health, McLellan said. For example , heroin users are at increased risk of contracting and transmitting HIV or hepatitis. About 90-95% of the costs of treating addicted persons is attributable not to treating addiction but to treating medical problems triggered by the addiction, according to Dr. Lewis.

However, PLNDP said there is a severe shortage of drug-treatment programs -- only about 15% of people who need treatment receive it. In seven states there are no methadone clinics for heroin addicts, and every U.S. methadone clinic has a waiting list. Only 5% to 20% of pregnant drug abusers can get drug treatment because of too few programs, patients' inability to pay, or too few inpatient programs that will accept the woman's other children, said Dr. Jeffrey Merrill, a researcher at the University of Pennsylvania.

The findings conflict with public opinion about approaches to the drug problem. An analysis of surveys published on March 18 in the Journal of the American Medical Association (JAMA) finds support for increased spending on drug treatment has dropped from 65% in 1990 to 53% in 1996. In contrast, 84% of Americans say the solution to drug addiction is tougher criminal penalties. Other popular approaches to drug addiction on the list are anti-drug education, more police, and mandatory drug testing. "There must be a bridge between what the public believes and the science," added PLNDP member Lonnie Bristow, M.D., immediate past president of the American Medical Association.

The JAMA survey found that Americans believe drug abusers are predominantly poor, uneducated and minorities. In fact, the majority are white, from well-educated families and initially employed. Dispelling those myths is vital to obtaining public commitment for drug treatment, said Richard Corlin, MD, a Los Angeles medical professor whose son was once a cocaine addict. "People think it is someone else's problem. It is not," said Corlin.

Dr. Lewis agrees that the stereotypes about drug addicts are not true, and are often part of the problem. "Stigma is a barrier to those who would otherwise seek treatment, to doctors who would otherwise do more in treating addiction, and to legislators and public health officials who would otherwise do more to make treatment available," said Dr. Lewis.

Physician Leadership on National Drug Policy - Brown University, Center for Alcohol and Addiction Studies, Box G-BH, Providence, RI 02912, Tel: (401) 444-1816, Fax: (401) 444-1850, E-mail: <>, Web: <>.

Brown University Digest of Addiction Theory and Application - Manisses Communications Group, Inc. 208 Governor Street, Providence, RI 02906, Tel: (401) 831-6020 or (800) 333-7771.