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The public believes that the war on drugs has thus far failed but, paradoxically, should be continued in much the same way, according to one of two surveys released last month by the nation's top physician drug policy group.
The group, Physician Leadership on National Drug Policy (PLNDP), called a press conference in Washington, D.C., to air the survey results, which ran in the March 18 issue of the Journal of the American Medical Association ("The Public and the War on Illicit Drugs"), and to announce the results of its own meta-analysis of 600 peer-reviewed studies on drug treatment. The meta-analysis found that treatment is highly effective and much less costly than prison.
Despite the evidence from hundreds of studies showing that addiction treatment cuts crime, improves the addict's health, and is much less costly than prison, public sympathy for increased spending for drug treatment has declined from a high of 65 percent of those polled in 1990 to 53 percent in 1996, according to the JAMA survey. The public has yet to make the connection between greater treatment availability and reduced crime and substance abuse, observed PLNDP vice chair Lonnie Bristow, M.D., past president of the AMA.
Further, said Bristow, the public views drug abuse as primarily a moral issue, caused mainly by peer pressure, "poor parenting," and promotion of illicit drugs by drug sellers. The public does not see drug abuse as primarily a public health issue, he said.
Given this, it is not surprising that the public strongly supports harsher penalties for the possession and sale of drugs, Bristow observed. Despite the misconceptions of the public, it is possible for physicians and the media to shape public opinion positively over time, said Bristow.
"Archimedes, many centuries ago, said if you give me a lever long enough and a place to stand, I can move the earth. You [the media] are the lever, . . .and what we are trying to communicate to you. . .is that science believes it can contribute to the solutions that must be brought to bear upon this problem, but in order to do that public opinion must be better informed than it has been until now."
The PLNDP meta-analysis compared the annual cost of several types of treatment with the cost of one year of imprisonment. Even the most costly form of treatment, long-term residential, which costs an average of $6,800 per addict yearly, is modest compared with the $25,900 yearly cost of incarceration.
Richard Corlin, M.D., speaker of the AMA House of Delegates, spoke personally of the misconception that hard drug addiction is concentrated in poor, urban minorities, revealing that his son had been a cocaine addict.
"I know on a firsthand basis what it's like to live with someone, to discover the problems, to confront the issue," said Corlin. His son's treatment has been successful, he said.
"I am not the father of the person you would guess to be a cocaine addict if you watched the news shows, read the newspapers, or watched any one of the crime shows that are on television. If you were to ask people based on those reports who are cocaine addicts, they would say, 'They are all very big, very strong, very mean African-American men.' That's simply not the truth. The request that we have of [the media]. . .is let us get the story out that cocaine addiction, that drug addiction, is not someone else's problem. It is present in every community."
The reason that public support for treatment programs is falling is that "people think it is someone else's problem. It is not," Corlin concluded. The true demographics of addiction show that the vast majority of addicts are white, followed by Hispanics, with only a fraction being African American.
Herbert Kleber, M.D., a member of APA's Council on Addiction Psychiatry, presented APA's view of addiction-related disorders as "treatable diseases." Representatives of the American Society of Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP) also spoke at the forum.
Despite ample evidence that addiction treatment "is both effective and cost-effective, support for treatment is still subject to unreasonable restraints in such areas as health insurance coverage and benefit programs," said Kleber. In addition, social stigma continues to influence health professionals, who often fail to diagnose substance-abuse disorders in people who do not resemble the societal stereotype of the alcoholic or addict.
Kleber noted that the APA Council on Addiction Psychiatry, in conjunction with the National Institute on Drug Abuse, has organized a special, 30-session program on substance abuse and treatment for APA's annual meeting in Toronto (Psychiatric News, March 6).
While APA supports making treatment more available, it is not enough to simply have more treatment, said Kleber. Treatment must be "of the appropriate duration and quality," he added. APA has been "very distressed, for example, that the recent trend for treatment of substance abuse has been six outpatient [sessions] conducted by a counselor. We feel that kind of treatment will lead to cynicism on the part of the public and policymakers" and thus erode public support for treatment.
APA further believes that a "comprehensive psychiatric evaluation is often essential to guide the treatment of a patient with a substance abuse disorder," Kleber asserted. While APA recognizes that addiction treatment is a multidisciplinary field, "we also recognize that somewhere between 30 percent and 70 percent" of addicted persons have comorbid psychiatric disorders that often go undiagnosed. Many of these disorders are readily treatable, but left untreated they greatly increase the likelihood that patients will drop out of treatment or relapse, Kleber commented.
The PLNDP is a group of top medical leaders formed last year under the aegis of Brown University's Center for Alcohol and Addiction Studies in Providence, R.I. (Psychiatric News, August 15, 1997).
The group is chaired by June Osborn, M.D., former chair of the National Commission on AIDS and current president of the Josiah Macy Jr. Foundation in New York City. Members include APA's incoming president-elect, Allan Tasman, M.D., and psychiatrist Stephen Scheiber, M.D., executive vice president of the American Board of Psychiatry and Neurology Inc. -R.B.K.