Plan Assailed as Not Aiding All Who Want Treatment

With as many as 6 million Americans needing treatment for drug addiction and room for only a small fraction of them in the treatment system, experts Tuesday called the Bush Administration’s plan to hike drug-treatment funding a welcome--but inadequate--step.

Some insisted that there should be a doubling or tripling of the current budget. Others criticized the absence of a promise of “treatment on demand.” And many called for a new acceptance of the chronic nature of addiction--a disease that some say can never be cured.

“We are not going to create ‘a drug-free America’ in my lifetime,” said David Mactas, who runs a chain of treatment programs in New England. “It’s not realistic . . . . It’s another (item) in the litany of what the federal government advertises and doesn’t deliver.”

The Administration’s proposal would hike by about 50% the estimated $604 million in federal money distributed annually to drug treatment programs--a network of more than 5,000 residential and outpatient programs nationwide that receive at least some public money.

Those programs, in addition to a smaller but growing number of private programs, treat hundreds of thousands of addicts annually. Rough estimates suggest that there are perhaps 300,000 to 400,000 patient slots in the system at any given time.

At the same time, federal officials have estimated that there are 2 million to 6 million Americans in need of drug addiction treatment. As a result, addicts wanting to enter residential programs in large- and middle-size cities face waits of as much as six months.

For example, in Oregon, a state with a relatively small drug problem, treatment programs turned away more than 3,000 addicts between July and December, 1988, state officials said, with 1,200 adolescents turned away during a 15-month period in 1987 and 1988.

“There is no commitment (in the Administration’s plan) to . . . provide treatment on request to every addict that wants it,” said Dr. Robert Newman, president of Beth Israel Medical Center in New York City. “I think that’s a terrible shortcoming.”

Steady Increases Urged

“We need steady, long-term, incremental increases in treatment and prevention in order to get to the point . . . where people who want to get into treatment . . . are not forced to wait,” said Karst J. Besteman, executive director of the Alcohol and Drug Problems Assn.

The federal share of drug treatment funding has declined since the early 1970s, experts said. Meanwhile, the number of drug users needing treatment has skyrocketed. The advent of crack cocaine and the danger of spreading the AIDS virus through needles have compounded the problem.

Many programs have responded by stretching themselves thin, according to program directors. Instead of one counselor for every 20 clients, some programs have just one for every 50. As a result, the quality of treatment has suffered, many experts said.

Need for Assistance Cited

Increased funding would be only a start, Besteman and others said Tuesday. They said that:

--Treatment programs cannot solve the problem alone. Assistance is needed from schools, vocational services and local communities. Without such support, recovering addicts will simply return to the lives that led them initially into addiction.

--Neighborhoods must accept new treatment facilities, because new programs will reduce drug use in their areas. Neighborhood opposition has prevented New York City from opening a single new methadone maintenance program for the last 15 years, officials said.

--More research is needed in drug-addiction treatment, a field that barely existed two decades ago. The fact that many treated addicts relapse into addiction suggests that new approaches should be explored.

--The public must appreciate better the nature of addiction and not expect a simple cure. Experts compared drug addiction to diabetes and heart disease--chronic health problems that may entail monitoring, relapses and continuing treatment over an entire lifetime.

Mactas, in particular, faulted the rhetoric of yet another “war on drugs.”

Language Misses Nuances

“It is the language of the military engagement . . . as if this is a war that can be won,” he said. “It is a language of ‘kingpins’ and ‘drug busts’ and ‘civil forfeiture.’ It’s the language of the absolute, with no understanding of the nuance.”

“You can’t just do something once and expect someone is cured for life,” said William Butynski, executive director of the National Assn. of State Alcohol and Drug Abuse Directors. “For most people, there are going to be ongoing problems.”

How effective is drug treatment?

Experts say that results vary widely, depending on the program and who is being treated. People with intact families, jobs, education and skills are far more likely to benefit than addicts who have lost their social supports--or had little or none before becoming addicted.

33% Remain Drug-Free

About one-third of all program graduates nationwide remain drug-free after two years, according to Jeff Kushner, director of Oregon’s Office of Alcohol and Drug Abuse Programs. Another third has significantly reduced its use of drugs and the other third has reverted to old patterns of drug use, he estimated.

“If you ask me to treat 20 doctors, lawyers and editors who have insurance, are referred by their employers, have been threatened with job loss and have professional and social skills behind them, they’re relatively easy to treat,” Besteman said.

“You give me a 13-year-old who’s functionally illiterate, who dropped out of school, has no family, has been hustling on the street . . . and there’s no social, emotional and personal strength to build on, the long-run outcome is quite a bit more dismal.”

Federal funding represents less than one-quarter of the total amount of money that pays for treatment, according to Butynski. States cover nearly half the costs, counties and local governments cover 10% and other sources, like private insurance, pay for 20%.

More Funds in 1970s

There was a time, in the early 1970s, when the federal share was much larger. According to Besteman, a deputy director of the National Institute on Drug Abuse at the time, large infusions of funds helped significantly reduce heroin addiction then.

Mactas, whose Marathon Inc. runs 10 facilities in four states, estimates that federal funding, adjusted for inflation, has dropped as much as 60% since 1973--leaving Mactas’ programs severely strapped in states with little or no state funding.

“In New Hampshire, my organization is paid $21 a day for a 24-hour program,” Mactas said in a telephone interview Tuesday. “You can’t get a cheap hotel room for $21.”

HIGHLIGHTS OF THE BUSH PLAN THE DRUG-PRODUCING NATIONS

Proposes convening an “Andean Drug Summit,” involving government leaders in Peru, Bolivia and Colombia, to plan an attack on drug suppliers. Increases funds for crop eradication and other international efforts from $250 million in fiscal 1989 to $449 million in fiscal 1990.

INTERDICTION AT THE BORDERS

Keeps current level of funding for anti-smuggling programs, emphasizing bringing on line new hardware and expanding use of sniffer dogs, anti-vehicle barriers and container inspections.

ON THE STREETS

Vastly expands grants to state and local governments to hire more police and combat trafficking in crime-infested neighborhoods. Boosts federal prison budget from $631 million to $1.48 billion, allowing for 85% increase in prison beds.

EDUCATION AND TREATMENT

Provides an additional $574 million in funds, offering more treatment for pregnant women and “cocaine babies,” demonstration projects for new approaches, and alternative schools for youths with drug problems. Federally funded treatment programs would be required to show that their methods were effective.

A thousand pounds of cocaine, seized recently, had a value of $92 million.

Source: White House