Friday, November 2, 2012

Attack demand side of drug abuse

I'd like to take a few minutes of your time by describing how we can, and why we need to, fundamentally shift the paradigm relative to dealing with the problem of prescription and illegal drug abuse in Massachusetts.

Cape Cod has seen a surge of criminal activity in the past ten years that is almost universally tied to drug and alcohol abuse. Nearly every burglary is motivated by the "need" to purchase drugs and alcohol. Nearly every domestic violence situation is linked to drug and/or alcohol addiction. Nearly every act of violence on our streets is traceable to the sale or abuse of mind-altering substances.

Every major societal issue has a component of supply and demand, and I have a long-standing belief that problem solving should be focused on the demand side. The "war on drugs" has been largely an attack on the supply side of the problem. How well has that worked to eliminate drugs on the street? How well did prohibition of alcohol accomplish its goal of creating a nation of teetotalers?

In the arena of addictions, focusing on the demand side of the issue falls into the two broad categories of education and treatment. Teach people to steer away from substances that can trigger addictions. Treat people with addictions knowing that it is a chronic condition that requires lifetime followup, just as a diabetes patient requires lifetime monitoring and care.

We have two new treatment programs in Massachusetts that are showing positive results. By no means do I intend to convey that these are the only programs showing progress. They are, however, taking us in a new direction.

The first is a five-year federally funded pilot program called Mission Direct Vet. It is for military veterans who have mental health challenges, such as post traumatic stress disorder (PTSD), as well as a drug or alcohol addiction. Additionally, those in the pilot program have legal issues; that is, they are facing jail time for their crimes.

Participants receive probation with the stipulation that they remain in Mission Direct Vet. Each is paired with a counselor and a peer and receives intensive treatment for their mental health and addiction issues.

Preliminary results from Mission Direct Vet are good. Recidivism is significantly lower than for veterans who do not get this level of care. Counselors have also reported that a number of patients have chosen recovery over suicide. How can one put a price on that?

The other treatment program is one happening right here in Barnstable County. Based on a pilot program in New York City I learned about as a member of the Joint Committee on Mental Health and Substance Abuse, the county sheriff has adopted a model that combines counseling with an opiate blocking drug called Vivitrol.

Inmates who qualify are given the first dose of Vivitrol before leaving the Barnstable County Correctional Facility and are enrolled in counseling at Gosnold Cape Cod, where Dr. Robert Friedman operates a treatment program utilizing Vivitrol to aid patients with managing their cravings.

At Rikers Island, the longer standing program overseen by Dr. Joshua Lee of New York University has shown excellent results: reduced recidivism, people back to work, families back together.

People ask me what the expansion of these programs would cost. I cite a precedent in the state of Texas where emphasis on treatment since 2005 has resulted in the closure of a state prison, the lowest crime rate in 40 years, and the savings of billions of dollars.

This paradigm shift is not only possible, it pays for itself, and we are on the way to seeing it happen in Massachusetts.

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