Note: Societal costs include crime, violence and loss of
productivity, etc.
Source: Rydell,
C.P. & Everingham, S.S., Controlling Cocaine, Prepared for the
Office of National Drug Control Policy and the United States Army
(Santa Monica, CA: Drug Policy Research Center, RAND Corporation,
1994), p. xvii.
In 1996,
voters in Arizona passed an initiative which mandated drug treatment
instead of prison for non-violent drug offenders. At the end of the
first year of implementation, Arizona's Supreme Court issued a
report which found:
A) Arizona taxpayers saved $2.6 million in one year;
B) 77.5% of drug possession probationers tested negative for drug
use after the program;
The Court stated, "The Drug Medicalization, Prevention and
Control Act of 1996 has allowed the judicial branch to build an
effective probation model to treat and supervise substance abusing
offenders... resulting in safer communities and more substance
abusing probationers in recovery."
Source: State
of Arizona Supreme Court, Drug Treatment and Education Fund:
Implementation Full Year Report: Fiscal Year 1997-1998, 1999.
In
January 2001, the National Center on Addiction and Substance Abuse
at Columbia University published an analysis of costs to states from
tobacco, alcohol and other drug addiction. According to the report,
"States report spending $2.5 billion a year on treatment.
States did not distinguish whether the treatment was for alcohol,
illicit drug abuse or nicotine addiction. Of the $2.5 billion total,
$695 million is spent through the departments of health and $633
million through the state substance abuse agencies. We believe that
virtually all of these funds are spent on alcohol and illegal drug
treatment."
Source:
National Center on Addiction and Substance Abuse at Columbia
University, "Shoveling Up: The Impact of Substance Abuse on State
Budgets" (New York, NY: CASA, Jan. 2001), p. 24.
In
January 2001, the National Center on Addiction and Substance Abuse
at Columbia University published an analysis of costs to states from
tobacco, alcohol and other drug addiction. According to the report,
"The justice system spends $433 million on treatment: $149
million for state prison inmates; $103 million for those on
probation and parole; $133 million for juvenile offenders; $46
million to help localities treat offenders; $1 million on drug
courts. Treatment provided by mental health institutions for
co-morbid patients totals $241 million. The remaining $492 million
is for the substance abuse portion of state employee assistance
programs ($97 million), treatment programs for adults involved in
child welfare services ($4.5 million) and capital spending for the
construction of treatment facilities ($391 million). (Figure
4.B)"
Source:
National Center on Addiction and Substance Abuse at Columbia
University, "Shoveling Up: The Impact of Substance Abuse on State
Budgets (New York, NY: CASA, Jan. 2001), p. 24.
In 1992,
the U.S. government spent only 7% of its drug-control budget on
treatment, the remaining 93% of its budget went to ineffective
programs of source control, interdiction and law-enforcement.
Source: Rydell,
C.P. & Everingham, S.S., , Controlling Cocaine, Prepared for the
Office of National Drug Control Policy and the United States Army
(Santa Monica, CA: Drug Policy Research Center, RAND Corporation,
1994), p. 5.
"The
Panel anxiously awaits the time when the disease of addiction is no
longer treated as a criminal justice issue, but as a public health
problem. Moreover, the Panel embraces the notion of a society that
enables any individual with a substance abuse problem, regardless of
criminal history, to receive treatment in a safe and respectful
environment. The Panel hopes to create a climate in which people who
are at risk for, suffering from, or in recovery from alcohol or
other drug addiction are valued and treated with dignity."
Source:
US Dept. of Health and Human Services, Substance Abuse and Mental
Health Services Administration, "Changing the Conversation:
Improving Substance Abuse Treatment: The National Treatment Plan
Initiative; Panel Reports, Public Hearings, and Participant
Acknowledgements" (Washington, DC: SAMHSA, November 2000), p. 41.
"According
to the ONDCP's 1999 National Drug Control Strategy, there are
approximately 4 million chronic drug users in the United States.
This closely aligns with the 1998 National Household Survey on Drug
Abuse, which found that 4.1 million people were in need of drug
treatment. The NIAAA report, Improving the Delivery of Alcohol
Treatment and Prevention Services, estimates there are 14 million
alcohol abusers, whereas the 1998 National Household Survey on Drug
Abuse finds approximately 9.7 million people in need of alcohol
treatment. Regardless of the source, a conservative estimate of
those in need of substance abuse treatment is between 13 and 16
million people. In contrast, both the 1997 Institute of Medicine
(IOM) report, Managing Managed Care, and the 1998 National Household
Survey conclude that approximately 3 million people receive care for
alcohol or drugs in one year. Although, as previously stated,
neither the estimates of need nor the estimates of those in
treatment are all inclusive, the picture remains the same - more
than 10 million people who need treatment each year are not
receiving it."
Source:
US Dept. of Health and Human Services, Substance Abuse and Mental
Health Services Administration, "Changing the Conversation:
Improving Substance Abuse Treatment: The National Treatment Plan
Initiative; Panel Reports, Public Hearings, and Participant
Acknowledgements" (Washington, DC: SAMHSA, November 2000), p. 6.
The
National Treatment Improvement Evaluation Study (NTIES) found that
with treatment: drug selling decreased by 78%, shoplifting declined
by almost 82%, and assaults (defined as 'beating someone up')
declined by 78%. Furthermore, there was a 64% decrease in arrests
for any crime, and the percentage of people who largely supported
themselves through illegal activity dropped by nearly half -
decreasing more than 48 percent.
Source: Center
for Substance Abuse and Treatment, National Treatment Improvement
Evaluation Study 1997 Highlights, from the web at http://www.health.org/nties97/crime.htm.
The 1997
National Treatment Improvement Evaluation Study (NTIES) stated,
"Treatment appears to be cost effective, particularly when
compared to incarceration, which is often the alternative. Treatment
costs ranged from a low of $1,800 per client to a high of
approximately $6,800 per client." To contrast, the average cost
of incarceration in 1993 (the most recent year available) was
$23,406 per inmate per year.
Source: Center
for Substance Abuse and Treatment, National Treatment Improvement
Evaluation Study 1997 Highlights, from the web at http://www.health.org/nties97/costs.htm;
Bureau of Justice Statistics, Sourcebook of Criminal Justice
Statistics 1996 (Washington DC: US Department of Justice, 1997), p. 4,
502. (Average cost is based on an adult jail and prison population of
1,364,881, and total corrections expenditures of $31,946,667,000 for
1993.)
A recent
study by researchers at Substance Abuse Mental Health Services
Administration has indicated that 48% of the need for drug
treatment, not including alcohol abuse, is unmet in the United
States.
Source: Woodward,
A., Epstein, J., Gfroerer, J., Melnick, D., Thoreson, R., and Wilson,
D., "The Drug Abuse Treatment Gap: Recent Estimates," Health
Care Financing Review, 18: 5-17 (1997).
Treatment
decreased welfare use by 10.7% and increased employment by 18.7%
after one year, according to the 1996 National Treatment Improvement
Evaluation Study.
Source: Center
for Substance Abuse and Treatment, National Treatment Improvement
Evaluation Study (Washington DC: US Government Printing Office, 1996),
p. 11.
A
recently concluded study of heroin maintenance in Switzerland for
the World Health Organization concluded:
-
The
health of participants improved.
-
Illicit
cocaine and heroin use declined greatly.
-
Housing
situation improved and stabilized- most importantly there were
no longer any more homeless participants.
-
Fitness
for work improved considerably, those with permanent employment
more than doubled from 14% to 32%.
-
The
number of unemployed fell by half (from 44% to 20%)
-
A
third of the patients that were on welfare, left the welfare
rolls. But, others went on to welfare to compensate for their
lost income from sales of drugs.
-
Income
from illegal and semi-legal activities decreased significantly,
from 69% of participants to 10%.
-
The
number of offenders and offenses decreased by about 60% during
the first 6 months of treatment.
-
The
retention rate was average for treatment programs. 89% over 6
months, and 69% over 18 months.
-
More
than half of the dropouts did so to switch to another form of
treatment. 83 of the participants did so to switch to an
abstinence-based treatment, and it is expected that this number
will grow as the duration of individual treatment increases.
-
There
were no overdoses from drugs prescribed by the program.
Source: Robert
Ali, et al, Report of the External Panel on the Evaluation of the
Swiss Scientific Studies of Medically Prescribed Narcotics to Drug
Addicts (New York, NY: The World Health Organization, April 1999).
According
to CASA (National Center on Addiction and Substance Abuse), the cost
of proven treatment for inmates, accompanied by education, job
training and health care, would average about $6,500 per inmate. For
each inmate that becomes a law-abiding, tax-paying citizen, the
economic benefit is $68,800. Even if only one in 10 inmates became a
law-abiding citizen after this investment, there would still be a
net social gain of $3,800.
Source: National
Center on Addiction and Substance Abuse at Columbia University, Behind
Bars: Substance Abuse and America's Prison Population, (New York, NY:
National Center on Addiction and Substance Abuse at Columbia
University, January 8, 1998), Foreword by Joseph Califano.
Treatment
availability for drug and alcohol addicted prison inmates has
declined over the last decade:
Among those prisoners who had been using drugs in the month before
their offense, 15% of both State and Federal inmates said they had
received drug abuse treatment during their current prison term, down
from a third of such offenders in 1991.
Among those who were using drugs at the time of offense, about 18%
of both State and Federal prisoners reported participation in drug
treatment since admission, compared to about 40% in 1991.
Source: Bureau
of Justice Statistics, Substance Abuse and Treatment, State and
Federal Prisoners, 1997 (Bureau of Justice Statistics, Washington, DC:
US Department of Justice, January 1999), p. 10.
"Despite
the many factors that contribute to the gap, the Panel agrees with
many in the field that inadequate funding for substance abuse
treatment is a major part of the problem. Over the last decade,
spending on substance abuse prevention and treatment has increased,
albeit more slowly than overall health spending, to an estimated
annual total of $12.6 billion in 1996 (McKusick, Mark, King,
Harwood, Buck, Dilonardo, and Genuardi, 1998). Of this amount,
public spending is estimated at $7.6 billion (McKusick, et al.,
1998). The public spending includes dollars from Medicaid and
Medicare, as well as other Federal funds from the Department of
Defense, the Department of Veterans Administration, the Department
of Justice, and the Substance Abuse Prevention and Treatment (SAPT)
Block Grant. The SAPT Block Grant provides Federal support to
addiction prevention and treatment services nationally through State
and local governments. Private spending includes individual
out-of-pocket payment, insurance, and other nonpublic sources, and
is estimated at $4.7 billion (McKusick, et al., 1998)."
Source:
US Dept. of Health and Human Services, Substance Abuse and Mental
Health Services Administration, "Changing the Conversation:
Improving Substance Abuse Treatment: The National Treatment Plan
Initiative; Panel Reports, Public Hearings, and Participant
Acknowledgements" (Washington, DC: SAMHSA, November 2000), p. 12.
"One
of the main reasons for the higher outlay in public spending is the
frequently limited coverage of substance abuse treatment by private
insurers. Although 70 percent of drug users are employed and most
have private health insurance, 20 percent of public treatment funds
were spent on people with private health insurance in 1993, due to
limitations on their policy (ONDCP, 1996b). In the view of the
Panel, private insurers should serve as the primary source of
coverage, with public insurance serving as the safety net."
Source:
US Dept. of Health and Human Services, Substance Abuse and Mental
Health Services Administration, "Changing the Conversation:
Improving Substance Abuse Treatment: The National Treatment Plan
Initiative; Panel Reports, Public Hearings, and Participant
Acknowledgements" (Washington, DC: SAMHSA, November 2000), p. 12.
"'Changing
The Conversation' initiated the first intensive exploration of the
stigmas and attitudes that affect people with alcohol and drug
problems. The Panel addressed stigma as a powerful, shame-based mark
of disgrace and reproach that impedes treatment and recovery.
Prejudicial attitudes and beliefs generate and perpetuate stigma;
therefore, people suffering from alcohol and/or drug problems and
those in recovery are often ostracized, discriminated against, and
deprived of basic human rights. Their families, treatment providers,
and even researchers may face comparable stigmas and attitudes.
Ironically, stigmatized individuals often endorse the attitudes and
practices that stigmatize them. They may internalize this thinking
and behavior, which consequently becomes part of their identity and
sense of self-worth.
"Public support and public policy are influenced by addiction
stigma. Addiction stigma delays acknowledging the disease and
inhibits prevention, care, treatment, and research. It diminishes
the life opportunities of the stigmatized."
Source:
US Dept. of Health and Human Services, Substance Abuse and Mental
Health Services Administration, "Changing the Conversation:
Improving Substance Abuse Treatment: The National Treatment Plan
Initiative; Panel Reports, Public Hearings, and Participant
Acknowledgements" (Washington, DC: SAMHSA, November 2000), p.
38-39.