These
are samplings of headlines from more than 100 stories related
to the drug economy in August 2008 editions of my local newspaper,
“The Washington Post”. Because I have worked in mental health
and addictions, or ATOD (alcohol, tobacco and other drug abuse
prevention and treatment) for many of the last 20 years, my eye is drawn to those
stories that either support the continued need for my work, or
stand as testament to its shortcomings.
September
is National Alcohol and Other Drug Recovery Month, and by mid-August
I had received no fewer than 10 mailings encouraging me to participate
in or organize celebrations marking the month. Yet, in what has
famously been labeled “the silly season” of national politics,
during which the Presidential candidates of the two major political
parties and their running mates push for and get the nod from
their fellow party-goers to pursue leadership of the USA, celebration
seems to be an overstatement of what’s called for, as serious consideration of a balanced
and comprehensive national approach to ATOD policy appears likely
to go underground, relegated, once again, to item #499 on the
list of 500 issues to be addressed at the Executive level.
According
to “ontheissues.org”, John McCain’s last statement or action regarding
ATOD issues or policy was 18 months ago, when he expressed his
appreciation of Mexican President Felipe Calderon for extraditing
drug dealers to the USA. McCain’s camp probably has figured out
that there is not enough consistent interest in ATOD policy in
the corridors of power to make it worth the effort to say anything,
though McCain’s experience as the husband of a woman in recovery
would seem to provide him with food for some thought on this issue.
Sarah Palin’s one statement on ATOD issues in the past year was
in recognition of a reduction in Alaska highway fatalities, which
she attributed to strict enforcement of laws regulating reckless
driving, drunk driving and seatbelt use.
Nine
statements or actions regarding ATOD issues or policy were recorded
by Barack Obama between August 2007 and August 2008 addressing
the demand side of the ATOD equation. In keeping with the tell-all
atmosphere of politics and celebrity today, three statements concerned
his own tobacco use and youthful experimentation with drugs. In
six other statements, he proposed the expansion of drug treatment
courts; treatment, including mental health counseling and job
training, for offenders with histories of substance abuse; elimination
of sentencing disparities for crack and powder cocaine; consideration
of needle exchange to reduce injection drug user transmission
of HIV/AIDS; maintenance of the age limit for alcohol use at 21;
and, he co-sponsored a bill to strengthen the Combat Methamphetamine
Epidemic Act of 2005. From his days as a community organizer,
Obama may harbor some memories of the power of alcohol and drug
use to disrupt the work of community participants in otherwise
successful organizing efforts.
Joe
Biden used the September 2007 Democratic Primary debate at Dartmouth
College to take a strong stand against lowering the drinking age
from 21 to 18, and to suggest the possible utility of laws to
limit smoking in public places and limits on alcohol consumption
as tools to address rising health care costs. At that time, his
campaign website cited his work to increase penalties for dealing
drugs near schools, his work to classify steroids as potential
drugs of abuse, his work to create the Drug Czar role, and his
work to establish drug courts. During the summer of 2007, he linked
drug use and commission of violent crime, addressed his support
for drug courts and offender diversion, and referenced sentencing
disparities, which he sought to eliminate through sponsorship
of legislation. His role in the establishment of a Drug Czar suggests
some attention to the supply side of the ATOD equation.
Now,
if we pretend for a moment that there really are more than two
candidates who actually will achieve serious consideration for
the Presidency of the USA, we see increased discussion of supply
side issues, in a statement from Ralph Nader
asserting that the War on Drugs has failed, a position by Cynthia
McKinney against military border patrols to battle drugs, and
calls from Brian Moore to cut off U.S. military aid to Colombia
and de-fund the War on Drugs. Nader also asserted that drug use
is “a health problem with social and economic consequences”. McKinney
indicated that she is against prohibitions on needle exchange
and medical marijuana. Bob Barr, for his part, also expressed
support for the legalization of marijuana for medical purposes. In the summer of 2007, Barr took
a stand against FDA regulation of tobacco products.
So,
in actuality, we can celebrate the fact that ATOD issues received
at least a mention by several candidates for the presidency. And, until she withdrew from her candidacy, Hillary
Clinton’s two tentative statements, one supporting diversion of
non-violent offenders, and one supporting non-retroactive reduction
of sentencing disparities, would have merited inclusion on the
list of proposed demand side initiatives.
Looking
beyond the Presidential campaign, there actually is much to celebrate
during National Alcohol and Other Drug Recovery Month. Since the
mid-1970’s, there has been totally amazing research on addiction
at the federal level, research which is now bearing fruit. Sponsored
in large part by the National Institute on Drug Abuse (NIDA) and
National Institute on Alcoholism and Alcohol Abuse (NIAAA), significant
research has focused on neural pathways and reward systems in
the human brain, and the causes, course, effects, prevention and
treatment of addiction.
The
field application of this research has been supported through
the yeoman efforts (big agenda, small dollars) of the Centers
on Substance Abuse Prevention (CSAP) and Substance Abuse Treatment
(CSAT), each of which has conducted or funded additional research
on prevention or treatment program implementation under the aegis
of the Substance Abuse and Mental Health Services Administration
(SAMHSA) within the Department of Health and Human Services. SAMHSA,
in a move definitely worth celebrating, in recent years submitted
a comprehensive report to Congress on the Prevention and Treatment
of Co-Occurring Substance Abuse Disorders and Mental Health Disorders.
The predisposition of individuals with depression, bipolar disorder,
schizophrenia and other very treatable mental health challenges
to self-medicate with alcohol, tobacco and other drugs is undeniable.
Addiction
treatment has been in the news as the recovery struggles of sports
and other entertainment figures have been highlighted in the last
few years, if not always in the most empathetic way, in a manner
that illustrates the difficulty of the “just say no” approach.
The news stories of celebrity treatment admissions and failures,
combined with the life stories contained in the several important
memoirs penned in recent years by individuals in recovery, serve
to underscore the assertion by NIDA that “... drug addiction ...
is a disease that impacts the brain and because of that, stopping
drug abuse is not simply a matter of willpower”.
Late
last year, a decision was made by the of the US Supreme Court
to allow federal judges leeway on sentencing guidelines for crack
cocaine offenses, which was followed by a vote by the U.S. Sentencing
Commission to allow retroactive reductions on sentence recommendations.
This was a major step in the effort to eliminate sentencing disparities
which, like health disparities, have a disproportionate impact
on peer people, women and people of color.
In
another positive move, in March of 2008 the Department of Veterans’
Affairs acknowledged in a statement for the Congressional Committee
on Veterans Affairs that the “incidence of substance use among
veterans tends to exceed that of comparable civilian populations.”
The statement went on to assert that substance use problems are
treatable, and delineated the intentions of the VA to substantially
expand mental health and substance abuse services for veterans
through provision of behavioral health screening services by every
VA provider, creation of new services and ramping up existing
outpatient, intensive outpatient, residential, and inpatient treatment
services. If this activity truly materializes, and is more than
just another promise broken by the VA, men and women returning
from the extreme stress of war may actually be able to access
the behavioral health services they need.
This
past winter, both the House and the Senate passed legislation
in support of on mental health parity, legislation which would
have added some insurance protections for the estimated 35 million
individuals in the U.S. who grapple with mental disabilities each
year. Both bills would have prohibited practices resulting in
higher co-payments or lower limits on mental health service visits
than are common for other illnesses. Though neither bill was signed
into law, sponsors of the mental health parity bills in both the
House and the Senate vowed to continue the fight for parity in
the next year.
The
pledge of 120 Members of Congress to restore funding of the Department
of Justice Drug Court Discretionary Grant Program to the $40 million
level after years of funding reductions is cause for celebration
at the more than 2,000 drug courts currently operating to provide
a mechanism for offender enrollment in treatment, toward reducing
offender recidivism and the total number of individuals incarcerated
in the U.S. for non-violent offenses. In addition to monitoring
offender treatment participation, most drug courts provide employment
assistance, housing assistance, assistance with linkage to health
services and assistance with development of life skills, including
family management skills.
All
of this activity is great, but the time for a serious celebration
of National Alcohol and Other Drug Recovery Month will occur when
an elected President finds the political courage to push and work
with Congress to develop, fund, implement and ensure sustainability
of a comprehensive, integrated national strategy to address “the
drug problem”. The strategy has to connect prevention, health
care financing, rural and urban health care access, Medicaid eligibility,
Early and Periodic Screening and Diagnostic Treatment (EPSDT),
training of medical and counseling professionals, primary care
screening and referral, emergency room screening and referral,
pharmaceutical pricing, ATOD treatment, mental health treatment
, liver disease prevention/reduction, heart disease prevention/reduction,
cancer prevention/reduction, HIV and STD prevention/reduction,
drug interdiction efforts, criminal justice initiatives, judicial
policy, housing policy, educational policy, child welfare
policy, alcohol taxation, tobacco taxation and other business
taxation policy.
The
strategy will have to ensure the allocation of resources to each
of these areas in accordance with not only the immediate rewards
they deliver but also in accordance with their promise to reduce
long-term societal costs of alcohol, tobacco and other drug use.
The strategy will need to address how to fully support the efforts
of States and local jurisdictions to establish prevention and
treatment systems that reduce the human and business costs of
drug use. Further, the strategy will need
to flesh out the commitment of the U.S. to participate as a partner
in the efforts of the United Nations Office of Drugs and Crime.
To
affect a comprehensive strategy, the next President will need
to identify assignment of oversight, demand accountability for
collaboration between the various involved agencies and, in all
likelihood, demand some consolidation of moving parts. Someone
or, better, some body or council needs to be truly empowered to
direct funding, strategic and other decision-making processes,
and to determine the appropriate balance of funding and resources
to dedicate to the demand and supply sides of the ATOD equation. It is hard to imagine that one-third of the $25 billion
or so that is dedicated to address a “drug problem” estimated
to cost the U.S. $500 billion annually is a reasonable proportion
to dedicate to the research, prevention and treatment of ATOD
abuse.
The
“War on Drugs” and its attendant “Drug Czar” construct need to
be kicked to the curb and replaced by the “Risk, Recovery and
Redemption Initiative”, or something else that acknowledges the
scientific progress made in ability to identify individual risk
for substance abuse, to provide cost-effective treatment that
is customized for the individual, and to assist the individual
to find, restore or enhance their ability to contribute to their
community and to society. At a point in history where the genetic
and environmental vulnerabilities of any individual to drug use,
abuse and addiction can be identified, a “War on Drugs” amounts
to a war on individual citizens and residents of this country.
An
integrated strategy needs leadership, not a Czar, for implementation.
This is the Information Age, the era of the much-heralded Global
Economy, an era in which the location of sites of drug crop cultivation
and production of drugs of abuse can be determined with some specificity.
An
emphasis on diplomacy and collaborative international efforts
to reduce drug trafficking and ensure viable alternative development
for the estimated 5 million people around the globe whose survival
depends on cultivation of drug crops should provide Presidential
and Vice-Presidential candidates whose leadership in the international
arena is legendary an opportunity to strut their stuff.
BlackCommentator.com Guest Commentator, Candice Cason,
has directed public drug treatment services for three different
jurisdictions in the Greater Washington, D.C. area. Click here
to contact Ms. Carson.