How to Make Addiction Treatment Way More Successful - Sage Advice From Two Experts

How to Make Addiction Treatment Way More Successful - Sage Advice From Two Experts

By John Lavitt 09/19/14

Overall, addiction treatment and public policy toward it is actually regressing despite pockets of progress. Two of America's great researchers analyze the current situation.

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UCLA Professor M. Douglas Anglin is one of the most respected addiction and treatment researchers in the United States. Anglin was the Founding Director of the UCLA Drug Abuse Research Center and an Associate Director of the Integrated Substance Abuse Programs (ISAP) from 1998 to 2010. He is currently a Senior Advisor in the Department of Psychiatry and Biobehavioral Sciences at UCLA. 

Anglin has been conducting research on substance abuse since 1972. He has been the principal investigator on more than 25 federally funded research studies. Anglin is also one of the longest surviving HIV positive patients with active AIDS in the country. 

This interview was aided by Professor Michael Prendergast, the Director of the Criminal Justice Research Group at UCLA ISAP. Prendergast has directed numerous projects studying drug treatment strategies in the criminal justice system and has been principal investigator of evaluations of treatment programs in correctional settings in California. His research work includes treatment and policy, issues in coerced treatment, and treatment effectiveness for drug-abusing offenders.

In 1994, you were part of a study that showed drug abuse programs to be truly cost-effective. The study estimated that $1.5 billion in savings resulted from the $209 million the state spent on treatment between October 1991 and September 1992. Fewer crimes committed by those in treatment resulted in the majority of the savings. The rest was largely due to a drop in health care expenses for the users. The Los Angeles Times reported your perspective on this success when you said: "This is the first time that I've seen the return on the investment so clearly laid out… Now, we can really be confident when we pound on our lecterns and say treatment works." Has this and other such studies led to the implementation of cost-effective alternatives in the criminal justice system? 

Anglin: The use of the criminal justice system to deal with drug users has been pervasive since the beginning of the 20th century. It began in 1914 with the Harrison Narcotics Act. In the 1930s, there were federal hospitals at Lexington and Fort Worth that were among the first to take criminalized populations and try to treat their drug addiction problems. But this didn’t last.

The next big phase was the War on Drugs that was initiated by President Nixon in 1968. That was the time I was a graduate student at the UCLA Department of Psychology, and I started to work with Professor Bill McGlothlin in addiction studies. I went from a relatively naïve small-town Arkansas boy to studying heroin addiction in one fell swoop. 

At that time, I got involved with the Civil Addict Program that had been established by the State of California in the early 1960s. The idea was to take drug offenders and get them inpatient treatment at minimal security prisons. After the treatment, they would be paroled with specialized parole agents who would test them and try to keep them away from the further use of drugs. If they relapsed, they would be sent back to the California Rehabilitation Center for three to nine months for additional treatment, then released again. 

The Civil Commitment Procedures had a good understanding of the pervasiveness and longevity of drug abuse once established. The Civil Addict Period was seven years, reflecting an understanding of the entrenched nature of drug addiction. The initial few years for addicts in the program seemed to always have a consistently high rate of incarceration at the California Rehabilitation Center. 

The opportunity to study that program developed into a natural experiment. Many of the heroin addicts in the program ended up being released on Writs of Habeas Corpus due to inadequate court processing. Bill McGlothlin got a grant from the National Institute of Mental Health – they were in charge of drug abuse studies in those years – and we took a matched sample of those released on these writs to compare on follow-up with those who remained in the program. We found that program to be effective, particularly from a cost perspective. 

Prendergast: I should note that the early years of the Civil Addict Program were successful, but after the 80’s and 90’s, the treatment became more lax and the effectiveness of the program dropped off. Although the Civil Addict Program is still on the books, it no longer has any real impact. The California Department of Corrections has moved on to providing treatment in prisons, primarily therapeutic communities and occasionally cognitive behavioral treatment. The Civil Addict Program is just not used very much anymore

In 1998, you were interviewed by the City Journal about the relatively new innovation of drug courts. You said, "The data are not yet available to indicate whether the drug court phenomenon as it has been variously implemented is an adjudication fad or provides, at least in some areas, the elements of a substantive intervention.” Sixteen years later, would you call it a fad or a substantive intervention? Do drug courts work?

Anglin: Rather than being a fad, it was really a jurisprudence movement. There are still a thousand or so drug courts in the U.S. and I believe they operate now in practically every state. The evaluations have been equivocal even as drug courts vary in terms of exactly what they do. The majority of drug courts steer drug offenders to treatment options and anonymous programs, particularly Alcoholics Anonymous, as an alternative to sentencing and prison. Even now, the results are mixed, the court is still out and no final verdict has been given. There is a Drug Court Association (the National Association of Drug Court Professionals), and they have standards of best practices. The drug courts that choose to abide by those standards tend to have a reasonable effect. 

Prendergast: The main issue with drug courts is that they are quite restricted in terms of whom they accept. That means that the total population of drug users they serve is relatively small. Although they are an important part of the treatment system, they are a relatively minor component when compared to the size of the drug using population among offenders. 

In a 1989 interview with The Desert News, you spoke about how drug abuse is unusual among older adults. You said, "With illicit drug abuse, there's an aging-out effect because it's a young person's game in terms of the hustle to obtain drugs.” Is this still the case? Can you describe this aging-out effect?

Anglin: The aging out effect, broadly referred to as natural recovery, happens to most drug users. As years pass, the numbers drop precipitously for people who have used drugs less than ten times. Somewhere between 6 and 10% of people who try drugs ever get involved in a protracted period of heavy use. Most of those do age out relatively quickly. 

There has been some pattern of change in the age relationship given certain circumstances. First, the baby boomers that went through the 1960s had a different perspective that tended to last longer. Many people went through that era exploratory when it came to recreational drug use and many continue to use recreationally. More recently, the huge increase in the use of diverted prescription drugs, mainly opiates, has changed the pattern. Prescription drugs have a flatter age range than the more illicit drugs. 

In 2001, in your continuing Civil Addict Program study that we touched on before, you looked at an aging population of heroin addicts. That study revealed the importance of early interventions. Here are details of the report from an article in Health Day News entitled, “Heroin Use Leaves Trail of Troubles”:

“The study, published this week in the Archives of General Psychiatry, included a third look at 242 of 581 male heroin addicts admitted to the California Civil Addicts Program in the early 1960s; 284 addicts in the original program had already died. The median age of the addicts this time was 57.4 years. Of those left, 20.7 percent tested positive for heroin use, 9.5 percent refused testing, and 14 percent were in prison and couldn't be tested. The bad news didn't stop there… Of the many who reported illegal drug use in the previous year, 40.5 percent had used heroin, 35.5 percent had used marijuana, 19.4 percent had used cocaine, 10.3 percent had used crack cocaine and 11.6 percent had used amphetamines.”

Are such results conclusive proof that early intervention by offering treatment to first-time offenders is no longer a choice, but a conclusive necessity if the American judicial system is going to effectively stem the tide of illegal drug addiction? 

Anglin: It should be the first option, the second option and the third option. The Civil Addict Program recognized that given long-term drug abuse and the entrenchment of the addict lifestyle, relapse is to be expected. You needed to swoop in and provide more substantive interventions in the face of relapse as opposed to more punishment. Although the rhetoric has been well accepted by the criminal justice system, the money is still focused on punitive measures. Today, the budget for criminal justice is 70% as compared to 30% for treatment options and interventions, and that’s the best it has ever been for the many decades that I’ve been working in this field.

The number of offenders treated in prison is still only 12 to 15%. California did establish an entire prison exclusively for drug offenders called the Substance Abuse Treatment Facility, but I am not sure if it’s still in operation. 

Prendergast: The California Substance Abuse Treatment Facility and State Prison in Corcoran is still in operation, but it is not totally devoted to treatment anymore; it still serves a large population of drug offenders, but small when compared to the number of drug offenders in the entire prison population.

Anglin: In other words, it’s still a drop in a bucket. 

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles with his beautiful wife, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.

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