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September 2005
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Understanding ‘need’ for treatment

Health and Human Services announced today the results of the 2004 National Survey on Drug Use and Health
I’m sure that there will be a number of interesting bits of data in this year’s results that I’ll talk about later, but there’s one general point that I wanted to address today: the “need” for treatment.
I’ve had concerns for some time about the definitions for abuse and dependence that are used when dealing with illicit drugs and alcohol. For example, the survey shows that 17.6 of those who used marijuana in the past year are classified as abusers or dependent, while that’s true of only 11.9% of those who used alcohol. Of course, in actuality, marijuana causes far less (and far milder) dependence than alcohol, but because “abuse” also includes definitions that are affected by the legal status, that jacks up the percentages for marijuana abuse.
The next step taken by the government study is to classify everyone in the “abuse” or “dependent” categories as “needing treatment.” They give no reason for this arbitrary judgment. And it’s pretty offensive, in my view.
Let’s take a look at a drug that isn’t covered by the survey: tobacco. Many Americans are dependent on cigarettes, and yet it would be odd to consider them all as needing treatment. They may need to decide to quit (and then have no problem doing so), or they may need to get some help quitting (such as a patch or a support group). But to say that merely because they are dependent, they are in need of treatment, sounds like a definition that has been written by treatment professionals to increase their business.
Back to illicit drugs and alcohol, if you take a look at the study’s own numbers, you see how preposterous the designations are. Of those supposedly needing treatment and not getting it…

According to the study, 23.48 million people (or 9.8% of the American population over 12 years old) needed treatment. Wow! What a cash opportunity for the treatment industry. And that’s right, of the 21.1 million who supposedly needed treatment and didn’t get it, only 1.2 million people actually felt that they needed treatment. Maybe 20 million people are delusional. But I doubt it.
The entire concept of “treatment” (and the definitions of those who need it) in drug policy data, needs to be re-examined from the ground up (and not by those who benefit from it). The mere fact that a study can claim that roughly 1 in 10 Americans need treatment is a strong warning sign that the data and/or assumptions are seriously flawed.

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