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May 2016
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Treatment Reform

Maia Szalavitz takes on an important area that needs significant reform: the treatment industry.

The Rehab Industry Needs to Clean Up Its Act. Here’s How.

There are so many areas of this industry that are broken or just plain corrupt. Part of this is due to historical non-evidence-based stigmatizing approaches toward addiction, some due to the lack of science in the federal government’s laws and regulations, and some due to the attempts to cash in on a potentially lucrative captive market by unscrupulous players.

“What we simply need is a nice bulldozer, so that we could level the entire industry and start from scratch,” says Dr. Mark Willenbring […] “Another approach is that you could use dynamite,” he deadpans. […]

And in no other area of medicine do insurers pay for hours of group “therapy,” films and lectures that consist overwhelmingly of indoctrination into the teachings of a self-help group, available for free in church basements. […]

In any other area of medicine, if patients were not informed about a treatment that cuts mortality by at least half—while being given one that has no effect on it—it would be considered malpractice. […] But in the addictions field—largely because the dominant abstinence-only model historically hasn’t recognized medication-assisted treatment (MAT) as an acceptable form of recovery—this happens almost every time someone with an opioid addiction enters an abstinence-only 28-day rehab, a detox or an abstinence-based outpatient program. […] Given this, stigmatizing maintenance or telling patients that it is “not really recovery,” is basically killing people. […]

In the past year, the addiction treatment industry—never trouble-free in the best of times—has been wracked by scandal. […]

But the treatment industry has for too long relied on referrals from the criminal justice system to stay solvent. […] Several problems result. For one, since their biggest customer is often the criminal justice system, many programs shape themselves to its dictates. “The field has been so distorted by its dependence on the criminal justice system, which is really the client,” […]

Unfortunately, nearly all long-term residential treatment centers in America— i.e., “therapeutic community” programs that last three months or longer—were originally modeled on a destructive cult called Synanon. […] While many have moved away from the most extreme tactics, a widespread belief that all people with addiction are lying “whenever their lips are moving” and a sense that negative experience is necessary to get people to realize that they need to change remains common. […]

Research has long shown that in most cases, outpatient treatment is as effective as inpatient care for alcoholism and other addictions. […]

We also need national standards for counselor education, for best practices in all types of treatment and for informed consent regarding options like medication. All counselors need to be educated about all aspects of addiction, not just their own recovery […]

These are some great critiques, and something that more people need to acknowledge. There is a tendency, by some, to simply talk about treatment being better than enforcement without noting that prohibition has seriously tainted the treatment field. Simply spending more on treatment without paying attention to what you’re getting is not reform.

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A Justice opens the door a bit on Supreme Court acceptance of the Constitutional right of jury nullification

Of course, the concept of Jury Nullification (choosing to find a defendant not-guilty because of your disagreement with the law) is a time-honored Constitutional power of the jury. After all, the jury of peers is the highest judge of the law in our system, and cannot be held to account as to their reason for making a finding.

However, the judiciary has been openly antagonistic toward the concept, even to the point of excluding jurors who believed in the concept, instructing juries that they’re not allowed to think that way, and even attempting to jail activities who are merely trying to inform the population of their rights as jurors.

So this is significant:

Justice Sotomayor Says ‘There Is a Place, I Think, for Jury Nullification’

This week Supreme Court Justice Sonia Sotomayor had some kind words for jury nullification, which empowers jurors to judge the law as well as the facts of a case and may involve disregarding the law when the law is unjust. During a discussion about juries at NYU Law School on Monday, Sotomayor, who used to serve on the U.S. Court of Appeals for the 2nd Circuit, was asked about a 1997 decision in which that court “categorically reject[ed]” nullification. “As we govern in the system, and watching it, I’m not so sure that’s right,” she said, according to Law360. “There is a place, I think, for jury nullification—finding the balance in that and the role judges should play.”

A small, but important step.

And, of course, jury nullification has been used to free some people brought to trial on drug charges. It has the potential, as more of the public becomes disenchanted with the drug war, to become even more heavily utilized, even to the point of making it difficult for prosecutors to bring certain kinds of charges forward.

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President’s drug control budget is a first, but still a whole lot of wasted money

For years, those of us in drug policy reform have pointed out that, while the government talks about prevention and treatment, the federal government budget has always been weighted toward enforcement and interdiction. It’s been really telling that, while they know that supply side spending is ineffective, they’ve still been doing the most there, in part because so many entrenched interests are involved.

Finally, for the first time, the proposed budget is different.

FACT SHEET: Administration’s Drug Control Budget Represents Balanced Approach to Public Health and Public Safety

The President’s Budget, submitted to the U.S. Congress today, represents the first time in the history of the Office of National Drug Control Policy that federal funding to reduce the demand for drugs is funded at similar levels as funds to reduce the supply of drugs.

So let me take a moment to congratulate the administration on finally spending less on attacking supply than on demand reduction and treatment. Good for you.

Now that I’ve done that…

They’re still proposing over 15 billion dollars on supply reduction efforts, which is an obscene amount of money to be pouring down that toilet. And out of the 15+ billion being spent on treatment and demand reduction, most of that is wasted as well, given the fact that the federal government is horribly behind in accepting scientific fact, and has its priorities based on political interests rather than good policy.

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Another SuperBad Advertisement

Via Making Noise in the South, A Super Serving of Shame and Stigma for Super Bowl 50

The National Council on Alcoholism and Drug Abuse (NCADA) is hitting us again at the Super Bowl. This time with “All American Girl” – an ad that’s supposed to show that you should care about heroin abuse because it affects pretty white girls, too.

But, of course, the ad then doesn’t show what you do when someone is having a problem with heroin – it lets them just wander off in the distance. No, this is just another one of those frying-pan scared-straight attempts at prevention that have been shown historically to not work.

And a shit-ton of money is being poured down the drain for this nicely scored, beautifully shot Super Bowl ad, when they should be helping Dan Morrhaim get some real reform passed in Maryland that will actually make a difference.

Here’s the ad:

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How do we get out of the political dark ages when it comes to the drug war?

There is so much good information available to us about drugs and drug policy if we’re willing to actually, you know, listen to it. But science and reality have been pretty much excluded from the public policy conversations when it comes to drugs, except for that “science” that supports the drug war regime.

The absurdity of this was brought home again to me with this article…

A Maryland Lawmaker Offers A Radical New Solution To The Heroin Crisis

That certainly sounded interesting. A radical new solution? Tell me more.

On Friday, he’ll announce the introduction of a sweeping set of bills that would upend the approach to the opioid epidemic, Morhaim, a Democrat, told HuffPost.

The approach is a radical one likely to scare off nearly all politicians and probably a majority of voters. So let’s back into his bills slowly.

Wow. So radical and new that even the article has to broach the idea cautiously. I can’t wait to find out… seven paragraphs later…

OK, ready to hear the idea?

The first option is to treat the addiction so that the person is no longer using heroin. For that, a variety of treatments need to be offered, depending on the user and the circumstances. The second option is to treat the social problem by giving the most difficult-to-treat addicts free heroin — or something very close to it — in a safe, controlled environment.

Really?

OK, don’t get me wrong. This is very good. And I applaud the lawmaker for bringing this forward.

But new? Radical? Not to anyone who has been paying attention. We’ve been talking about these ideas at Drug WarRant for many years. These are ideas that have been tried, tested, and proved – the science is there. They’ve just been excluded from political consideration.

It’s sad that in today’s world… in a major world power with amazing intellectual resources, we’re stuck in the drug policy equivalent of medieval barber surgeons, and that anyone who actually proposes scientifically proven reform is considered some kind of scary radical.

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Dramatic reduction in NYC marijuana arrests

Annual Arrests for Marijuana in NYC Drop From Nearly 51,000 in 2011 to Under 17,000 in 2015

According to data just released by the New York State Division of Criminal Justice Services, New York City marijuana arrests in 2015 dropped to under 17,000 for the first time since 1996. The 16,590 arrests for low-level marijuana possession in 2015 is a 42% decline from the 26,386 in 2014 and a 67% drop from the nearly 51,000 arrests in 2011.

This is welcome news and a clear sign of some changes in leadership. New York City is one of those places where showing marijuana in public was an arrestable offense, and so cops would stop-and-frisk and tell people to empty their pockets. Once it was out of their pockets, they’d get arrested for having it out in public.

A 67% drop in four years is pretty incredible. Part of it comes from the announcement in 2014 by Mayor de Blasio and Commissioner Bill Bratton to stop arresting for simple possession of less than 25 grams.

Of course, 16,590 arrests is still way too high.

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Open Caucus Thread

The Iowa caucuses are underway. Use this thread to discuss the election. Opinions are fine, disagreements are fine, but please no name-calling or insulting others (including candidates you oppose). We’ve got friends on all ends of the political spectrum on the couch.

For many years, I’ve felt that the Presidential election had little impact on drug policy — that we had to focus on building the grass roots, and bringing the population up to speed so that the politicians would be forced to follow.

So my question to you is… has that dynamic changed? With multiple states legalizing marijuana, and with a broader sense nationally that the criminal justice reform is necessary (including the Black Lives Matter movement), is this one of those moments where the right President could actually make a significant difference toward shortening the drug war?

Or, will it simply not matter? Will the political realities of compromise and bureaucracy thwart most of the efforts of a reform-minded President and, alternately, negate the backsliding attempts of a prohibition-minded President?

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Global Drug Survey

Readers may wish to participate in the Global Drug Survey, if you haven’t before. The goal this year is to have over 120,000 participants, in order to have really good information about drug use worldwide.

What makes this survey of particular interest is that this is an independent organization that doesn’t have prohibition as its mission.

To quote them:

Global Drug Survey seeks to become the largest most credible source of current drug use data trends in the world.

Accepting that the hidden masses of those who use substances are not the focus of government research or public health interventions, we seek to inform the wider drug using populations about their use of substances in a way that is meaningful, relevant and useful.

We strongly support harm reduction and accept that pleasure drives the majority of drug use, which for most people most of the time is not a source of distress or harm in their lives.

We acknowledge that drugs can be harmful but that the risk of harm can be significantly mitigated by the adoption of common sense risk reduction strategies.

We seek to limit the harm drugs may cause individuals and their communities by being honest, open and transparent about drug use and sharing our findings with the public without government or funder interference.

That’s something I can get behind.

I’ve taken the survey, and it seems incredibly comprehensive.

You can see findings from previous surveys here.

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Quote of the Day

Radley Balko:

“In the month that police and federal officials wisely used cunning, patience to apprehend the Oregon militia leaders, there were at least 3,000 violent raids on the homes of suspected drug offenders.”

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Open thread

I came to New York for the weekend, to see a few shows, and attend BroadwayCon, which, fortunately, is in the hotel where I’m staying, because I’m not going outside right now. Shows are closed, vehicles have been banned, transportation shut down.

We’ll see how fast this clears up and when I get home.

In the meantime, I understand pizza has been ordered and should be arriving soon for the couchmates. Enjoy.

If the blizzard here doesn’t subside by tomorrow, send coffee.

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