Stillpoint Press of Santa Barbara
Founded in 1993
The Addiction Recovery Agenda 2009
Change We Need
The greatest barrier to successful recovery from addiction is not denial.
The greatest barrier to successful recovery is the absence of hope.
America is filled with hope right now in celebrating the election of Barack Obama as President of the United States of America.
The new administration promises change, and so much change is needed. Much damage has been done the last eight years in our moral life, our economy, our environment, and in our relationships with the earth and with other nations.
The new Administration has many high priorities. Addiction recovery should be a high priority as well. Many good and strong efforts have been stifled the past eight years, and so much progress has been reversed.
Below is a proposed Recovery Policy Agenda for the Obama Administration. But first ...
Why Addiction Recovery Needs to be a Priority
The emotional and spiritual cost to our nation of untreated addiction and substance abuse cannot be measured.
The financial cost to our society of these problems (excluding nicotine) has been estimated at $265 billion per year – about $75 per month for every man, woman, and child in America. That cost includes health care costs, increased insurance premiums, automobile accidents, criminal justice costs, social service costs, and lost productivity. (Click here for details)
In spite of a world-wide food shortage, much of the arable land on the planet is being used to grow tobacco, coffee, marijuana, cocoa for cocaine, poppies for opium, grapes for wine, and grains and hops and vegetables for other forms of liquor. Much more is used to grow cane and beets for processed sugar, and corn for the syrup that has become the universal sweetener for junk-food and a primary cause of our epidemics in obesity and Type II Diabetes.
It is impossible to develop intelligent strategies to address health care, redevelopment of inner cities, responding to HIV and AIDS and other chronic illnesses, homelessness, and runaway prison and other criminal justice costs without addressing addiction and substance abuse.
It is respectfully proposed that the following Policy Agenda for addiction recovery - which has been submitted to the Obama Transition team - be incorporated into efforts at rebuilding and strengthening our communities and our economy. Just as our current economic crisis provides opportunities for positive change in the areas of energy, national security, and the environment, implementing the following agenda provides the opportunity to prevent untold suffering of those afflicted and their families, significantly reduce health care and social services costs, heal addiction in our communities, and reverse the shameful scar of the United States incarcerating a larger proportion of its citizens than any nation on earth.
(click on each "read more" for details)
1. Increase block grant funding for alcohol and other drug (AOD) recovery services, and significantly increase funding for AOD services for Veterans. (read more)
2. Re-establish, update, and implement the Center for Substance Abuse Treatment’s (CSAT’s) Changing the Conversation: A National Treatment Plan. (read more)
3. Restore alcoholism and drug addiction to the status of disabilities under the Federal Social Security Administration. (read more)
4. Restore and significantly expand drug court funding. (read more) (Click here for a history of drug courts)
5. Restore and significantly expand funding for AOD treatment in Federal Corrections, The Bureau of Prisons, and Federal Parole services. (read more)
6. Assist States and local jurisdictions in restoring and significantly expanding AOD treatment in state corrections and parole services. (read more)
7. Restore and expand the 1998 Recovery Community Support Program under CSAT. (read more)
8. Restore and expand the 2004 Recovery Community Services Program under CSAT. (read more)
9. Implement CSAT’s Treatment Improvement Protocol (TIP) on the use of acupuncture in the treatment of addiction. (read more) (Click here for more information on acupuncture and addiction)
10. Assess all Regulations Governing the treatment of alcoholism and addictions. (read more)
11. Develop a five year plan for the integration of AOD treatment in public health and social services at levels comparable to its integration in criminal justice. (read more)
12. Develop a five year plan for comprehensive community-based resources to support recovery from non-drug addictions. (read more)
1. Block Grant Funding IncreaseBlock grant funding* for substance abuse treatment is administered by the Center for Substance Abuse Treatment through State governments, and provides “safety net” funding for recovery support where other resources are unavailable. Typically, there are waiting lists for these scant resources. This allocation needs to be dramatically increased.
Funding administered by the military and by the Veterans Administration for AOD problems is significantly lacking in every venue: military hospitals, VA hospitals, and Vet Centers.
* Any funds allocated to support recovery from addiction should not be viewed as costs but as an investment - or as "cost containment" measures. (see cost of untreated substance abuse).
2. Implement Changing the Conversation
Estimating that 10 million Americans who were addicted to drugs were not receiving treatment, the Federal Center for Substance Abuse treatment published in 2000 Changing the Conversation: A National Treatment Plan to improve and strengthen recovery support throughout the nation. This comprehensive document – two years in the making - reflected extensive input from recovery communities and stakeholders.
Barack Obama, in his campaign for President, heralded the old joke that “Washington DC is the place where good ideas come to die.” Lots of good ideas spring from the Washington culture – including this National Treatment Plan – but without sustained advocacy efforts by those in power, they wither and die.
This Plan needs to be dusted off, updated, and then aggressively implemented.
3. Make Alcoholism and Drug Addiction Disabilities Under SSI
The Bush administration was not responsible for eliminating alcoholism and drug addiction from the list of disabilities for which one could receive Social Security Disability benefits including Medicaid insurance eligibility. This crippling and short-sighted move is traced back to the Republican Congress under the leadership of Newt Gingrich in 1996. It was included in a budget continuation bill that Clinton could not possibly veto.
Conservative Republicans led the effort based on complaints that alcoholics and drug addicts were receiving checks from the government to “fund their habits.” But the fact is, the system of administrating these benefits had undergone substantial recent changes and was beginning to be very successful. People receiving benefits were (1) receiving comprehensive and individualized case management services to assure they were participating in treatment and recovery support services; (2) were given a two year period to achieve sobriety and become self sufficient (at which point their benefits would cease), and (3) were subject to a protective payee system under which their funds were closely monitored.
This system provided a powerful incentive for people to attempt and achieve successful recovery; more important, the status of their disability made them eligible for Medicaid, which is the primary funding mechanism for substance abuse treatment for the uninsured.
The Drug Court movement has been one of the most positive and successful governmental initiatives of the past 20 years. It formally began in Miami in 1989 when interdiction in cocaine traffic created judicial gridlock, and several enlightened leaders in the criminal justice and treatment communities formed strategic alliances and implemented a system of care for drug offenders (click here for full history).
One of these dedicated leaders was Miami/Dade District Attorney Janet Reno. President Bill Clinton brought her to Washington in 1992 as Attorney General in part to make this unique system available throughout the nation.
Many drug courts have started since then, but funding has decreased significantly and only a small handful of new programs have been funded. Drug Courts have been extensively evaluated and are effective in reducing crime and saving criminal justices costs (including the cost of incarceration). They result in successful recovery by people for whom the event of arrest was the best and sometimes the only opportunity for intervention.
Few local jurisdictions have the resources available to implement drug court programs on a scale needed to significantly impact costs. Existing drug courts therefore need to be provided with additional resources, and the model needs to be dramatically expanded throughout the nation.
To reiterate again, any funds allocated to support recovery from addiction should properly be viewed not as costs but as an investment - or as "cost containment" measures. (see cost of untreated substance abuse).
5. and 6. Expand Funding for Treatment in State and Federal Corrections Systems
We incarcerate more people per capita than any other nation on earth, at costs that range from $12,000 to $24,000 per year per prison bed. One in every one-hundred of our citizens is in prison. It is estimated conservatively that 80% of the individuals in our jails and prisons are there as a direct or indirect result of problems with alcohol or other drugs. In advocating for treatment in other venues, one has to address the housing component, but in this case, they are already conveniently housed and in most cases amply motivated to begin recovery!
Yet only a miniscule percentage of those incarcerated in Federal, State, and local jurisdictions receive treatment!
These systems are suffering from breathtaking arrogance in terms of what constitutes treatment, and ignorance of recovery and appropriate levels of service is rampant. Some prison officials say that you have to screen people carefully to make sure there is a need for substance abuse treatment or else you can do real harm. As if someone in a State prison could be further harmed by being exposed to recovery opportunities! Other places assume that the only inmates who need treatment are those with alcohol or drug crimes – as if burglars and forgers and other felons probably don’t have drug problems. In many prisons people with violent offenses are given anger management classes instead of AOD treatment – as though their being inebriated at the time of the violent act is incidental.
Leadership is required at the highest level to swamp all of these systems with AOD recovery support services so we can break this ugly, expensive, and insane cycle of injustice.
7. Restore and Expand the Recovery Community Support Program
People with illnesses and their families form organizations such as the American Cancer Society and the Mental Health Association to advocate for public awareness and research and improved treatment for the illness that affects them.
For a variety of complicated reasons, this has not been the case with people with alcoholism and drug addiction and their family members. Therefore, in 1998, CSAT launched its Recovery Community Support Program. The program became CSAT’s flagship program by 2002 when dozens of projects around the country mobilized recovering people and their families to influence local, state, and national policies governing alcohol and other drug issues.
Bush terminated the program, replacing it with the Recovery Support Services Program in which these projects were to stop their advocacy functions and instead recruit and train recovering people to help others in recovery in order to expand treatment capacity.
The RCSP should be renewed and expanded to give recovering people and families a clear voice in issues affecting them.
8. Restore and Expand the Recovery Community Services Program
The Recovery Community Services Program – which replaced the original Recovery Community Support Program – was designed to train and recruit recovering people to act as peers and mentors to others with alcohol and other drug problems. The program was cut in 2008.
This program should be reinstated to recruit recovering support staff for treatment programs from among the recovering population.
9. Complete and Publish the CSAT Acupuncture TIP
CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch of CSAT to facilitate the transfer of state-of-the-art protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources.
While acupuncture for treating addiction began receiving government support from criminal justice agencies in the late 1980s, its formal endorsement by public health and substance abuse agencies took another twenty years to achieve. This latter support is most directly the result of the advocacy and vigilance of Alan Trachtenberg, MD, a public health physician who has worked with federal mental health and substance abuse agencies. Thanks to his efforts, CSAT has considered acupuncture to be an "allowable cost" in the detoxification phase of treatment since the mid-90s. In 2001, CSAT Director Dr. Westley Clark was aware that acupuncture was being widely used in treatment, and made the decision to develop the TIP under the leadership of Dr. Trachtenberg, who was then CSAT's Director of Pharmacologic and Alternative Therapies.
Trachtenberg assembled a consensus panel of experts from the field. The panel co-chairs were Michael O. Smith, MD, Director of Lincoln Hospital Recovery Center in New York, and Janet Konefal, Ph.D., M.P.H., C.A., Associate Professor and Chief, Division of Complementary Medicine, Department of Psychiatry and Behavioral Sciences at the University of Miami School of Medicine. The final editing of the TIP was assigned to Arthur Margolin, Ph.D., Research Scientist at Yale University School of Medicine.
When Trachtenberg left the Agency, the TIP lost its advocate and hence its momentum. This is another good idea that withered for lack of support and advocacy.
Auricular "detox" acupuncture provides a portable, safe, effective, popular, and inexpensive opportunity for AOD clients to address acute and post-acute withdrawal symptoms without using other drugs. This TIP should be completed and published so that these guidelines are available to programs everywhere.
(click here for an Acupuncture and Addictions FAQ)
10. Assess Regulations Governing AOD Treatment
Research has not been able to isolate the variables involved in successful addiction recovery, so no research findings are conclusive except the self-evident finding that people who stay in treatment do better. Until the psychological, sociological, physical, and spiritual malaise of addiction is better understood, the funding authorities need to encourage innovation and the full participation of those with first-hand experience in successful recovery.
Formal treatment in the 20th Century was a descendant of Alcoholics Anonymous, which was founded in 1935. Somewhere around the discovery of beta endorphins – the first neurochemicals identified as being involved in addiction – the research and psychiatry communities succumbed to reductionist, complex, and convoluted clinical theories and a labyrinth of self-centered research and clinical power struggles. One example of this was the great debate over “treatment matching,” and the erroneous assumption that no one treatment modality fit the needs of every client. That assumption gave rise to pouring money into differential diagnosis and assessment and screening protocols, front-loading treatment with a quagmire of paperwork barriers and licensure requirements that had nothing to do with clients and their recovery.
What effective treatment looks like for the vast majority of alcoholics and drug addicts is (1) motivational interviewing or intervention to prompt an attempt at recovery, (2) a drug-free method like acupuncture for reducing craving and other withdrawal symptoms, (3) basic education and relapse prevention tools – preferably delivered in a group setting by people themselves in recovery, and (4) peer mentors to assess secondary needs (safe housing, mental health services, etc.) and to engage people in the natural community supports such as 12-step, faith-based, or self-help programs that will support long-term recovery.
For the minority of people for whom these core services are inadequate, counseling, residential care, and pharmaceutical interventions may be added.
11. and 12. Integrate AOD Treatment in Public Health and Social Services at levels Comparable to its integration in Criminal Justice Systems
It is with some irony that people who worked in the recovery field prior to 1990 now view the involvement of criminal justice agencies in AOD treatment. Using criminal sanctions to motivate people to attempt recovery was long sought in the 1970s and 1980s, because it was known that many offenders were alcoholics and drug addicts and needed treatment. Then the criminal justice community – led by enlightened judges, probation and parole officers, and prosecutors - opened their doors to helping offenders achieve recovery.
Now, they seem to dominate the field. For many treatment programs, 90% or more of their client base are mandated by criminal justice agencies.
Incentives and leadership are required at the Federal level to raise awareness about the enormous impact of AOD problems in other public systems such as Public Health, Mental Health, and Social Services.
Again, note that any funds allocated to support recovery from addiction should not be viewed as costs but as an investment - or as "cost containment" measures. (see cost of untreated substance abuse).
The addictions we are used to talking about in public are the ones to alcohol and other psychoactive drugs. That’s because the consequences of those addictions are so dramatic. These addictions are also in our awareness because they are so widespread; everyone either has the problem in their own family or knows someone who does. And most people have lost someone they love to cancer or other diseases caused by cigarette smoking.
But there are other devastating “non-substance” addictions that now threaten us individually and collectively. These are actually far more widespread than the addictions to alcohol and other drugs. And these addictions are the ones around which we have now hit a bottom.
There is a cluster of three major addictions that are the most dramatic. This “Big Three Cluster” includes addiction to (1) Consumerism (shopping, spending, and specific commodities such as oil), (2) Gambling (not just at Indian casinos, with lottery tickets, and online casinos but also gambling on the future value of real estate and other commodities, mortgages, stocks and bonds), and (3) Debt (credit, which is acquiring material possessions with wealth that hasn’t yet been earned).
That’s not all, of course. There are also our addictions to food and to eating, and to overeating, and to substances that have produced the epidemic in America of obesity and Type II Diabetes, such as sugar (especially corn syrup), carbohydrates, starch, and probably to some chemicals and chemical processes we haven’t figured out yet.
Then there is addiction to pornography, which not only fuels the internet, but has replaced the cocktail lounge as the most lucrative secondary revenue source for hotels through their pay-per-view in-room TV movies.
There is also addiction to relationships, to romance, to sex, to exercise, to dieting, to yoga, to television, to football, to work, to religion. And so on. Excluding these addictions from public funding for AOD problems is a result of politics, of clinical “turf” issues, of stigma, and of philosophical differences regarding the etiology of these disorders. But the result is that recovery support services for non-drug addictions is virtually non-existent or unavailable in many regions of the country and among many populations. The Federal Government needs to provide leadership in building consensus concerning these disorders and developing effective and accessible systems of recovery support in all communities for all addictions.
Acupuncture Education Resources:
Acupuncture and Addiction Resources