The tackling drug addiction initiative aims to increase the access of uninsured drug-dependent citizens to comprehensive drug rehab services that respond to their individual needs. To achieve access to Maryland drug rehabs, the Program is helping Baltimore, Maryland to develop a sustainable, high-quality addiction treatment system that uses research-based clinical practices and that benefit from interagency coordination. The drug rehab initiative also seeks to demonstrate to policymakers and the general public that sound addiction treatment practices and policies will save lives, reduces crime, rebuild families and communities, and use public funds wisely.
The success of this approach may have national significance as the public seeks alternatives to the nation’s ineffective “war on drugs.” Current U.S. drug policy emphasizes crop eradication, interdiction and domestic law enforcement over addiction treatment and prevention, although research indicates that drug addiction treatment is between seven and twenty-three times more cost-effective than its policy alternatives. Despite increased interdiction, drugs have become stronger, cheaper and more easily available; and more Americans are in prison for drug related convictions than ever. Further, civil rights are eroded by drug laws permitting asset forfeiture without due process and by sentencing inequities. For example, the possession of crack cocaine, used more frequently by the poor, exacts harsher sentences than possession of powdered cocaine.
Connection to Open Society Values
The tackling drug addiction initiative is founded on the belief that expanding access to drug rehabs will help marginalized people both recover from addiction and develop the skills, resources and zeal to participate more fully in community life. With this increased civic engagement, Baltimore, Maryland will be able to build healthy families and communities and to benefit from the views, knowledge and experience of all of its residents, thereby setting the stage for a more just and open society. Expanding access to drug addiction treatment is therefore an important objective of Baltimore, Maryland. Given the complexity and demands of building a comprehensive and accessible system, the Program collaborates regularly with Baltimore’s work- force and criminal justice initiatives and partners with other funders and public agencies.
Nature of Drug Addiction
Drug addiction is one of the most common diseases in the United States. It is estimated that over nine million Americans need drug treatment programs, making drug addiction more prevalent than coronary heart disease and stroke and as prevalent as cancer. Addiction exacts an enormous burden on the nation, costing an estimated $69 billion in lost productivity, $12 billion in health care costs and $10 billion in spending on child welfare systems. There are more than 9,000 drug-induced deaths each year; and 25% of the nation’s AIDS cases result from injection drug use. Further, drug related arrests have significantly contributed to the doubling of the nation’s incarceration rate since 1985.
Drug use in the United States is widespread. The National Household Study conservatively estimated that 14 million citizens over the age of 12 were current drug users in 1997. The initial choice to use drugs is voluntary; as addiction develops, however, continued drug use becomes largely involuntary. Indeed, addictive drugs induce persistent changes in the brain that partially explain both the compulsive nature of drug use and the risk of relapse.
Genetic, individual and environmental factors play a role in the development of many illnesses, including addiction. As addiction runs in families, scientists are currently working to discover its precise genetic mechanism. Individual factors, such as the presence of depression or other psychiatric illness, may increase a person’s vulnerability to addiction. Social factors, including environmental stress and drug availability, also play a role. Finally, addictive drugs produce powerful physical and emotional changes that contribute to compulsive drug taking.
Effectiveness of Drug Addiction Treatment
Drug addiction treatment is as effective as treatment for other chronic disorders. For example, the one-year relapse rates for addiction, asthma and hypertension are quite similar at 60%, 70% and 55%, respectively. For the past 30 years, federally sponsored research has repeatedly confirmed that treatment results in positive outcomes and is cost effective. For example, a recent study demonstrated a reduction in alcohol and drug use (52% and 69%, respectively) one year after treatment. A 1994 study showed a 64% reduction in arrests one year after treatment. Further, drug treatment prevents the spread of HIV. Patients enrolled in methadone maintenance were five times less likely to contract HIV than drug injecting people not in treatment. For more information on the effectiveness of treatment, see Why Invest in Drug Treatment? What the Research on Treatment Effectiveness Tells Us (available from OSI–Baltimore).
Drug Addiction in Baltimore, Maryland
Maryland’s Alcohol and Drug Abuse Administration estimates that 60,000 of Baltimore’s 650,000 residents are drug dependent. Addiction has a devastating impact on the city. Drug dependent people commit a large number of property crimes to purchase drugs. Approximately 70% of Baltimore’s over 80,000 annual arrestees have positive drug tests. Alcohol and drug abuse are thought to fuel a significant proportion of the over 8,000 annual child abuse and/or neglect investigations in the city. Baltimore continues to be among the top cities in heroin and cocaine use found through hospital emergency room patient data surveillance. Finally, intravenous drug injection is the major cause of HIV transmission in the city.