Healing America's Drug Users:
Getting Treatment Resources Where They're Needed
We are proud to be associated with the President's historic commitment of providing $1.6 billion over five years to increase funding for treatment. We look forward to working with the Department of Health and Human Services to implement this commitment in such a way that the resources are targeted to areas and populations with the greatest need. This Administration is committed to going beyond merely providing additional funding for drug treatment. We will seek to achieve a greater understanding of addiction and of the types of programs that prove effective, as well as to foster a climate where drug users are empowered to take an active, responsible role in their recovery
According to the 2000 NHSDA, there were approximately 4.7 million people in need of treatment; of these, 2.8 million were classified as drug dependent and an additional 1.5 million were classified as drug abusers. Of the 4.7 million people in need of treatment, only an estimated 800,000 (17 percent) people were receiving it, leaving nearly 3.9 million needing treatment, but neither seeking nor obtaining it. This is not, however, simply a matter of expanding the system's capacity, since, remarkably, fewer than 10 percent of the 3.9 million (381,000) reported thinking that they needed help. Moreover, an estimated 129,000 reported that they sought treatment but were unable to obtain it.
The story the data tell is that the vast majority of people who are identified by survey criteria using dependency measures as needing drug treatment do not acknowledge that they have a problem and do not seek treatment. This difference between survey results and individual assessments of their own need is not a mystery. Denial is a recognized component in the cycle of drug use; and it serves as a serious obstacle to those who so desperately want the user to stop their use. We must take steps to assist the drug user in recognizing the severity of the problem and begin the healing process. We will provide more effective outreach. That means employers, schools, communities, and families not allowing denial to continue, but assisting people who have drug use problems to get help.
Most drug users, the lucky ones at least, are no strangers to coercion. People in need of drug treatment are fortunate if they run up against the compassionate coercion of family, friends, employers, the criminal justice system, and others. Such pressure needs no excuse; the health and safety of the addicted individual, as well as that of the community, require it. Compassionate coercion begins with family, friends, and the community. Americans must begin to confront drug use and drug users honestly and directly. We must encourage those in need to enter and remain in drug treatment.
Drug users who are not so fortunate, or who have not responded to the entreaties of family and friends, all too often become involved in the criminal justice system. The criminal justice system must take this involvement as an opportunity to apply compassionate coercion to teach individuals to take responsibility for their own actions and enable them to obtain the treatment they need, but did not seek on their own. The Administration is committed to taking full advantage of our state and federal criminal justice systems' ability to provide drug treatment to those within their jurisdiction. As part of this effort, in Fiscal Year 2003, we are seeking to expand drug courts and the Residential Substance Abuse Treatment program.
In order to target our resources in the most effective manner possible, we must gain a greater understanding of the magnitude of the treatment "need." While available surveys are helpful, they do not take into account several populations, including individuals currently in residential treatment programs, the incarcerated, or the homeless not living in shelters. ONDCP will work with the Department of Health and Human Services and the Department of Justice to attempt to determine more precisely the number of persons needing, currently seeking, or obtaining drug treatment services.
Simultaneous with our efforts to gain a greater understanding of the need for substance abuse treatment, we will increase the capacity of the drug treatment infrastructure for those who seek to avail themselves of the service or who can be coerced into doing so. This increase will attempt to target resources to the areas of greatest need while building effective treatment programs for the disparate needs of individual drug users. We must continue to support, improve, and expand effective treatment services across all modalities—residential, outpatient, inpatient, methadone, and detoxification to better treat the dependent and user populations. Research has demonstrated that drug use can alter the structure and function of the brain, diminishing the capacity of the user to make judgments, control impulses, and meet responsibilities. The Administration will also continue to pursue advances in brain imaging technology and medications development to better equip treatment professionals to recognize and treat those addicted to illegal drugs.
The most difficult single challenge for people with a substance use problem is not obtaining and successfully completing a treatment program but staying in recovery. A drug user is not necessarily "cured" after completing a single program, or even a series of programs. For some, addiction is a life-long challenge, one that requires the sustained effort of the drug user and his or her family and friends to stay in recovery after the treatment programs are completed. We know that some people will relapse, fall back into drug taking behavior. As a society, we must take an active role in their lives and find a way to get these individuals back into treatment and recovery. We know that for those who accept responsibility and obtain treatment services, treatment can prove successful. Only with this continuum of effort can we know we have done our best to provide life-saving assistance to those who need it.
This Strategy builds upon the significant bipartisan interest we enjoy in expanding our nation's commitment to effective drug treatment programs and research. The President's FY 2003 Budget includes an overall increase of $224.2 million for drug treatment programs. The following are key highlights that will begin an unprecedented effort to heal America's drug users:
- Targeted Capacity Expansion (TCE) Program: +$109 million. This additional funding will help to expand the Treatment TCE program, which is designed to support a rapid, strategic response to emerging trends in substance use. Included in this proposal is $50 million to be used for a new component of the TCE program. This new component would be structured to reserve funding for state-level competitions, weighted according to each state's need for treatment services.
- Substance Abuse Prevention and Treatment (SAPT) Block Grant: +$60 million ($43 million drug-related). This increase in the SAPT Block Grant will provide additional funding to states for treatment and prevention services. States use these funds to extend treatment services to pregnant women, women with dependent children, and racial and ethnic minorities.
- Residential Substance Abuse Treatment (RSAT): +$7 million. This enhancement will expand total funding for the RSAT program to $77 million in FY 2003. The RSAT program is a formula grant that distributes funds to states to support drug and alcohol treatment in state corrections facilities.
- Drug Courts: +$2 million. These additional resources will expand total funding for the Drug Courts program to $52 million in FY 2003. This program provides alternatives to incarceration by using the coercive power of the court to force abstinence and alter behavior through a combination of escalating sanctions, mandatory drug testing, treatment, and strong aftercare programs.
