The Division of Behavioral Health Colorado Department of Human Services submitted the following report on October 31, 2009.
"The Costs and Effectiveness of Substance Use Disorder Programs in the State of Colorado
The opening page of the report is as follows:
Addiction begins with casual use.
The consequences of alcohol misuse and illicit drugs are the single greatest drain on state budgets.
(Excerpt from Blueprint for the States: Policies to Improve the Ways States Organize and Deliver Alcohol and Drug Prevention and Treatment, Findings and Recommendations of a National Policy Panel, by Join Together, 2006)
Researchers say addiction may require lifelong management. Addiction shares many characteristics with other major chronic diseases such as hypertension, diabetes and asthma. For example:
•Genetics play a role • The medica limpact on the body is significant • Complications develop if the disease is untreated • Self-care is critical to success •Medication can help.
(Excerpt from McLellan, Thomas A., and David Lewis, Charles O’Brien, and Herbert Kleber. “Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcome Evaluation.” Journal of the American Medical Association (JAMA) 284, no.13 (October 4, 2000) 1689-1695.
Addiction fits the U.S. Centers for Disease Control and Prevention definition for chronic disorders.
They are prolonged, lasting for at least 3 months, do not resolve spontaneously, and are rarely cured completely. Even so, addiction treatment is less available than treatment for other disease.
(Excerpt from Unforeseen Benefits: Addiction Treatment Reduces Health Care Costs, Closing the Addiction Treatment Gap, by Open Society Institute, July 2009.)
The Executive Summary states the following:
Substance use disorders in the State of Colorado are a significant health, social, public safety and economic problem. Prevention and treatment are crucial public safety measures.
• Substance use disorders continue to be a problem in Colorado, although rates of use have declined since 1979 because of prevention, treatment and enforcement.
• Prevention and treatment are effective in reducing the amount of substance use disorders in Colorado. A substance use disorder is a preventable behavior and addiction is a treatable disease.
• It is more economical to prevent or treat a substance use disorder than to deal with its impact on the individual or society.
• Resources to provide substance use disorder prevention and treatment are limited; the problem far outpaces the resources.
• Incarceration alone is an ineffective and costly way to control drugs.
• Treatment not only saves lives, it saves money.
The Summary of the Treatment Outcomes is as follows:
• Clients and their addiction counselors work together to develop individualized treatment plans, which identify goals clients wish to obtain from their treatment. At time of discharge, counselors and clients assess progress made toward these goals. Sixty-one percent of clients discharged from substance abuse treatment had moderate to high achievement of treatment goals.
• Perhaps the most critical measure of substance abuse treatment success is the change in frequency of drug use from admission to discharge. In FY09, there was a decline from 48% to 19% (admission to discharge) in the proportion of all treatment clients reporting any substance use in the previous 30 days.
* Comment: (This is including outpatient rehab as well, but it is our contention that clients in a program should have close to 0% [Admission to discharge] substance use. We have programs that can document less that 19% substance use level post-discharge)
• Overall the severity of problems or issues with family, socialization, employment or school and medical or physical problems was reduced at discharge.
• Decreases in DUI/DWAI and other arrests.
• Decreases in medical hospital visits and medical emergency room visits. Clients with one or more psychiatric emergency room visits and one or more psychiatric hospital admissions in the prior 6 months decreased from admission to discharge.
• Decreases in medical hospital visits and medical emergency room visits. Clients with one or more psychiatric emergency room visits and one or more psychiatric hospital admissions in the prior 6 months decreased from admission to discharge.
Editorial Comment:
This report is based on programs that continue to accept the premise that addiction is a "disease". If you look at the outcomes, you will see that they are far from what one would expect from most other diseases. We contend that this model of treatment has been proven to be ineffective and costly, both in dollars, lives and causing the public to believe that "nothing can be done to help". It is unusual for us to talk to individuals that have 5 to 10 previous treatment failures. These people have been convinced that their problem is the result of a chronic and progressive disease and they will continue to live a life of relapse. Needless to say, when they do an effective rehab, they feel that they have been "born again" and their thankfulness is a benefit to everyone.
Admittedly, there are some points that are certainly worth attention, but Colorado Drug Rehab staff are aware of programs that end this "disease" and the consequences are much greater than what is quoted by this state report.
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