Oregon Switch to Strength-Based Treatment

A huge majority of people who need treatment for ATOD (Alcohol, Tobacco, Other Drugs) problems don't want treatment, studies show. Dr. Westley Clark, keynoter at the counselors' conference in Burbank yesterday, got a big chuckle from the audience with this statistic. Practically everyone took it as proof that "denial is not a river in Egypt."

But maybe some of the people who reject treatment have a point. Maybe they've talked to people who've tried treatment and it didn't feel right. Maybe treatment made them feel powerless, and ashamed, and depressed. Maybe treatment made them feel like Bad People. And that was scary.

Dr. Karen Wheeler, addictions policy manager in the Oregon Department of Human Services, has been listening. She says that treatment shouldn't be a frightening experience, and it shouldn't make you feel more worthless than you already feel.

Wheeler has announced a new strength-based orientation for substance abuse treatment in Oregon. "We are telling state-financed treatment providers to stress people's strengths and resilience, not their symptoms and illness," she says.

"No matter how long you have been addicted, we believe you have strengths to overcome your disease. We believe in your recovery." Source.

In my opinion, Wheeler is on the right track. Seeing and working with the addict's inner power to overcome addiction is a basic tenet of the LifeRing approach. See How Was Your Week, Ch. 2, Sec. 2.4. Maybe if treatment makes you feel like there is something worthwhile inside of you, fewer people will reject treatment and more people will take advantage of it. Isn't that worth trying?

I look forward to learning more about how Oregon implements the new strength-based treatment philosophy.

Settings With the Highest Smoking Rates

BURBANK, CA: "There is probably no setting in the U.S. with higher rates of smoking than substance abuse treatment facilities and 12-step meetings, where 80-95% of people smoke." "A significant number of adult substance abusers start smoking while in treatment/recovery." -- From "Addressing Nicotine Dependence in Treatment," a presentation by Bruce Allen Jr., Joan Waddell, and Loretta Worthington (right), addiction treatment professionals specializing in nicotine cessation; at the annual addiction counselor's conference this afternoon in Burbank.

I know a hospital complex that takes up an entire city block. Nowhere in this block can you smoke, except on the deck of the addiction treatment program. I have met patients in this program who had never smoked, or who had given up smoking years earlier, and started or restarted smoking during treatment there.

This panel presentation marshaled a number of additional studies to show that alcoholics and addicts who quit smoking maintained their sobriety from alcohol and drugs more successfully than those who did not. There is more material on this topic here and here.

Dealing with Spiritual Abuse

BURBANK, CA: One of the workshops at the addiction counselors' annual conference this afternoon was Queers 101 -- What Every Addiction Counselor Should Know About Lesbian/ Gay/ Bisexual/ Transgender clients. The presenter, Joe Amico, had been booted out of his position as a successful senior minister of a mainstream Christian denomination when he came out as gay. He then became an addictions counselor, and has spoken and written widely about the topic.

Someone in the audience asked Amico to talk about the spiritual dimension of recovery for LGBT people. He said that many LGBT people had suffered what he calls spiritual abuse in the churches, in the form of sermons that brand homosexuality as a sin and tell queer people that they will burn in hell. As a result of such spiritual abuse, many LGBT people had extreme difficulty with the 12-step approach, riddled with God references as it is. Amico referred the questioner to an article Amico had written about the topic. Source.

Spiritual abuse is one more reason why it's important to have a secular option. No doubt one of the reasons why the LifeRing meeting at the LGBT Center in San Francisco is so popular is that LGBT people can work on their recoveries here without constant reminders of past painful religious experiences that filled them with shame and self-loathing.

On religious intolerance of LGBT people, read Elton John's statement with commentary, here.

"We are not 12-step sponsors for pay"

BURBANK, CA: H. Westley Clark, M.D., J.D., M.P.H, director of the Center for Substance Abuse Treatment of the federal Substance Abuse and Mental Health Services Administration (SAMHSA), gave the keynote at the annual addiction counselors' conference in Burbank this morning. In the course of reviewing the high rate of turnover, the low level of educational preparation, and the low pay scale in the addiction counseling profession, he said that some people are confused about what counselors do. "We are not 12-step sponsors for pay," Clark emphasized. "I love 12-step programs but we are not. We are driven by state of the art knowledge in a very complex field."

The remark drew vigorous applause from maybe a third or half the audience of several hundred addiction professionals in the ballroom of the Burbank Hilton. The main reason for the low pay and the low esteem in which addiction counselors are held is the constant recruitment of 12-step graduates who see the job primarily as a service opportunity, work for peanuts, and bring with them little but their own experiences. A lot of people in addiction counseling are in fact no more than "12-step sponsors for pay," and this holds back the profession.

At the start of his Powerpoint presentation, Clark showed a photo of Pres. Bush with a sentimental quote about people helping people. As a high federal employee, Clark probably had to show such a slide. Not a single person in the audience applauded.

Admitting Alcoholism So As to Keep Drinking

I've had a running argument with people who think that labeling yourself an alcoholic is essential to getting sober. I agree, the label may be useful to get some people sober, but other people use the label as an excuse to drop out of recovery. Now here's another twist: a drinker who uses his alcoholism as a reason not to get into recovery in the first place.

Rapper DMX insists he can handle alcohol better than most of his peers, because he has alcoholism in his blood. The rap star, real name EARL SIMMONS, is famous for his love of cognac and he's adamant he can still function after downing glasses of his favourite tipple, while others just pass out. He says, "I have alcoholism in my blood, in my family. My grandfather died from drinking a fifth of vodka straight. It is no problem... I am a little drunk." But DMX insists his speedy metabolism stops him from getting drunk - as long as he keeps moving. He adds, "Once I sit my a** down, it's a problem. Source.

Bottom line: admitting that you're an alcoholic doesn't necessarily help you. Identifying yourself as an alcoholic can even delay your recovery, like in this example. What's essential is not the label, but the desire to stop drinking.

Nicotine "Most Addictive Substance"

"Nicotine is the most addictive substance known on this planet," Dr. Reichert said. "It is more addictive than heroin or cocaine, it's more addictive than caffeine, it's more addictive than anything." Reichert is lead author of a new study that finds smokers succeed more often at quitting if they combine behavioral changes with group support and pharmacological aids, than if they try to quit by will power alone. Source.

Drinking Speeds AIDS progression

Heavy drinking significantly speeds the progression of AIDS, research with primates suggests. Damage to the immune system is the probable mechanism. Source.

Parents Clueless About Kids' ATOD use

You suspected this? Parents are unaware of their kids' alcohol, tobacco, and other drug (ATOD) use about half the time. Parents are so clueless that it isn't even worth asking them, researchers say. That's the finding of a study released today in Alcoholism: Clinical and Experimental Research. Source.

Should Counselors Disclose Their Recovery Status?

Should addiction counselors disclose their own recovery status to their clients? Historian William White says that this issue has been debated for more than a hundred years already (Slaying the Dragon). The issue flared when I was a client at the Kaiser Permanente Chemical Dependency Recovery Program in Oakland in the early 90s -- some clients, probably egged on by an ambitious counselor, tried to split the staff over their personal recovery status.

The freshest thing I've read on the issue recently is by Jennifer Berton (right), ethics consultant for the California Association of Alcohol and Drug Abuse Counselors (CAADAC), writing in the otherwise somniferous September issue of the organization's newsletter. Among her points, in brief:

(1) There are great counselors not in recovery and lousy ones in recovery, and vice versa. What makes a great counselor is the level of professional training and a personal inner quality of empathy. (This point is supported by research cited in the Hester/Miller Handbook of Alcoholism Treatment Approaches.)

(2) If counselors insist that their personal recovery is a professional qualification or advantage, they divide the field of addiction recovery from all other areas of psychology and medicine, and lower the esteem in which it's held. A pulmonary surgeon doesn't have to be a lung cancer survivor; a psychiatrist doesn't have to have a history of hospitalizations for schizophrenia, etc. Colleagues in other fields tend to look down on addiction counselors as really just lay people reselling their own experience, not as trained professionals.

(3) If counselors practice disclosure at their workplace, they model workplace disclosure to clients. But workplace disclosure may not be at all wise for clients, depending on the circumstances. Workplace confidentiality may be a much more prudent policy.

Berton's much longer discussion is worth reading if you're interested in this issue either as a client or a counselor.

What if Teens Tell Their Own Stories?

Parents don't get much traction shaking their index fingers at kids about the dangers of drugs. Teens notoriously tune out when parents go into preaching mode. But what if addicted teens told their own stories? That was the strategy behind a town hall meeting in Oakland MI (Detroit area) organized by the Save Our Youth Task Force. Here's a report, source. No data yet on how well it worked, but the concept has plausibility.

Don't Hold Your Breath

The Lung Cancer Alliance, a nonprofit dedicated to prevention of lung cancer and support for its victims, has sent a letter to the Securities and Exchange Commission demanding that it take action against tobacco companies for secretly upping nicotine levels in cigarettes. Source.

A federal court in August issued a sweeping judgment against the tobacco industry for conspiracy, consumer fraud, racketeering, and related wrongs. Source.

The State of Massachusetts Department of Public Health followed up with a study showing that nicotine content in major cigarette brands had increased over the past six years. Higher nicotine content makes it easier to get addicted and harder to quit. Source.

The Alliance's argument that the tobacco companies committed fraud on shareholders by secretly raising nicotine levels has abstract merit. But tobacco company shareholders stand to profit from the fraud. And the SEC under Bush isn't going to upset the apple cart. Don't hold your breath on this one.

Anonymity: Outing and Inning

A book review in this week's New York Observer observes that there is a rash of books now hitting the market in which more-or-less prominent people out themselves as AA members. Source. Cases in point: reporter Tom Sykes, Hazelden exec William Cope Moyers (son of the media icon Bill Moyers), reporter Jason Leopold, author Augusten Burroughs, and a number of others who are, in reviewer Choire Sicha's phrase, alcoholics who are "anonymous no more."

Sicha astutely observes that this small deluge of addict memoirs comes in the wake of James Frey's A Million Little Pieces, a work that was not flattering to AA or to the AA-based treatment industry. Frey's blockbuster stayed on the bestseller lists for a long time despite (or because of) Frey's grudging admission that some key points were fictitious. (Remember, "there's no such thing as bad publicity.")

Sicha sees no connection between the negative impact of Frey's bestseller and the current crop of pro-AA testimonials. He thinks the books just respond to a perceived public thirst for more addiction memoirs. He naively quotes Bill W. 's bromides about anonymity and humility, as if these had anything to do with how AA really operates. It doesn't occur to Sicha that this crop of promotionals might be a kind of P.R. campaign to counteract the shadow that Frey's book cast over some sacred cows of American recovery.

If you're a lovable celebrity, and you got sober in AA, AA itself will "out" you. You will be invited to speak at openly or covertly AA events, the press will be there, and you will be quoted about your successful recovery from alcoholism thanks to a 12-step recovery organization that you can't identify but whose abbreviated name has two identical letters which happen to fall at the beginning of the alphabet. And since there might be readers who still don't get it, you might as well, in your memoirs, name its name. As long as you remain a lovable celebrity, you will get no static from AA for bending your anonymity into a pretzel, or breaking it outright. On the contrary, you'll be lionized and in demand on the AA speaker circuit, and Hazelden may publish you.

"Outing" is a useful word. We also need a word for the opposite process, namely cloaking someone's AA affiliation after they've stopped being a lovable celebrity and become a big ugly public embarrassment. Will "inning" or "re-closeting" work? The most recent case in point is Mel Gibson, who had been attending AA religiously since 1991, and used to be a big lovable celebrity whose AA membership was a matter of public knowledge. All that changed when Gibson was caught on Aug. 28 driving drunk and spouting sexist, anti-Semitic, arrogant, belligerent and obscene remarks. Definitely not lovable. Suddenly the American press stopped referring to him as an AA member, and his story was reframed as if AA participation would be a New Thing for him and would Make a Difference. I've written about this case earlier here and here.

Anonymity? Humility? Those are only for the losers. Sicha's book review is that of an acolyte who can't or doesn't want to see through the cloud of spiritual smoke in the cathedral. Shouldn't journalists writing about others who break anonymity come out of the closet themselves?

Congress One Big AA Meeting

“If we could turn Congress into one big A.A. meeting,” he said, referring to Alcoholics Anonymous, “where people would be required to say what they mean and mean what they say, it would be a lot better Congress.” -- Representative James Ramstad, Republican from Minnesota, quoted in the NY Times today. Source.

Oh, where to start?

If Congress were one big AA meeting:

• Floor debate would consist of canned monologues, Bible readings, and speeches full of cliches and slogans
• The members with the longest tenure would run the place
• Nobody in the country would know who's really making the decisions
  
• Nothing said in Congress would become public knowledge except if leaked through the rumor mill
• A good portion of those present would be drunk or hung over
• The members would proclaim that all their decisions were inspired by God
• Funding for secular programs would be cut and diverted to faith-based programs

Wait a minute! Maybe Congress already is one big AA meeting. The Times article quotes a source saying there's "a very powerful recovering community" (read: 12-step) in the capitol, and points to an informal caucus of about 60 unnamed representatives who lobby for legislation affecting treatment for addiction and mental health. Names outed: Ramstad, Rep. Patrick Kennedy (D.-R.I.), several former members.

For a religious take on this gem of a quote from Ramstad, browse to The World Views Blog

Make them Eat Dinner

"MOSCOW. Sept 19 (Interfax) - The Russian Interior Ministry is drafting a bill requiring mandatory medical checkups of teenagers detained by police for alcohol or substance abuse.

"The problem of adolescent alcohol and substance abuse remains as acute as before. In 2006 alone, more than 12,600 crimes have been committed by teenagers after drinking or drug use," Vladimir Golubovsky, deputy head of the Interior Ministry's Public Order Department, told the press in Moscow on Tuesday." Source.

Medical checkups? Dumb idea. They should be forced to have dinner with their parents instead. See below.

Blaming the Parents

Norman Rockwell created famous Saturday Evening Post covers showing families at dinner in small-town America. I always suspected that few of the teens at THOSE dinners ever smoked, drank, or used drugs.

Now comes Joe Califano, director of CASA, the National Center on Addiction and Substance Abuse at Columbia University, with a study that proves it. Teens (ages 12-17) who have dinner with their family five or more times a week are statistically about half as likely to use nicotine, alcohol, marijuana or other drugs as other teens. Source.

That factoid fits with Califano's theme that teen substance abuse is a parent problem. The drift of CASA's work is to put the responsibility on parents to solve the nation's ATOD problem. (ATOD = Alcohol, Tobacco and Other Drugs.) If kids don't start using before they're 21, chances are they never will.

But maybe it's not so simple. When CASA's researchers asked both kids and their parents WHY they don't have dinner together more often, only ten per cent of the kids and seven per cent of the parents said it was because they chose not to. Three quarters said their schedules -- mainly, work schedules and commutes -- didn't allow it.

So, picture mom and/or dad working two jobs, or working late shifts, or commuting long hours, all to provide a home for the kids in the current economic climate of declining real wages and growing income inequality. Parents are working harder and longer hours just to keep from losing the roof over their heads, and that doesn't leave a lot of opportunity for Norman Rockwell family dinners. Think of Drey's mom in the movie Half Nelson, working two shifts as security guard, including nights and weekends.

You just don't get a sense of the real world of parenting today when you read CASA's report. A little empathy for working parents wouldn't be out of place for Califano. It seems that it's been a very long time since he was Secretary of Health, Education, and Welfare under a Democratic president.

CASA's report might also ask why there is still such a significant proportion of users among teens who do have dinner with their family five or more times per week. CASA's report says 13 per cent of the family eaters have tried cigarettes, 32 per cent have tried alcohol, 12 per cent have tried marijuana, and similar percentages are using those substances currently. Why didn't the "magic wand" of family dinner (Califano's phrase) work with these kids? Would we consider the nation's ATOD problem solved if these were the national numbers?

Astonishingly, CASA's researchers didn't ask whether families consumed alcohol at dinner, or whether parents used nicotine or other drugs inside the family home. Isn't it relevant to ask whether parents are modeling ATOD use for children inside the home?

Making a policy issue of parents who drink, smoke, or use drugs makes sense. Blaming the national drug problem on parents who are working their hearts out to make ends meet in this economy does not.

Bush spends 2.2 Billion of Our Tax Money on Religious Programs that Lower Professional Standards

The Bush administration is now spending $2.2 billion (with a B) subsidizing churches and other religious institutions to run social programs. Source. That includes addiction treatment programs. On this, see my 2004 article, "Bush Taking the Ax to Recovery." "Faith-based" is a big business now, a handy label to get fat government contracts, similar to "homeland security." (If they really rely on faith, why do they need government handouts?) No professional training or licensing is required for staff in the faith-based treatment programs. Addiction counselor organizations such as NAADAC, who have been trying to pull up the level of professional standards in treatment programs, face a gut-punch from the religious competition, and it's all being done at public expense.

Ann Richards of Texas dies

Ann Richards, the former governor of Texas and an out-front recovering alcoholic, died Sept. 16 at age 73. Richards was one of the first political figures, if not the first, to demonstrate that you can be open about your recovery from addictions and win elections.

In the 1990 gubernatorial race, polls showed Richards trailing. An opponent told the press he hoped Richards wouldn't go back to drinking because of it. The remark offended voters and Richards pulled ahead and won the election.

"Among Richards' accomplishments as governor of Texas was to add 2,000 treatment beds in state prison, with funding for a total of 14,000 beds getting legislative approval. However, when Richards lost the governor's seat to George W. Bush, he slashed the program; today, Texas has just 3,250 treatment beds for prisoners." Source.

Richards later lost her shine as a recovery hero when she went to work as a lobbyist for the tobacco industry. But she is best remembered as the politician who won the respect of the voters by being open and up-front about her addiction and her recovery.

College Recovery Speaker Available

I wish she'd been around when I was in college:

Dr. Kitty Harris is available to speak to issues involving college student substance abuse and recovery.

Harris is director of Texas Tech University’s Center for the Study of Addiction and Recovery (CSAR), the largest and one of the oldest college recovery communities in the nation.

Texas Tech’s nationally recognized program currently serves recovering students from 20 different states. CSAR offers recovery and educational assistance to students in recovery from alcohol and drug addictions and to students in recovery from eating disorders.

Now preparing to celebrate its 20th anniversary, the center has grown to nearly 100 students and has utilized federal grants to develop a curriculum for creating recovery communities on other college campuses. Harris has overseen or advised on the development of recovery communities at schools such as the University of Colorado at Boulder, the University of Texas and the University of Texas at San Antonio.

Contact: Kitty Harris, director, Center for the Study of Addiction and Recovery, Texas Tech University, (806) 742-2891, or kitty.harris@ttu.edu.

Thanks for this info, Don Phillips. More here.

See also, College is a Slippery Place, in this blog

Tony Blair's Answer to Popular Discontent

Experts warn that Britain has gone from a nation "enjoying a harmless tipple" to one developing "a dangerous alcohol addiction". The researchers say that the average UK resident's life expectancy has been reduced by ten months for men and five for women, due to drinking. Source.

This story comes less than a year after Tony Blair's government pushed through a new 24-hour drinking law, scrapping Britain's decades-old regulation of pub closing hours. When the 24-hour law went into effect last November, a critic warned:

"Thousands of prominent doctors have gone on record as saying that this is crazy and will lead to a boom in health problems among young people .... Yet the Government seems determined to press ahead ... The pretext is set to give Police more power on the streets and allow them to take more liberties with people out after 9pm.... " Source.

Oh, and people will be too wasted to worry about Blair's policies in Iraq, Lebanon, Afghanistan, etc.

Choice a Hallmark of Recovery Movement

"One of the recovery movement's hallmarks is empowering people to self-direct their services. This allows people to make their own choices, develop self-esteem and self-confidence, and to become self-determining. This involves people's accountability to live up to their potential. This same level of accountability needs to be present in the structure [of the treatment program]." -- Lori Ashcraft Ph.D. and William A. Anthony Ph.D., "Factoring in Structure -- Recovery needs a solid foundation to take root," in Behavioral Healthcare, Aug. 2006, p. 17.

Client self-direction, making choices, developing self-esteem, self-confidence, and becoming self-determining ... exactly what the Recovery by Choice workbook is built around. And yes, for clients to be able to take this road, the structure of the treatment program must permit it and support it. You won't get this kind of recovery in a treatment program structured around the postulate that clients are too (choose all that apply:) stupid, crazy, dishonest, manipulative, in denial, etc. to ever make intelligent, pro-recovery choices.

Kids Smarter Than Parents About Drugs

Parents tend to be clueless about teen alcohol and drug use, and frequently allow drinking and drug use at parties they chaperone, says a survey conducted by The National Center on Addiction and Substance Abuse (CASA) at Columbia University.

• One-third of teens and nearly half of 17-year olds attend house parties where parents are present and teens are drinking, smoking marijuana or using cocaine, Ecstasy or prescription drugs.
• 80 percent of parents believe that neither alcohol nor marijuana is usually available at parties their teens attend. BUT 50 percent of teen partygoers attend parties where alcohol, drugs or both are available.
• 98 percent of parents say they are normally present during parties they allow their teens to have at home. BUT a third of teen partygoers report that parents are rarely or never present at the parties they attend.
• More teens name drug use as their number one concern than any other issue (27 per cent). Fewer than half of their parents (12 per cent) identify drugs as teens' top concern.
  

Joe Califano, the chairman of CASA, concludes that “Teen drinking and drugging is a parent problem. Too many parents fail to fulfill their responsibility to chaperone their kids’ parties." Source. True ... but let's give credit where it's due. Despite the "denial, self-delusion and lack of awareness of these parental palookas" (Califano's phrase), the use of tobacco, alcohol and drugs among kids is declining. Source.

Bottom line: Kids today look smarter about tobacco, alcohol and drugs than their parents.

The full CASA survey report is available here.

Study: Underage Drinking Vital to Industry Profits

Underage drinking is vital to liquor industry profits in two ways, says a recent study in the Archives of Pediatric and Adolescent Medicine. Underage drinkers are a $22.5 billion market for alcoholic beverages. Moreover, underage drinkers are much more likely to turn into heavy drinkers or alcoholics when they grow up. More than 96 per cent of adult alcoholics started drinking before age 21. Adults who abuse alcohol or are dependent on it are a $25 billion market for alcoholic beverages. These two categories together -- underage drinkers and adult alcohol abusers or dependents -- make up nearly 40 per cent of the market for alcoholic beverages in the U.S. The study authors say "the alcohol industry has a compelling financial motive to attempt to maintain or increase rates of underage drinking.”
A summary of the study was published by the Center for Substance Abuse Research (CESAR) at the University of Maryland in a weekly bulletin available online here.

Survey: College is a Slippery Place

In general, people with more education tend to go lighter on tobacco, alcohol, and drugs. To this there is one important exception: booze in college. The current national survey reveals that full time college students drink more often and more heavily than their peers. This finding has held steady over the past four years.

There is no similar gap for illicit drug use; it's about the same on campus as off. Cigarette use among full time college students is much lighter (30 per cent) than among people of similar age not enrolled full time, or at all (43 per cent). But alcohol use by full time students is a solid six per cent higher.

The survey did not ask whether the colleges in question had fraternities and sororities.

Survey: Teens Wising Up About Tobacco, Drugs

Fewer kids aged 12-17 are using tobacco, alcohol, and illegal drugs, according to a government survey released Sept. 7. Cigarette smoking in this age group shows the strongest decline, from 13 per cent to 10.8 per cent between 2002 and 2005. Illicit drug use dropped from 11.6 per cent to 9.9 per cent during the same short period. Alcohol use dropped about one per cent to 16.5.

That's the good news. The bad news is that one out of ten teenagers, more or less, is still using nicotine or illegal drugs and about one out of six is using alcohol. This, despite about 80 per cent of kids having been exposed to "anti" messages in or outside of school.

There's a lot more bad news also in the full report from the Substance Abuse and Mental Health Administration (SAMHSA), available online. National averages from all age groups showed no major changes. About 126 million Americans used alcohol in the past month -- 52 per cent, up a tick from last year. About 71 million Americans used tobacco in the past month, which is about 29 per cent, down a hair from last year. About 20 million (8 per cent) used an illicit drug, unchanged.

Addiction Treatment Behind Bars

The National Institute for Drug Abuse (NIDA) has followed up its groundbreaking "Principles of Effective Drug Abuse Treatment" (1999) with a similar work that addresses issues of treatment behind bars. Titled "Principles of Drug Abuse Treatment for Criminal Justice Populations" and available online, the report is worthwhile reading for anyone concerned with the huge number of people incarcerated in connection with drug and alcohol use.

NIDA's earlier report highlighted the importance of an individualized approach to treatment. Its number one finding was: "No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. "

What holds for addiction treatment on this side of the bars is also true on the inside. The current report says, as point five, "Tailoring services to fit the needs of the individual is an important part of effective drug abuse treatment for criminal justice populations. Individuals differ in terms of age, gender, ethnicity and culture, problem severity, recovery stage, and level of supervision needed. Individuals also respond differently to different treatment approaches and treatment providers." In other words, effective treatment behind bars requires much the same basic respect for individual differences as treatment anywhere else.

Notable also is NIDA's growing recognition of the importance of patient involvement. "Effective drug abuse treatment engages participants in a therapeutic process," the report says, which suggests that getting patients involved in designing and planning their own treatment process promotes therapeutic engagement.

Although NIDA stops short of recommending any specific treatment modality, its research clearly points toward secular and broadly behaviorist approaches. The report says, "In general, drug treatment should address issues of motivation, problemsolving, skill-building for resisting drug use and criminal behavior, the replacement of drug using and criminal activities with constructive nondrug using activities, improved problemsolving, and lessons for understanding the consequences of one’s behavior."

In an accompanying op-ed piece, NIDA director Nora Volkow makes a strong case that treatment for drug-abusing offenders is more effective than incarceration without treatment, and that effective treatment, if it were available, could make a major dent in the crime rate and in the prison population. Source. Needless to add, as incumbent head of a major government department (NIDA is a part of the National Institutes of Health which is part of the Department of Health and Human Services), Volkow is silent on the issue of fading federal spending for treatment, other than faith-based approaches (see earlier blog) -- policies that run directly counter to the research that underlies NIDA's report.