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Do Drug Addiction Treatment Programs Work?

There are over 19 million drug addicts in the United States, and yet at any given time only three million are in drug treatment programs. Why is that?

Part of the reason is that drug abusers take a long time to decide to enter treatment voluntarily. According to one government study, the average “decision” time is about seven years. The majority enter treatment because it is court-ordered or to avoid jail time. The vast majority of drug-abusing teenagers enter treatment for those same two reasons or because their parents insist on it.

Many drug addicts avoid treatment because they believe these programs will not really change their lives. They may have tried and failed. In the largest study ever done on drug treatment programs, about half the people in treatment were first-timers. The other half had tried an average of 3.5 times.

This does not mean that drug treatment programs are ineffective. According to a report in the Journal of the American Medical Association, drug treatment programs are just as effective as treatments for chronic diseases such as asthma, hypertension, and diabetes. The cure rates were about the same for all these chronic diseases, including drug dependence. Indeed, one recommendation of this study was,”Drug dependence should be insured, treated, and evaluated like other chronic illnesses.” This study concluded that whether or not people recover depends on whether they follow their doctors’ advice. The problem is that about the same percentage of drug addicts as those with other chronic conditions do not follow medical advice and therefore do not recover.

The U.S. government completed the largest study ever done on the effectiveness of drug treatment programs in 1999. The Drug Abuse Treatment Outcome Study or “DATOS” involved interviews of over 10,000 people as they entered drug centers. The clients were 66% male and 47% African-American with a median age of 33. They were re-interviewed a year later and then again after two years from starting treatment.

DATOS used three measures to determine how effective treatment was: 1) Was the person employed or in school? 2) Did the person have suicidal thoughts? 3) Did the person still use drugs?

The DATOS researchers found that drug addicts who stayed in treatment the longest had the best outcomes. For example, those who remained in a long-term care unit at least three months and those who stayed in methadone outpatient treatment at least a year were more likely to be drug-free at the end of the two-year study. Those who quit too early were more likely to go back to abusing drugs, feeling suicidal, and being unemployed. Retention in a drug program depended partly on its quality. Programs that offered a wider range of services and counselors who formed better relationships with their clients tended to retain more people in treatment. Those clients who were more highly educated, had private health insurance and better jobs tended to do better in treatment. People who had anti-social personality disorders did not fare as well, no matter what their socio-economic status. However, people with other kinds of psychological problems, such as attention deficit disorder or depression, did as well as others in the programs.

The DATOS researchers concluded that operating drug treatment centers saved the government money by reducing crime and unemployment. For every dollar spent in methadone clinics, the return was between $6 and $7. Although long-term care centers are expensive, the DATOS researchers estimated that the government saved $10,344 per client, mostly by reducing robberies, forgeries, and other crimes.

The DATOS studies are more than ten years old now, and much has happened to improve drug treatment programs since then. We know that some counseling techniques work better than others. We have better medications to keep people comfortable during detoxification. We know that relapses and start-overs are a predictable and normal part of recovery. We understand the importance of building good support systems for people before they return home. We realize that many people have to remain in groups like Narc-Anon for years to maintain sobriety. Today’s drug treatment programs are better and more effective than ever. If the people enrolled in them follow the advice of their medical professionals, then they can and do recover.