Trinity Broadcasting Network’s “Public Report”: Interview of General McCaffrey, Dr. Karlin, and Joan Bunnell
Transcript of Seattle/Tacoma Trinity Broadcasting Network’s “Public Report” interview of General McCaffrey, Dr. Karlin, and Joan Bunnell on November 9. 2004
GP (George Pettingel, Host): Good morning, and welcome to Public Report. I’m George Pettingel. Now, listen to these figures: 50,000 people die every year across the US because of drug-related causes. Isn’t that fantastic? Fifty-thousand. Or how about this one: Over $276 billion are spent annually by us, the tax payers, because of drug problems. Here in the state of Washington, $2.5 billion are spent on drug programs or other causes-crime, what have you. We’re facing a war. Not a war in Iraq, not a war on crime, but a war on drugs and drug addiction. We’re going to talk about that this morning with a panel of very distinguished people. I’m going to start with the General, General Barry McCaffrey. Welcome to the program.
BRM (Gen. Barry McCaffrey): Very good to be with you.
GP: US Army retired.
GP: Next to you is Dr. Barry Karlin. You own a company, we’ll get into that in just a moment, that has treatment programs all over the country for drug addiction.
BK (Dr. Barry Karlin): Right.
GP: And then, next to me, Joan Bunnell. Did I say that right?
JB (Joan Bunnell): You said it right.
GP: You’re program director of Lakewood Treatment Solutions Program, also of a program in Federal Way.
JB: Yes, right next door.
GP: Where we’re located. Welcome, all of you, to the program. General, I want to start with you. You have spent your career as a military man. You have been in wars; you’ve been on the fronts; you have been very concerned with national security. Now, why did you ever get involved in drug programs?
BRM: Well, I darn sure wasn’t a volunteer!
GP: Someone volunteered you!
BRM: Well, I’ll tell you what happened. I was in Latin America; I was a four-star joint commander of our military operations in the South, and I was very heavily involved in drug interdiction programs. President Clinton, at the time, was not doing too well in the polls, it was his first term in office, and they went after me to add someone with credibility as a planner, as somebody who would be energetic on it. I told them, “No,” so they started working on my, and finally, my dad said, “Hey, shut up and do what the President told you to do!” And that’s how I ended up as Drug Policy Director.
GP: That’s how you did it and ended up as Director of the White House Office of National Drug Control Policy for five years.
BRM: Yeah, that’s right. And to be blunt, it was the most important thing I ever did in my life. We’ve got sixteen million of us, as Americans, who are chronically abusing either illegal drugs or alcohol- alcohol being probably the most dangerous drug in America. Some of the things we tried to do while I was in office were to focus on children. You have to go to your 6th-12th graders and do something to get Mom and Dad, the pediatrician, the minister, you know, the coaches, the people who are important in a child’s life to tell them that we don’t use drugs. Now, the problem that Dr. Karlin and I are now working on, and Joan, as a clinic director, is what do you do about those who are chronically addicted? And, thankfully, there is something we can do about it.
GP: What was the drug situation like nationwide when you became Drug Czar, and what is it like now?
BRM: Well, it was getting worse among adolescents, and that’s what concerned us. You know we tell people: You want to understand what the drug problem will be like in Tacoma, Seattle, Yakima? Look at your eighth-graders. If drug use is going up-and that means smoking pot, binge drinking beer, and using “X” [ecstasy]-then look out ten years, and you see the face of your problem. The problem in ’96, when I took office, was that there was a sharp spike in adolescent drug use, and that’s what had everybody concerned. Now, you back off the problem, and you say, “Look, the worst here in America was 1979 when 14% of citizens were past monthly drug users. Now it’s down to 7%, so it’s clearly gotten better, but, as parents, as professionals in the workplace, it’s a problem to be reckoned with.
GP: And it’s never going to be over with, and people are never going to be satisfied until we do something that really eradicates the problem.
BRM: Well, that’s right. So the most important thing to do is deal with your children. But also, CRC Health Group now, we’re here in the state of Washington, we’re about to have five of these treatment clinics and try to address the problem of chronic addiction. So your viewers, if one of their children is involved in this program, or an employee, or an Army buddy, or a friend, help is possible.
GP: You’re from the state of Washington. That’s right?
BRM: Yes, all three of my kids are UW grads. I wrote checks to UW for twelve years, George, I belong in this state.
GP: You sure do. Okay, we’ve talked about the national drub problem, now what’s the drug addiction problem in the state of Washington?
BRM: Well, Joan, who has fifteen years as a professional, knows all about it. Methamphetamine abuse, heroin, and cocaine, are all prevalent in the state. More than eight hundred labs last year were taken down in this beautiful state we live in. It’s a huge problem; but again, don’t focus just on the adult addict. What we really should be worried about are our children. To what extent have we created and environment in our families and our schools where we tell our kids, “Look, we don’t use drugs. Therefore, neither do you.”
GP: That’s right. They follow our lead, don’t they?
BRM: Sure, absolutely.
GP: Okay, this is one of those hypothetical questions: If you could be Drug Czar of this nation all over again, would you proceed any differently?
BRM: Well, we did a lot of the easy things first, and it’s easy to talk to America’s parents and employers to tell them prevention programs and education programs are important, and it’s easy to deal with America’s law-enforcement community. We expect to have high integrity, courageous law-enforcement officers. So those points I’d put over there. What’s important to me now is the kind of work Joan’s doing, and CRC. How do we get families to come in with their loved one who’s chronically abusing drugs and do something about it? And that’s why Dr. Karlin and I are grateful to be on this show, to make that message unmistakable: There is something we can do to get your loved one into sobriety and maintain it.
GP: We are working on the problem and things are getting better and things are looking better, aren’t they? Dr. Karlin, let me talk to you. You formed an organization, you co-founded CRC Health Group. Tell us what that is.
BK: CRC Health Group at this point is the largest provider of treatment for chemical dependency in the United States. We have about eighty-three facilities in twenty-two states across the country. Its origin is a little unusual. In all candor, I knew nothing about chemical dependency when I founded the company back in 1995. I was in the corporate world of high technology and one day I got tired of that-the idea that I’d wake up when I was eighty years-old and look back at my career, and I could say, “Gee, I helped some giant corporation make another billion dollars.” It just didn’t seem to be what my life was about. So totally serendipitously, a friend of mine said to me, “There’s a chemical dependency facility near Waterloo for sale.” I said, “Well, what kind of chemicals do they manufacture?” I had never heard that term. I had no idea what the term even meant. So I went down, looked at the facility, and that day changed my life. What happened is I made three observations. Number one, the people who were there, the patients, alcoholics and drug abusers, looked like regular people. I had this vision based on the movies of the typical alcoholic or drug abuser was a drunk lying down in the street which, of course, is totally fallacious. That’s not the real world. The second thing is the counselors; there was a passion about what they were doing. You could feel it. It was amazing. It was an amazing experience, and I remember walking away that day from the facilities saying, “These people are doing something important-something that matters,” and so I walked away and said, “I want to get involved. There’s a chance for me to do something in my life that one day might make a small difference,” and I think that’s what it was; that’s what we all try to do. So I bought my first facility in 1995. Since then we’ve grown very rapidly acquiring, let’s see, another eighty-two facilities, and the fundamental goal is to provide a comprehensive treatment program designed ultimately to allow a person to go to a treatment program and get treated in their totality. They look at you as a whole person and say, “Let’s understand all the different components of your disease, understand a comprehensive treatment program designed to help you lead a better quality life and put in place a treatment program to help you live a better quality life. That’s ultimately what CRC is about. So whether it’s a methadone clinic or buprenorphine, or residential or outpatient or online counseling, slowly but surely, we’re trying to put together a comprehensive, continuous spectrum of treatment programs which together allow us to individualize treatment and help a person lead a better quality life.
GP: And the people who work for you are making a difference.
BK: Absolutely. You know, this is a disease, and General McCaffrey gave you the numbers. Nineteen million people in the US right now, do not get treatment who need treatment. By the way, when it comes to the numbers, there is no shortage of numbers. In this the Department of Health and Human Services, SAMSA, and other federal agency that General McCaffrey was a key force in building up, publish studies all the time, but here’s the one line: Three million get treatment, nineteen million don’t get treatment who need treatment. The key is you’ve got to put in place new delivery mechanisms-new ways to get people into treatment. That works. It’s that simple. Every study that’s been done, and there are a lot of them, says that for every one dollar you spend on treatment, society waves anywhere from seven to eleven dollars. That works.
BK: Treatment works. The key is you’ve got to make it accessible; you’ve got to make sure that it lasts forever.
GP: You mentioned stereotypes that I have also. I think of a drug addict as someone who is lying on the street drunk or is sticking a syringe, a needle, in is
arm, and they’re the lowest dregs of society.
BK: That’s not true.
GP: Joan, I have to ask you this one because you work on the street with these people all the time, and I have to ask you: what is a typical drug addict like? What do they look like? Who are they?
JB: They look like us. They look like us. Most definitely. That is a misperception that they are needle-injecting white males who are sickly or criminal behavior associated with it. That’s long gone, long gone. Our new face of addiction is the younger generation. Eighteen to twenty-five is our fastest-growing population. Also, prescription pain pill abusers are one of the fastest-growing populations, particularly Oxycontin.
GP: I was going to ask you about that. Oxycontin-that’s one of the drug choices today-it’s the drug of choice today.
JB: Most definitely. Easy access, lots of people using, even the old addicts from twenty, thirty years ago who are injection users are complimenting their injection drug use with Oxycontin.
GP: Is the use of prescription drugs becoming a major problem?
JB: Of, definitely, especially over the last five years. It started out four to five years ago, the last few years, and especially the last two years have really seen a change. That’s what we get the most calls for.
GP: How do you treat a person who uses prescription drugs and abuses them? Is it different treatment than the regular morphine addicts from the past?
JB: There are several aspects of treatment. An opiate’s an opiate’s an opiate. So what we do at CRC in our clinics up here right now is our opiates specialty division treats with medication-assisted treatment and counseling. So we use the buprenorphine and also the methadone.
GP: OK. That’s the key word: buprenorphine. I have to ask you about that. I’ve never heard of that. What is bupreï¿½ I can’t even say it!
JB: You said it before.
GP: Buprenorphine. What is it?
BK: It’s a drug that was approved last year by the FDA with extensive clinical trials. Just like methadone, it’s used to treat opiate addiction.
GP: But how does it work? How is it different from the traditional drugs?
BK: All drugs have certain characteristics. Buprenorphine is known as an agonist, which has certain advantages, and in particular, it works particularly well with some populations which have certain characteristics. For example, people who are not yet chronically abusers of opiate drugs can do well with buprenorphine. It helps minimize withdrawal symptoms during detox. So there are certain kinds of treatment protocols for which buprenorphine happens to be a very effective drug. It’s not a replacement for methadone. Methadone is a wonderful drug. It’s strange, methadone has a stigma which is entirely unwarranted which is a tragedy because methadone is inexpensive; it really works. You go in for your daily dose, you take your methadone, and for the next twenty-four hours, you will experience no cravings, you will live a normal life. But buprenorphine addresses certain populations for which methadone is not necessarily well-suited. So what it does, its impact on society is that some people for whom methadone is not appropriate can use buprenorphine, and people who otherwise are unable to have access to a workable solution now have a potential solution. It’s another tool in the armor that we can use, that we can deploy to make a dent in this treatment problem.
GP: Here’s another tool, and I think you use this one, too: eGetgoing. What is that?
BK: eGetgoing, a topic close to my heart. I have a passion for eGetgoing. I established it about four years ago. Here’s what happened. I looked around and said “19 mil people don’t get treatment? This is unbelievable! How is that possible?” So I sat down with my intake department counselor, and said, “Look, for every five or six calls we get to a typical residential center only one person is admitted. That, by the way, is true to the nation as a whole. Why is it that eighty percent of the people who call a residential program do not get admitted for treatment? The answer is always the same: number one, affordability. They can’t afford residential treatment.
GP: They can’t afford it. It costs money.
BK: You don’t have insurance coverage, you don’t qualify for public reimbursement, you aren’t rich enough; you’re out of luck. Problem number one. Problem number two: anonymity a great many people b/c of the fact that when you go to a residential program, people can see you, are concerned with problems of anonymity. You’re a pilot, you’re a physician, you’re a teacher, you’re a housewife with the PTA.
GP: And if you’re missing, someone knows about it.
BK: Exactly. So privacy is a big issue that prevents people from going into treatment. Denial, a lot of people are just in denial. If they know they need treatment, I don’t want to go there. Lack of capacity-a nationwide shortage of adolescent capacity. And, by the way, it all starts when you’re an adolescent. If you make it to the age of twenty-one without having a problem with drugs or alcohol, you have a ninety-seven percent chance for the rest of your life, you will not have a serious problem.
GP: Well, that’s what Doctor [General?] McCaffrey pointed out. It starts with the kids. We’ve got to stop it at that point.
BK: So in thinking about this, I said, “What we need is something different; we need a new delivery vehicle. Instead of requiring the patient to come to us, we need to take treatment to where the patient is at.
GP: Now, how are you going to do that?
BK: Technology, the Internet.
GP: The Internet?
BK: The Internet, yes. The way that eGetgoing works is this: the basic idea is simple-to emulate, as closely as possible, the way that a typical outpatient program would work. Except that it’s happening live using online audio and video over the internet. So, you conduct a group session, ten people, sitting in their rooms at a regular computer, they can all see the counselor live on their computer screen.
GP: They’re sitting in the privacy of their own homes, contributing to a discussion over the internet.
BK: Exactly, so you have full audio in both directions just like a teleconference; they can see the live counselor, and of course, the wonder is that there’s all kinds of tools because of the computer power that you can take advantage of. Things like private email messages to your counselor in the middle of the session, white boards, and so forth. The result of this is thatï¿½ two big impacts. Number one: the potential increase in the number of people who have access to treatment, and number two: the ability to provide continuing care. When you come out of a structured program, an official program, this gives you a way to stay connecting to your counselors indefinitely, reducing relapse rates.
GP: So does this program work?
BK: It works.
GP: It sure sounds like fun, and it’s private, but does it work?
BK: We’re very excited, and I’ll share with you some data. We’ve now have had six hundred patients go through the program, fifteen thousand individual sessions overall. To give you three statistics, completion rates: eighty-one percent of people who enter the program complete the program, versus forty percent for traditional outpatient. By the way, the completion rate is probably the single most important statistic for determining long-term sobriety. Satisfaction: one hundred percent satisfaction of people who have completed the program. Quality of life: there are various measures used to measure quality of life. Ninety percent improved their quality of life. When you actually compare the stats, to traditional programs, they are superior. Now that is not to say that we’ve conducted controlled, double-blind, scientific studies; that takes time. But all the initial data is very, very encouraging. To quote one particular psychiatrist, he said, “Barry, on a scale of one to ten, I don’t know if this is a nine or a ten or a five, but I do know it’s a lot better than nothing.” And so, we’re very excited. I think it’s one more example of an innovative tool. It’s not a substitute for traditional treatment, it’s an enhancement; it’s a tool, which will help, again, to make a dent in the treatment problem.
GP: Joan, in your work, as a program director of a local treatment center. You use chemicals, I suppose, to treat your patients. Do you also use eGetgoing?
JB: Actually, right now, we anticipate that coming to our new Tacoma program, and currently it is in the Federal Way program, nearing the end of the training period, to be up and running real soon.
GP: Very exciting.
JB: Very fascinating.
GP: And it is using cutting-edge technology. Any means you can use to get help to these people, you want to do, don’t you?
BK: Yes, and you know what is really exciting is adolescents? We were told by adolescents early on, see adolescents love the Internet. They’re comfortable with the Internet, they’re used to it, and when adolescents are going online and getting treatment online, it’s a nice thing, it’s a fun thing to do, it’s entertainment. And with adolescents, a big part of the whole attack on the drug problem is prevention, education, and intervention before it becomes a serious issue. And that is why the Internet, again, is so powerful. We have a variety of products designed to work with the adolescent prior to the treatment phase. Also, it gives the schools the ability to do things like assessments and so on, and so lots of potential in a multitude of directions, so we’re very excited. It’s something we think that can transform the way treatment is delivered.
GP: Yes, yes. You’re smiling. Now you’re familiar with this program.
BRM: Yeah, I think it’s marvelous. You know, the first thing we worry about is relapse. We can get people in treatment; detox them practically in a couple or three or four or five days. We can put them in two, three weeks of residential care, but we’ve got to get them back to their family and keep them sober a day at a time. This computer based health care delivery system can do that. George, you put your finger on it; it’s fun to do, particularly for adolescents. A lot of peopleï¿½
GP: Now, let me interrupt I’ve got to tell you this: I looked at the website, I brought it up, and I thought: I want to do this! And then I said, “Wait a minute, I’m not a drug addict!”
BRM: We can do it Spanish, in an Indian dialect, with the Native American population, you can do it in rural communities, and I think the other thing we do-it’s not a substitute for residential care-but it does allow people to come into treatment who are a little bit scared about walking up to the door of Joan’s facility. So there’s a lot of promise in it.
GP: When you were Drug Czar, you used ad campaigns. Did they work?
BRM: Sure. No question. What we tried to do is communicate, particularly with youngsters, from the eighth to the twelfth grade in language that was relevant to them based on scientific observations. So if you tell a twelve year-old, “Don’t use drugs and marijuana because you’ll get lung cancer,” they say, “That’s at age fifty; I’ll never be that old.” But you can say, “Look, don’t use drugs. Your mother will be ashamed of you. You’ll get pregnant. You’ll look foolish. You’ll get thrown off the football team.” So you’ve got to communicate with people in a truthful manner but in ways that are relevant.
BK: One of the techniques of eGetgoing that addresses the early issue is that we have video vignettes, they’re two minute segments and they’re showing real life situations with adolescents, and with adults for that matter, showing the consequences of what happens if you take drugs or alcohol. So for example, there might be a party scene where you have a party with a bunch of teenagers and they’re all drinking and taking drugs. And then in the vignette you see the consequences of that action or that behavior where the teenagers end up lying in the street, hit by a car, you know; bad things happen. You play the vignette online, people are engaged, and they’re entranced when they see it. Then they have a discussion as well; do you want to be that person? Look what happens. So you get an opportunity to visualize, using professional actors, the consequences of that kind of behavior. It’s one of the many tools that’s available to us because of this kind of technology.
GP: Yeah, OK. This is a cutting-edge kind of thing that you’re doing with this program. I want you to look into the future even a little bit further, if you would. If you had unlimited resources, and you could do whatever you wanted to do, what would you do in terms of drug addiction treatment that we’re not doing now?
BRM: Well, part of it’s a matter of scale for gosh sakes. You know we’ve got this scale. Most of us don’t use drugs. There are 290 million of us. We don’t abuse alcohol. Most of us, thankfully, don’t smoke cigarettes anymore. But among those who do, let’s use fifteen million as the figure, we need to do more. So it’s not good enough to have five facilities here in Washington. Before we’re done with this we need to reasonably offer care to everybody. Now one of the things, George, that I’d be remised if I didn’t say, particularly on this program is part of it’s technology, part of it’s a twelve-step process, part of it’s asking for support from a higher power. If you’ve never been to an Alcoholic’s Anonymous meeting, an open meeting, your viewers ought to go. It’s an incredibly powerful experience, and part of that is to understand that there is a spiritual dimension to recovery, and it’s something we’ve got to talk about and understand, and reach out to people with.
GP: Uh-huh. And I’ve got to ask you this; I’ve only got a few minutes left. Faith-based programs tend to work, whether it’s alcohol or drugs or whatever, they tend to work, don’t they?
BRM: They do.
GP: But why doesn’t the government use those programs? Fund those programs?
BRM: Well, actually, I think President Bush has done a lot of this. And he’s tried to reach out to these communities. And, you know, I’ve been to a lot of these programs: Baptist programs, Jewish programs, Catholic programsï¿½ And adding this spiritual dimension to recovery is an important tool. But you’ve got to be careful of: dealing with the federal government isn’t necessarily a good deal. And so a faith-based organization, sometimes you want to retain the unique characteristics of having people in the delivery system who are good Baptist boys and girls, or Catholics, or whatever. And so we got to be careful how we do this, but the power of faith is an important tool, and you’ll find it in CRC Health Groups also.
GP: Is that component involved in this?
BK: Absolutely, almost all twelve-step based programs are going to have some kind of spiritual component to it, in varying degrees, some more so than others. It’s really a function of the local community, one of the characteristics of the patients that might be at that facility, so it varies quite dramatically. And some programs are Christian-based all the way to the secular programs, there’s a wide variety. But we embrace, as an organization, we embrace all forms of treatment as long as they work well, as long as there’s evidence that the approach used by the facility concerned is efficacious, that it has good results, then we embrace it. Faith-based programs are a part of that. There’s no question about that, and in certain parts of the country especially, they’re very strong, they’re effective, and we support those. For me, the notion of faith-based program is part and parcel with the spectrum of treatment that’s out there to the extent that the government supports those programs. I think that’s tremendous, it’s very positive. And that’s something, to me, that’s just part of the landscape.
GP: I’ve got one minute left. Half-an-hour goes by too quickly, there’s just too much to discuss. It would take hours and hours to talk about all of the ramifications of what we’re talking about here. But I want to give each of you a chance. What do you want to impart to our viewing audience as a challenge or a word of information. What do you want to leave with them? Joan?
JB: I would leave with: treatment’s available, it is the answer, it does work, there’s hope, there is a way to get help for your loved one or yourself.
GP: That was short enough. Good. General?
BRM: Leave the kitchen table, go get on the phone, and deal with your loved one by getting them into treatment. Treatment will help. Recovery is possible.
BK: What can I say? Same thing. They stole my thunder. Treament works. Get on the phone, make a phone call, get help. It’s that simple.
GP: Be concerned about our young people? About your children? About your neighbor’s children?
BK: Keep an eye on your kids. See what’s going on in their lives, and when there’s something amiss, call us.
GP: OK, I like that. I want to thank you all for being here today. I wish we had more time. What a wonderful thing you’re doing. Thank you, you’ve been on the national scene, and now working locally, that’s great. General McCaffrey, US Army retired, and Dr. Barry Karlin, thank you so much. And Joan Bunnell, director of the Lakewood Treatment Solutions, thank you for being with us today. I really enjoyed this. Thank you for being with us today, I hope you found this instructive, you have a great day.