Conclusions—The Likely Results of More Treatment

If the expansion of drug treatment follows the already dominant model of substance abuse treatment created in the case of alcoholism, then the results of changing drug policy to emphasize treatment over punitive approaches to substance abuse will be at odds with the goals of most drug reformers. The actuality would seem to differ from the intended in the following ways:

1. While the goal of "harm reduction" for reformers focuses on the provision of greater social services for the extremely addicted individual with few social and economic resources, the greater availability of alcohol treatment in the U.S. has apparently led to the reduction of social services for this group. As a result, homelessness among such drinkers has increased. It is as though treatment substituted for providing external services for these individuals.
2. The fact that alcohol is a legal drug has in no way lessened the influence of strongly moralistic traditions of American thought which disapprove of intoxication, emphasizing abstinence and the need to avoid intoxicating substances in even moderate doses. Thus, the drug reform goal of greater recognition and acceptance of controlled drug use will not be served by expanded drug treatment. Rather, to judge from the alcohol treatment experience, expanded treatment lowers the threshold for the level of drug use and problems thought to require treatment, and accepts abstinence as the only successful outcome of treatment (although efforts to introduce moderate drinking treatment in the U.S. have begun to make very slight inroads).
3. Even with a substance like alcohol, where use of the substance is not itself illegal, treatment has become increasingly coercive. Therefore, the hoped-for consequence of offering more treatment for drug abusers will not eliminate, reduce, or even reverse the expansion of coercion into drug treatment.
4. The idea that shifting from a law enforcement to a treatment model will not actually increase the freedom of ordinary Americans who use drugs or the choices available to drug addicts seems a paradoxical and alarming consequence of drug policies meant to be more liberal and less punitive. Yet, the path in this direction is inexorable.
5. Despite the coerciveness and intolerance of American drug and alcohol treatment policy, the most alarming consequence of the expansion of treatment rolls is not the external imposition of views of alcoholism, but the willingness of so many people to accept and internalize these definitions of themselves as alcohol and drug abusers and addicts. This trend will accelerate with expanding treatment.

The expansion of treatment enlarges the number of people who feel they need treatment. These shifts in reported dependence symptoms are not because people drink or use drugs more or in more harmful ways, but because they believe they have less control over their drinking and drug use and over themselves. At the same time, they come to define more and more of their life problems in terms of their substance use. In the U.S. today, addiction is already the dominant paradigm for people to understand and deal with their problems. And when you are addicted, what you need is treatment (Peele, 1995).

Finally, despite all this greater treatment, we have no indication that addiction, alcoholism, etc., are declining. We have no indication when we examine community populations who experience treatment as it is actually administered en masse in the U.S. that treatment reduces substance abuse. Studies of community populations find that those with substance abuse problems who resist treatment in fact fare better; but if treatment is to expand, these people must be directed into treatment programs. Remarkably, substantial evidence from the most authoritative government sources indicates that resorting to standard American treatment is a risk factor for continued substance abuse.

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