|
Page 2 of 11
An Opposing Position
Before accepting this position as irrefutable, let us look to the massive alcohol treatment industry in the United States for likely clues about where a grossly expanded drug treatment system would take us. Alcohol is, after all, legal, and presumably the only problem with alcohol use is when it becomes abusive, at which point treatment is the indicated response. This seems like the ideal towards which many in the drug policy field aspire. But we shall see that some key goals of drug reform are not in fact the likely results of making the shift to a policy like that followed in the United States towards alcohol.
Some of the goals of shifting from a punitive to a treatment-oriented drug policy are listed in Table 1:
Table 1. Goals of a Less Punitive Drug Policy
| Intended goal | Likely result |
| harm reduction |
warehousing, homelessness |
| wider choices in drug treatment |
rigid adherence to 12-step approach |
| less moralism |
zero-tolerance/moralism |
| accept controlled use |
treatment of casual users |
| greater personal freedom |
more coercive treatment |
| acceptance of drugs |
ambivalence around drug use, more self-labeling by users |
The Explosion in Alcoholism Treatment
The fate of alcoholism treatment illustrates how these likely results will come about. Table 2 depicts changes in alcohol treatment beds in the United States between 1978 and 1984.
Table 2. Changes in Alcoholism Beds 1978 - 1984
| 1978 | 1984 |
| Government |
10,240 |
10,458 |
| Not for profit |
4,952 |
11,520 |
| For profit |
813 |
4,003 |
| Total |
16,005 |
25,981 |
The total number of beds increased dramatically in this six-year period (62 percent), but all this change occurred among nongovernmental non-profit (133 percent) and for-profit (390 percent) institutions (USDHHS, 1987). State, municipal, and federal hospital beds for alcoholics remained constant. This shift occurred in a burst, but is part of a long-term increase in treatment of alcoholics, much of which comprised AA group attendance (AA claimed 6,000 members in the United States in 1941 and 1,127,471 members in 1995; Alcoholics Anonymous, 1995).
The 1978-1984 upturn in private hospital treatment of alcoholism occurred because federal funding for alcohol treatment in the mid-1970s took the form of block grants which permitted states to support private hospital programs, as well as due to an expansion in coverage for alcohol abuse by private insurers (Peele, 1991). Since that time, greater scrutiny by private insurers and others of inpatient referrals and treatment has led to a relative shift from inpatient to outpatient treatment. This movement was fueled by overwhelming data that hospital treatment for alcohol problems was not cost-effective (Miller and Hester, 986).
However, total alcohol treatment in the United States remains high to the present, both historically and in comparison with other countries (see Room and Greenfield, 1993). Inpatient treatment remains a significant proportion of this treatment, although it is less dominant than in the 1980s. In 1995, there were 690,000 admissions involving alcohol abuse/alcoholism (more than half of all substance abuse admissions in the U.S.). More than 60 percent of these admissions were in outpatient settings (SAMHSA, 1997).
|
