III. Goals, Objectives, Targets, andPerformance Measures of Effectiveness
Goals, Objectives, and Targets
| Goal 3: | Reduce health and social costs to the public of illegal drug use. |
Drug dependence is a chronic, relapsing disorder that exacts an enormous cost on individuals, families, businesses, communities, and nations. Addicted individuals frequently engage in self- destructive and criminal behavior. Treatment can help them end dependence on addictive drugs. Treatment programs,moreover, can reduce the consequences of addictive drug use on the rest of society. The ultimate goal of treatment is to enable a patient to become abstinent and to improve functioning through sustained recovery. On the way to that goal, reducing drug use, improving the addict's ability to function, and minimizing medical consequences are useful interim outcomes. Treatment options include therapeutic communities, behavioral treatment, medication (e.g., methadone, levo-alph-acetyl-methadol (LAAM), or naltrexone for heroin addiction), outpatient drug free programs, hospitalization, psychiatric programs, twelve-step recovery programs, and treatment that combines two or more of these options.
Providing treatment for America's chronic drug users is both compassionate public policy and a sound investment. For example, the recent Drug Abuse Treatment Outcome Study (DATOS) found that outpatient methadone treatment reduced heroin use by 70 percent, cocaine use by 48 percent, and criminal activity by 57 percent, and increased employment by 24 percent.2 The same survey also revealed that long-term residential treatment achieved similar successes.
SAMHSA's 1997 Services Research Outcome Study, the Center for Substance Abuse Treatment's (CSAT's) 1997 National Treatment Improvement Evaluation Study (NTIES), the 1994 California Drug and Alcohol Treatment Assessment (CALDATA), and other studies demonstrate that treatment reduces drug use, criminal activity, high-risk behavior, and welfare dependency.3 NTIES' principal conclusions are that:4
- Treatment reduces drug use. Clients reported reductions in drug use of about 50 percent in the year following treatment.
- Many types of programs can be effective. Methadone programs, outpatient treatment, and both short- and long-term residential programs reduced drug use among participants.
- Criminal activity declines after treatment. Approximately one half (48.2 percent) of the NTIES respondents were arrested in the year before treatment, but only 17.2 percent were arrested in the year after treatment. Similar decreases were observed among respondents who claimed their primary income source were illegal activities.
- Health improves after treatment. Following treatment, substance abuse-related medical visits decreased by more than 50 percent and in-patient mental health visits by more than 25 percent. So, too, did risk indicators for sexually-transmitted diseases.
- Treatment improves individual well-being. Following treatment, employment rates increased while homelessness and welfare receipts decreased.
The 1994 CALDATA study was a retrospective cost-benefit analysis that examined the cost benefit of treatment services in the state from the perspective of both taxpayers and society. The study found that the department's programs cost taxpayers 209 million dollars in 1992 and yielded benefits of 1.5 billion dollars in reduced crime.
Objective 1: Support and promote effective, efficient, and accessible drug treatment, ensuring the development of a system that is responsive to emerging trends in drug abuse.
Rationale: A significant number of American citizens have been debilitated by drug abuse. Illness, dysfunctional families, and reduced productivity are costly by-products of drug abuse. Effective treatment is a sound method of reducing the health and social costs of illegal drugs.
Objective 2: Reduce drug-related health problems, with an emphasis on infectious diseases.
Rationale: Drug users, particularly injection users, put themselves, their children, and those with whom they have sexual contact at higher risk of contracting infectious diseases like HIV/AIDS, hepatitis, syphilis, gonorrhea, and tuberculosis.
Objective 3: Promote national adoption of drug-free workplace programs that emphasize a comprehensive program that includes: drug testing, education, prevention, and intervention.
Rationale: Drug abuse decreases productivity. Approximately three-quarters of adult drug users are employed. Comprehensive workplace policies that incorporate drug testing and employee assistance programs that include prevention, intervention, and referral to treatment can reduce drug use.
Objective 4: Support and promote the education, training, and credentialing of professionals who work with substance abusers.
Rationale: Many community-based prevention and treatment providers currently lack professional certification. The commitment and on-the-job training of these workers should be respected by a flexible credentialing system that recognizes first-hand experience even as standards are being developed.
Objective 5: Support research into the development of medications and related protocols to prevent or reduce drug dependence and abuse.
Rationale: The more we understand about the neurobiology and neurochemistry of addiction, the better will be our capability to design interventions. It is well established that pharmacotherapies are effective for heroin. They may also be effective against cocaine, methamphetamine, and other addictive drugs. Research and evaluation will broaden treatment options, which currently include detoxification, counseling, psychotherapy, and self-help groups.
Objective 6: Support and highlight research and technology, including the acquisition and analysis of scientific data, to reduce the health and social costs of illegal drug use.
Rationale: Efforts to reduce the cost of drug abuse must be based on scientific data. Therefore, federal, state, and local leaders should be given accurate, objective information about treatment modalities.
Objective 7: Support and disseminate scientific research and data on the consequences of legalizing drugs.
Rationale: Drug policy should be based on science, not ideology. The American people must understand that control of substances that are likely to be abused is based on sound research and intended to protect public health.
