Bush Treatment Initiative Draws Mixed Reviews

By Phillip Smith, DRCNet. Posted February 9, 2003.

During his State of the Union address, President Bush announced a new drug treatment initiative, promising a $600 million dollar program to place an additional 300,000 people in treatment during the next three years. "As a government," said Bush, "we are fighting illegal drugs by cutting off supplies, and reducing demand through anti-drug education programs. Yet for those already addicted, the fight against drugs is a fight for their own lives."

Bush tied the treatment initiative to his push for faith-based initiatives as "acts of compassion that can transform America, one heart and one soul at a time." He further emphasized the faith-based aspect of his program when the only treatment provider he mentioned in was the Healing Place Church in Baton Rouge, LA. And he waxed religious again, telling Americans who are addicted to drugs that "the miracle of recovery is possible, and it could be you."

After the State of the Union Address, Bush's point man on drug policy, drug czar John Walters, provided a few details at a Washington press conference. The new initiative creates a voucher program that will complement existing alcohol and drug abuse treatment programs, said Walters, increasing treatment capacity and access to effective treatment programs. Under the plan, people assessed as needing drug treatment will receive vouchers to pay for drug treatment under programs monitored by the states. The states will be required to monitor the outcomes of treatment and seek cost-effective treatment modalities.

"This initiative offers a new and effective way for the federal government to help people get into recovery," said Walters. "We know that treatment works. But we also know that there are too many Americans who, for a variety of reasons, cannot access the treatment they need. By giving people a choice, and the direct means to help connect them with effective treatment, we will be able to more directly help drug users who have recognized their problem. This program will also help treatment providers and the overall drug treatment system by bringing increased accountability into the system."

Drug reformers and treatment experts greeted the announcement with a mixture of wariness, mistrust and hope. "We hope this means that people given vouchers can seek out not just unproven faith-based programs, but also treatment modalities that are well-studied and known to be effective," said Bill McColl, a policy analyst for the Drug Policy Alliance. "Study after study has shown there are effective forms of treatment, such as cognitive behavior therapy and moderation management," he told DRCNet.

Dr. Bill Miller, Distinguished Professor of Psychology and Psychiatry at the University of New Mexico and former co-director of the school's Center for Alcohol, Substance Abuse and Addiction, also urged the use of proven drug treatment models.

"I think the government ought to be putting its money into evidence-based treatments, not experimental ones," he told DRCNet. "Faith-based, what does that mean? What is the treatment that is being delivered?" he asked. "I haven't seen any evidence for the efficacy of treatment based on religious content, but that's not to say that a faith-based counseling center using couldn't use evidence-based treatments. We're not talking about faith healing here, and I hope the government will spend its money in a way that encourages people to use the scientific base that is available."

Mary Barr, director of Conextions, a New Jersey counseling center that combines public education, broad-based counseling and drug treatment, was skeptical about where the treatment dollars would end up. "Bush is going to say this is a drug treatment initiative, but he is going to put more money in law enforcement anyway," Barr told DRCNet. "He said he's going to create 300,000 new spaces; how is he going to do that when he's putting everyone in jail? Will these be spaces for court-ordered treatment?"

That's a good question, and there is as yet no firm answer. The Bush Justice Department sought substantial funding increases to support drug courts and their mandated drug treatment in budget proposals released last week. But the Drug Policy Alliance's McColl doesn't think drug courts will eat up all the funds. "It will be up to the states," he said. "The likelihood is that we will see substantial non-criminal justice system treatment, but a lot of grants currently go to coercive treatment. We just don't have any information on how much will go to drug courts yet."

Kevin Zeese of Common Sense for Drug Policy also expressed concern about what the treatment money would buy. "A word of caution is needed," Zeese told DRCNet. "The treatment push has been leaning too much toward coercion and faith-based treatment in recent years. It is important that we start to treat drug treatment as a health issue, not a criminal justice issue and not a religious issue."

If groups like DPA and CSDP expressed reservations about the initiative, organizations representing marijuana users -- the vast majority of all drug users -- are even less excited. Among drug czar Walters' other initiatives is the ongoing campaign to portray marijuana as a dangerously addictive drug and its users as drug addicts needing treatment. "In many ways, this treatment initiative is shaped to play into the drug czar's campaign theme that marijuana is addictive," said Paul Armentano, senior policy analyst for the National Organization for the Reform of Marijuana Laws. "Of course, that's not the case," he told DRCNet, "but with marijuana arrests at an all-time high, many will be arrested and face the option of treatment or jail. We don't believe the overwhelming majority of marijuana smokers need or will benefit from drug treatment, but that helps pump up the numbers of smokers in treatment and advances Walters' false argument," he said.

"It's a double-edged sword," Armentano continued. "We don't want to see marijuana smokers going to jail. So from a pragmatic standpoint, I guess we applaud that choice. But we have to remember these people are seeking treatment not because they are in trouble with their habit, but because it's that or jail."

Mary Barr, herself a veteran of brutal "therapeutic community" treatment programs based on the Synanon model, remains wary of any sort of coerced treatment, but also reluctantly agreed that it beat jail. "I distrust mandated treatment," said Barr. "Mandated treatment leads us down a dangerous path. People are caught up in the criminal justice system and go to prison if they break the rules. I don't want to give up and say that mandatory treatment is okay, but until we have some real changes in policy, even that is better than nothing. What we really need is treatment on demand, not by court-order, and the only way to get money for that is to stopping spending it on throwing people in jail. Let's take the money out of corrections and put it in social programs."

But this is the Bush version of a social program, and there may be some good to it. "No one really knows how this will work yet," said DPA's McColl. "The devil is in the details."

Philip Smith is the editor of DRCNet's Week Online.

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