Research provides the foundation for some critical policy messages that advocates need to deliver to policymakers, according to experts who spoke at the second Demand Treatment! Leadership Institute, held Sept. 23-25 in Denver, Colo.Discrimination and ignorance remain big stumbling blocks for advocates of increased addiction treatment services, according to Geoff Laredo, director of policy, legislation, and public liaison at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Researchers in the addiction field are subject to the same kinds of stigma faced by the people they study, he said.
"People don't believe it's a disease," he said. "People don't believe the research."
For example, said Laredo, researcher Larry Gentolillo has shown that brief interventions aimed at addictive behaviors, delivered to patients in trauma centers, decrease injuries by half. Yet such interventions rarely take place. And proven medications to treat addiction -- such as antabuse, naltrexone, and acamprosate -- are not even available to patients through Medicaid. "If this were any other disease, people would be falling over themselves to do something about it," he said.
"The people who we work with deserve health services," said Laredo. "The denial of health services is discrimination."
Federal researchers have learned the hard way that it's not enough just to do good research, said Laredo: information has to be delivered to the public in a clear and usable form.
NIAAA's Project MATCH, for example, found that while researchers were unable to firmly match different treatment interventions to specific populations, all of the interventions studied had high rates of success. "But what got reported was 'no matches,'" recalled Laredo. "We did a lousy job on the press and media side in terms of what we found."
"Press and public relations are sometimes just as important, if not more important, that just having the research," he said. "Most people don't read the scientific journals, so the information just sits there."
Laredo told representatives from the 16 Demand Treatment! programs attending the conference that they also need to demand data from researchers. "We need information to make sure we're asking the right questions," he added. "We need to hear from you."
The good news is that there is plenty of research available to support arguments for increased treatment services, experts pointed out. Studies have shown that addiction relapse rates "are not too different from other diseases, and in some ways, better," said Patrick Flynn, Ph.D., of the Institute of Behavioral Research at Texas Christian University.
"Everybody knows someone who treatment didn't work for, and that hurts our policy arguments," added Timothy P. Condon, Ph.D., associate director of the National Institute on Drug Abuse. But that's no different than other diseases, like cancer -- a fact that advocates should be quick to point out to the public and policymakers. "Everyone knows someone for whom chemotherapy didn't work," Condon said. Yet nobody would argue that funding for chemotherapy should be cut because it is ineffective.
Flynn also cited evidence to support the assertion that longer stays in treatment yield better outcomes: 52 percent of patients who stayed in therapeutic communities at least 90 days avoided regular drug use, he said, while only 29 percent of those who were in treatment less than 90 days did so.
Other studies have shown that 69 percent of people in the criminal-justice system who get treatment stay arrest-free, while only 29 percent of those who don't get treatment stay out of trouble with the police.
Before any of these arguments can be made, however, advocates must first address misunderstandings about the basic nature of addiction. NIDA has been trying to get the public to grasp the distinction between "drug abuse" -- which Condon calls "a preventable behavior" -- and addiction, which NIDA terms a brain disease.
"Drug abuse is a voluntarty behavior, but after a while the brain changes and it becomes involuntary," said Condon, who added, "The goal of treatment is to flip the switch back."
Part of advocates' challenge in explaining addiction is the fact that it is "incredibly complex," Condon noted. "It's not just a brain disease," he said. "You can't fix it with a pill ... you have to address its behavioral and social components."
The bottom-line message, however, is simple. "Drug abuse is preventable. And addiction is treatable," said Condon.
COMMENTS ON THIS ARTICLE: