Saying that "too many Americans in search of treatment cannot get it," President Bush used his Jan. 28 State of the Union address to unveil a $600-million proposal to help people with addiction get help with their recovery.

Bush said the "Recovery Now" program would fund vouchers that addicted individuals could use to get treatment at their choice of programs, including those that rely on faith-based methods. The money, allocated over three years, would allow an additional 300,000 people to get addiction treatment, Bush said.

"Tonight, let us bring to all Americans who struggle with drug addiction this message of hope: The miracle of recovery is possible, and it could be you," said Bush.

Recovery advocates were ecstatic to hear Bush's ringing endorsement, especially in such a high-profile setting. "It propelled me out of my seat, cheering -- and then I burst into tears," said Susan Rook, director of communications and outreach for Faces and Voices of Recovery. "For the president of the United States to talk in the State of the Union about the 'miracle of recovery' puts recovery on the national agenda ... For the first time in history, the solution was placed front and center instead of the problem, and that's extraordinary."

"In my lifetime I've never heard a president name the disease and so strongly identify the remedy," agreed John Avery, public-policy director for NAADAC/The Association for Addiction Professionals. "He said recovery is possible, and that's powerful language and great presidential leadership on this issue."

"The skepticism in policy circles has been that people cycle in and out of treatment and that it doesn't work," added Avery. "The president said no -- recovery happens."

Concerns About Funding, Faith

However, enthusiasm for the president's plan was somewhat tempered by concerns about its chances of being funded by Congress in the face of a massive federal budget deficit, and worries about the implications of opening up federal addiction funding to faith-based programs.

Avery pointed out that the House of Representatives failed to fully fund Bush's treatment budget for 2003, although he said that the Republican-dominated Congress might be more willing to support a plan that is couched in the language of religion.

During the State of the Union, Bush touched upon addiction's impact on personal morality, and went out of his way to praise faith-based treatment programs. "Our nation is blessed with recovery programs that do amazing work," said Bush. "One of them is found at the Healing Place Church in Baton Rouge, La. A man in the program said, 'God does miracles in people's lives, and you never think it could be you.'"

Tonja Myles, cofounder of the Healing Place Church, sat in the front row of the spectator's gallery near first lady Laura Bush, as did Henry Lozano, head of the faith-based Teen Challenge of California and co-chair of the President's Advisory Council on Drug-Free Communities.

Addiction experts acknowledge that faith and religion have played an integral part in recovery programs since the founding of Alcoholics Anonymous, and can be effective. "We don't have a problem with faith-based providers," said NAADAC's Avery. "Our concern is with what kind of treatment is being provided. Historically, faith-based programs have been in the field all along ... We welcome anyone who wants to provide effective, evidence-based services."

"I've discussed the voucher proposal with the president and consider it an important first step in addressing the lack of access to treatment for people who are chemically dependent," said Rep. Jim Ramstad (R-Minn.), who has freely discussed his own addiction and recovery. "I agree with the president that faith-based treatment centers should not face discrimination by the federal government in providing treatment because I've seen, firsthand, their positive treatment outcomes."

Faces and Voices' Rook called Bush's framing of the recovery issue a "wake-up call" for the traditional treatment community. "He doesn't use all of the 'appropriate' language of the recovery community, but he is typical of the larger recovery community," she said. "There are many pathways to recovery."

Assessment, then Vouchers

Still, many remain wary that faith-based programs will be exempted from state and federal regulations that apply to other treatment programs, as was the case when President Bush helped establish Texas' faith-based funding initiative in the mid-1990s.

"ASAM's commitment to quality in treatment leads us to recommend that any system of vouchers that may be established be used only for treatment by programs that are accredited and licensed by the appropriate state agency, making them subject to quality assurance, regulation and inspection by the state," said Lawrence S. Brown, Jr., M.D., MPH, FASAM, president of the American Society of Addiction Medicine.

But John Walters, director of the White House Office of National Drug Control Policy (ONDCP), said that Recovery Now would increase, not decrease, accountability. According to ONDCP, individuals would be assessed and receive a voucher to pay for an appropriate level of treatment. States would be required to monitor the outcomes of the voucher program, and to make adjustments based on the extent to which improved client outcomes are achieved in a cost-effective manner.

"The new initiative is designed to allow treatment providers, faith-based and other community organizations, workplaces, and schools to help drug users receive the treatment and support services that are best suited to their individual needs," according to ONDCP.

"We know that treatment works," said Walters. "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."

The accountability measures built into the voucher proposal represent a fundamental shift from current public funding streams, which typically measure success in terms of the number of clients served. "The measure is not output of a system, but person-specific measures of function," noted NAADAC's Avery, who said the voucher proposal embraces many of the key concepts of the federal National Treatment Plan, such as client-need driven services and multiple points of entry into treatment.

"The devil is in the details, which will become apparent in the budget in the weeks and months ahead," said William Moyers, vice president of external affairs for the Hazelden network of treatment programs. "It's uncertain now whether the president intends for this money to go to unlicensed faith-based programs without trained professionals, or to the kinds of recovery programs we know well. But I feel some reason for optimism that recovery from addiction is an important issue in Washington right now."