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From the Field: Substance Abuse: A 12-Step Primer for Change

Alcoholism & Drug Abuse Weekly

By Peter Provet, Ph.D.


As we move towards the Presidential election and change continues to be the candidates’ overarching clarion call, there has been little, if any, discussion about changing the devastating trajectory of substance abuse, a road that takes many down the paths of homelessness, AIDS, jail and poverty.

Analogous to the recovery process, both candidates have reached a critical milestone: admitting a problem exists. The next steps are harder: understanding the problem and committing to fix it. Below are the 12 Steps that may begin to get us there:

CHANGE: There must be continued reductions in drug use across all populations with a concomitant increase in treatment services.

The rate of current illicit drug use among persons aged 12 or older has remained steady at approximately 8 percent for the last five years.

Ninety percent of those who need treatment do not receive it.

CHANGE: The links between drug use and health must be further identified and incorporated into prevention and treatment initiatives.

Drug abuse is a major factor in the spread of HIV and hepatitis: injection drug use accounted for approximately one-quarter of AIDS cases in 2005 and is responsible for most cases of hepatitis C.

CHANGE: A far greater proportion of the federal drug control budget must be directed towards demand reduction rather than supply reduction.

The federal drug budget, which totals approximately $20 billion, emphasizes supply reduction methods over demand reduction programs.

CHANGE: Substance abuse must be recognized as a primary driver of homelessness, crime, school drop out, joblessness, teen pregnancy and other social ills and addressed accordingly.

Substance abuse and addiction are significant yet often overlooked factors in many of society’s ills. Substance abuse costs to society are as high as $484 billion annually. This includes health care costs, lost earnings and costs associated with crime, homelessness, welfare and accidents.

CHANGE: Addiction must no longer be seen as a discrete, curable condition, but rather as a chronic relapsing disease akin to diabetes.

The emerging paradigm classifies addiction as a chronic disease, analogous to type II diabetes, heart disease and hypertension.

CHANGE: The biology of addictive disorders and corresponding treatments must be further researched and integrated into the field.

New medications and vaccines in development work to combat addiction by mitigating withdrawal symptoms, counteracting the ability of the brain to process the drug, altering the ingested substance to hasten the body’s removal of it, and activating or suppressing drug or alcohol specific receptors in the brain. Pharmacological advances should not be at the expense of resources for behavioral interventions, as emerging evidence shows that the two approaches in combination are most effective.

CHANGE: Treatment works for the individual and for society. It has a proven impact in stopping drug use, reducing crime, and in returning addicts to society as functional family members, coworkers and neighbors.

Overall, treatment of addiction is as successful as treatment of other chronic diseases, such as diabetes, hypertension, and asthma. According to several studies, drug treatment reduces drug use by 40 to 60 percent and significantly decreases criminal activity during and after treatment.

CHANGE: Addicts can no longer be marginalized as members of society. Addiction must be recognized as any other medical disorder that necessitates medical treatment.

Most insurance policies offered by employers discriminate against people with alcohol or drug addiction by requiring far greater patient burden. People seeking treatment for addiction must often pay higher deductibles and copayments and receive less coverage for number of visits, days of coverage and annual or lifetime dollar limits for treatment.

CHANGE: Addiction can no longer be perceived as a moral failure but rather as a disease with genetic, biological and psychosocial determinants.

The stigma associated with drug addiction prevents many from seeking treatment. It also discourages doctors from treating addicts and pharmaceutical companies from developing new treatments. Furthermore, the face of addiction must change from the traditional stereotype of the young minority, poor, criminally-inclined male. Drug abuse affects people across gender, culture, age and socioeconomic status; it impacts adolescents, mothers, seniors and veterans.

CHANGE: Society can no longer minimize and segregate the impact of addiction — it affects families, neighbors, friends, colleagues and communities.

  • 31 percent of America’s homeless suffer from substance abuse;
  • As many as 60 percent of adults in federal prisons are there for drug-related crimes, and drugs and alcohol are implicated in the crimes of 81 percent of state prison inmates;
  • Children with prenatal cocaine exposure are one-and-a-half times more likely to need special education services in school;
  • Drug users are more likely to have missed tow or more days of work in the past month;
  • Children from homes with substance abuse issues are far more likely to be served in the foster care system than in their own homes.

CHANGE: Efforts must be accelerated and expanded to redirect nonviolent offenders to treatment instead of incarceration.

CHANGE: With presidential leadership, America can shift the paradigm from “fighting a drug war” to treating a medical disorder. By bringing drug addiction more fully into the public health arena and tipping the balance of funding in favor of treatment, education and prevention rather than interdiction, senior leadership can change the course of addiction in our country. The data strongly support such a course of action; the time for change is now.

The data cited are all referenced, and can be obtained from the author at

Peter Provet, Ph.D., is president of Odyssey House, a private, non-profit substance abuse and mental health treatment, medical and housing agency based in New York City. He is a clinical psychologist, and formerly an Assistant Professor of Psychiatry, Albert Einstein College of Medicine.

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