So What Should We Do About Drug Addicts?

[Wahoo Redux]

This topic managed to shut down the Libraries thread.

As someone who has been recovering so long that my recovery could have earned tenure by now, and as someone who saw a great many problems and failures among friends and family because of alcohol, and as someone who lost a sibling to meth addiction, I see no easy answers.

I am just wondering what you all think.

What should we realistically do about the plague of addiction eating away at our culture?

[spork]

Take down the firewall between mental health treatment and addiction treatment. The USA's wealthcare industry divides them into two completely separate services that can't be integrated.

I recognize that the above says nothing about the prevalence of mental illness and addiction in the USA, the causes of which are quite complex but that to a large degree boil down to: 1) widespread poverty, and 2) lack of access to effective treatment.

[nebo113]

I live in a meth/oxy county, and have two cousins who died from addiction.  We have completely inadequate public treatment resources.  Law enforcement is too often complicit and/or closes its eyes.  Well known community figures are involved.  Local pharmacies knowingly accepted prescriptions from pill mill doctors.

60 odd people were recently arrested, most of them for meth.

It's hopeless.

[ciao_yall]

In other developed countries, they don't seem to have this problem.

First, they build affordable housing in and around cities. No tolerance for NIMBYism.

They have a public health infrastructure so people can be treated when they are ill, and a reasonably good social safety net.

Not to mention day care, schools, and activities to keep kids busy and out of trouble.

Yes, taxes are high and unemployment isn't great. Still beats the alternative...

[lightning]

I live in a meth/oxy county, and have two cousins who died from addiction.  We have completely inadequate public treatment resources.  Law enforcement is too often complicit and/or closes its eyes.  Well known community figures are involved.  Local pharmacies knowingly accepted prescriptions from pill mill doctors.

60 odd people were recently arrested, most of them for meth.

It's hopeless.

I think we are expecting too much.

Like education, even with all the government support programs, charitable non-profit support, family support, and cultural de-stigmatization, there will still be some that cannot be reached--some because they simply don't want to change.

It's true with education. It's true with those suffering from drug addiction and alcoholism.

But that doesn't mean we should beat up ourselves because we're not reaching everybody. Likewise, the lack of the ideal unattainable success rate does not mean that we give up and de-fund these public programs and walk away from the private non-profit programs.

We have to give up the idea that it is possible to have a perfect society. That only leads to an increased perception of failure and an excuse for the fiscal hawks to cut support programs.

In other developed countries, they don't seem to have this problem.

First, they build affordable housing in and around cities. No tolerance for NIMBYism.

They have a public health infrastructure so people can be treated when they are ill, and a reasonably good social safety net.

Not to mention day care, schools, and activities to keep kids busy and out of trouble.

Yes, taxes are high and unemployment isn't great. Still beats the alternative...

Taxes are just as ridiculous in the USA, when you add up sales tax, state tax, & property tax, into the federal income tax & payroll taxes. (And, I have not even mentioned the informal "tipping" tax where North Americans are compelled to pay a 20% service charge whenever they engage the services of a service sector employee.) The problem in the USA is that we get a much lower return on the public investments. For the kinds of taxes most people in the USA pay, Medicare for all, including coverage for addiction treatment, should be a no-brainer. Instead, some go without health care and addiction treatment and most of the rest of the population pays for shi**y private health care. And, it's not like these relatively high taxes are properly supporting other things like educational institutions, infrastructure, policies that incentivize development of affordable housing, etc.

Full disclosure, I have largely insulated myself from people with drug and alcohol problems. I've had my fill of trying to intervene and help out. I'm tired of it. But, I try my best to support programs that serve the public good. Most of all, I don't harbor impossible-to-meet expectations of these programs and the human beings that they serve.

[Caracal]

[\

I think we are expecting too much.

Like education, even with all the government support programs, charitable non-profit support, family support, and cultural de-stigmatization, there will still be some that cannot be reached--some because they simply don't want to change.

It's true with education. It's true with those suffering from drug addiction and alcoholism.

But that doesn't mean we should beat up ourselves because we're not reaching everybody. Likewise, the lack of the ideal unattainable success rate does not mean that we give up and de-fund these public programs and walk away from the private non-profit programs.

We have to give up the idea that it is possible to have a perfect society. That only leads to an increased perception of failure and an excuse for the fiscal hawks to cut support programs.

By most metrics the US does have a worse illegal drug problem than almost any other country. Add in alcohol and things looks less clear. Rates of alcohol us in the US are lower than in western Europe and in some parts of eastern Europe, alcohol use is off the charts. Americans sometimes have this imagined idea of sophisticated europeans sipping alcohol in responsible ways, but the reality is often pretty different.

It's true that nothing is going to completely eliminate substance addiction, but we actually do have a pretty good idea of what works, from harm reduction to treatment programs to anti-addiction medications. None of these things are perfect, but if you provide funding for this kind of support it's pretty clear you give people a much better chance. 

[nebo113]

 [/quote]
 but we actually do have a pretty good idea of what works, from harm reduction to treatment programs to anti-addiction medications. 
[/quote]

The area where I live has been a one horse economy for over 100 years.  Boom or bust.  Now, it's pretty much bust, so many people, especially young men, feel hopeless.  Local pill mills and pharmacies supported their drug usage, but with few exceptions, those enablers made money and were not charged or jailed.  Only the users.

[Caracal]

 but we actually do have a pretty good idea of what works, from harm reduction to treatment programs to anti-addiction medications. 
[/quote]

The area where I live has been a one horse economy for over 100 years.  Boom or bust.  Now, it's pretty much bust, so many people, especially young men, feel hopeless.  Local pill mills and pharmacies supported their drug usage, but with few exceptions, those enablers made money and were not charged or jailed.  Only the users.
[/quote]

Right, there's a different discussion about the larger causes of drug abuse, but lots of people want help and can't get it.

[Diogenes]

Step one: Don't say "Addict" since that's no longer recommended by experts since it applies an essentialist label to the person. And we know that stigma only makes things worse.

Substance Use Disorder cuts across class lines, but it's not the great equalizer because most of the worse possible outcomes are caused by lack of resources.

So like others have said, create a health care system that one, actually cares about helping people over profits and two, make sure it covers mental health thoroughly.

Have a social safety net that is at least in the same ballpark as all other developed rich countries.

End the completely failed War on Drugs and move those resources to Harm Reduction programs.

[ciao_yall]

Article in the New York Times about how help does work.

People need more than just a shelter bed.

Also, where I live, a lot of the homeless people prefer the "stability and safety" of their own tent or car to the shelters.

If they go into a shelter, they are separated from the friends and pets. They lose their spot on the street, park, wherever. They might lose their tent to the street cleanup or car to towing/impound. They risk having things stolen. It can be hard to get a good night's sleep if it's noisy. And they get rousted from bed at 7 AM and have to clear out.

So, when they are "refusing help" they are actually making the best decision for themselves.

[kaysixteen]

Awright, I am going to say some things which may seem harsh, and which in some cases *reflexively* run contrary to the views of secular liberals who live, in many/most cases, in places where, like it or not, addicts and the drugs they use are not visible, and the addicts are more or less shown the door, sometimes quite harshly, by the local constabulary (heck, in very blue Mass. here, where we have legalized weed emporia, the decision to allow such establishments is wholly up to the local communities, and which communities do you think do NOT allow such places, requiring those desirous of purchasing their wares to come to places like Rusty City, where politicians want the tax revenues the weed shops provide, and where the local population, such as it is, is much much more supportive of the presence of such places in their midst.)   But facts are stubborn things.

1) 'Harm reduction' is a moral choice, and a bad one, because such actions a) allow addicts to remain addicts, stuck in their addiction, with all the attendant life debiitations appartaining thereto, and b) society (which does have some rights) is stuck with dealing with the addicts, which, even with 'harm reduced', still means these people will be... well.

2) As I have noted, it is necessary for Americans to be willing to pay a lot of taxes to get ourselves back into the mental hospital businesss, and to establish the sound, evidence-based rehab facilities needed to address narcotics addiction.  And then, once these places are up and running, those properly served by them must be forced to go there.  Not asked, not bribed, cajoled, etc., just forced.  *for their own good*, and, again, for the good of society, which, again, *has some rights*.

3) Now to the very easy part-- what to do with the scumbags who sell drugs, import them, write and fill peddled prescriptions for unnecessary narcs, etc.-- don't let the door hit you in the butt as you are frogmarched off to the greybar hotel for hard hard time.  And for cops who take bribes, look the other way as these aforementioned dirtbags do their dirtbaggery, well... I suspect you can guess what I think.   These people are at war with the people, and should be treated as such.

[downer]

These are big social issues. It is useful to distinguish between helping people who have existing problems with substance use, and moving to become a society where people don't become so hooked in the first place.

Drug and alcohol treatment in the US has been mostly ideological and political rather than evidence based. The dominance of AA and abstinence approaches rather than harm reduction has caused a lot of trouble. Maybe things are improving but it's two steps forward and one step back.

[Anselm]

I am all for giving out free opiates to addicts.  They won't have to steal for drug money.  They can hold down a job with a stable clean dose at a regular time and location.  They won't have anything left over to share or sell.  I am not sure what to say about cocaine and methamphetamine. 

I am also upset that the response to the opioid crisis means that is harder for us to get needed pain medicine.  At one time you could call a dentist at their own home and get a prescription phoned in for you.  Now you have to see them in person.  Those of us without a history of abuse should not have to worry about getting pain relief.  A tooth infection will keep me awake through the night which then will cause heart rhythm problems. 

[Diogenes]

Awright, I am going to say some things which may seem harsh, and which in some cases *reflexively* run contrary to the views of secular liberals who live, in many/most cases, in places where, like it or not, addicts and the drugs they use are not visible, and the addicts are more or less shown the door, sometimes quite harshly, by the local constabulary (heck, in very blue Mass. here, where we have legalized weed emporia, the decision to allow such establishments is wholly up to the local communities, and which communities do you think do NOT allow such places, requiring those desirous of purchasing their wares to come to places like Rusty City, where politicians want the tax revenues the weed shops provide, and where the local population, such as it is, is much much more supportive of the presence of such places in their midst.)   But facts are stubborn things.

1) 'Harm reduction' is a moral choice, and a bad one, because such actions a) allow addicts to remain addicts, stuck in their addiction, with all the attendant life debiitations appartaining thereto, and b) society (which does have some rights) is stuck with dealing with the addicts, which, even with 'harm reduced', still means these people will be... well.

2) As I have noted, it is necessary for Americans to be willing to pay a lot of taxes to get ourselves back into the mental hospital businesss, and to establish the sound, evidence-based rehab facilities needed to address narcotics addiction.  And then, once these places are up and running, those properly served by them must be forced to go there.  Not asked, not bribed, cajoled, etc., just forced.  *for their own good*, and, again, for the good of society, which, again, *has some rights*.

3) Now to the very easy part-- what to do with the scumbags who sell drugs, import them, write and fill peddled prescriptions for unnecessary narcs, etc.-- don't let the door hit you in the butt as you are frogmarched off to the greybar hotel for hard hard time.  And for cops who take bribes, look the other way as these aforementioned dirtbags do their dirtbaggery, well... I suspect you can guess what I think.   These people are at war with the people, and should be treated as such.

I am a professor of biopsychology. So I know a thing or two about this. Stop saying "Addicts" I know some groups like AA still use it, but in your case, you are stigmatizing. Moral questions aside, the research is pretty clear on a number of different points:
- It's cheaper to house someone and give them fairly intensive support than have them sit in a jail cell. This is partly why even very right-wing politicians like Mike Lee and Rand Paul have supported a shift from just jailing drug offenses to supporting things like Housing First initiatives and prison education programs.
-The claims about institutions being too expensive simply are not true, at least not anymore. But out-patient is more effective and humane anyway (but still far cheaper than the prison system we have in place now)
-We already have a Harm Reduction mentality around legal drugs like alcohol, nicotine, and caffeine. Why draw the line there?
-Harm Reduction also reduces harm to non-drug users. Clean needle exchanges keeps needles out of your public parks. Housing First keeps excrement off your sidewalk.
-It is an agreed upon fact that drug criminalization over history was racist and politically motivated.
-Rates of drug use are actually mostly constant across race and class. It's just that you don't see the cocaine being used inside the walls of that frat house. And you don't see the rich man passed out drunk on expensive whiskey in his study.
-Wanna get rid of the seedy black market? Legalize and regulate! Alcohol prohibition has shown that criminalization only increases harms to users and society at large. We will never get rid of all harms (hence the reduction part) but it's evident we are actually increasing harms right now.

[apl68]

Agreed on the need to give people with drug problems help beyond just locking them up in jail.  Strongly disagree that taking an anything-goes approach to drug use and counting on "harm reduction" to save us from the consequences of that is a viable approach.  Harm reduction for traditional drugs like alcohol and tobacco use hasn't really worked.  Alcohol-related deaths have skyrocketed in recent years.  Tobacco-related deaths are down, but that's because tobacco use is far less socially acceptable than it once was. 

Meanwhile use of pretty much everything else is going nowhere but up, because it is now socially acceptable, and "harm reduction" isn't working.  California has let the streets flood with drugs while spending billions on harm reduction, and their city streets have turned into slaughterhouses of addiction and drug deaths.  Maybe harm reduction has saved some lives here and there, but it hasn't begun to make up for the consequences of unchecked drug use.

I've known several people here in our town who have successfully gotten beyond drug use.  Two in particular.  One is the woman I mentioned on another thread who works for our local Salvation Army and other efforts.  The other is one of our staff members.  In each case getting jailed for drug offenses served as a wake-up call for them, and they finally stopped pushing the snooze button. They each were able to leave the drugs behind because they found something that worked in their lives.  Following Jesus gave them hope, gave them support, and gave them access to a supportive community.  Their lives have changed so that they don't feel that same need for drugs.  I've mentioned those two in particular, but I've known a number of others.