March 15

Why I Write About Politics I

I work with people struggling with addiction. I am a person who struggled with addiction. Helping others is my passion, and my debt to those who helped me.

So why do I write about politics? Because politics and addiction are related. Decisions made in the political arena directly affect not only those who now struggle, but whether or not people who have not become addicted will do so in the future.

The Criminal Justice System

The criminal justice system is one of the biggest influences. It’s a system that not only fails to promote recovery, but often makes recovery more difficult. First, we should know that the rate of recovery among prisoners released after serving time for drug offenses is approximately zero. A 1974 study noted, “[w]ith few and isolated exceptions, the rehabilitative efforts that have been reported so far have no appreciable effect on recidivism.” Based on that observation, decades of inattention to rehabilitation followed.

Not only that, but even for those who desire to get clean it’s often difficult to recover with the realities placed on them by the system. For example, it’s hard to get a decent paying job or even rent an apartment with a felony on your record. Here in Harrisonburg, where James Madison University’s huge enrollment strains the availability of rentals, often the only option for those coming out of prison is a room in one of the “drug den” hotels downtown. When I took one man down to look at a place, in the 20 minutes we spent there he saw five people he knew from his substance abuse years. That’s hardly an environment conducive to recovery!

In rural Utah, released prisoners are not allowed to get their drivers licenses back until they’ve paid their fines. Yet they may live 20-30 miles from where work is available. If they don’t work, they can’t pay their fines and they go back to jail. If they drive to work without a license and get caught, they go back to jail. It’s a Catch 22. Many of them do go back to jail because they can’t find a solution to the conundrum.

The Fallacy of Prohibition

Our drug policies not only fail to prevent and treat addiction, they actually promote addiction. A 1992 study showed that despite increasing negative consequences, illicit drug use actually rose in some communities, while the use of legal substances like alcohol dropped.

How is it possible that prohibition promotes addiction? The Cato Institute cites Richard Cowan’s “Iron Law of Prohibition”:

[T]he more intense the law enforcement, the more potent the prohibited substance becomes. When drugs or alcoholic beverages are prohibited, they will become more potent, will have greater variability in potency, will be adulterated with unknown or dangerous substances, and will not be produced and consumed under normal market constraints.

The 1972 book, Licit and Illicit Drugs by Edward M. Brecher found a similar link. The stronger the prohibition, the more potent the form of the drug and the more rapid the ingestion method (i.e. smoking or injecting as opposed to swallowing or snorting).

This is not only economics. It’s common sense. As Creedence Clearwater Revival noted in their 1969 song, “Bootleg,”

Take you a glass of water
Make it against the law.
See how good the water tastes
When you can’t have any at all.

The basic laws of economics say that something becomes more valuable as it becomes scarce. Prohibition makes the prohibited substance not only more expensive, but also more desired. We can try to blame that on immorality, but the truth is, it’s basic capitalism. Prohibition is an anti-capitalist approach.

We lament the rise of addiction and overdoses in this country, but our legal system isn’t designed to reduce the problem. Instead, it makes it worse for those who are already in addiction. Whether it prevents people from becoming addicts should also be obvious– if our legal system worked as a preventive measure, the problem wouldn’t be increasing.

There are some basic changes we could make to move us in the direction of positive change. Decriminalization is one. And I say this as a recovering addict who knows first-hand the danger and damage of the substances involved. But the fact is, criminalization is a failure. It has made the drug problem worse. And, as we say in recovery, “If you kleep doing what you’re doing, you’ll keep getting what you’re getting.” If we want something different, we have to do something different. And that is a political problem, not a moral one.

March 10

Broken Minds in a Broken System

Cory grew up in a violent home. He turned to alcohol at an early age. He also suffers from schizophrenia. When he drinks, he sees the world as a threat and responds in kind. He was released from prison a few months ago after a decade for making a threat he did not have the ability to carry out.

Cory needs psychiatric help. He’s been on a waiting list for months. Now he’s back in jail, awaiting trial for getting drunk and making a threat he had neither the means nor the knowledge to act on.

Jack, too, grew up in a violent household. He turned to drugs at age 12 and lived on the streets for a time. He recently graduated from a recovery house and is trying to live clean and sober. But Jack suffers from bipolar disorder. When he gets manic, which is about every other week, he gets paranoid and believes the world is out to get him. The only way he knows how to manage this is through self-medication. Needless to say, he hasn’t stayed clean for more than a few days at a time.

Jack, too, has been on the waiting list to see a psychiatrist. In his desire for help, he went to the emergency room and was hospitalized, but the medications they put him on didn’t help. He wound up back there again last week, in a suicidal depression after a week of manic behavior and drug use. The doctors changed his medications and sent him home.

These two men, both of whom want to change their lives, may be just statistics for most people, sad stories that we want to believe are the exception rather than the rule.

I don’t have that luxury. Like them, I have struggled with addiction. Like them, I suffer from mental illness– in my case, PTSD (Post-Traumatic Stress Disorder). And like them, I struggle to get help in a broken mental health system.

When Trauma Comes Home

My recent troubles began, like so many things, with Covid. The isolation caused by the pandemic not only led to depression, but eliminated a lot of my regular coping mechanisms. Visiting friends and working at the library became impractical if not not impossible. My world shrank to our home, and my family became my social circle. Between Covid and the weather, my 6-year-old, special-needs son has only been to school about one day a week this year, causing his problem behaviors to multiply and adding to my emotional challenges.

Meanwhile, our political situation deteriorated, frighteningly resembling a traumatic situation I experienced almost 30 years ago. I’ve done a lot of work on my trauma over the past two decades, but now the nightmares returned. So did the irritability, depression, and sensitivity– all classic symptoms of PTSD.

I’d been seeking help. It took over two years to find a practitioner who dealt with trauma (and accepted my insurance), and I’ve only been working with her for a couple of months.

About two weeks ago, unbeknownst to me, my 16-year-old intentionally startled my wife. She let out a blood-curdling scream. And something inside me snapped. I left the house and drove around for two hours, unable to deal with my feelings and the world around me. I scratched myself because the pain felt good.

After much internal consideration of less desirable alternatives, I went to the hospital. They shipped me to a facility two hours away, where I received medication and watched TV for a week. (I hate TV, so this was not a relaxing vacation.) Then they released me, advising that it would take weeks to know if the  medication was really helping. The side effects are arguably worse than the PTSD symptoms they are intended to treat, and the psychiatrist I saw after leaving the hospital immediately discontinued the medication.

Our Broken System

Our mental health system is broken. It doesn’t do prevention or healing, it manages crises. Getting an appointment if you’re not in crisis can be difficult or impossible, even with health insurance. Waiting lists are long for those who are not bad enough to be hospitalized.

For those requiring hospitalization, our system uses a “catch and release” approach, diagnosing and medicating patients, then sending them home before the effects of the medication on that specific person become evident. How often have we heard a psychiatrist, following up on a hospital visit, say, “I don’t know why they selected that medication!” When side effects crop up, refer to the previous paragraph. Your options are to suffer, or go back into crisis management. Six years ago, I was hospitalized three times– once for the condition, and twice to deal with the life-threatening side effects of the supposed treatment of the condition.

And our system doesn’t do healing. Instead, it manages crises of symptoms with medication. It works for some, but many do not find relief. This approach pays little attention to addressing the underlying condition– much like using pain pills without treating the broken bone.

There are exceptions. Dialectical Behavioral Therapy, for example, has been shown to reduce both the frequency of crises and, for some conditions, the need for medication. Eye Movement Desensitization and Reprocessing (EMDR) is incredibly effective in treating trauma. Long term inpatient substance abuse treatment, when paired with mental health care for underlying conditions, can be very effective not only in treating addiction, but in preventing future mental health crises. But there isn’t enough of it. In fact, in many communities, there isn’t enough mental health care available, period.

A system is defined as “a set of things working together as parts of a mechanism or an interconnecting network.” By that standard, our mental health “system” isn’t a system at all. The parts don’t work together. Some parts are missing.

Does ignoring our mental health make the problem go away? Hardly.

An estimated 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem. –“The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System
Few of these prisoners get treatment. Most will return to incarceration after being released.

Counting the Cost

We pay for our nation’s mental health problems, whether or not the treatment is effective. But instead of recognizing the problem, we ignore it or criminalize it. By official estimate, we pay $80 billion per year to incarcerate 2.3 million people, But that doesn’t include the out-of-pocket costs to the families of the incarcerated. One wonders, what kind of a nation would rather pay for jails and prisons than treatment facilities for its sick citizens?
Suicide is the 10th leading cause of death in the nation, and the 2nd leading cause (behind accidents) for Americans aged 10-34. Yes, you read that right: Suicide is the 2nd leading cause of death for children 10-14 years old, and continuing well into their 30s. Yet we’d rather argue about gun control than address the cause, which is mental illness.
With nearly 1 in 5 Americans living with a mental illness, you’d think we’d pay more attention to it. That’s almost one person in every American family. But we seem to be too ashamed of mental illness to admit this medical affliction– as if having diabetes, for example, was a moral failing.
Mental illness is NOT a moral failing. And that’s why I post about it. Go a few rounds with our mental health care “system,” and you may begin to see our national denial the way I do: Mental illness is not a crime, but ignoring it is.
January 4

Midwest Book Review on The Soul of an Addict

The Soul of an Addict’s ability to delve into the heart of the addictive personality and mindset leads readers onto a path of discovery and insights on the path away from addictive traits and habits… [The book] is an eye-opening, relevant, insightful guide that’s highly recommended for any individual interested in addiction…

Read the entire review here.

Then buy the book here!

December 1

“A Most Practical Book”

My eyes have been opened to dimensions of addiction I never knew about. One of the most practical books I have read in a long while, I expect to use it in my relationships with persons who have addictions. I recommend it to anyone wanting to better understand and relate to people in their lives who suffer addiction.

–Suzy Kanode, Pastor and Spiritual Director

Check out The Soul of an Addict today!

September 26

Why We’re Losing the War on Drugs

Singapore’s arrival card. The big red letters leave no doubt as to their policy.

In the past 40 years, we’ve spent trillions of dollars on the War on Drugs in an effort to eliminate supply. Yet drug overdoses are up over 1,200%. We’re losing the war. And not for lack of trying.

We’re losing the war because the very premise of it is flawed.

Trying to solve the drug problem by eliminating the supply presumes, as many conservatives believe, that drug addiction is a choice. Eliminate the supply and people will make better choices.

It’s like those candy displays at the cash register of your local store: you want it because it’s there. It’s tempting. That’s called an impulse buy. And if it didn’t work, they wouldn’t keep doing it.

But drugs are not an impulse buy. Yes, the first time a person uses is clearly a choice, unless it’s given by a medical professional. And that does happen.

But once a person becomes addicted, the drug fills a need that nothing else does. It’s no longer an impulse buy. It’s a requirement.

As I argue in my book, The Soul of an Addict, for an addict the drug provides more than just relief from withdrawals and from past traumas and pains. It provides certain basic human needs which the user has not found anywhere else. These include identity, purpose, meaning for life, structure, and a moral code consistent with these.

Without the drug, in the absence of a suitable alternative, the person is miserable. They’re not waiting for an impulse buy. They are actively looking for relief, and they will do anything and pay anything to get it.

This is a ready-made market, a demand for the substance. And, as anyone who has taken an economics class knows, where there is a demand there will be a supply. Scarcity and risk cause the price to go up. But the person who needs drugs will find a way to pay that price, because they quite literally believe they can’t live without the drug. And that means the methods they use to obtain money may cross the line of legality, from theft to prostitution– and worse.

Is it even possible to stamp out the availability of drugs?

I say no, and here’s why.

Singapore is a small, island nation off the southern tip of Malaysia. It is ideally suited to control what crosses its borders because there are very few ways in or out. And Singapore has one of the toughest drug smuggling laws ion the world. Their arrival card makes it clear: the penalty for smuggling drugs is death. And they’re not kidding: smugglers are executed.

If anyone could eliminate the supply if drugs, it would be Singapore. Yet they had 14 drug overdoses in 2017. Their rate of overdose has more than doubled over the past 30 years. Yes, that’s far better than the U.S. rate of overdoses. Singapore’s is 0.25 per 100,000 people; ours is 18.75. They also have better health care and social services and less wealth inequality than we do, which would tend to drive down the rate of drug abuse and overdose.

But, even with supposedly absolute control and strict penalties, drugs are still available in Singapore. And if they can’t stamp them out with limited access points and draconian penalties, how do we expect to?

The War on Drugs is doomed to fail because it’s impossible to address the problem on the supply side. So long as there is a demand, someone will take the risk to make money by providing a supply. (Singapore’s penalty is death, yet people still risk it!)

And we can’t address it by locking up those who use drugs. We’ve spent trillions of dollars trying. Our prisons are full. Yet the problem keeps getting worse.

There’s got to be a better way.

And there is, but we’re not going to like it.

We’re not going to like it because it calls into question our post-modern ethos of consumerism, the whole premise that life can be fulfilling because of what we buy. That ethos is false, yet that’s what it takes to keep our economy afloat. People have to keep buying. When people start saving money instead, the Federal Reserve gets nervous. They need us to be happy consumers, floating in a sea of debt buying stuff we don’t need (but think we do).

Some of us may be satisfied with this purpose for life some of the time. But the fallacy is revealed in the rise of drug overdoses, alcohol deaths, and suicides. Consumerism doesn’t answer the big questions in life. Like, “What is it all for?”

That’s the realm of religion, not social policy. And religion is something society doesn’t prescribe for us. In fact, it has increasingly fallen out of favor. Over the past 40 years, the number of Americans who identify their religious affiliation as “None” has risen from 7% to 21%.

But even that number may be optimistic. I’ve been to many churches where the point of going to church is to go to church. It’s what we do. Yes, there’s a vague message that we should live good lives, but no specific guidance for doing so.

I’ve been to other churches which focus on what happens after we die. For someone like me, a recovering addict, this fails to answer the burning question of my life: how do I live now? (And if the afterlife is so much better, isn’t that an argument for a sooner death?)

Sociologist Emile Durkheim suggests that a religion provides identity, meaning, structure for life, and a moral code. If that is so, then much of what we experience in church fails to meet the requirements of a religion. It doesn’t provide these basic human needs. No wonder the fastest growing religion in America is “None”! And no wonder deaths of despair are rising.

Doing Something Different

There is an answer to the drug problem. The Twelve Step programs recognize it. Every aspect of those programs is designed to give people identity, purpose, structure, and a sense of belonging. Although most of these programs aren’t religious, they do a better job of practicing a religion, in the sociological sense, than some churches.

Why can’t churches do what the Twelve Step programs do? They could. So could non-religious groups. But that would mean bucking the national religion of consumerism– and potentially being branded un-American, or worse. It would mean pushing back against the long-embraced idea that religion belongs in the private sphere. If your purpose and structure for life comes from your religion, it’s going to show.

Do we really believe that it’s better to spend trillions of dollars on trying to stamp out supply and incarcerate users, no matter the price tag? Is that a necessary “overhead expense” to maintain our consumer economy? Or is that just what we’ve always done?

In either case, it isn’t working. The problem is getting worse.

It’s time to do something  different.

September 9

Praise for Soul of an Addict

“The book elucidates the agony of addiction in a fresh, new way. It emphasizes the role of trauma in setting the stage for debilitating behaviors, and explains the importance of community support in the healing process. With anecdotes of many people who grapple with addiction and have survived, as well as sad stories of addicts who died, this book provides healthy doses of grit and inspiration.” –Christopher Key Chapple, Loyola Marymount University

September 7

The Medical View of Addiction

Medicine has struggled to understand addiction. This may be because it’s not entirely a medical problem. But science doesn’t consider spiritual aspects, and for the purposes of this discussion I’m willing to leave those aside.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the “bible” for diagnosis by professionals. The current version is DSM-V. Not surprisingly, the previous version was DSM-IV. The newer version introduced some major changes to the way substance abuse disorders are diagnosed.

DSM-IV, issued in 1994, generally offered two categories of substance abuse disorders: substance use disorder, and dependence. These corresponded to chronic abuse of a substance, and physical dependency on the substance. There were codes for various substances, distinguishing for example between opioid dependency and alcohol dependency. The DSM-V (2013) combines there and streamlines the diagnosis. As this summary explains, DSM-V

does away with separate “dependence” and “abuse” diagnoses and combines them into “substance use disorder.”

The current version sees substance abuse as a spectrum rather than two separate conditions.

While this does make diagnosis easier, it appears to me to move substance abuse treatment backward by failing to recognize the complexity of factors at play.

For example, let’s consider physical dependence. Anyone who takes opioids (or other physically-addictive medication) over a long period will become physically dependent. It doesn’t matter whether they began using for pleasure, or if they were prescribed the drug by a doctor because of a medical need. They will need the drug to avoid going into withdrawals, which are typically both painful and disorienting. And in the case of alcohol (and certain other drugs), withdrawal can be life-threatening. Someone dependent on alcohol, for example, will crave it. And the cause of this craving is biological: they’ll go into withdrawals if they don’t get it. This is what DSM-IV described as “dependence.”

Yet dependency alone does not indicate whether that person will return to the drug once separated from it. When the physical dependency is relieved through a withdrawal process, medically supervised or not, there is no further need for the drug. Many people, once relieved of their dependence, take what might be described as the sane response: they never touch it again.

On the other hand, let’s consider what is sometimes described as “risky use.” A person who is not dependent on a substance nevertheless seeks it out and abuses it. The cause of this is not physical but psychological. Whether they seek pleasure or to kill the pain of some past trauma, the drug serves a purpose in their lives. They choose to pursue it of their own free will. This is what DSM-IV described as “substance use disorder.”

Interestingly, substance use disorder does seem to be a spectrum. Some people are able to choose to quit of their own volition. Others need help to quit. And some pursue their obsession with the substance, as Alcoholics Anonymous observes, “into the gates of insanity or death.”

These two, very different, facets of substance abuse are combined in DSM-V into a single spectrum. Yet the opioid crisis should show us the fallacy of this “improvement.”

One of the popular news items in the opioid epidemic is the number of people who began using because an opioid was prescribed by their doctor for a medical condition. (Here’s an example.) This theory presumes that chronic physical pain is the cause of opioid use that results in dependence. And this may well be for some people.

Yet many, perhaps most, opioid addicts struggle with a condition I can only describe as “addiction.” Yes, they are physically dependent. Yet once separated from the drug, whether through rehab or incarceration, they return to it despite its adverse effects on their lives. Not because of physical pain, but because of a psychological obsession with what the drug does for them.

At the very least, in these people we can see an overlapping of two distinct conditions: dependency and an obsession to use. These are not the same. One is physical, the other is psychological. Both need to be treated for successful recovery. Yet without recognizing the difference between the two conditions, how can they be treated?

This is true for any drug user. For a successful result, a person who is dependent because of chronic pain must be treated differently from one who is not dependent but seeks the drug by choice. Yet in the case of the addict, who has both conditions, treating one or the other is simply pointless. Not only is it ineffective, but the failure of this approach erodes confidence that recovery is possible.

And recovery is possible! While success with opioid addiction recovery from a medical perspective remains dismally low, tens of thousands have recovered through other, non-medical methods. These include Twelve Step groups like Narcotics Anonymous, religious based programs like The Bridge Ministry, and many others.

Because when withdrawals end, that’s when the real healing begins. Now that we don’t have a physical need, how do we live without the psychological need? Medicine doesn’t do that. Even psychology tends to fall short in offering resources.

Perhaps this is because they don’t really understand what an addict needs, because the vast majority of medical professionals have never experienced it.

But those who have been there and recovered do know. It is to them we should look for answers. Oddly, that seems to be the one place science hasn’t looked. Which may be why their understanding of addiction and recovery sometimes seems to be moving backward.

 

For more on addiction, read my book, The Soul of an Addict, available in Paperback and Kindle editions.

September 3

Getting Out

Whether it’s jail or rehab, how does an addict stay clean when they get out?

I met William in his last week at a program that helped former inmates deal with addiction and prepare for the real world. We talked for almost an hour. I told him my history, and about how I stayed clean. He seemed excited to know someone in recovery. He took my number, and promised to call as soon as he got settled in his new apartment.

I never heard from him.

The are literally hundreds of thousands of men and women incarcerated for drug related offenses, many of them nonviolent. What happens when they get released? Some of these go to halfway houses or rehabilitation programs. Do these improve their chances? Thousands are voluntarily in rehabs. Are their chances any better?

There’s one aspect of addiction that few programs, and few theories of addiction, take into account: Addiction is a way of life. It defines what we do with our time. Conversely, it tells us what to do when we don’t know what to do.

This means the first day or two after getting out, whether from incarceration or from a program, are critical. Structure has been removed. Even if there’s a job to go to, which there often isn’t at that stage, there are still 16 hours in the day to navigate. In an unfamiliar world. With complete freedom of choice. After months or years of complete structure, the person is suddenly expected to know what to do with their time.

That’s not a reasonable expectation. Anyone who has become unemployed, or who has faced a quarantine that disrupts their normal routine (and that’s most of us now), knows that it isn’t easy to find a new routine. And we generally start with what we know, whether that’s exercise or prayer.

What an addict knows is not exercise or prayer. I say this as one who struggled with addiction for many years. The drug becomes the center of our lives, defining our identity and our purpose. And it tells us what to do with our time.

How long will a person wait for something new to happen before returning to their old ways? My experience indicates that it may be as little as 24 hours, and certainly not more than a few weeks.

This is the window of opportunity for the person to develop not only a new routine, but a new circle of friends and support. In the absence of those, he or she is alone and without tools for navigating their new reality.

If you think about how long it takes to find and adopt a new routine, find support, and make friends, this is a nearly impossible task.

So what is the answer?

Those who have relationships with supporters and friends before their release are more likely to succeed. They already have some of the most important pieces in place. If we want to support addicts in staying clean, this should begin while they’re still inside, whether it’s a rehab or a jail.

But secondly, when they get out we shouldn’t expect them to reach out to us. They have been conditioned not to trust, and to believe that those who need help are weak. It takes time for those beliefs to change– time they may not have. There’s also the shame factor. They may be ashamed of their social status, and of their need for help. They also may be afraid of rejection, betrayal, or abandonment– all common occurrences in the world of addiction.

We need to reach out to them! And we need to do so with persistence, but not harassment. They may or may not respond. They may or may not stay clean. Working with addicts always risks heartbreak, including the ultimate heartbreak of funerals. But we do it because there would otherwise be even more funerals.

William, my new friend who disappeared, taught me one thing: not to just give out my number, but to take his. I didn’t do that for him, and he is likely back in the trap of old behaviors. But I have done it for others since then.

For more on addiction, read The Soul of an Addict: Unlocking the Complex Nature of Addiction.
August 30

Now Available: The Soul of an Addict (and a free download)

It’s available! In both paperback and Kindle formats. The Soul of an Addict: Unlocking the Complex Nature of Addiction, by D.J. Mitchell.

Addiction is more complex than it may seem. Written for the non-addict who seeks to understand substance addiction, The Soul of an Addict shows that addiction not just a disease or a choice. Using statistics, anecdotes from the lives of addicts, and the author’s personal experience with addiction and recovery, the book argues that addiction affects all aspects of human existence, including identity, purpose, life structure, and morality. It serves as a religion in the addict’s life, and any approach to recovery must also provide these essential needs. With one in seven Americans struggling with substance abuse, this book brings a timely analysis for anyone concerned about addiction.

“A must-read… As a therapist I will be recommending this book to my clients.” –Milt McLelland, CMHC, Roots Counseling Center

For more information, click here.

Want a free look? Download the Introduction and first chapter here!

August 19

Coming Soon: The Soul of an Addict

Draft cover for The Soul of an Addict

My first non-fiction book is coming soon. The Soul of an Addict: Unlocking the Complex Nature of Addiction argues that addiction is far more complex than most models accept. Is it a disease? A choice? Yes. But it’s also more than either of these. In fact, addiction has the sociological characteristics of a religion.

The book is supported by statistics, anecdotes from my work with addicts, and stories from my own struggle with addiction. It will be available in two weeks.

Here’s an excerpt from Chapter Twelve, “What Is Recovery?”

Jenna was in her fifth round at a treatment facility when I met her. She dropped out before the end of the program and went back to using drugs.

Nate got clean and sober the first time he went to treatment and never used again.

Ben was sentenced to treatment by the court after his fifth conviction for DUI. He went to avoid prison, yet he got clean and stayed clean for many years.

Vivian had a spiritual experience after an alcoholic binge, attended Twelve Step meetings and never drank again.

Dan found sobriety in a church run by a pastor in recovery.

Al got sober through Twelve Step meetings while in prison for vehicular manslaughter.

Vern failed at treatment facilities and methadone clinics for years, but after doing some time in jail and living in his car for a year, he finally got clean in a Twelve Step program.

Treatment takes many forms, and has varying rates of success. But, whether an expensive rehab facility, a publicly funded treatment center, a church-based support group, or a cost-free Twelve Step meeting, some form of support is usually necessary to help us get out and stay out of our addiction. The reason is simple: If we knew how to stay clean and sober without treatment, if we could envision a way of life sufficient to replace addiction, we would have given up drugs already.

Treatment for drug and alcohol addiction is big business in the United States. In 2017, nearly three million people underwent treatment.[1] It’s estimated that Americans spend $30-35 billion a year attending rehabilitation centers for drug and alcohol abuse.

That doesn’t include the nation’s largest single “treatment” system: prison. According to researchers Wendy Sawyer and Peter Wagner, nearly half of all federal prisoners, about 100,000 people, are incarcerated for nonviolent drug offenses.[2] It’s estimated that half a million nonviolent drug offenders are incarcerated in state and local prison systems. [3] At an estimated $30,000 per prisoner per year, that’s another $15 billion expense that falls to the taxpayers.

In 2016, some 168,000 people on parole or probation were returned behind bars not because they committed a new crime but because of technical violations such as staying out past curfew. Sawyer and Wagner argue that the justice system is structured to promote failure, not to reward success.[4]

It’s worth noting that those who go through treatment are more likely to be white (about 80%). Those who go to prison are more likely not to be white (about 70%). The rate of addiction does vary slightly between races, but perhaps not as expected. Of the three most populous races, whites lead in substance abuse problems with 7.7%. Blacks have a rate of 6.8%, and 6.6% of Hispanics struggle with substance abuse.[5] Yet blacks are six times more likely to be incarcerated for drug offenses than whites.[6]

Jacob, a young African-American man, was arrested for drug-related offenses. While represented by a public defender, he was sentenced to four years in prison. Later, he managed to pay an attorney several thousand dollars to have the judge reconsider the sentence. It was reduced to one year followed by a court-ordered drug treatment program. Financial resources clearly make a huge difference in the outcome of drug offenses in the criminal justice system.

There’s another troubling statistic. In 2017, more than 20 million Americans sought treatment for a substance abuse problem. Only 12% of them actually received treatment. That’s a huge improvement over prior years. In 2014, for example, only 7.5% of those seeking treatment actually received it.[7] But still: out of every eight people who seek treatment, seven do not receive it. The most common reason cited, by almost half of those who could not obtain treatment, was lack of insurance coverage.[8] They couldn’t afford the cost.

Footnotes:

[1] Bose, Table 5.10A.

[2]“What America Spends on Drug Addictions,” Addiction-Resources.com, 2005 (https://www.addiction-treatment.com/in-depth/what-america-spends-on-drug-addictions/, accessed August 14, 2019). There are many more recent estimates on what Americans spend on the substances themselves, but I was unable to find a more current estimate of the cost of rehab. Gabrielle Glaser, “The Irrationality of Alcoholics Anonymous,” Atlantic Feb 2015 (https://www.theatlantic.com/magazine/archive/2015/04/the-irrationality-of-alcoholics-anonymous/386255/, accessed August 15, 2019). “Offenses,” Federal Bureau of Prisons, Aug 9, 2019 (https://www.bop.gov/about/statistics/statistics_inmate_offenses.jsp, accessed August 14, 2019).

[3] Wendy Sawyer and Peter Wagner, “Mass Incarceration: The Whole Pie 2020,” Prison Policy Initiative, March 24, 2020 (https://www.prisonpolicy.org/reports/pie2020.html, accessed May 15, 2020).

[4] Ibid.

[5] Bose, “Results from the 2017 National Survey on Drug Use and Health: Detailed Tables, 2018 (https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf, accessed May 15, 2020).

[6] NAACP, “Criminal Justice Fact Sheet” (https://www.naacp.org/criminal-justice-fact-sheet/, accessed May 15, 2020). Numbers for Hispanics were not included. Also see Alana Rosenburg, et. al., “Comparing Black and White Drug Offenders: Implications for Racial Disparities in Criminal Justice and Reentry Policy and Programming,” J Drug Issues 2017 47(1), 132-142 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614457/, accessed May 15, 2020): Blacks are more likely to be incarcerated for smaller offenses; 49% of Blacks and only 10% of whites in the study were convicted of marijuana possession compared with 7% of Blacks and 50% of whites convicted for heroin possession.

[7] Rachel N. Lipari and Struther L. Van Horn, “Trends in Substance Abuse Disorders among Adults Aged 18 or Older,” The CBHSQ Report, SAMHSA, Jun 29 2017 (https://www.samhsa.gov/data/sites/default/files/report_2790/ShortReport-2790.html, accessed August 15, 2019). Compare Rachel N. Lipari, Eunice Park-Lee, and Struther Van Horn, “America’s Need For and Receipt Of Substance Abuse Treatment in 2015,” The CBHSQ Report, SAMHSA, Sep 16 2016 (https://www.samhsa.gov/data/sites/default/files/report_2716/ShortReport-2716.html, accessed August 15, 2019) reports that 10.6% of those who sought treatment received it in 2015. The percentage receiving treatment has

[8] Bose, Table 5.50A, shows 421 of 1,033 (41%) surveyed either didn’t have health insurance, or had health insurance that didn’t cover treatment.