Achieving the Public Health and Safety Potential of Substance Abuse Treatments

Abstract

Heavy use of alcohol and drugs is associated with serious public health and public safety problems, including transmission of infectious diseases, disproportionate use of medical and social services, traffic accidents, and street crime (Gerstein & Harwood, 1990; Institute of Medicine, 1990; Merril, 1993; Rice, Kelman, & Miller, 1991). These alcohol- and drug-“related” problems not only reduce the safety and quality of daily life throughout this country, but they are also a source of substantial expense. For example, Rice and colleagues have estimated that the total cost to the country in 1990 was $99 billion for alcohol abuse alone, and approximately $67 billion for drug abuse (Rice, Kelman, & Miller, 1991). These economic, health, and safety issues have brought renewed interest in the expansion of treatment programs, more public financing for treatment, and even increased use of court-mandated treatments as a method of dealing with the public health and safety problems related to substance abuse (Institute for Health Policy at Brandeis University, 1993; Schmidt, 1995). At the same time, many segments of society are skeptical about the effectiveness of substance abuse treatments; there are those in government, healthcare financing, and the public at large who question whether treatment is “worth it.” As recently as July of last year, the Wall Street Journal questioned the effectiveness and value of substance abuse treatment, saying “... the success rate of treatment programs is highly uncertain” (Wall Street Journal, 1994, p. A12).