######## Section 6: 

######### Addiction, Treatment, and the Substance Abuse Treatment System

This section addresses the final component of the drug-free workforce
triad---the substance abuse treatment system. It provides an overview of
addiction, the treatment system, and the funding streams for treatment
programs.

**6.1 Definition and Nature of Addiction**

Drug addiction is a complex disorder that can involve virtually every
aspect of an individual's functioning---in the family, at work, and in
the community. In fact, drug abuse and addiction are among the most
significant and challenging health and social problems facing society
today. Fortunately, addiction is treatable. To understand the types and
components of substance abuse treatment, it is important to first be
familiar with the nature of addiction.

Addiction is a chronic, progressive, relapsing disorder characterized by
compulsive use of one or more substances that results in physical,
psychological, or social harm to the individual and continued use of the
substance or substances despite this harm. Addiction is a brain disease.
Research by the National Institute on Drug Abuse shows that long-term
exposure to drugs produces addiction---that is, the compulsion to take
drugs---by eliciting changes in specific neurons in the central nervous
system.

It is important to note that not everyone who uses alcohol or
experiments with illegal drugs goes on to become dependent or addicted.
In fact, many people can use alcohol without serious negative
consequences. Unfortunately, it is not possible to tell early on whose
use may lead to addiction.

Although addiction unquestionably begins with a voluntary act of using a
drug, continued use can become involuntary, ultimately to the point that
behavior is driven by a compulsive craving. The compulsion results from
a number of factors, including dramatic changes in brain function
produced by prolonged exposure to the drug. This is why addiction is
considered a brain disease. It is this compulsion that causes most of
the problems surrounding addiction. Once addicted, it is almost
impossible for many people to stop the spiraling cycle of addiction on
their own without treatment.

This compulsiveness is the root of the enormous health and social
problems associated with drug abuse. Understanding that addiction is a
consequence of fundamental neurological changes means that a major goal
of treatment must be either to reverse or to compensate for those brain
changes. Fortunately, research and remarkable scientific advances over
the past 25 years have increased understanding of the voluntary acts of
drug abuse and the compulsive nature of dependence and addiction. Most
importantly, this insight has provided the nation with a strong
scientific basis for drug abuse prevention and treatment efforts.

None of the above-mentioned genetic, biological, social, environmental,
and behavioral factors can completely deny the role of personal
responsibility. Having addiction does not absolve an individual of
responsibility for his or her behavior, but it does explain why many
addicts cannot simply stop using drugs by sheer force or will alone. As
with any illness, lifestyle behavior change is a critical part of
achieving and sustaining recovery.

######## 6.2 Drug Addiction Treatment  {#drug-addiction-treatment .unnumbered}

**6.2.1 Overview**

Addiction to alcohol and other drugs is a complex disease with a number
of physical and psychological effects. Similar to other chronic
conditions, addiction usually requires some form of treatment or
intervention to halt the disorder's progression. Although addiction
produces significant, lasting changes in brain chemistry and processes,
research demonstrates that treatment for addiction can restore a person
to normal, everyday functioning. In fact, overall, treatment of
addiction is just as successful as treatment of other chronic diseases,
such as diabetes, hypertension, and asthma.

Because of addiction's complexity and pervasive consequences, drug
addiction treatment typically must involve many components. Some of
these components focus directly on the individual's drug use. Others,
like employment training, focus on restoring the addicted individual to
productive membership in the family and society. Still others focus on
helping individuals overcome addictions by utilizing methods that
provide a type of inner personal transformation that helps them to
resist relapses.

Treatment for drug abuse and addiction is delivered in many different
settings, using a variety of behavioral and pharmacological approaches.
In the United States, more than 11,000 specialized drug treatment
facilities provide rehabilitation, counseling, behavioral therapy,
medication, case management, and other types of services to persons with
drug use disorders. Because drug abuse and addiction are major public
health problems, a large portion of drug treatment is funded by local,
state, and federal government programs. Private and employer-subsidized
health plans also may provide coverage for treatment of drug addiction
and its medical consequences.

Drug abuse and addiction are treated in specialized treatment facilities
and mental health clinics by a variety of providers, including certified
drug abuse counselors, psychiatrists and other physicians,
psychologists, nurses, social workers, and faith-based practitioners.
Treatment is delivered in outpatient, inpatient, and residential
settings. Although specific treatment approaches often are associated
with particular treatment settings, a variety of therapeutic
interventions or services can be included in any given setting.

## 6.2.2 Different Kinds of Treatment

There is no one-size-fits-all treatment program. Ideally, treatment
should be tailored to the specific needs of the individual and will vary
by setting, duration, and intensity. While a number of different
treatment settings exist, all have been shown to be effective in
reducing drug use.

Once an individual enters treatment, an individualized treatment plan is
created for him or her, commonly drawing upon many elements or
treatments, which can include such interventions as:

-   Detoxification to achieve initial abstinence and minimize physical
    withdrawal symptoms

-   Individual and group counseling

-   Residential therapeutic community living

-   Opioid agonist therapies such as methadone maintenance

-   Independent living skill training

-   Educational and employment training

-   Family and social network therapy

-   Medical treatment for co-occurring illnesses

-   Job, day care, and housing referral

-   Self-help group participation to help avoid relapse.

Recovering addicts often need to start fresh. It is important for
recovering addicts to reintegrate into the community, to find work,
establish a residence, and participate in a drug-free lifestyle. A
critical component of drug treatment is providing the necessary skills
so that employment can be obtained and sustained after treatment is
completed.

Addiction is a chronic relapsing disease, shown to exhibit relapse and
re-treatment rates on a par with many other chronic medical conditions
like kidney disease and diabetes. Likewise, staying symptom-free
requires lifelong attention to healthy lifestyle behaviors. Most chronic
disease relapse is triggered by voluntary choices. For example, for a
person suffering from kidney failure, having an alcoholic drink at the
office party or skipping dialysis to attend a social event could trigger
renal failure. For a diabetic, eating or drinking the wrong things or
lax monitoring of one's blood sugar could trigger insulin shock. For an
alcoholic or drug addict, accepting the offer of a drink or drug at a
party, or misusing prescription drugs to cope with a stressful life
event, could trigger addiction relapse. Thus, for most chronic disease
sufferers, maintaining a healthy lifestyle depends on routine
therapeutic and social support. That is why recovering addicts are
encouraged to participate in long-term aftercare programs or recovery
group meetings to help them avoid relapse. Many faith-based providers
specialize in aftercare programs providing structure and activities that
create supportive elements designed to remove recovering addicts from
previous negative environments and influences.

## 6.2.3 Seeking and Obtaining Treatment

## 

## Few people spontaneously decide to seek treatment, and not many want to go through the rigors of treatment. Common reasons people seek help are because the court ordered them to, because loved ones or colleagues urged them to seek it out, or because supervisors intervened and job loss was feared. Although for women a less confrontational approach is generally more effective, studies have shown convincingly that many people who enter drug treatment programs in which they face "high pressure" to confront and to attempt to surmount their addiction do comparatively better, regardless of what prompted them to seek treatment in the first place. 

## 

## Treatment availability is a critical component in reducing use of illegal drugs and abuse of alcohol. Its importance cannot be disregarded. For a variety of reasons, including a lack of adequate treatment capacity and of adequate child care or transportation, finding the treatment individuals need may be challenging. 

## 

There is a disparity between the number of people who need substance
abuse treatment and the number of people who receive it. As noted
previously in Section 2.1.3, the 2001 National Household Survey on Drug
Abuse found that the number of people age 12 and over who abused alcohol
or illicit drugs (16.6 million) was more than five times greater than
the number of people in the same age group who received substance abuse
treatment (3.1 million).

However, there are at least limited resources in most communities to pay
for treatment for people who lack health insurance or have exhausted
their insurance benefits. Organizations that can help locate local
programs include but are not limited to:

-   State alcohol and drug treatment provider associations

-   Local councils on alcoholism and drug abuse

-   City or county health departments

-   State alcohol and drug abuse agencies

-   State chapters of the American Society of Addiction Medicine

-   State chapters of the national Association of Alcoholism and Drug
    Abuse Counselors

-   Employee Assistance Programs

-   Faith-based and community-based organizations

-   SAMHSA's online Substance Abuse Treatment Facility Locator
    (http://www.findtreatment.samhsa.gov/facilitylocatordoc.htm) or
    Helpline (1-800-662-HELP; TDD - 1-800-228-0427).

######## 6.3 Funding Streams for Substance Abuse Treatment in the United States {#funding-streams-for-substance-abuse-treatment-in-the-united-states .unnumbered}

Funding substance abuse treatment services for individuals can come from
a variety of public and private sources, including Medicaid/Medicare,
Temporary Assistance for Needy Families (TANF), and private insurance*.*
Although public and private insurers pay for most health care in the
country, coverage for treatment is often limited or not always included.

Since neither public nor private insurers cover treatment to the same
degree as other health benefits, governments finance a greater
proportion of treatment costs than of other health-related costs. The
federal government contributes to treatment funding through
Medicaid/Medicare and the Substance Abuse Prevention and Treatment
(SAPT) Block Grant, which are discussed in more detail below. States
also have allocated funds for substance abuse from TANF and the State
Children\'s Health Insurance Plan.

## 6.3.1 The Substance Abuse Prevention and Treatment Block Grant Program

The SAPT Grant Program accounts for approximately 40 percent of public
funds expended on substance prevention activities and treatment
services. It disburses funds to the states, territories, and the
District of Columbia based on a congressionally mandated formula to
determine how much each state gets and is administered by the Department
of Health and Human Services' Substance Abuse and Mental Health Services
Administration (SAMHSA), Center for Substance Abuse Prevention and
Center for Substance Abuse Treatment.

While the SAPT Block Grant provides federal support to substance abuse
prevention and treatment services nationally, it empowers states to
design solutions to specific addiction problems that are experienced
locally. Although the program enables states to provide substance abuse
treatment and prevention services through a variety of means, both
statute and regulations place special emphasis on provision of treatment
and primary prevention services, both to injecting drug users and to
women with substance abuse problems who are pregnant or with dependent
children.

SAMHSA's reauthorizing statute, PL 106-310 from October, 1, 2000,
includes a provision to replace the SAPT Block Grant with Performance
Partnership Grants. When fully implemented, these grants will give
states and territories greater flexibility in how to obligate and spend
funds for treatment and prevention services for people at risk for
alcohol and other drug addiction.

States and territories submit annual reports and plans to the federal
government describing how they expended SAPT Block Grant funds during
the previous fiscal year and how they intend to obligate funds available
in the current fiscal year. States and territories design their services
and delivery systems to address specific local substance abuse problems.

Funding for the SAPT Block Grant program was \$1,600,000,000 in 2000;
\$1,665,000,000 in 2001; \$1,725,000,000 in 2002; and \$1,785,000,000 in
2003. The 2004 estimate is \$1,785,000,000.

Where to find more information about the SAPT Block Grant Program:

-   [*http://www.samhsa.gov/budget/content/2004/2004budget-14a.htm*](http://www.samhsa.gov/budget/content/2004/2004budget-14a.htm).

In addition to block grants, SAMHSA provides discretionary grants that
are awarded to various levels of government as well as local groups,
including community- and faith-based organizations, to meet new and
emerging needs. Among these is the Targeted Capacity Expansion program,
designed to address gaps in treatment capacity by responding to unmet
local needs for alcohol and drug treatment services. Funds are provided
to expand or enhance substance abuse treatment in local communities. For
further information, visit
<http://www.samhsa.gov/programs/content/brief2002/MeetNeeds/tcep.htm>.

## 6.3.2 Access to Recovery Initiative

## 

## In January 2003, President Bush announced the Access to Recovery Initiative. This program is to fund vouchers that individuals could use to seek substance abuse treatment at the program of their choice. The money would be allocated over three years and, according to the Office of National Drug Control Policy, would allow an additional 300,000 people to seek treatment. The program also would permit many different segments of society---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.