Austin Frakt asks a simple question: “Do we spend too little on substance use treatment?”
The simple answer is “Of course. Absolutely.” Many, many studies indicate that such services improve health and well-being and reduce crime. One of my own co-written papers contributes to this literature, finding that the reduction in one crime–armed robbery–more than offset the cost of intensive treatment in criminally active populations.
A more complicated answer would include some caveats, though….
First, a lot of substance abuse treatment is very poor. We need to spend more money, but we also need to hold providers to higher quality standards. Our work on methadone maintenance dosing and HIV prevention provides obvious examples. An admirable, often-overlooked aspect of health reform is to provide patients with better options to manage substance use disorders, and to integrate such care within the broader world of medical care.
Second, most people with problematic substance use probably don’t need and will certainly never receive specialized addiction treatment services. We need to do a much better job (a) identifying and referring people to treatment, and (b) dealing with problematic substance use that doesn’t reach the level that would satisfy formal screening criteria for treatment intervention. Efforts such as SBIRT (Screening, brief intervention, and referral to treatment) are therefore especially important.
Third, we need to recognize that substance abuse treatment will always have frustrating shortcomings, and cannot address many of the most poignant harms associated with intoxicating substances. If we expect too much from treatment or claim too much for what treatment can accomplish, we may be disappointed.
In part, this reality underscores the importance of non-treatment policies such as alcohol taxes and a variety of harm reduction interventions. In part, this reflects the even simpler reality that the misuse of intoxicating substances brings many harms which we cannot fully address.