From PLNDP and JOIN TOGETHER A P H Y S I C I A N ’ S G U I D E O N
H O W T O A D V O C AT E F O R
M O RE EF FE C TI V E NATIONAL
A N D S T AT E D R U G P O L I C I E S
CONSE NS US STAT EMEN T Adopted by Physician Leadership on National Drug Policy, July 1997
Addiction to illegal drugs is a major national problem that creates impaired health, harmful behaviors, and
major economic and social burdens. Addiction to illegal drugs is a chronic illness. Addiction treatment
requires continuity of care, including acute and follow-up care strategies, management of any relapses, and
satisfactory outcome measurements.
We are impressed by the growing body of evidence that enhanced medical and public health approaches
are the most effective method of reducing harmful use of illegal drugs. These approaches offer great
opportunities to decrease the burden on individuals and communities, particularly when they are integrated
into multidisciplinary and collaborative approaches. The current emphasis—on use of the criminal justice
system and interdiction to reduce illegal drug use and the harmful effects of illegal drugs—is not adequate
to address these problems.
The abuse of tobacco and alcohol is also a critically important national problem. We strongly support
efforts to reduce tobacco use, including changes in the regulatory environment and tax policy. Abuse of
alcohol causes a substantial burden of disease and antisocial behavior that requires vigorous, widely acces-
sible treatment and prevention programs. Despite the gravity of problems caused by tobacco and alcohol,
we are focusing our attention on illicit drugs because of the need for a fundamental shift in policy.
As physicians we believe that:
• It is time for a new emphasis in our national drug policy by substantially refocusing our investment in the
prevention and treatment of harmful drug use. This requires reallocating resources toward drug treat-
ment and prevention, utilizing criminal justice procedures that are shown to be effective in reducing
supply and demand, and reducing the disabling regulation of addiction treatment programs.
• Concerted efforts to eliminate the stigma associated with the diagnosis and treatment of drug problems
are essential. Substance abuse should be accorded parity with other chronic, relapsing conditions inso-
far as access to care, treatment benefits, and clinical outcomes are concerned.
• Physicians and all other health professionals have a major responsibility to train themselves and their stu-
dents to be clinically competent in this area.
• Community-based health partnerships are essential to solve these problems.
• New research opportunities produced by advances in the understanding of the biological and behavioral
aspects of drugs and addiction, as well as research on the outcomes of prevention and treatment pro-
grams, should be exploited by expanding investments in research and training.
Physician Leadership on National Drug Policy will review the evidence to identify and recommend medical and
public health approaches that are likely to be more cost-effective, in both human and economic terms. We
shall also encourage our respective professional organizations to endorse and implement these policies.
(see inside back cover for list of supporting organizations)
JOIN LE ADING PHYS ICIANS IN ADV OC ATI NG F OR B ET TER NATI ONAL DRU G POLI CIES
Drug addiction is a chronic illness that the editor of the Journal of the American
impairs health, elicits harmful behaviors, Medical Association,and a former editor of
and creates major economic and social bur- both the New England Journal of Medicine
dens. Substance abuse is an epidemic in and Science. Together, they share a firm
America, and no racial, cultural, or social group is commitment to improving the way addiction treat-
immune; it particularly threatens our young people. ment is perceived and delivered in our country. The
Fortunately, there are effective medical and public Robert Wood Johnson Foundation and the John D.
health approaches to address the problem. Doctors and Catherine T. MacArthur Foundation provide
are using these treatments and are witnessing lasting primary support for this project.
benefits for their patients. National drug policy,
The basic premise of PLNDP is that drug addic tion
however, remains behind the times.
is a chronic, relapsing disease,like diabetes, coronary
Nearly four years ago, a group of distinguished, dedi- heart disease, or hypertension. Unfortunately, the
cated physicians came together to form Physician stigma associated with addiction—as well as the
Leadership on National Drug Policy (PLNDP), the general ignorance about its ability to be successfully
first all-physician group of its kind to address the treated—have relegated it to the domain of law
issue of national drug policy. The group developed a enforcement, with insufficient focus on medical
consensus statement (see inside front cover of this intervention. Despite the best intentions of public
guide) stressing the need for a medical and public officials, the emphasis on the criminal justice approach
health approach to national drug policy. The 37 alone is not solving drug problems in this country.
non-partisan founding members of PLNDP include
Moreover, comprehensive drug treatment is cost-
many former high-ranking health or drug policy
effective. The outdated thinking on drug abuse needs
advisors under the Reagan, Bush and Clinton admin-
to be replaced with medically sound policies for treat-
istrations. David C. Lewis, MD, is the Project
ment, prevention, and research. As a physician, you
Director and the founder of the Center for Alcohol
can play a critical role in achieving this goal.
and Addiction Studies at Brown University. PLNDP
members include: Dr. Louis W. Sullivan, former U.S. PLNDP involves physicians from around the country
Secretary of Health and Human Services; David – many of whom have already lent their credible and
Kessler, MD, immediate past Commissioner of the influential voices to this national movement. If you
Food and Drug Administration; Edward Brandt, MD have not already become a PLNDP Associate, we
and Philip Lee, MD, who were Assistant Secretaries invite you to join. This guide provides basic informa-
of Health and Human Services under Presidents tion about PLNDP, background material on the issues,
Reagan and Clinton, respectively; Antonia Novello, and resources for getting involved. If you have already
MD, former U.S. Surgeon General under the Bush become a PLNDP Associate, this guide will help you
administration and current Health Commissioner of determine what action steps you want to take and pro-
New York; Frederick Robbins,MD, Nobel Laureate; vides tips and resources to help you take these steps.
1
PH YS ICI AN LE AD ERS O F P LN DP
JUNE E. OSBORN, MD THOMAS F. BOAT, MD GEORGE D. COMERCI, MD H. JACK GEIGER, MD
(CHAIR) Chair, Department of Clinical Professor of Arthur C. Logan Professor
Sixth President, Josiah Pediatrics, University of Pediatrics, University of and Chair, Community
Macy, Jr. Foundation. Cincinnati College of Arizona College of Health and Social Medicine,
Former Chair, U.S. Medicine and Director, Medicine. Former City University of NY
National Commission on Children’s Hospital President, American Medical School. Founding
AIDS. Former Dean, Research Foundation. Academy of Pediatrics and member and Immediate
University of Michigan, Former Chair, American the Ambulatory Pediatric Past President of Physicians
School of Public Health. Board of Pediatrics. Association. for Human Rights and
Physicians for Social
GEORGE D. LUNDBERG, MD EDWARD N. BRANDT, JR., RICHARD F. CORLIN, MD Responsibility.
(VICE CHAIR) MD, PHD President, American Contributing Editor,
Editor-in-Chief, Medscape. Director of the Center for Medical Association. American Journal of Public
Former Editor, JAMA. Health Policy and Regents Former Speaker, American Health. Former Chair,
Former Professor and Professor of Internal Medical Association House Department of Community
Chair of Pathology, Medicine and of Health of Delegates. Assistant Medicine, Tufts University
University of California- Administration and Policy Clinical Professor, Medical School.
Davis. Past-President, at the University of University of California-
American Society of Oklahoma Health Sciences Los Angeles,School of ALFRED GELLHORN, MD
Clinical Pathologists. Center. Former Assistant Medicine. Past President, Director, Aaron Diamond
Secretary for Health in the California Medical Foundation Post Doctoral
DAVID C. LEWIS, MD U.S. Dept. of Health and Association. Research Fellowships in
(PROJECT DIRECTOR) Human Services (Reagan AIDS and Drug Abuse.
Founder, Center for Administration). JAMES E. DALEN, MD Former Director of
Alcohol and Addiction Vice-President for Health Medical Affairs,NY State
Studies, Brown University. LONNIE R. BRISTOW, MD, Sciences and Dean, College Department of Health.
Professor of Medicine and MACP of Medicine at the Arizona Founding Director Sophie
Community Health, Chairman, Board of Health Sciences Center. Davis School of
Donald G. Millar Professor Regents of the Uniformed Editor, Archives of Internal Biomedical Education,
of Alcohol and Addiction Services University of Medicine. Past President, Vice President, Health
Studies. Health Sciences. Past American College of Chest Affairs - City College of
President of the AMA. Physicians. New York.
ERROL R. ALDEN, MD
Deputy Executive Director, CATHERINE D. DEANGELIS, DAVID S. GREER, MD
CHRISTINE K. CASSEL, MD
American Academy of MD, MPH Dean and Professor
Chair, Department of
Pediatrics (AAP) and Geriatrics and Adult Editor, JAMA. Former Emeritus, Brown
Clinical Professor of Development of Mount Professor of Pediatrics, University School of
Pediatrics, University of Sinai School of Medicine, Johns Hopkins University Medicine and Founding
Chicago. Professor of Geriatrics and School of Medicine. Director of International
Medicine. Past Chair of Physicians for the
SPENCER FOREMAN, MD
JEREMIAH A. BARONDESS, MD the American Board of Prevention of Nuclear War.
President, New York President of Montefiore
Internal Medicine. Past
Academy of Medicine and Medical Center and Past
President of the American HOWARD H. HIATT, MD
Chair of the Association of
Professor Emeritus of College of Physicians. Professor of Medicine at
American Medical Colleges
Clinical Medicine, Cornell Harvard Medical School,
(AAMC).
University Medical College. LINDA HAWES CLEVER, MD Senior Physician at the
Chair, Department of Brigham and Women's
WILLARD GAYLIN, MD
FLOYD E. BLOOM, MD Occupational Health at Hospital. Secretary,
Clinical Professor of
Chair, Department of California Pacific Medical American Academy of Arts
Psychiatry at Columbia
Neuropharmacology, The Center. Medical Director and Sciences and directs
College of Physicians and
Scripps Research Institute, of the Renewal Center for the Academy's Initiatives
Surgeons. Co-founder of
La Jolla, California. Former Healthcare Professionals of for Children program.
the Hastings Center.
Editor, Science. the Institute for Health Former Dean of the
Former President and
and Healing. Past Editor, Harvard School of Public
Chair of the Hastings
Western Journal of Health.
Center and currently a
Medicine. member of the Board of
Directors.
2
JEROME P. KASSIRER, MD CLAUDE H. ORGAN, JR., MD STEPHEN C. SCHEIBER, MD LOUIS W. SULLIVAN, MD
Professor and Former Vice Professor and Chair, Executive Vice President, President, Morehouse
Chair, Department of Department of Surgery, American Board of School of Medicine.
Medicine, Tufts University University of California, Psychiatry and Neurology. Former Secretary of Health
School of Medicine. Past Davis-East Bay. Editor, Adjunct Professor of and Human Services (Bush
Chair, American Board of Archives of Surgery. Former Psychiatry, Northwestern Administration).
Internal Medicine. Former Director and Chair, University Medical School, Founding President,
Editor, New England American Board of Surgery. and the Medical College of Association of Minority
Journal of Medicine. Wisconsin. Health Professions Schools.
ROBERT G. PETERSDORF, MD
DAVID A. KESSLER, MD Distinguished Professor of SEYMOUR I. SCHWARTZ, MD ALLAN TASMAN, MD
Dean, Yale Medical School. Medicine, University of Distinguished Alumni President, American
Former Commissioner, Washington and Professor and Chair, Psychiatric Association.
Food and Drug Distinguished Physician, Department of Surgery, Professor and Chair,
Administration (Bush and Veterans Health University of Rochester Department of Psychiatry
Clinton Administrations). Administration. Past School of Medicine and and Behavioral Sciences,
President of the Association Dentistry. President-elect University of Louisville
PHILIP R. LEE, MD of American Medical and Chair, Board of School of Medicine.
Senior Advisor and Colleges, the Association of Regents of the American President, American
Professor Emeritus School American Physicians,and College of Surgeons. Association of Chairs of
of Medicine, University of the Association of Editor, Journal of the Departments of Psychiatry.
California- San Francisco Professors of Medicine. American College of Deputy Editor, The Journal
(UCSF). Former Assistant Surgeons. Past President, of Psychotherapy Practice
Secretary for Health in the P. PRESTON REYNOLDS, MD,
Society for Clinical and Research.
U.S. Dept. of Health and PHD
Surgery and the American
Human Services. (Clinton Associate Professor of DONALD D. TRUNKEY, MD
Surgical Association.
Administration). Former Medicine, Vice Chair, Chair, Department of
Director and Founder of Department of Medicine Surgery, Oregon Health
HAROLD SOX, MD
the Institute for Health and Chief, Division of Sciences University.
Joseph M. Huber Professor
Policy Studies,UCSF. General Internal Medicine, Former Chief of Surgery,
of Medicine and Chair,
Former Chancellor, UCSF. Johns Hopkins University. San Francisco General
Department of Medicine at
Hospital.
the Dartmouth Medical
JOSEPH B. MARTIN, MD, PHD FREDERICK C. ROBBINS, MD
Nobel Laureate in School. Director, Robert
Dean, Harvard Medical
School. Former Physiology and Medicine. Wood Johnson Foundation.
Chancellor, University of Director, Center for Generalist Physician
California - San Francisco. Adolescent Health of Case Initiative at Dartmouth.
Western Reserve University. Immediate Past President,
ANTONIA NOVELLO, MD, Dean Emeritus, Case American College of
MPH Western Reserve School of Physicians and Chair, ACP’s
Health Commissioner, Medicine and University. Educational Policy
State of New York. Former President, Institute Committee.
Visiting Professor of of Medicine.
Health Policy and ROBERT D. SPARKS, MD
Management, Johns ALLAN ROSENFIELD, MD Past President and Chief
Hopkins University School Dean of the School of Executive Officer,
of Hygiene and Public Public Health, DeLamar California Medical
Health and Special Professor of Public Health Association Foundation.
Director for Community and Professor of Obstetrics President Emeritus and
Health Policy. 14th and Gynecology, Columbia Senior Consultant, W.K.
Surgeon General of the University. Chair, NY State Kellogg Foundation.
U.S. Public Health Services Department of Health AIDS
(Bush Administration). Advisory Council. Former
Acting Chair, Department of
Obstetrics and Gynecology,
Columbia University.
3
ABO UT P L NDP AND JO IN T O GETH ER T HE M ED IA NE ED S Y O UR E XPE RT I S E
Word about Physician Leadership on National Drug Coverage by the media influences public opinion.
Policy has spread rapidly throughout the medical Public opinion and the media influence politicians
community. More than 6,000 medical practitioners who make our public policies. Therefore, working
from across the country have already become with the media is an excellent way for physicians to
Associates. Many of them have become involved in advocate for drug policy and treatment. Your influ-
efforts to change policies, educate the media and ence as a physician lends credibility to any medical
public and formed alliances with local groups work- story, and your advice is valued not only by the gen-
ing to change drug policies. PLNDP welcomes eral public but also by decision makers who follow
physicians and medical students to serve as PLNDP these stories and craft public policy. Reporters are
Associates. Once you become an Associate, PLNDP eager to identify knowledgeable medical experts who
will keep you informed as policy recommendations can improve their coverage of public health issues,
are developed. but sometimes they have difficulty finding the right
experts, and their stories suffer as a result. By increas-
Join Together, a national resource for community-
ing your involvement with the media, you can help
based groups fighting substance abuse located at the
ensure the accuracy of news reporting and generate
Boston University School of Public Health, is one of
more attention to key issues related to drug treatment.
PLNDP’s Outreach Partners. Join Together can put
you in touch with groups in your community who Consider the following examples of oversights in
are already working to improve drug policy and media coverage:
would welcome your support and participation. To These present an opportunity to offer medical expertise
get information about groups in your community, and redirect the attention where it needs to be.
call Join Together at 617-437-1500 or send an email
• An article focusing on criminal sentencing for
to plndp@jointogether.org.
drug abusers fails to address the cost savings of
rehabilitation.
Become a PLNDP Associate to Get the Resources and
Support You Need • A TV exposé on managed care neglects to discuss
Go to our web site, or mail in the enclosed postcard. parity for addiction treatment.
PLNDP on the Web
Explore PLNDP in more depth by visiting the web site at • A talk radio conversation reinforces the stigma
www.plndp.org. where you will be able to:
associated with alcoholism, discouraging listeners
• Join PLNDP as a Physician or Medical Student
Associate (free of charge) from seeking help.
• Order Free Videos
• Download PLNDP Position Paper on Drug Policy
• Download PLNDP Policy Reports
• Download Research Reports
• Access Action Kits such as this guide and others
4
The following are some steps you can take, in con- TV or radio stati on ;m en ti on the news story and your
junction with physicians who specialize in addiction expertise; and offer yourself as a resource or guest.
3
medicine and local anti-drug coalitions to work with Use coverage for additional leverage. Once
the media on this issue. More in-depth information you have published an op-ed, you may want
on media relations is available on the PLNDP Web use it to seek additional coverage on the
site at www.plndp.org topic. Send a copy of the op-ed to a TV assignment
1
Write an Op-Ed or a Letter to the Editor. The editor, a specific reporter, or a radio producer, with a
next time a drug-related article or TV news note suggesting that they cover this critical issue and
coverage attracts your interest, follow up by volunteering to serve as a resource or guest. You can
writing a response. An “op-ed”, or opinion editorial, also send copies of editorials to legislators (see below
is a signed article that asserts an opinion or urges the for suggestions on policy advocacy).
4
reader—perhaps an elected official or other decision Come prepared for interviews. Try to get as
maker—to take a particular course of action. Op- much information about the story from the
eds are usually written by people who are not staff reporter before the interview so you can pre-
writers for the newspaper—including syndicated pare. Know the limitations of your expertise and
columnists, academics, politicians, or concerned citi- clarify these with the reporter before the interview
zens. A letter to the editor is generally a shorter begins. Most importantly, in the age of the sound
piece written in response to an article about which bite, communicate your main points succinctly and
the writer has a conflicting viewpoint or can offer stay focused on the key message. Collaborate with
additional supporting information. You’ll find sev- physicians in your area that specialize in addictions
eral sample op-eds and letters to the editor, as well as (American Society of Addiction Medicine, ASAM)
a step-by-step approach for crafting and submitting and various community organizations that support
them, on the PLNDP web site. They can be submit- similar perspectives.
ted by several co-signers, giving you an opportunity
5
Use available resources. Physician Leadership
to include leaders of community anti-drug groups
on National Drug Policy offers numerous
and addiction specialists.
reports and resources to help you locate sta-
2
Offer Yourself as a Resource. When you read tistics,create talking points, and prepare for media
an article or see a report on a topic where interviews. Start with the PLNDP Web site at
you have expertise, drop a note to the www.plndp.org, or contact the PLNDP National
reporter, acknowledging that you saw the reporter’s Office (email: plndp@brown.edu, 401-444-1817). Be
coverage and could be a good resource on similar sure to let PLNDP know about successful media con-
stories in the future. If you read about a breaking tacts you make. Dissemination of sample articles, Op
story in the morning paper, it will likely be covered Eds and Letters to the Editors motivate others to get
on the evening TV news or on talk radio programs. similarly involved and continue to participate in the
Call, fax or e-mail the news assignment desk at the movement!
continued on page 6
5
continued from page 5
SAMPLE LETTER TO THE EDITOR
Dear Ed i to r:
I am wri ting in re s po n se to your arti cle about drug abu se (or insert bet ter descri ption of the arti cle you ' re
wri ting in re s po n se to) en ti t l ed "[title of a rti cl e ] " , [ d a te of a rti cl e ] .
I am a Phys i cian As so ci a te of the Phys i cian Le a d ership on Na tional Drug Policy (PLNDP) wh i ch was fo rm ed
by 37 of the nati o n’s leading phys i cians including many fo rm er high - ranking health or drug policy advi so rs under
the Re a ga n , Bush and Clinton administra ti o n s . David C. Lewi s , M D, is the Proje ct Di re ctor and the fou n d er of t h e
Cen ter for Al coh ol and Ad d i ction Studies at Brown Un ivers i ty. PLNDP mem bers include: Dr. Louis W. Su ll iva n ,
fo rm er U. S . S e cret a ry of Health and Human Servi ces; David Ke s s l er, M D, i m m ed i a te past Co m m i s s i o n er of the Food
and Drug Ad m i n i s tra tion; Edwa rd Bra n d t , MD and Philip Le e , M D, who were Assistant Secret a ries of Health and
Human Servi ces under Pre s i d ents Re a gan and Clinto n , re s pe ctively; An tonia Novell o, M D, fo rm er U. S . Su rge o n
Gen eral under the Bush administra tion and current Health Co m m i s s i o n er of New Yo rk; Fred eri ck Robbi n s , M D,
Nobel La u re a te; the ed i tor of the Jou rnal of the Am erican Medical As so ci a ti o n , and a fo rm er ed i tor of the New
En gland Jou rnal of Med i cine and Sci en ce . Your arti cle stren g t h en ed my re solve to fight for more ef fe ctive drug
preven tion and tre a tm ent pro gra m s .
We need a new drug co n trol policy in this cou n try that re co gn i zes that drug abu se is not only a criminal justi ce
probl em but also a medical and pu blic health probl em . Our national drug policy should focus on edu c a ting the pu b-
lic and in pa rticular our youth about the deva s t a ting co n se q u en ces of using dru gs and the need to provide adequate
tre a tm ent pro grams for those alre a dy addicted . Law en fo rcem ent and addiction tre a tm ent must be linked ef fe ctively
so that no one falls betwe en the cra ck s .
States should be encouraged to adopt legislation to provide insurance coverage for substance abuse equal to other chronic
diseases. Currently, an estimated five million individuals are in need of treatment for drug abuse, yet less than one-third receive it.
Medical sch ools need to add addicti o n - rel a ted cou rses to their curricula so that the next gen era tion of d o cto rs
bet ter understands how to scre en fo r, d i a gn o se , and refer pa ti ents with drug and alcoh ol addicti o n . Re cent data
s h ow that 20% of m edical stu d ents re ceive no su b s t a n ce abu se training while 56% indicate re ceiving a small amou n t
of training (Jou rnal of Ad d i ctive Di se a se s , Volume 19, Nu m ber 3, 2 0 0 0 ) .
Mo re than 20 million Am ericans are addicted to dru gs and alcoh ol , and about 130,000 Am ericans die each ye a r
f rom those addictions alone. However, su b s t a n ce abu se has even wi d er- ra n gi n g
In San Jose, CA, Dr. David Breithaupt, m edical and so cial ef fe cts since it of ten occ u rs in co n j u n ction with and co m pl i c a te s
PLNDP Physician Associate asked the editor the tre a tm ent of m a ny ot h er medical and psych i a tric diso rd ers .
of his local paper to support the inclusion My wo rk with PLNDP has co nvi n ced me that every nei gh b o rh ood , every et h n i c
of addiction treatment in state legislation grou p, every family can be affe cted by drug addicti o n . We must care en ou gh abou t
requiring parity for mental health benefits. the lives of our ch i l d ren and our co m mu n i ties to su ppo rt drug pol i cies that tre a t
When the editor declined, Breithaupt a d d i ction as a pu blic health probl em and not merely a criminal one.
wrote an op-ed laying out the medical and Si n cerely,
economic benefits of parity for addiction
treatment. The editor published the op-ed,
and even wrote his own article concurring
with Breithaupt’s pro-parity stance. Both
editorials were published during the state
legislature’s deliberation of parity legislation.
6
HELP SHAPE FEDERAL AND STATE POLICY
While some physicians remain cautious about political Effects of Outpatient
involvement, this trend is changing. The medical Drug-Free Treatment
community has been instrumental in passing policies Before Treatment After Treatment (one year)
on tobacco, child safety seats, bicycle helmets and
42%
domestic violence intervention. Now your help is Cocaine (weekly use)
18%
needed in fashioning a more effective drug policy.
As physicians, you see the devastating effects of 25%
Marijuana (weekly use)
9%
substance abuse every day. No profession is better
able to advocate for a better solution to the problem. 31%
Heavy Alcohol
15%
22%
Illegal Activity
14%
Effects of Long-Term
Residential Treatment 82%
No Full-Time
76% Work
Before Treatment After Treatment (one year)
19%
Suicidal Ideation
66% 11%
Cocaine (weekly use)
22%
Outpatient Drug-Free (ODF) Treatment Programs, DATOS
17% Sample (N=764). Admitted patients on average had less severe
Heroin (weekly use)
6% drug use histories and criminal activity than those admitted to
LTR programs. Pretreatment rates for weekly cocaine use
40% dropped in the year following ODF treatment; comparable
Heavy Alcohol
19% reductions were found for weekly marijuana use and heavy
drinking. Longer time in treatment was related to significantly
41% better follow-up outcomes on a variety of behavioral criteria
Illegal Activity
16% SOURCES: Hubbard R, Craddock S, Flynn P, Anderson J, Etheridge R,
Overview of First Year Follow-up Outcomes in the Drug Abuse Treatment
88% Outcome Study (DATOS), Psychology of Addictive Behaviors 11(4): 261-278
No Full-Time
Work (1997); Simpson DD, Joe G, Broome K, Hiller M, Knight K, Rowan-Szal G,
77%
Program Diversity and Treatment Retention Rates in the Drug Abuse
24%
Treatment Outcome Study, Psychology of Addictive Behaviors 11(4): 279-293
Suicidal Ideation (1997). Data analyzed by D. Dwayne Simpson, PhD and Kevin Knight, PhD.
13%
Long-Term Residential (LTR) Treatment Programs, DATOS
Sample (N=676). Note the significant changes in alcohol and
drug use and illegal activity. SOURCE: Hubbard R, Craddock S, Flynn P, Federal and state policies must move beyond judicial
Anderson J, Etheridge R, Overview of First Year Follow-up Outcomes in the
Drug Abuse Treatment Outcome Study (DATOS), Psychology of Addictive
remedies to ensure adequate funding for treatment
Behaviors 11(4): 261-278 (1997); Simpson DD, Joe G, Broome K, Hiller M, and prevention. Currently, more than two-thirds of
Knight K, Rowan-Szal G, Program Diversity and Treatment Retention Rates
in the Drug Abuse Treatment Outcome Study, Psychology of Addictive
the federal drug control budget goes to enforcement,
Behaviors 11(4): 279-293 (1997). Data analyzed by D. Dwayne Simpson, PhD with less than one-third left for treatment, preven-
and Kevin Knight, PhD.
tion and research.
continued on page 8
7
continued from page 7 WAYS YOU CAN GET INVOLV E D
A major 1994 RAND Corp. study that was commis- • Write letters to federal and state lawmakers
sioned by the US Army, found that law enforcement
• Meet personally with policymakers or their staff
costs 15 times more than drug treatment to achieve
the same degree of benefit in reduced cocaine con- • Form or serve on a policy committee for a med-
sumption, reduced crime,and reduced violence. ical association to which you belong and place
the drug treatment issue on the agenda
Substance abuse treatment and prevention must
become more of a priority, and more of a possibility. • Use your influence in academia to explore
enhancements in substance abuse training for
PLNDP’s public policy goals include the following:
medical students
1. Reallocate resources toward drug treatment and
• Share your personal and professional experi-
prevention
ences with the dangers of drug and alcohol
2. Ensure parity with other chronic illnesses in access abuse, and your trials and successes in dealing
to care, treatment benefits, and clinical outcomes with these problems.
3. Reduce the disabling regulation of addiction treat-
• Become involved in community-based partner-
ment programs
ships and advocate for policy change.
4. Use effective criminal justice procedures to reduce
supply and demand
To help physicians get more involved, PLNDP offers
5. Expand investments in research and training educational resources to increase their understanding
6. Eliminate the stigma associated with diagnosis and of this issue at www.plndp.org. At this website you
treatment of drug problems can access the PLNDP Physician Paper, research
reports, news articles,the PLNDP Action Kit, as well
7. Train physicians and students to be clinically com-
as information about our free videos.
petent in diagnosing and t reating drug problems
The Importance of Personal Contact Physicians inter-
As a busy physician, you have time constraints for
ested in changing drug policies should work with
getting involved in each of the policy areas men-
others who are already working to change policy. It
tioned below. Even so, consider making one goal a
is important to know who all the stakeholders are,
priority and work in partnership with PLNDP and
opponents as well as supporters. Knowledge is
colleagues in your state and community. Your efforts
power. At a minimum,find out which groups are
can make a profound difference, simply by virtue of
already engaged in changing drug policies and how
your expertise and your status in the eyes of local,
they are trying to influence policy. (Join Together
state,and federal policymakers.
can help you identify groups in your community.
8
Contact Join Together by calling 617-437-1500 or for the policymakers attention). Good working rela-
sending an email to plndp@jointogether.org and tionships often begin in social settings.
request a list of local groups in your area). Coalitions
Legislators, like physicians, are busy people. Always
of people from different groups working in harmony
come to a meeting prepared to give your message
usually have the best chance of effecting positive
concisely. Leave a fact sheet with the critical informa-
change. Understanding the perspective of opponents
tion such as the talking points below. Even more than
is important in order to prepared to respond effec-
statistics, what often moves policymakers are per-
tively to the arguments against changing policy.
sonal stories that illustrate the negative effects of the
In deciding which legislators to ask to be the lead policy on the lives of real people.
sponsors of legislation, it is critically important to
Testify at Public Hearings Public hearings offer
assess and choose the leaders in both branches who
important opportunities to influence members of the
will be most likely to champion the cause and will
legislative committee that will decide whether or not
also have strong influence on the legislative leader-
to advance the policy proposal. In most state legisla-
ship. Asking the wrong person to carry a bill can be
tures anyone can testify at a public hearing. Plan to
the “kiss of death”. Obviously, the best possible spon-
ask your colleagues to testify in p erson if possible
sor would be the chairman of the committee that will
and to write letters to be delivered on or before the
most likely decide the fate of the bill.
day of the hearing. Encourage your patients or their
The key to educating legislators and persuading them family members, who have been the victims of exist-
to become actively involved in your cause is meeting ing drug policy, to also testify and write letters. Often
with them in person and developing a relationship their stories are what move the legislators the most to
that is mutually respectful and trusting. Don’t under- become
estimate the value of meetings and good relations supporters of In California, Dr. Gary Jaeger, PLNDP
Physician Associate and a family medicine
with legislator’s key staff. Legislators rely on their the needed
specialist, convinced the California Society
staff for information, analysis and advice. change in law of Addiction Medicine to create a policy
and policy. committee to promote state policies sup-
Aides often act as gatekeepers, deciding who their porting addiction treatment. Overcoming
legislators should bother to meet with. Educating key misgivings about physician activity in the
legislative staff and cultivating good working rela- political realm, the newly formed committee
worked with physician colleagues and advo-
tionships with them will be most helpful.
cacy groups to build support for addiction
treatment parity legislation. Dr. Jaeger met
It is not necessary to go to the capitol to meet with
with key legislators and staff to ensure the
legislators. In fact, most legislators will have more proposed legislation incorporated essential
time and attention for their constituents in their information. He and his panel provide
ongoing input on addiction policy to the
district office or another setting outside the capitol
California Medical Association as the efforts
(where there are many people and events competing to adopt parity legislation continue.
continued on page 10
9
continued from page 9
TALKING POINTS FOR WORKING WITH MEDIA OR LEGISLATORS
The following are talking points you can use when contacting legislators or the media.
• Drug abuse treatment has a marked economic impact. A 1997 study, published in the Journal of
Quantitative Criminology found that drug treatment saves $19,000 per patient in crime-related costs in the
year following treatment. Compared with the much lower costs of treatment for addiction—$2,828 for
methadone maintenance,$8,920 for residential treatment,and $2,908 for outpatient drug-free treatment,
drug treatment can offer immense savings.
• More than 20 million Americans are addicted to drugs and alcohol, and 130,000 die from those addictions
each year.
• Currently only one-third of those who need treatment for drug abuse receive it.
• Addiction is a chronic, relapsing illness, similar to coronary heart disease,asthma, and high blood pressure.
With proper medical intervention, it is manageable and treatable.
• Medical experts are seeking increased federal spending on drug treatment programs so that all those who seek
treatment can obtain it.
• Incarcerating drug addicts has not reduced,let alone controlled,the national drug problem. It has only led
to an increase in the size of the prison population.
• More than two-thirds of national drug control spending goes to law enforcement, with less than one-third
going to prevention, treatment and research combined.
Dr. Ken Roy, PLNDP Physician Associate and
a Los Angeles based physician, scheduled a • Insurance costs for drug treatment is inexpensive.A recent study by the
meeting with his first-term U.S. Rand Corporation concluded that the cost for large corporations and
Representative to discuss the PLNDP
HMOs to provide complete substance abuse benefits would be $5.11
Consensus Statement and the positive
impact on the community when addiction annually per employee.
treatment is accessible to anyone who
needs it. Dr. Roy asked the Congressman
to support federal parity legislation, and
assured him that he would make himself
available whenever the Congressman or his
staff needed information on addiction
treatment issues. Consequently the
Congressman and staff have a medical
expert to turn to for information and
advice as drug treatment and other med-
ical issues are raised in the discussion and
debated surrounding federal legislation.
10
DEMAND PARITY – EQUAL COVERAGE FOR SUBSTANCE ABUSE TREAT M E N T
Health plans and third-party payers typically provide However, studies show that full parity for substance
less insurance coverage for substance abuse treatment abuse treatment would increase insurance premiums
than for other medical conditions. Many insurance by as little as 0.2 percent or $5.11 yearly per insured
companies still provide no support for treatment individual. Meanwhile, the potential cost offset from
benefits and programs for substance abuse. Offering treatment is significant.
equitable medical coverage would give substance
abuse “parity” with other chronic conditions, making
Monthly Healthcare Costs
treatment more widely accessible, with significant for Treated vs. Untreated
overall savings from improved health and increased Substance Abuse
productivity. The 1996 Mental Health Parity Act Costs for Addicted Individuals Before Treatment
Costs if Left Untreated
passed by Congress achieved this objective for mental
Costs Following Treatment
health benefits. Unfortunately substance abuse Costs for Nonaddicted Individuals
remains excluded from federal parity laws. However,
as of January, 2001 health insurance plans for the
more than 9 million federal employees and their
dependents include parity for substance abuse treat-
ment.
To develop parity for substance abuse treatment across
the nation, PLNDP endorses:
• Development of a model state substance abuse par-
ity act, with endorsement from major
organizations in the field of addiction treatment
• Federal legislation to require parity for substance
abuse with other chronic diseases in service limits,
Treatment Cost Offset. SOURCE: Langenbucher J, Offsets Are Not
limits on outpatient care, cost sharing, and Add-Ons: The Place of Addictions Treatment in American Health Care
Reform, Journal of Substance Abuse 6: 117-122 (1994).
deductibles
• Increasing the number of states with parity legisla- Currently, only six states have passed comprehensive
tion substance abuse parity laws,largely as a result of
• Increasing the proportion of health plans provid- physician and advocacy group involvement.
ing parity for addiction treatment
One of the main obstacles to substance abuse parity
is the misperception that treatment costs too much.
11
RESOURCES
STAY INFORMED WITH
PLNDP DIRECT
Note: most of these materials are all available free of
charge and can be downloaded from the PLNDP web-
site www.plndp.org
Drug addiction as a chronic medical problem is the
subject of a new JAMA article co-authored by
PLNDP Project Director Dr. David Lewis. The arti-
cle reviews the research literature and finds that drug
dependence has characteristics similar to chronic ill-
nesses such as diabetes, hypertension,and asthma,
and should be treated using long-term care strategies
shown to produce lasting benefits.A. Thomas A new online partnership between Join
McLellan, PhD; David C. Lewis, MD; Charles P. Together Online and Physician Leadership
O'Brien, MD, PhD; Herbert D. Kleber, MD. Drug on National Drug Policy (PLNDP) pro-
Dependence, a Chronic Medical Illness: Implications
vides PLNDP Associates with an easy way
for Treatment, Insurance, and Outcomes Evaluation.
JAMA. 2000;284:1689-1695. to keep up with the latest news, research
findings and policy developments affecting
ACTION KIT
their efforts.
PLNDP Action Kit includes colorful charts and
graphs which illustrate the facts about substance
abuse and treatment which are also available as PLNDP Direct, a free email newsletter
teaching slides for presentations. available in daily or weekly editions, fea-
tures announcements and special highlights
RESEARCH REPORTS
January 2000: PLNDP Position Paper on Drug Policy from the PNLDP office alongside a custom
November 1998 Research Report:“Health, Addiction news feed from Join Together Online’s
Treatment, and the Criminal Justice System” award-winning website for communities
March 1998 Research Report: “Addiction and working to reduce substance abuse.
Addiction Treatment” PLNDP Direct subscribers will also have
access to an archive of over 30,000 articles,
VIDEOS
Trial, Treatment, and Transformation resource materials, facts and web links.
This 18-minute video profiles two graduates of
Richmond, Virginia’s drug court who chose the drug Sign up for a free PLNDP Direct subscrip-
court as an alternative to prison and the effects the tion at www.plndp.org or return the
drug court has had on their lives. The video presents
evidence on the effectiveness of treatment programs as enclosed postcard. Hundreds of PNLDP
compared to incarceration, and examines alternative Associates have already subscribed to this
approaches to combating juvenile drug use and relapse. customized newsletter.
Drug Addiction: The Promise of Treatment
This videotape is a powerful instrument for decreasing Don’t wait to join them -
stigma and increasing access to treatment. It can be
used by health and other professionals, community
sign up today!
coalitions, and all others interested in drug policy.
12
ORGANIZATIONS THAT HAVE ENDORSED THE PLNDP CONSENSUS STATEMENT AS OF MARCH, 2001
Professional Orga n i z a ti o n s
American Academy of Addiction American Medical Student Association
Psychiatry (AAAP) (AMSA)
American Association of Community American Academy of Pediatrics (AAP)
Psychiatrists (AACP) American Psychiatric Association (APA)
American College of Obstetrics American Society of Addiction Medicine
and Gynecology (ASAM)
American Medical Association (AMA) American College of Surgeons (ACS)
St a te Medical As so ci a ti o n s
California Medical Association New Hampshire Medical Society
Connecticut Medical Association Medical Society of New Jersey
Medical Society of the District of North Carolina Medical Society
Columbia
Ohio State Medical Association
Medical Association of Georgia
Oklahoma State Medical Association
Iowa Medical Society
Oregon Medical Association
Kentucky Medical Association
Rhode Island Medical Society
Maine Medical Association
South Dakota State Medical Association
MedChi, The Maryland State
Tennessee Medical Association
Medical Society
State Medical Society of Wisconsin
Minnesota Medical Association
Nebraska Medical Association
Cou n ty Medical Soci eti e s
Pima County Medical Society, AZ Sacramento-El Dorado Medical Society, CA
Part of PLNDP’S educational campaign is seeking endorsements of the Consensus Statement by
national professional societies and state medical societies. If you belong to a professional
society/organization that has not endorsed our consensus statement please contact us for ways
you can help (email: plndp@brown.edu).
P R I M A RY SUPPORT FOR PLNDP IS PROVIDED BY THE ROBERT WOOD JOHNSON AND THE JOHN D. AND
C ATHERINE T. MACARTHUR FOUNDAT I O N S .
JOIN TOGETHER P L N D P N AT I O N A L P RO J E C T O F F I C E
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