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Acupuncture and the New Recovery Movement Alex
Brumbaugh Prepared
for the National Acupuncture Detoxification Association March
7 - 8, 2003 Washington, D.C.
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In March of 1998, PBS aired a series hosted by Bill Moyers called "Moyers on Addiction: Close to Home." In the last segment of the show, he interviewed William White, author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America and asked for his historical reflections on addiction in America. White said that beginning in the 17th Century, there have been fairly predictable cycles in attitudes concerning alcohol and other drug problems. On the down side of these cycles, alcohol and other drug problems become increasingly stigmatized, criminalized, and de-medicalized, accompanied by a significant reduction in resources that would support recovery and treatment. Historically, these movements bottom out, and then there emerges a new recovery movement. For example, White writes in Slaying the Dragon that "in the mid to late 19th Century, an elaborate network of recovery support groups and addiction treatment institutions dotted the landscape. These included native American recovery circles, the Washingtonians, fraternal temperance societies, and reform clubs. There were recovery oriented inebriate homes, and physicians in the American Association for the Cure of Inebriety proclaimed to the world that addiction was a disease that could be inherited or acquired, and it was one from which people could totally recover. Recovery activists - alone and in groups - offered themselves as living proof that recovery was possible. "In the opening days of the 20th century, that entire network had vanished. By the early 20th Century, many addicted people were locked away for years in rural penal colonies. Others either languished in state psychiatric hospitals undergoing brain surgery or shock therapies, or died in the street. Believing that addicts and alcoholics were a "bad seed" that threatened the future of society, Americans passed laws providing for their mandatory sterilization. Religious and prohibitionist movements had framed the character of the alcoholic in the language of moral degeneracy." William White pointed out in the 1998 interview with Moyers that the most recent upswing in the cycle was the Modern Alcoholism Movement, which began in 1935 with the formation of Alcoholics Anonymous. The book Alcoholics Anonymous was published in 1939. In 1945, Marty Mann - the first woman to get sober in AA - formed the National Council on Alcoholism (NCA) in New York. The AA Co-Founders were on her founding Board. Interestingly, the leadership for these new recovery movements is inevitably provided by people who are successfully recovering. NCA's mission was to bring the good news to the non-recovering world that alcoholism was not a moral failing but an illness from which people can and do recover. NCA affiliates were formed all over the country. One was formed in my home town of Santa Barbara, California, in 1949 as the "Santa Barbara Committee on Alcoholism." One of the things they did was to found a men's recovery home called New House, where I got sober in 1983, and then a women's recovery home called Casa Serena where my wife got sober right after that. The Santa Barbara Committee on Alcoholism eventually became the Council on Alcoholism and Drug Abuse, which operates most of the public treatment in Santa Barbara County - all acupuncture-based. The Community Recovery Network, of which I am the director, is a program of that agency. So all of this is close to home for me. According to William White, the Modern Alcoholism Movement reached its peak when Betty Ford publicly announced her chemical dependency. That was accompanied by a veritable explosion of treatment and recovery resources. I recall the recovery landscape in Santa Barbara during the early 1980s when I got sober. There were four flourishing recovery clubs, the book stores had shelves filled with books on recovery, and our local hospital's program was so successful that they were able to offer to the community free drop-in services, family intervention services, and a free 30-day bed. In was also in those years that the National Acupuncture Detoxification Association was reaching fruition. By the time Bill Moyers was interviewing William White for his 1998 PBS series, the Modern Alcoholism Movement had ended. In my town, the one remaining recovery club was in financial crisis, most of the recovery books had disappeared, and the local hospital was considering dropping some of their chemical dependency programs altogether. In the preceding ten years, there had been a 75% decline in the value of private insurance coverage for alcoholism and other drug addiction; half the treatment programs in the country had closed while the demand for drug treatment had increased 400%; alcoholism and other drug addiction had been eliminated as disabilities under Social Security, and the prison population in the United States was higher per capita than in any nation on earth. William White hoped in 1998 that this was the bottom, and predicted that we would soon witness the emergence of a New Recovery Movement. There were definitely
some signs in the years that immediately followed that the prophecy would
come true. He wrote a wonderful article in 2000 charting the hopeful beginnings
of that movement entitled "Toward
a New Recovery Movement." But if the cycle is on its way up, it's not going to be in a straight line, partially because of the severe budget deficits faced by most States right now. David Eisen is not with us this year because Oregon has just eliminated its Medicaid benefit for alcohol and drug treatment, and other States may follow suit. On the other hand, however, Wyoming has just passed the most comprehensive alcohol and drug services plan ever undertaken by a U.S. state. The plan uses tobacco settlement money and commits to spending about $50 for every state resident in support of addiction prevention, early intervention, and treatment. Wyoming's treatment community, and to a lesser extent, its recovering community, were instrumental in educating lawmakers over a three-year period about the extent of the state's problems and how they could be addressed (click here for Join Together news feature on the Wyoming initiative). Let me cite a few of the activities around the country that serve as other indicators that William White's prophecy of a New Recovery Movement may come to pass. In 1998, the Center for Substance Abuse Treatment (CSAT), a program of the Substance Abuse and Mental Health Services Administration here in Washington - and the official Federal agency that deals with treatment - launched the Recovery Community Support Program. Nineteen initial 3-year grants were awarded around the country to mobilize the recovery community to have a voice in local alcohol and other drug policies. Our Community Recovery Network program in Santa Barbara with which I am associated was fortunate to be one of them. Another was awarded to our friends in Portland at Central Cities Concern - the Recovery Association Project (RAP). One of the major lessons learned in these projects was that it's a challenge to mobilize the recovery community in the period of three years, so in 2001 CSAT found the funding to allow about half of the projects to continue for another three years, and also funded about a dozen new projects for five years. Still more projects will be funded this year. There are also many grass roots recovery organizations that have sprung up around the country without federal funding, and some of the original grantees who weren't refunded have survived. Some in smaller States are receiving funding from their State Alcohol and Drug Programs. But when the Bush Administration came to Washington, the priorities shifted. Bush's agenda was that all treatment dollars invested by the Federal government should go for direct treatment expansion. Thanks to CSAT Director Dr. Wesley Clark, the Recovery Community Support program was saved, but with the caveat that all the projects had to shift from advocacy to peer-driven services. I'll give you an example of both advocacy and peer-driven services from RAP, the Portland project. Recovering people mobilized there to protest to the Multnomah County Board of Commissioners an alarming rise in Hepatitis C and drug overdose. RAP convinced Multnomah County to fund three mentor positions for recovering addicts to provide help in the first weeks to people discharged from the Hooper Detox center. Today these recovering addicts - who made a presentation to this group in Las vegas last year - meet people at the door on discharge from detox and take them to 12-Step meetings and help them secure clean and sober housing and other support services that they need. So we have an example of both advocacy and peer support services. NADA has always advocated for peer-delivered services by urging the recruitment of Acu-Detox Specialists from the recovery community. NADA also presents acupuncture as a complement and never an alternative to other services, and notice that these recovery support services complement but do not replace either formal treatment or mutual aid groups such as the 12-Step programs. Most of these new recovery movements have adopted a policy of neutrality on all of the ways in which people get and stay sober, and have worked hard to be inclusive. There are so many orientations of recovering cultures that this has been more easily said than done in some cases. Our group in Santa Barbara found it necessary to develop a formal white paper called "The Nature of Recovery" that defined recovery in the most inclusive manner. So peer-support services are a good thing, but the loss of this federal funding for advocacy is a tremendous setback. Instead of critiquing and advocating for changes in a dysfunctional and politically-driven service system, these projects are now having to figure out how the recovery community can fit into that system. Join Together in Boston, funded by the Robert Wood Johnson Foundation, is another player in what we hope will become a New Recovery Movement. They have awarded a number of small "Demand Treatment" grants. Join Together's Director David Rosenbloom asks the important question: "Whose official job is it to demand treatment?" That is not currently - with a few small exceptions - in anybody's job description. One of the exceptions
is Paul Samuels, Director of the Legal Action
Center, which has a small handful of lawyers and policy experts in
New York and Washington, D.C. They use the ultimate advocacy strategy,
which is, "Sue them." Cases they have won and enforced include
privacy protections for people living with HIV and AIDS, and their legislative
advocacy has established laws and won lawsuits protecting people with
histories of alcoholism, addiction and AIDS - and the providers who serve
them - from discrimination. According to Samuels, the goals of the New
Recovery Movement should be (1) to promote and celebrate recovery by putting
a face on recovery and (2) to eliminate stigma and discrimination against
people in recovery and people with criminal records who have paid their
debt to society and are rehabilitated. As Marty Mann, the founder of the NCA, said, we have to do three things: "Fight stigma, fight stigma, and fight stigma." The NCA, by the way, is now the National Council for Alcoholism and Drug Dependence, and has one of the few paid lobbyist here in town working to increase alcohol and other drug services. They also have nearly 200 affiliates around the country, but most are now dedicated to providing direct services rather than to advocacy. The title of Bill Moyer's series on addiction, "Close to Home," was appropriate. His son, William Cope Moyers, also a journalist, has gone public with his personal recovery and is now Hazelden's Vice President of External Affairs. He has traveled throughout the country with an excellent slide presentation called "The Great Awakening," which chronicles the history of stigma. He quotes the late Senator Harold Hughes, a prolific advocate who spoke openly about his recovery from alcoholism: "Without the example of recovering people, it is easy for the public and policy makers to continue to think that victims of addiction disease are moral degenerates and that those that recover are the morally enlightened exception." Moyers urges that we need to effect change during this moment of opportunity. "It is time to show evidence and proof that millions of Americans have overcome alcohol and drug addiction and are now leading healthy and productive lives." Another organization that provides the best evidence that there is a national recovery movement is Faces and Voices of Recovery here in Alexandria, Virginia. Under the previous name of "The Alliance Project," they received funding from the Robert Wood Johnson Foundation to do a first-ever national telephone survey to try and begin to determine how many recovering people there are and to find out their opinions about a variety of things. Among the survey findings:
Now we should distinguish between the grass roots recovery movement and a concurrent professionally-driven public health advocacy movement. The thing that inevitably happens historically with these indigenous recovery movements is that there is the natural human tendency to "bottle" what works and sell it. For example, the earlier Modern Alcoholism Movement spawned the multi-million dollar "Modern Alcoholism Treatment Industry" that one could argue ended up contributing to the movement's demise. According to William White (Toward a New Recovery Movement ...), "Recovery advocacy in the 1940's, 1950s and 1960s evolved into the treatment industry of the 1970s and beyond and, by doing so, lost its education and advocacy focus." We'll discuss some of the problems with that later on. White (ibid) urges that "recovery movements must be, above all, grounded in the recovery values of honesty, simplicity, humility, gratitude, and service," that "There is the role of professionals and treatment institutions. Visionary professionals have always been part of recovery advocacy movements. I think we need to invite them into this movement as well, but I think we need to continue to make sure that this movement stays recovery focused and does not become the marketing arm that supports the financial interests of the treatment industry. Treatment and recovery are not the same, and we will support the treatment industry only to the extent that it demonstrates greater concern for the progress of its clients than its institutional profits." While the mantra of the New Recovery Movement is about putting a face on recovery and reducing stigma and discrimination, the mantras of the more professionally driven treatment advocates are, "Addiction is a Disease" and "Treatment Works." This has long been the message of organizations like the American Society for Addiction Medicine, but the most eloquent statement of this comes from the Physician Leadership on National Drug Policy led by Dr. David Lewis of Brown University. The organization is made up of physicians across a wide range of specialties. Dr. Lewis and Thomas McLellan published an article in 2000 in the Journal of the American Medical Association called "Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation," comparing the etiology, course, and treatment of addiction with that of the other chronic diseases of diabetes, asthma, and hypertension. The article demonstrates that if you measure success based on treatment retention and repeat visits, we are just as successful and sometimes more successful at treating addiction than we are at treating these other disorders. Physician Leadership on National Drug Policy - which does not address alcoholism - has also produced a video making the case, and the treatment that they most proclaim is methadone maintenance. Indeed, methadone advocates are far ahead of the advocates for other modalities - including acupuncture. Organizations like "The National Alliance of Methadone Advocates" and "Advocates for Recovery Through Medicine" have chapters in nearly every state. I attended a Recovery Summit in St. Paul in 2001, and members of the recovery community interacted in small group discussions and focus groups with people who had been on methadone maintenance for many years. Their message was that they no longer used heroin, they had reunited with their families, and they were leading productive lives in their communities. They identified themselves as recovering and definitely wanted to be a part of the national advocacy conversation. Then there are other
professional organizations such as the Partnership
for Recovery, a coalition of non-profit alcohol and drug treatment
providers including the Betty Ford Center, The Caron Foundation, Valley
Hope Center, and Hazelden. The message on their web page is that "70%
of Americans have health insurance that discriminates against people seeking
help for addiction treatment." Then there is the
National Association of Alcohol and Drug
Counselors, who also have a lobbying presence here in Washington. The front-burner policy agenda of these organizations is substance abuse parity - advocating for federal and state laws requiring that private insurance companies cover substance disorders on a par with other chronic diseases. I was privileged to hear the late Senator Paul Wellstone speak on this subject at the Recovery Summit in St. Paul in 2001. He and his Republican colleague from Minnesota, Congressman Jim Ramstadt, perennially introduced federal parity legislation, which was perennially defeated because of the insurance lobby. Wellstone said that parity was a good issue on which to rally because it is a resource issue, a discrimination issue, and a symbolic issue of official acknowledgement of alcoholism and drug addiction as diseases. The countervailing view is that they are not diseases but "social problems." The insurance industry's passion in defeating these bills is threefold: First, they understandably do not want to set the precedent that they are in the business of funding the solutions to social problems. Second is the "benefit accrual" argument. I attended a conference in 1999 sponsored by The National Center on Addiction and Substance Abuse at Columbia University and heard a senior official of Blue Cross say that while they know that untreated addiction causes multiple other health problems that are expensive to treat, they also believe that if they fully funded alcohol and other drug treatment, "the cost would accrue to them while the benefits would accrue to someone else." This means that by the time the health consequences happen, odds are that either the person will be covered by another insurance company or will be in the public health system. Finally, of course, is the historical cost issue. Private insurance companies are simply going to leave no stone unturned to resist going back to the days of carte blanche $30 and $40 thousand dollar reimbursements for 30 days of hospital-based treatment. The advocacy landscape is also proliferated by a variety of other organizations with varying and sometimes controversial views on alcohol and other drug problems. On one end of the continuum are prohibitionist organizations like Dads and Moms Against Drug Dealers, and at the other are organizations such as the Harm Reduction Coalition and the Drug Policy Alliance. The major themes of these latter organizations are to end the war on drugs and protect human rights. One current advocacy thrust of some of these groups is to fight the federal government's new advertising campaign that "drug use promotes terrorism." One of the land mines in recovery advocacy is to become drawn into the debate which often polarizes the organizations on this continuum - the debate of prohibition versus decriminalization or legalization. This debate is fraught with "hot button" issues that can move the conversation away from recovery resources. The great reality for recovery advocacy should be that people's need for help in recovering from heroin and cocaine and marijuana exists independently of the legal status of those drugs, and people with chronic drug problems need recovery support whether or not their drug use promotes terrorism. Temperance, prohibition, and prevention movements and recovery movements have had a long and sometimes awkward history of dancing together. I was a presenter at the annual policy conference of the National Association of Alcohol and Drug Counselors in Washington a couple of years ago, and the keynote address was given by the president of Mothers Against Drunk Driving, for whom adequate resources for treatment is viewed as the most effective form of drunk driving prevention. For another example, there was something akin to the modern AA Speaker's circuit in the 19th Century which was a major feature of the temperance movement. It should be mentioned here that - as NADA knows - recovery sometimes makes for strange political bedfellows. For example, there is often a knee-jerk tendency to associate support for treatment resources with a Democratic political agenda. Oregon has lost its alcohol and drug Medicaid benefit under Democratic leadership. Congresswoman Nancy Pelosi addressed this group in San Francisco a few years ago bemoaning that Clinton hadn't even mentioned drug problems in his most recent State of the Union address. There have been significant increases in federal funding under Bush, and his statement about addiction in his last State of the Union upstaged even Betty Ford. He said, "Addiction crowds out friendship, ambition, moral conviction, and reduces all the richness of life to a single destructive desire… Our nation is blessed with recovery programs that do amazing work. … The miracle of recovery is possible, and it could be you." Regardless of what you think about his faith-based agenda, that is unprecedented language to come from the "bully pulpit" of a Presidential State of the Union address. I want to conclude by talking a little about our Santa Barbara project. Our mission is to provide leadership in community responses to alcohol and other drug problems. Given addiction's components of ego grandiosity and self-centeredness, that may sound a little arrogant. But I want to make the case that two things make successfully recovering people and their family members imminently qualified to assume this leadership. The first part is that people in recovery understand - because of their life experience - the devastating impact that alcohol and other drug problems have on the lives of people and institutions. As many of you know, there are people of good will out there who are capable of staging three-day conferences on things like HIV and AIDS, homelessness, domestic and workplace violence, and welfare reform without even mentioning the profound role that alcohol and other drugs play in these problems. The second part of this recovery perspective is that we know there is a solution to alcohol and drug problems. The reason we know that isn't because we are smarter than somebody else, or because we read it in a book and were convinced. We know that because we live in that solution on a daily basis. Our lives are a testament to that solution. The recovery advocacy agenda is to bring this recovery perspective to the non-recovering world - especially to those people with alcohol and other drug problems who are not yet in recovery and their family members, and to opinion leaders, policy makers, and elected officials. We have a saying in the recovery culture that "we need to stop living in the problem and start living in the solution." That is our advocacy message. There are so many
gaps in the politically fragile alcohol and drug service system in our
communities. But the largest gap is at the "front end" of that
system. The largest gap is Advocacy. The context in which that system
operates lacks the recovery perspective. Our vision for the individuals
and families with alcohol and other drug problems and the larger social
and political institutions that serve them is that they would all "stop
living in the problem and start living in the solution." The problem is that
alcohol and other drug problems are behind:
Alcohol and other
drug problems are behind one out of every five dollars we spend on:
Alcohol and other
drug problems are behind most new AIDS cases - including pediatric AIDS
cases - and almost all of the cases of hepatitis C, which is epidemic
in many communities, often drug overdose is often among the top ten causes
of accidental death. Alcohol and other
drug problems are behind 75% of all the cases of
Alcohol and drugs
are behind 80% of all the police calls that go out in most communities.
Alcohol and other drug problems are contributing factors for 80% of the
people on probation and parole, and in our County jails and State prisons.
Alcohol alone is a key factor in:
Our conventional wisdom
is that the greatest barrier to successful recovery is denial. The longer
I work in this field, I think there is an ever greater barrier, which
is hopelessness. A lot of people don't believe that recovery is
an option. This not only applies to the 20.5 million Americans not yet
in recovery, but to their family members and to the institutions where
the problem manifests. This is not surprising, because successful recovery
is so often hidden. A central thesis of William Cope Moyers' presentation
on "The Great Awakening" was that the face of addiction is prominent
in the public consciousness, but the face of recovery is not. The political authority for responding to alcohol and other drug problems in California lies with County governments. However, most Counties rely upon the State for both policy guidelines and financial resources. If you go over to CSAT here in Washington and ask them where your advocacy efforts should be directed to be most effective, they will probably refer you to your own Statehouse. We have had some successes at the local County level, as they did in Portland, but our volunteer leadership has decided to turn our attention to advocacy at the State level, where most of the important decisions concerning AOD resources are made. In order to do this, we have to accomplish three things based on the lessons we have learned at the local level. First, we need to mobilize a constituency. I want to tell you a relevant Washington D.C. story. It is a little known fact that Harry Truman - a democrat from Missouri - tried to get a Civil Rights bill through Congress in the 1940's. In fact, he ran for President in 1946 on a platform that included Civil Rights, causing southern Democrats to leave the party and form the Dixiecrats, nominating Strom Thurmond as their candidate. So if you were following the news about Senator Trent Lott's resignation, there is another piece of the story. Truman was not successful, and his successor Dwight Eisenhower - a Republican from Kansas - arguably one of the most popular presidents of the 20th Century - tried to get a Civil Rights bill through Congress and failed. His successor John F. Kennedy - a Democrat from Massachusetts - was building the case when he was assassinated, and his successor, Lyndon Johnson - a democrat from Texas - finished the job. Now the difference between Harry Truman and Lyndon Johnson was not that Johnson was a superior politician, and it was not that the members of Congress had become enlightened or less racist. The difference was Martin Luther King. King gave the Congress a gift, which was the constituency required to do the right thing. One of our most important learnings in advocacy is that it is a mistake to view elected officials as people who oppose the recovery agenda. A woman in Virginia who is a member of the recovery community approached her very conservative State representative when her family was unable to find a drug treatment program for her son. The representatives response was, "Where have you been?" He had had a problem in his family as well, and wanted to do something, but didn't believe there was a voter constituency to support it. Michael Smith has said that he "never met a drug addict who didn't want to get clean and sober." I would append that to include: "I have never met an elected official who didn't want to do something about alcohol and other drug problems if they thought there was a constituency to support it." If someone is elected to office and they want to do something and they look out on the electorate and can't see support for that, they are as helpless as you and I - unless - like Harry Truman - they are willing to commit political suicide. Government policies and legislation are not driven by common sense, nor by research or education or even by fiscal prudence. They are driven by constituencies. Recovery does not have a constituency. I have met some of the treatment lobbyists here in DC, and it is very lonely work. They can get in to see members of the Congress, but when they do there isn't much to talk about because they don't represent either big campaign contributors or broad based constituencies of voters. When it comes time to appropriate funds for cancer research, members of the American Cancer Society fill the chamber. When it comes time to appropriate funds for alcohol and other drug treatment, the room is empty, and so are the mailboxes of the members of the committee. A great lesson from Martin Luther King is that he realized early on that there probably weren't enough Black people - especially in the South - to provide a compelling enough constituency - even if all could be registered to vote. He would need to cultivate allies, who he called "white people of good will." In the history of health constituencies in America - such as the American Cancer Society - the organizations are powered not by those recovering but by family members. We have learned something else, that it is often more important for a constituency to be vocal than to be big. Sometimes all you need is the appearance of a constituency. One of my mentors is a retired attorney who is an activist with the Mental Health Association. He subscribes to what I call the "Flaming Arrow" brand of advocacy. When a small band of Native Americans would circle a wagon train, the thing was to keep moving so you couldn't tell how many there were, and to occasionally shoot a flaming arrow into the circled wagons to alarm everyone. Many elected officials are satisfied with just enough of a constituency to justify their actions to the people who elected them. The second thing we realize we will need to do in our advocacy work in California is to form strategic alliances. I just made the statement that "Recovery does not have a constituency," and that is not technically correct. The National Acupuncture Detoxification Association learned the lesson of alliances very early on. I know there are some people in this room who have at times objected to the seeming dominance of our podiums by people from the criminal justice community. I haven't looked at the statistics recently, but the last time I did, the majority of funding as well as official support for acupuncture in this country came not from the public health quarter but from criminal justice. In California, the most powerful constituency supporting alcohol and other drug services is the Department of Corrections and the State Associations of Probation Officers and judges. There are countless very powerful political action groups already in place in your own community and state capitals and nationally whose interests would be well served by the recovery agenda. But alcohol and other drug problems are often "off the page" of the policy agendas of these groups, and that's where education and networking comes in. For example, our California State Chamber of Commerce and Business Round Table could get our entire agenda passed in a heartbeat. And they should, because 70% of drug addicts and 80% of alcoholics are in the workforce (Substance Abuse and Mental Health Services Administration, 1999) costing American business $100 billion per year in lost productivity, higher workers compensation claims and insurance benefits, and of course taxes to support untreated addicts and alcoholics in the public systems of criminal justice, mental health, social services, and public health. So if they really came to believe the President's words that "The miracle of recovery is possible," they could become our most important ally. The third thing we need to do to achieve our advocacy goals is a great and interesting challenge, and it is the area of the strongest relationship of the New Recovery Movement to acupuncture. The treatment and recovery field has a tremendous deficit which is that we lack consensus on what constitutes good treatment and on what the infrastructure should look like and, more important, what it would cost to do it. The "best practice" standards of the Modern Alcoholism Treatment era are that you need to go in the hospital for thirty days, and they will start out by administering drugs intravenously (the most expensive route of administration) and monitoring all of your vitals every so often, and then when you have detoxed they will give you lectures on what drugs do to the body and will give you some counseling and will try to give you reasons to stop that are better than the ones you already have, which - as Michael Smith has said many times - is very difficult. They may also try and get you to bring in all the family members who haven't abandoned you yet and give them counseling and education. At the end of thirty days you are discharged and given a big book of Alcoholics Anonymous and told to go to meetings, get a sponsor, and pray. This is real faith-based treatment. Now lots of people got sober in these programs, and lots of them are still sober today, and one of the definitions of successful treatment that I like is "participation in any discipline which an individual believes will help them achieve and maintain sobriety." But we have learned a lot about treatment since then, and much of that model doesn't begin to approach what we now know about "Best Practices." One of my biases is that we need to stop thinking of the service landscape in terms of "programs" and begin thinking in terms of a comprehensive infrastructure. That's what General Barry McCaffrey said we need as he was leaving his job as Drug Czar: "A comprehensive infrastructure for prevention and treatment." One of the advocacy challenges we have accepted in California is to develop the blueprint for that comprehensive treatment and recovery support infrastructure and to estimate what the investment would be. Investment
is the correct word to use, not cost. One of the current problems
is that in the view of managed care and of public bureaucrats and accountants
and policymakers, alcohol and other drug services are bundled in with
public health and social services and viewed as added costs, when the
reality is that investing in those services saves millions in other state
systems. According to a study by the National Center on Addiction and
Substance Abuse at Columbia University, States overall spend 13.1% of
their budgets on the negative consequences of untreated addiction. Of
every dollar states spend on substance abuse, 96 cents goes to shovel
up the wreckage in State programs and only four cents goes to prevent
and treat the problem (CASA,
2001). If your State is currently experiencing a deficit, I invite
you to compare the size of that deficit with the 13.1% of their total
budget that is going for untreated alcohol and other drug problems. Here are the kinds of questions that are involved in our focus groups to get the answers to some of these cost and investment questions. Based on prevalence estimates from the last Household Survey of 7.3%, there are 2.5 million Californians with alcohol and other drug problems who are not yet in recovery. One interesting question of course is, how many of these could achieve successful recovery with no formal treatment at all but with the appropriate non-professional community supports? The answer that has come from our surveys and focus groups is that if we had a comprehensive and mobile recovery-based case management system in place - like those mentors in Portland - who were on call and ready to respond immediately when anybody reported that someone had an alcohol and other drug problem, the average would be about 45%. Then, in terms of what investment is required, we need to figure out, of those needing formal treatment, how many need inpatient medical detox; how many need 90-day residential treatment, and how many can achieve success with intensive outpatient treatment only? Also, what will be the rates of treatment drop-out and re-entry? Now you don't have to think about those questions very long to realize that your answers to those questions - and hence the price of the investment for the infrastructure - would be radically different if you included what we know about acupuncture and our acupuncture program outcomes. As I mentioned, we have learned a lot about treatment since the days of the 30-day hospital-based programs, and we have a lot of tools in the arsenal to educate the blueprint. We have a host of new pharmaceutical interventions based on brain research. We have NIDA's 13 Principles of Effective Treatment based on all of the treatment research. We have 38 Treatment Improvement Protocols (TIPS) that have been developed by CSAT which are a compendium of best practices based on a combination of research and the consensus of people working in the field. We need to add to these tools more information from the recovery community about things that have been effective for them. But I think the most important tool in this arsenal is acupuncture. Acupuncture will soon be CSAT TIP Number 39, which is the main reason that we are having our conference here in Washington.
Now these are all things that we know. But that doesn't mean that anybody else knows these things. Why would anybody else know these things - even people who work in ordinary treatment programs? Most recovering people don't know, and certainly the non-recovering, non-treatment world doesn't know. In the years I spent on the front lines of treatment, I became very myopic. I saw my own universe and it seemed so big that I forgot there were, as Michael Smith has said, lots of other realities out there. This is understandable because the work demands so much. I have forgiven myself my myopicism. But it is important to recognize that we do our work in a certain context. The policies that govern our work were developed and written in a certain context. The funding that pays our salaries and that paid to get us here this morning originates within a certain context. I am not suggesting that you publicize your program's successful outcomes. I am suggesting that you shout them from the highest rooftops at the top of your voice. So much of our growth in acupuncture treatment is the result of our early pioneers making a study of that context and giving testimony in the right places and putting acupuncture needles in the right ears. We are in Washington today because Laura Cooley - when she was in Texas - advocated with and got needles in the ears of Republican Congresswoman Kay Granger, and Granger came back to her office here in Washington and telephoned the Director of the Center for Substance Abuse Treatment and asked what they were doing about acupuncture, and now we are going to be TIP Number 39, which provides the formal vaidation of our work that we have sought for twenty-five years. Is there a local recovery or treatment advocacy program in your local community? Do they know of your work? How can you serve them? They need members, because they are trying to build a constituency. How about your program's alumni? How about your clients' family members? When we look at the context of things, the larger context here are the historical cycles that William White describes. We are possibly at an historic hour of opportunity. Acupuncture must not miss this opportunity. Advocacy means to
give voice. Subjectively, it means to find ones voice. The recovery
community needs to find its voice. Family members need to find their voice.
We as a field need to find our voice. We who work in acupuncture and addiction
need to find our voice. Thank you very much.
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