Yet in our ongoing fight to convince lawmakers that addiction is a disease, that substance abuse touches all sectors of the population and people from every race, religion, creed and socio-economic strata, we appear to still have fallen short. We know full well that we face an uphill struggle, fighting decades, if not centuries, of stigma and discrimination. Many still view those in need of treatment (but apparently not worthy of it) as poor, lazy, weak and in need of being taught a lesson. While we have our champions in congress, such as Rep. Karen Bass or Rep. John Sullivan, too many members of congress continue to write legislation that advances outdated stereotypes, ignoring science and unbiased evidence in the process.

The economic and political environment in Washington is undoubtedly toxic, and as a result, not much gets done. When nothing is done for long periods of time, larger pieces of legislation become necessary in order to provide stopgap measures that our country’s economy desperately requires. Yet the larger the bill, the easier it is for members of congress to attach smaller policies that can “fly under the radar,” because few politicians will risk voting against such vital legislation over more marginal issues. As is becoming annoyingly customary, the appropriations process this year went long past the required statutory deadline of September 1 (hence the need for so many continuing resolutions). In the end, after five continuing resolutions passed in order to avoid a government shutdown, 9 of the 12 appropriations bills were rolled into one, with close to a trillion dollars of our nation’s budget wrapped up in it. Called a “megabus” (because it was bigger than an “omnibus” bill, which generally holds two or three appropriations packages), it passed in late December and was signed into law.

What did not receive headlines or air time was an amendment to the bill that undid a major victory for our field that was less than two years old. Less than two years ago, advocates celebrated a tremendous victory as a ban on the use of federal funds in needle exchange programs was lifted, a ban that had been in place for more than 20 years (“Eye on the Needle,” Recovery View, September 4, 2009). Tucked deep into the megabus, in three separate places, was legislative language that reinstated the ban. In the Health and Human Services section, the ban was reinstated for programs in the United States. In the State Department/Foreign Operations section, it was reinstated for the funding of syringe exchange programs abroad. Finally, in the Financial Services section, the ban was reinstated in the District of Columbia, despite scientific evidence that syringe exchange programs there improved public health and saved the government money.

“Eight federal studies accomplished by bodies as diverse as CDC and the IOM have repeatedly shown that syringe exchange helps prevent HIV and does not increase drug abuse. New studies show that it also can prevent hepatitis C,” said Bill McColl, political Director at AIDS United. “Local communities have now been disempowered from making the decision to use federal HIV prevention funds on one of the best known means to actually prevent these diseases. The failure to scale up syringe exchange to prevent HIV and viral hepatitis has already cost the U.S. hundreds of millions of dollars and will run into the billions if this policy is not reversed.” McColl went on to add that Congress and the President must stand up to the anti-science rhetoric.

Another large piece of legislation getting much media attention was the bill that would prevent payroll taxes from increasing. Stuffed deep inside this bill was a provision that no one in the national media was talking about. Rep. Jack Kingston (R-GA) wrote into the law a provision that would allow states to force those who apply for unemployment benefits to undergo drug testing. In a press release, Kingston claims he was told by a small business owner in his district that half of all job applicants failed a drug test (an anecdote that is clearly exaggerated and unreliable.) This comes on the heels of Florida forcing such testing on welfare recipients, a law that has been challenged in the courts and could very soon be ruled unconstitutional. Further, in Florida, where it is estimated that 8% of the general population would test positive for illicit drug use, the first round of welfare recipients tested under the new law revealed that approximately 2% of those tested used illicit drugs, a rate four times lower than the general population. This proposal did not become part of the Senate’s version of the legislation, but will almost certainly be reintroduced in the current session of Congress. In anticipation of this, 14 senate democrats issued a letter in direct opposition to the policy. As George Washington said to Thomas Jefferson, “We pour legislation into the senatorial saucer to cool it.”

What such a provision does is advance the notion that those who abuse drugs are the lazy, the unemployed, the lower class or the less fortunate. As we know, nothing could be further from the truth. Addiction touches everybody, from all backgrounds and from all economic classes. The disease of addiction is not kept at bay simply by having a good, stable job. Yet that is exactly the mindset that such a provision advances. “Suspicion-less drug testing is an expensive and ineffective method of identifying people with alcohol and drug problems and getting them the help they need to get well,” said Pat Taylor, Executive Director of Faces and Voices of Recovery. “By singling out particular types of public benefits, drug testing proposals stereotype Americans who are unemployed and/or in need of public assistance during these challenging economic times. When it comes to unemployment insurance, individuals are eligible for benefits because they have been employed – and for a long enough period of time to be eligible. “

Many critics of this policy also cite it as singling out only one specific group of government benefit recipients, and the result is discrimination. “They want to make every one of their constituents urinate in a cup before they can collect unemployment benefits, a program that every American has paid into in case they need it,” said Bill Piper, National Policy Director for the Drug Policy Alliance. “In other words, they not only want people struggling with drug abuse to die, they want to treat every American as a criminal.”

“If the goal of these proposals is to make sure that anyone who gets a public benefit takes a drug test, executives of companies that receive tax credits and other benefits; taxpayers who take the mortgage interest deduction; students with government loans and grants; and other beneficiaries of public benefits should also be tested,” remarked Taylor.

Some find it odd that those who claim to be fiscal conservatives are the ones introducing these policies, since they end up costing states more money in the long run. “In both cases they’re wasting taxpayer dollars on failed policies,” said Piper. Taylor agrees. “These proposed policies are misguided, ineffective and waste precious taxpayer resources.

Despite all our advances and policy victories over the past years, we must be keenly aware of these efforts. They further discriminate against those afflicted with addiction and jeopardize our progress. We must continue to our effort to frame the debate around substance abuse treatment policy, one that is grounded in health, science and an expertise that is brought to the table by professionals, such as substance abuse and recovery counselors.

September is once again Recovery Month, when advocates for substance abuse and addiction recovery around the United States celebrate their achievements with their communities. While many communities celebrate in similar fashion – via recovery walks or attending professional baseball games where recovery advocates are honored for their work – each community is encouraged to put its own personal touch on its events, under the guidance of national organizations and government agencies. In Washington, it is an annual opportunity to bring the advocacy community together to highlight the need for policies that encourage and support recovery.

To help local organizations plan, promote and educate the community during Recovery Month, as well as throughout the year, 75,000 hard copies of the 2011 toolkit were distributed to health care, education, business and faith-based organizations, as well as coalitions and government agencies. Through the website, www.RecoveryMonth.Gov, the Substance Abuse and Mental Health Services Administration (SAMHSA) provides invaluable resources for communities around the country that wish to join in the celebration.

“Faces & Voices of Recovery (FAVOR) is looking forward to 2011’s Recovery Month observances that will bring together hundreds of thousands of people across the country – people in recovery, family members, friends and allies – at events large and small, building our recovery advocacy movement,” said Pat Taylor, the executive director of FAVOR. “We will be educating the public and policymakers about the reality of recovery from addiction to alcohol and other drugs, and are excited about this year’s September 24^th Rally for Recovery! at the 2011 hub in Philadelphia.” The Pennsylvania Recovery Organization – Achieving Community Together (PRO-ACT) will host the event, and more than 12,000 participants are expected, including Office of National Drug Control Policy Director, Gil Kerlikowske, SAMHSA/CSAT Director, Dr. Westley Clark, TV anchor, Laurie Dhue, and contestants for the first-ever Recovery Idol, along with the region’s growing recovery community.

Few people realize that planning for Recovery Month is an ongoing process, with a full-time staff, led by Ivette Torres at SAMHSA, dedicated to its success. SAMHSA also invites its Recovery Month Planning Partners from all parts of the country to Washington three times a year in order to develop ideas and themes. Even as Recovery month 2011 is taking place, the planning partners were meeting on September 7 and 8 this year to plan for 2012 and beyond. The “hub” event in 2012 will take place for the first time in Detroit.

Recovery Month 2011 seeks to build on the success of previous years. In 2010, according to SAMHSA, there were 1,072 Recovery Month events (a seven-percent increase, or 71 more events, than the 1,001 events held in 2009) in all 50 States, the District of Columbia, Guam, Puerto Rico and the United Kingdom, with a projected attendance of 3,888,160 individuals (an increase from 1,003,209 in 2009).

SAMHSA has expanded Recovery Month’s social media initiatives while growing its pre-existing and thriving social media channels and outreach. A Twitter account was launched on January 27, 2010, during the quarterly Recovery Month Planning Partner Meeting. The site garnered 1,038 Twitter followers throughout the year. The Recovery Month New Media E-Newsletter was also published on a monthly basis starting in January. SAMHSA conversed with 116 bloggers, which resulted in 25 blog posts that focused on Recovery Month. The Facebook page increased its visibility by 58.6 percent, adding 3,004 new “likes” for a total of 4,898 “likes” since the page’s launch in 2009. The Recovery Month YouTube channel garnered 9,501 new channel views, an increase of 668 percent over 2009, for a total of 10,923 channel views from its launch. Video views increased by 5,047 (or 580 percent) for a total of 5,917 video views, and subscribers increased to 594, a 1,485-percent increase from 40 subscribers in 2009.

In Washington, one of the highlights for recovery month each year is the Recovery Month luncheon. This is a chance for national leaders to join with people from around the country as they celebrate. Attended by Kerlikowske and SAMHSA Administrator Pam Hyde, the lunch this year was hosted by the National Council on Alcohol and Drug Dependence (NCADD). The featured speaker was Judy Collins, an advocate of recovery for many decades. The author of two books, one of which focused on the loss of her son after his own struggles with addiction, Collins spoke of her experiences and the role recovery has played in her life.

At the luncheon, the 9th Annual Rhode Island Rally 4 Recovery was recognized by SAMHSA as the top rally in the nation in 2010. “The State of Rhode Island is honored to be part of the National Recovery Month movement, and we look forward to making this month the biggest and best ever,” said event organizer, Jimmy Gillen, who serves as executive director of the Anchor Recovery Community Center in Providence.

Also at the lunch was the reading of a presidential proclamation, which officially recognized September as National Alcohol and Drug Addiction Recovery Month. In his proclamation, President Obama cited that, “Recovering from addiction to alcohol and other drugs takes strength, faith and commitment. Men and women in recovery showcase the power each of us holds to transform ourselves, our families and our communities. As people share their stories and celebrate the transformative power of recovery, they also help dispel myths and stigmas surrounding substance abuse and offer hope for lifestyles free from alcohol and other drugs.”

Obama calls on advocates to promote recovery and to support the growth of healthy, resilient individuals and families in the United States. He gave special mention to the abuse of prescription medication, reaching what he calls “epidemic levels”. The proclamation made reference to the 2011 National Drug Control Strategy, which supports successful, long-term recoveries through research, education, increased access to treatment and community-based recovery support. The President called on the nation to promote second chances and recognize each individual’s ability to overcome adversity.

Recovery Month will be back in 2012, so please visit www.Recoverymonth.gov for updates.

In normal life if something does not work, we recognize that reality, explore our options and try something different. But even though virtually no one will say that our War on Drugs is working, we continue to spend ever more money and other resources on something that has been proven not to work. “If spending lots of money didn’t work, we’ll just have to spend much more” seems to be the philosophy.

The evidence of the failure of the War on Drugs is all around us. Today illicit drugs almost literally could not be made more available if we tried. Look at it this way: People in prison can get all of the drugs they want. It costs more money, but they are fully available. For example, Charles Manson was transferred from Corcoran State Prison in California to a different facility a few years ago because he was found to be selling drugs from his prison cell. And he was in solitary confinement! So if we cannot keep drugs out of our prisons, what makes us think that we can keep them off the streets of any of our towns or cities?

Every day in our nation’s newspapers there are articles about violent deaths being caused not by drugs, but by drug money. With great fanfare we destroyed the Medellin Cartel. But did it make any difference? No, within just a few months the Cali Cartel was up and running. Now we have destroyed the Cali Cartel. Has it made any difference? Again the answer is no. Illicit drugs are just as big and successful a business as ever.

As an example, just a few years ago the head of the United States Drug Enforcement Administration was quoted as saying that at any one time about 200 tons of cocaine are being warehoused in Mexico within three miles of the U.S. border just waiting to be smuggled into our country to any place where there happens to be a shortage. In addition, even though our government has spent about $470 billion on “Plan Colombia” with our military actions and spraying of herbicides in rural areas, the cost of Colombian cocaine in our country today is only about one-third of what is was in the 1980s. Of course, we are also seeing the same results in Afghanistan with heroin. And in case you have not noticed, violence and actual warfare caused by drug money has broken out in Mexico along our border, and has literally spilled over the border into the Southwest United States.

Even when the police are successful in seizing a large quantity of drugs, that only temporarily reduces the supply, which increases the price of the drugs and in turn increases the incentive for people to sell them. The end result of this economic reality is that the policy of Drug Prohibition is doomed to failure, which means that “victory” increasingly is simply defined as slowing down the pace of defeat.

When I discuss this issue publicly, the biggest argument I hear in favor of maintaining our policy of Drug Prohibition, “with all of its defects,” is that changing it would “send the wrong message to our children.” So what about our children? Actually, our policy of Drug Prohibition is putting our children in harm’s way for each of two deeply disturbing reasons.

First, it is easier today for children to obtain any illicit drug, if they want to, than it is alcohol. Why? Because illicit drug dealers make money by furnishing it to them. You might say that no one wants your teenage children to become addicted to cocaine, but you would be wrong, because some people make a great deal of money if that happens. As a result, a lot of drug dealers offer free samples of illicit drugs to our children, even on their school campuses. Of course, that does not happen with regard to other sometimes dangerous and addicting drugs, such as alcohol and tobacco. Why? Because when we make drugs illegal, we give up all of our ability to regulate and control them. That means that by default, the strength, quantities and purity levels of the drugs that are being sold and the age restrictions for the buyers are exclusively controlled by the illicit drug dealers – and they don’t ask for i.d.

Secondly – and I saw this happen continually when I was a federal prosecutor, and later when I was presiding over a juvenile court calendar – every day adult drug sellers recruit our children to help them in their scurrilous business. Why? Because for a relatively small amount of money and the threat of violence, adult drug dealers can have all the young people they want to use as “go-fers,” lookouts and couriers, and so on. And then just as night follows day, as soon as the reliability of the young people has been established, the adults trust them to sell small amounts of drugs in their communities. They do this, of course, so that the youngsters make more money, and so do the adults.

So then ask yourself this question: When teenagers sell drugs in their communities, who do they sell to? Us? No, they will naturally sell to their teenage peers, thus recruiting more and more young people to a lifestyle of drug usage and drug selling. It is not a pretty sight, and it is all directly caused by our failed and hopeless policy of Drug Prohibition.

Yes, once we finally came to our senses and repealed Alcohol Prohibition, we were still left with problems of alcohol misuse, abuse and addiction. But at least we were no longer plagued with the Al Capones and their violence and corruption in the alcohol distribution business, as well as the medical problems presented by the lack of quality control for the “bathtub gin.”

What should be our plan instead? In my view, we should resume using the Criminal Justice System in the way it was designed: to hold people accountable for what they do, instead of what they put into their bodies. Along those lines, it makes as much sense to me to put that gifted actor Robert Downey, Jr. in jail for his cocaine addiction – and he certainly seems to have one – as it would to have put Betty Ford in jail for her alcohol addiction. It is the same thing; it is a medical problem. But if Robert Downey, Jr., Betty Ford or you or I drive a motor vehicle while under the influence of any of these mind-altering drugs, that will still be an offense. Why is that? Because now those people would by their actions be putting the safety of other people at risk. When we finally are able to make that distinction in our approach, we will begin to make real progress in this area.

So what action should we take now? The first thing to do is for our President to appoint a blue ribbon commission to investigate the possibility of change – as publicly as possible. Then the first substantive action we should take is to treat marijuana like alcohol. What would happen if we were to do that? Three things and all of them positive. First, we taxpayers in California would literally save about a billion dollars every year that we now spend in a futile effort to eradicate marijuana, and to prosecute and incarcerate non-violent marijuana users. Secondly, we could tax the stuff, and raise about one and a half billion dollars every year for the state coffers. So those two things alone would change the budget deficit in California alone by about 2 ½ billion dollars every year. And that is money that we should use for drug education and drug treatment, which will result in decreased problem usage of all drugs. Or we could use the money to help finance health care for the uninsured people in our state and country. But the third thing would be more important than the first two combined, because this we would be making marijuana less available for our children than it is today, as we have already discussed. So what is not to like?

Eighteenth-century English jurist William Blackstone said that “The law is the embodiment of the moral sentiment of the people,” and I certainly agree with him. But just because we change our approach to this serious problem does not at all mean we condone drug abuse, and our children will understand that concept. There are better ways of accomplishing our goals of reducing drug abuse and all of the crime, misery and corruption that accompany it.

So let’s take off our muzzles, and give ourselves permission to discuss the subject of drug policy openly, fully and honestly. We have nowhere to go but forward.

The Republicans, now in the majority in the House of Representatives, in large part ran on a platform of smaller government and spending cuts. While a large percentage of their candidates would not specify exactly what programs should be cut, this still does not bode well for health and behavioral health programs. The appropriations bill that funds the Department of Health and Human Services – and in turn SAMHSA and the NIH – is the largest non-military domestic spending bill to come out of congress each year. It is produced by the Appropriations subcommittee on Labor, HHS, and Education, or Labor/H for short. Being one of the largest spending bills, it naturally has a huge bull’s-eye on it.

There have been discussions and rumors that the House leadership would like to see domestic spending reduced to FY 2008 levels, or at the very least FY 2010 levels. This was the goal of the Sessions-McKaskill amendment, introduced in 2010, and defeated by the Senate. Yet now, with a new political landscape, FY 2008 levels for domestic discretionary spending may be returning. Regardless, it is highly unlikely that the House of Representatives will approve any increases for SAMHSA or NIH. Of course, the Senate remains in Democrat hands. So passing any budget can be difficult, and a government shut down this time next year is a possibility. This could have a severe impact on those who depend on Medicare to cover the cost of their treatment, and countless other social services.

The House Appropriations Committee, responsible for establishing funding levels for every federal program, will be chaired by Hal Rogers of Kentucky. While Mr. Rogers does not have an impressive record of supporting Labor/HHS programs in the past, he is a dedicated founder of the newly established House Caucus on Prescription Drug Abuse. Mr. Rogers has been a strong voice for establishing policies that can cut prescription drug abuse and illegal trafficking. However, most of his work thus far has focused on law enforcement and their involvement in this issue. It remains to be seen if this zeal carries over to funding research and services that are connected to this issue. The subcommittee responsible for appropriations to the Department of Health and Human Services, and in turn agencies such as NIDA and SAMHSA, will be Denny Rehberg of Montana. He has a mixed record on health and substance abuse issues, but only an 11 percent rating from the American Public Health Association. He cast a “no” vote on the House bill to enact the Wellstone/Domenici Parity act. He later voted “yes” on the final version, but the initial “no” vote is making many in the advocacy community very cautious.

Also of concern is the recently released report of the National Commission on Fiscal Responsibility and Reform. Among their recommendations are the elimination of the Office of Safe and Drug Free Schools, as well as a 10-percent across-the-board staffing cut at the federal level, with additional cuts to the Congressional and White House budgets. On the discretionary spending front, they propose rolling back spending to FY 2010 levels starting in FY 2012, and require a 1-percent budget cut every year from FY 2013-2015.

While at first glance the staffing and budget cut seems like sound economic policy, keep in mind how dependent our field is on agencies and offices such as SAMHSA, ONDCP, and NIH. Less people doing more work means that our allies in government will be less efficient, and not in a position to give us the help we need. Like it or not, the funding streams for addiction treatment and prevention are heavily linked to federal funding, which need to be protected at all levels.

Of course, all of this looks forward to FY 2012. In reality, the budget for FY 2011 has still not gone into effect. The government has been operating on what is known as a “continuing resolution” since September 30, 2010, at FY 2010 levels. Despite several attempts to pass the FY 2011 budget in the closing days of the 111th congress, and the lame duck session this past December, it never came to fruition. This was due in large part to Republicans blocking the legislation in the Senate, knowing they would have a better chance to cut spending if they could postpone votes on the FY 2011 budget until the new Congress was sworn in. The current continuing resolution is in effect until February 4, 2011. If a budget, or new CR, is not passed before then, it will result in a government shutdown. That means any and all services reliant on government funds will cease to operate until a budget is passed. This could severely impact substance abuse services.

As far as health care reform is concerned, it is almost a sure thing that the entirety of the bill will not be repealed. With the Democrats in the Senate and the White House, there is no way that such legislation will pass. However, this does not mean that changes will not be forthcoming. What it comes down to is how certain provisions of the Affordable Care Act are being funded. Those parts that require appropriations over the next two years face trouble in the House. Even before the election, Republicans attempted to chip away at certain provisions via the Johnanns amendment, which would have taken billions of dollars out of the Public Health and Prevention fund created by the act. The amendment was defeated, and $40 million allocated to SAMHSA for the integration of substance abuse treatment into primary care was preserved. In California, grassroots efforts by groups such as CAADAC and CFAAP urged a defeat of the amendment, joining with hundreds of other national associations.

According to the National Council of Community Behavioral Health, we will likely see many proposals related to changing the healthcare reform law, and most concerning to the addiction and mental health community will be efforts to scale back, or delay the Medicaid expansion scheduled for 2014. We have already discussed that federal discretionary funding will not be growing, and that additional federal Medicaid assistance is unlikely. The consequences of these actions is to put further pressure on state and county appropriations, further eroding addiction and mental health funding for indigent populations.

Of particular concern to the research community, and those whom support NIDA and NIAAA, is the election of Pat Toomey of Pennsylvania to the Senate. Mr. Toomey has a history of challenging NIH grants that he considers to be controversial, and has attempted to de-fund specific grants in the past. While most of these grants were focused on human sexual behavior, many are connected to the prevention and treatment of HIV. Members of the substance abuse treatment community, as well as many outside it, understand what a critical role substance abuse plays in the transmission of HIV, both via risky behavior with syringes, and unsafe sexual behavior brought on by substance abuse.

Also of concern is the appointment of Rep. Joseph Pitts to chair the subcommittee on health of the influential Energy & Commerce committee. Pitts, by virtue of this position, will have oversight of all HHS departments, including NIH and SAMHSA. Pitts, like Tomey, has a history of challenging the scientific merit of NIH grants that have focused on human sexuality. Not only do challenges to specific NIH grants reflect a lack of knowledge about the scientific process and how specific grants are chosen to be funded, but it is a threat to the culture of NIH, thus impacting the thousands of grants that focus on addiction research. With NIDA and NIAAA in the NIH forefront due to the possibility of a new institute being created, it is very possible that many of their grants can come under scrutiny. Also, if a new institute is created in place of two, Congress may see this as an opportunity to cut research funding in order to appear fiscally responsible. At NIH, Director Francis Collins has already spoken his mind. The reduction in funding proposed by Speaker-to-be John Boehner would be “very devastating” and would demoralize scientists, whose odds of winning a research grant from the agency could drop to about 10 percent, he told the Washington Post.

A notable absence in the 112th congress will be that of Rep. Patrick Kennedy, the undeniable Congressional champion for substance abuse treatment over the last decade. Following closely on the heels of Rep. Jim Ramstad’s retirement after the 111th Congress, the Addiction, Treatment, and Recovery Caucus has lost both its Democrat and Republican chairmen in a span of just two years. This means that Congress is now without a member whose top priority is substance abuse treatment and prevention. Many members of Congress are sympathetic to the issue, but none currently in Congress make it a top priority, save possibly one exception, Rep. Mary Bono-Mack of California, who has worked hard to become a visible leader on the issue. Rep. Tim Ryan of Ohio will be taking over as the Democratic chairman of the ATR caucus, joining Rep. John Sullivan of Oklahoma as the Republican chairman.

Without a doubt, it’s going to be an interesting and challenging two years.

According to the same Website, the fiscal effects of this measure could vary substantially depending on: (1) the extent to which the federal government continues to enforce federal marijuana laws and (2) whether the state and local governments choose to authorize, regulate and tax various marijuana-related activities. There could be savings of potentially several tens of millions of dollars annually to the state and local governments on the costs of incarcerating and supervising certain marijuana offenders.

Marijuana is classified by the Drug Enforcement Agency as a schedule 1 narcotic, the same classification given to cocaine, heroin and methamphetamine. In 1936 the Federal Bureau of Narcotics (FBN) noticed an increase of reports of people smoking marijuana, which further increased in 1937. The Bureau drafted a legislative plan for Congress, seeking a new law, and the head of the FBN, Harry J. Anslinger, ran a campaign against marijuana. During this particular time frame, the media was swarmed with propaganda regarding the effects of marijuana. Anslinger devised advertisements and commercials to inform the public of the believed side effects of marijuana. Citizens who were high on marijuana were portrayed as crazy, insane, suicidal, had murderous intentions and the like, according to the propaganda.

Blatant racism was also a factor in creating policy. As Anslinger once wrote, “There are 100,000 total marijuana smokers in the U.S., and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing, result from marijuana usage. This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others.” Disregarding the scientific research on the subject and the falsified claims, the Marijuana Tax Act passed in 1937 quickly and with little debate and no opposition in Congress.

According to SAMHSA’s most recent National Survey on Drug Use & Health, released just this September, marijuana was the most commonly used illicit drug (15.2 million past-month users). The survey also found that among 12 to 17 year olds, marijuana use increased by 9 percent — going from 6.7 percent in 2008 to 7.3 percent in 2009. Consider these numbers in context: Among persons aged 12 or older, the rate of past-month marijuana use in 2008 (6.1 percent) was similar to the rate in 2007 (5.8 percent). The rate of current marijuana use among youths aged 12 to 17 decreased from 8.2 percent in 2002 to 6.7 percent in 2006 and remained unchanged at 6.7 percent in 2007 and 2008. So the increase in marijuana use from 2008 to 2009 is especially poignant.

Monitoring the Future, the nation’s largest and most cited longitudinal study on substance use in children, is funded by the National Institute on Drug Abuse and conducted by Dr. Lloyd Johnston and his team at the University of Michigan. According to the most recent results, marijuana use among American adolescents has been increasing gradually over the past two years (three years among 12th graders) following years of declining use, according to the latest Monitoring the Future study, which has been tracking drug use among U.S. teens since 1975.

“So far, we have not seen any dramatic rise in marijuana use, but the upward trending of the past two or three years stands in stark contrast to the steady decline that preceded it for nearly a decade,’’ said Johnston, the study’s principal investigator, last December. “Not only is use rising, but a key belief about the degree of risk associated with marijuana use has been in decline among young people even longer, and the degree to which teens disapprove of use of the drug has recently begun to decline. Changes in these beliefs and attitudes are often very influential in driving changes in use.” The proportion of young people using any illicit drug is also up slightly over the past two years. This measure is driven largely by marijuana use, because marijuana is the most widely used of all illicit drugs.

The Drug Policy Alliance is one of the chief supporters of Proposition 19. “Prop. 19 would reduce racial disparities in California’s criminal justice system by taking away a major excuse for law enforcement to search, harass and arrest young black and brown men; weaken Mexican drug cartels by taking away their profits; and allow marijuana to be controlled, regulated and taxed,” said Bill Piper, Director of National Policy for the Drug Policy Alliance. “While some marijuana users become dependent on the drug — about 9% — it is safer and less addictive than alcohol or tobacco. Most importantly, repealing marijuana prohibition would end the practice of destroying people’s lives by branding them criminals for nothing more than using marijuana. The war on marijuana has become a means of disenfranchising communities of color, allowing the facade of a marijuana arrest to be used to legally discriminate against people of color in housing, employment and public assistance. Instead of wasting billions of dollars arresting and incarcerating people for marijuana, the U.S. should spend that money on treatment for the small number of marijuana consumers who need it.”

The California Society of Addiction Medicine is in a unique position: It takes no official position on Prop. 19, but wants Californians to look at the research before they make up their minds on how to vote. Dr. Timmen Cermak is president of the California Society of Addiction Medicine, and has written extensively on the issue. Cermak represents the doctors who specialize in the treatment of drug abuse, including alcohol. CSAMS is committed to combining science and compassion to treat our patients, support their families and educate public policy makers. Less than one-third of the Society of Addiction Medicine’s 400 physician members believe prison deters substance abuse. Most believe addiction can be remedied more effectively by the universal availability of treatment.

According to the FBI, nearly half — 750,000 — of all drug arrests in 2008 in the United States were for marijuana possession, not sales or trafficking. Cermak believes Prop. 19 does offer a way out of these ineffective drug policies. However, two-thirds of CSAM members believe legalizing marijuana would increase addiction and increase marijuana’s availability to adolescents and children. A recent Rand Corp. study estimates that Prop. 19 would produce a 58-percent increase in annual marijuana consumption in California, raising the number of individuals meeting clinical criteria for marijuana abuse or dependence by 305,000, to a total of 830,000. Marijuana is addicting to 9 percent of people who begin smoking at 18 years or older. Withdrawal symptoms — irritability, anxiety, sleep disturbances — often contribute to relapse. Because adolescent brains are still developing, marijuana use before 18 results in higher rates of addiction — up to 17 percent within two years — and disruption to an individual’s life. The younger the use, the greater the risk.

Cermak asserts that Prop. 19 erroneously states that marijuana “is not physically addictive.” This myth has been scientifically proven to be untrue. CSAM believes that Prop. 19 asks Californians to officially accept this myth. Public health policy already permits some addictive substances to be legal — for instance, alcohol, nicotine and caffeine. Cermak asks that if Californians decide to legalize marijuana, who will pay for the additional treatments that will be needed? If marijuana is legalized, a truly fair, socially just public policy would use tax revenue from marijuana sales to pay for increased treatments. The Society of Addiction Medicine strongly recommends that, if marijuana is legalized, restrictions must minimize access for anyone younger than 21, and a tax on revenues must be directed to treatment.

Many who represent the treatment community are staunchly opposed to Prop 19. “We agree with the stance of the California Society of Addiction Medicine,” said Warren Daniels, Founder and President of CFAAP, the California Foundation for the Advancement of Addiction Professionals. “If the public decides to try legalization as an alternative strategy, it would be well advised to be aware of the addictive nature of marijuana and to be prepared to create an effective public health, prevention and treatment response to what will undoubtedly be an increase in marijuana use.”

The Community Anti-Drug Coalitions of America, a very influential voice in federal drug policy and prevention, has also weighed in on the issue. “With national data already showing softening attitudes and across-the-board increases for drug use — particularly marijuana, which increased in all grades according to a recent survey — this is not a message we can afford to send to California or the rest of America’s youth,” said Gen. Arthur T. Dean, CADCA Chairman and CEO, in a recent press release. “Marijuana already costs the United States $181 billion annually in increased health care and treatment costs, crime and lost productivity. So any revenue gained by taxing marijuana would be far outweighed by the health care and criminal justice costs to the state.”

Even law enforcement organizations are split on this issue. Those groups opposed to Proposition 19 include the California District Attorneys Association, and the California Police Chiefs Association, Yes on 19’s endorsements include that of the National Black Police Association. “At each step of my law enforcement career — from beat officer up to chief of police in two major American cities — I saw the futility of our marijuana prohibition laws,” said Joseph McNamara, former police chief in San Jose and Kansas City, MO, now a speaker for Law Enforcement Against Prohibition (LEAP). “But our marijuana laws are much worse than ineffective: they waste valuable police resources and also create a lucrative black market that funds cartels and criminal gangs with billions of tax-free dollars.”

For the most part, members of Congress, even from California, have been silent on the issue. Perhaps because it is a state issue that politicians are hesitant to interfere with, perhaps because the issue is so closely contested. Whatever the reason, California’s congressional delegation has taken a pass on getting involved. The lone exception seems to be Senator Diane Feinstein, who called Proposition 19 “a jumbled legal nightmare that will make our highways, our workplaces and our communities less safe.”

Other federal policymakers have expressed their disapproval. Not surprisingly, the Office of National Drug Control Policy is in opposition. Gil Kerlikowske, John Walters, Barry McCaffrey, Lee Brown, Bob Martinez and William Bennett were directors of the Office of National Drug Control Policy in the administrations of Presidents Obama, George W. Bush, Bill Clinton and George H.W. Bush, respectively. In an op/ed piece in the Los Angeles Times, they cite that no country in the world has legalized marijuana to the extent envisioned by Proposition 19, so it would be impossible to predict precisely the consequences of wholesale legalization. They also express concern over increased social costs.

A chief concern of these experts is highway safety. They cited a 2004 meta-analysis published in the journal Drug and Alcohol Review of studies conducted in several localities showed that between 4 percent and 14 percent of drivers who sustained injuries or died in traffic accidents tested positive for delta-9-tetrahydrocannabinol, or THC, the active ingredient in marijuana. Because marijuana negatively affects drivers’ judgment, motor skills and reaction time, it would stand to reason that legalizing marijuana would lead to more accidents and fatalities involving drivers under its influence. The authors closed the op/ed by citing the bi-partisan effort it took to produce the piece.

All polls have reported this vote going down to the wire, and the result is sure to influence future policy. Regardless of the result, advocates on both side of the issue have taken this opportunity to educate the public. In the end, however, it is almost certain that the courts will have the final word, as state and federal laws are bound to conflict.

The Director of ONDCP — also referred to as the “Drug Czar” — is Gil Kerlikowske, the former chief of police in Seattle. In introducing the strategy to Congress, he presented it as informed by scientific breakthroughs in the fields of treatment and prevention; innovations in law enforcement; and the input of both the federal government and local agencies. Kerlikowske, and the ONDCP deputy director, A. Thomas McLellan, brought with them to Washington the hope that the ONDCP could shift its focus away from the “supply” aspect of drug control, which entails law enforcement, to the “demand” reduction aspect, which includes prevention and treatment.

While Kerlikowske and McLellan appear to be sincere about this shift in direction, the budget of ONDCP has not reflected such a change in course. Despite President Obama’s statement that “I directed the ONDCP to re-engage in efforts to prevent drug use and addiction, and to make treatment available for those who seek recovery,” the budget is still weighted heavily on the demand side. Some experts, such as John Carnavale of Carnavale Associates, have pointed out that at least in the Reagan White House the budget matched the rhetoric — the “War on Drugs” was aimed at busts and harsh jail sentences for traffickers, and had the supply-side budget to match.

“The administration’s drug strategy is largely similar to President Bush’s failed strategy, especially when it comes to short-changing drug treatment while wasting money on ineffective supply-side programs,” said Bill Piper, Director of National Policy at the Drug Policy Alliance. “It does, however, break from the past in several important respects. Most notably by setting numeric goals for reducing fatal drug overdoses, embracing needle exchange, and supporting reform of the crack/powder cocaine sentencing disparity. Combined, these changes could be a first step to implementing a new bottom line in U.S. drug policy; one that focuses on reducing the problems associated with both drugs and the war on drugs.”

The strategy focuses heavily on prevention, which aligns it well with the Obama White House’s emphasis on prevention of chronic diseases in its health care reform efforts. To achieve this, ONDCP places an emphasis on community involvement. Among its highest priorities, the strategy calls for the development of a community-oriented national prevention system, and providing scientifically supported information via the National Youth Anti-Drug Media Campaign. There would also be support for mentoring initiatives, and the fostering of collaboration between public health and public safety organizations.

The plan also emphasizes a desire to see primary care as a bigger part of the solution, as it would increase early interventions. ONDCP would like to see increased screenings in all healthcare settings, which would in turn require more education for health professionals so they can recognize the warning signs of substance abuse. As prescription drug abuse remains a rampant problem, drug monitoring programs are also part of the strategy for primary care settings.

Because substance abuse in America is as much a criminal justice issue as a health issue, there is also a fair amount of the strategy dedicated to the criminal justice system, and reforms that would advance new directions in drug policy. ONDCP wants to promote alternatives to incarceration through a variety of methods. These would include encouraging partnerships between law enforcement and community organizations, mandating treatment for chronic offenders that “disproportionately burden the health care and criminal justice systems,” and supporting post incarceration re-entry efforts, such as job placement and access to drug-free housing.

There is also commitment to working on the international level, since the U.S. is one of the most lucrative markets for illegal drugs. In addition to conducting joint law enforcement operations with other nations, the ONDCP aims to expand support for international prevention and treatment initiatives. Partners for this effort would include the United Nations and the Organization of American States.

“As Director Kerlikowske has witnessed in his listening sessions with the recovery community, there’s more to recovery than not using alcohol or other drugs,” said Pat Taylor, Executive Director of Faces and Voices of Recovery. “We salute the agency’s recently released strategy’s attention to the barriers to recovery that are keeping people from housing, jobs and driver’s licenses as they work to get their lives back on track…With the “War on Drugs” over and a renewed emphasis on prevention, treatment and recovery, the strategy is identifying long-overdue solutions that address addiction as the public health crisis that it is.”

Included in the coalition are such prominent advocacy organizations as the American Psychological Association, the National Association of State Alcohol and Drug Abuse Directors (NASADAD), Community Anti-Drug Coalitions of America (CADCA,) the American Psychiatric Association, The American Society of Addiction Medicine (ASAM) and the International Certification and Reciprocity Consortium (IC&RC.)

“The Friends of NIDA is an organization that is organized around a consensus message about drug abuse and what needs to be done to understand and treat it,” said Marie Dyak, Executive Director of the Entertainment Industries Council. “It does what it is designed to do: advocate for science-based research to treat a very complex disease, aspects of which do not exist in so many other chronic illnesses.”

The Friends are most well known for its briefings on Capitol Hill. Always well attended—sometimes by more than a hundred Congressional staff—it seeks to inform policy-makers of the benefits of NIDA research, as well as its “real-world” applications. Briefings almost always include an introduction by NIDA Director, Dr. Nora Volkow, and feature one or two NIDA-funded scientists who explain their research. Often, someone who has benefited from treatment based on NIDA research also speaks. Briefing subjects try to blend NIDA research priorities with important political topics, such as treatment for veterans, prescription drug abuse and methamphetamine addiction. Other briefing topics include drug use and HIV, the role of genetics in substance abuse, and treatment in the criminal justice system. The briefings are always presented in conjunction with the Congressional Addiction, Treatment and Recovery Caucus. Members of Congress, including ATR Caucus chair Rep. Patrick Kennedy, Rep. Grace Napolitano, Rep. Brian Baird and Rep. Rick Larsen, have frequently attended and spoken at the briefings.

One memorable briefing, on the subject of prescription drug abuse, featured a 19 year old from Massachusetts named Nick, who spoke about his addiction to prescription drugs, how it led to other abuses and its effect on his life and his family. As he paused several times to compose himself, he worked his way through his story and clearly made an impact on almost everyone in attendance. He courageously told his compelling story of becoming addicted to Vicodin and OxyContin. He noted that over time, he also became addicted to heroin and found that he no longer recognized his life. Nick also spent time in the criminal justice system and was at one point pronounced dead in an emergency room. At that point, he said that he chose to muster his strength to dedicate himself to a treatment regimen that included the medication buprenorphine as an adjunct to counseling. Since then, Nick said that he is growing stronger every day and is appreciative of the opportunity to be an active and important part of society.

Nick was asked to review for the audience core “take home messages.” Nick called on a strong investment in prevention programming—from the elementary grades through high school. In addition, he explained that addiction “does not discriminate” and noted that the treatment protocols made possible through the research at NIDA literally saved his life.

It is these presentations, unfiltered and unpolished, that give a human face to the benefits of NIDA research. Other memorable speakers include those who partook in a briefing on nicotine and tobacco addiction, including Shirley Reimer, a patient who quit smoking through the National Quitline, and shared the story of her success, and Preston Young, a patient who quit smoking during a translational clinical research study funded by NIDA, who spoke about his personal experience with nicotine addiction.

 “The Friends of NIDA has done an excellent job educating Congress on the benefits of investing federal resources into addiction research,” said Rob Morrison, Executive Director of NASADAD. “Through Hill briefings that feature NIDA-funded researchers and people in recovery telling their stories, policymakers make the connection between the front-end investment and the dividends seen in their District.”

Like many advocacy-based coalitions in Washington, the Friends are almost always most busy during the appropriations season. Thanks in large part to Ed Long of Van Scoyoc Associates, the Friends are always successful in including comments in the reports accompanying both House and Senate appropriations legislation. This “report language,” as it is called in D.C., expresses support from the committees for specific work being done at NIDA, and encourages it to continue in the future. Such congressional support is critical to a government agency such as NIDA, as continued funding is a large part of the recipe for progress.

The Friends also receive leadership and advice from a very knowledgeable and influential Board of Advisors. Many former ONDCP and NIDA directors sit on the board, including General Barry McCaffery, Dr. Alan Leshner (Currently the CEO of The American Association for the Advancement of Science), Dr. Bob Dupont and Dr. Charles Schuster. Also on the board is former U.S. Representative and Chair of the House Committee on Commerce, Thomas Bliley.

The leadership of NIDA has always been appreciative of the Friends efforts. Cindy Miner, Director of the NIDA Science Policy Division, remarked, “Through their educational efforts, the Friends of NIDA have been an important ally in raising the public’s awareness of NIDA’s scientific achievements in addiction research, and consequently helping to reduce the stigma of addiction.”

(Materials from all Friends of NIDA briefings can be found at http://thefriendsofnida.org/events.asp)

Yet while legislation and federal funding exist to provide for the prevention and treatment of substance abuse and addiction, no such programs exist for the protection and care of problem gamblers. The same applies to the professionals who treat these patients. While funding for the training of substance abuse counselors and the treatment of drug addicts and alcoholics is small when compared to the size of the problem drug addiction presents for our country, these funds tower over the funding received by the problem gambling field, which hovers dangerously close to zero.

However, the statistics on those who problem gambling affects warrant a review of the allocation of these funds. Four to six million American adults and 500,000 adolescents meet the criteria for a gambling problem. Fifty percent of problem gamblers in treatment meet current or lifetime criteria for substance abuse, and 30 percent of substance abusers in treatment meet current or lifetime criteria for problem gambling.

Problem gambling is defined as gambling behavior that causes disruptions in any major area of life: psychological, physical, social or vocational. The term problem gambling includes, but is not limited to, the condition known as Pathological or Compulsive Gambling, a progressive addiction characterized by increasing preoccupation with gambling; a need to bet more money more frequently; restlessness or irritability when attempting to stop; chasing losses; and loss of control manifested by continuation of the gambling behavior in spite of mounting, serious, negative consequences.

Recently, federal legislation has been introduced to address the issue. The Comprehensive Problem Gambling Act authorizes the Federal health agencies to address problem gambling and provides an appropriation of $71 million over five years for grants to state, tribal and local government health agencies, non-profits and universities on the prevention, treatment and research of problem gambling. Introduced in June 2009 by Reps. Moran, Terry and Wolf, HR 2906 has 42 sponsors to date: 33 Democrats and nine Republicans. Such senior members of the House as Rosa DeLauro (D-CT), Barney Frank (D-MA) and Mike Castle (R-DE) have signed on as co-sponsors. Senators Brownback (R-KS) and Merkley (D-OR) are scheduled to introduce the Senate companion bill, hopefully on March 8 (as of this writing).

“While no hearings have been scheduled, we remain optimistic the bill will pass this year,” said Keith Whyte, Executive Director of the National Council on Problem Gambling (NCPG), the national advocate for programs and services to assist problem gamblers and their families. “When [the Comprehensive Problem Gambling Act] passes, it will literally be the first-ever Federal grants for problem gambling prevention and treatment programs.” The mission of the NCPG is to increase public awareness of pathological gambling, to ensure the widespread availability of treatment for problem gamblers and their families and to encourage research and programs for prevention and education. There are currently 35 state affiliates of the NCPG.

The act would amend the Public Health Service Act to require the Secretary of Health and Human Services (HHS), acting through the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), to establish and implement programs for the identification, prevention and treatment of problem and pathological gambling. It would require the Secretary to carry out a national campaign to increase knowledge and raise awareness of problem gambling. The Secretary would also be empowered to encourage media outlets to provide information aimed at preventing problem gambling and target their message to radio and television audiences of, but not limited to, sporting events and gambling. The Secretary would be authorized to make grants to states, local and tribal governments and nonprofit agencies to provide comprehensive services with respect to the treatment and prevention of, and education about, problem gambling.

The act would also require the President to establish and implement a national program of research on problem gambling, appoint an advisory commission to coordinate federal research, and consider the National Gambling Impact Study Commission’s recommendations. Acting through the SAMHSA Administrator, the President would also be required to develop a Treatment Improvement Protocol for problem gambling.

There are now 33 states that provide some public funds, usually through the Single State Agency (SSA). The Association of Problem Gambling Service Administrators (www.apgsa.org) is the trade association that represents problem gambling services at the state level, similar to how the National Association of State Alcohol/Drug Abuse Directors (NASADAD) represents the SSAs.

A search of the National Institutes of Health (NIH) database revealed that there are currently nine active NIH-funded studies that focus on pathological gambling. This is not to say that there are not other NIH-funded studies that could provide insight to the brain activity that relates to problem gambling. Several studies on other types of addictions could help the problem-gambling field find answers and develop better treatment protocols. But only nine such studies represent research directly related to problem gambling, with the funding for these grants totaling less than $2 million.

“There is a dire need for SAMHSA and other agencies to provide technical assistance, program development and best practices to make the most efficient and effective use of these funds,” said Whyte. “Problem gambling is highly co-morbid with substance abuse, and there is increasing evidence that providing services to treat problem gamblers will reduce usage of other public services, not just health-related but also criminal justice, and provide overall savings to agencies and states.”

Given the high co-morbidity of problem gambling with substance abuse and mental health, the resistance of many substance abuse/mental health providers to brief screening and prevention initiatives has been a major challenge. In response, NCPG has developed National Problem Gambling Awareness Week (www.npgaw.org), a grassroots campaign to raise awareness of problem gambling and to encourage health care providers, especially substance abuse and mental health personnel, to screen their clients for problem gambling during the week.

The American Psychiatric Association recently proposed to shift problem gambling into the new Behavioral Addictions section of the DSM-V, which is currently being compiled. This has the potential to help substance abuse and mental health professionals recognize the relationship between substance abuse and problem gambling, given the similarities in the underlying neuro-biological mechanisms. It would also provide additional validity to problem gambling as an addiction, requiring the necessary programs to appropriately diagnose and treat the disorder.

The author wishes to thank Keith Whyte for his cooperation in developing this article.

Named for the U.S. senators the late and loved Paul Wellstone and Pete Domenici who sponsored it,  the parity act, according to William Moyers VP of foundation relations at Hazelden, “eliminates discrimination by insurance companies by expanding access to treatment for people who want to use their coverage to get help for addiction to alcohol or other drugs, as well as depression, eating disorders and other mental illnesses…..[the new law] opens the door to hope and help for 112 million people with employer-sponsored group health plans. Now, those plans are required to match the financial benefits for mental illness and addiction like they do for all other medical or surgical benefits, including out-of-pocket expenses, deductibles and co-pays.”

One can hardly open a newspaper, turn on the TV or log onto the internet without seeing yet another celebrity or public official being carted off to treatment in sunglasses and a floppy hat or standing boldly against the rush of negative press they are so likely to experience if they openly talk about their battle with depression.

But now this issue has a chance to move from the tabloids to the clinics and treatment facilities where meaningful change actually has a chance to happen. Thanks to a more enlightened senate and congress, or maybe just a more honest one, mental health and addiction can come out of the closet as disorders that need and deserve the same sort of organized and aggressive treatment as say a spreading cancer, because that is just what they are.

According to the most recent statistics from SAMSHA:

• One of every eight Americans has a significant problem with alcohol or drugs, with 40 percent of the group having a “dual diagnosis,” or concurrent mental/nervous disorder;
• Approximately 27 million Americans either use illicit drugs regularly or are “heavy drinkers.” Of these almost 16 million are estimated to need immediate treatment;
• By age eighteen, almost 12 percent of all young people are illicit drug users;
• An untreated alcoholic’s medical costs are approximately 300 percent higher than non-alcoholic’s medical costs;
• Approximately 70 percent of illegal drug users are employed and contribute significantly to workplace absenteeism, accidents and injuries, decreased productivity, increased insurance expenses, employee turnover costs and on-the-job violence;
• The estimated annual direct cost to our society resulting from substance abuse is more than 250 billion dollars;
• It is generally accepted that chemical dependency, along with associated mental health disorders, has become one of the most severe health and social problems facing the United States.

Happy people create happy people and happy homes. Depressed or addicted people share their moods as well, only in darker and more troubled hues. For every one person who suffers from mental illness or addiction there are easily (and probably conservatively) four more who suffer deeply and for decades. The emotional and psychological trauma that often times results from living with addiction and mental illness can and often does create a set of symptoms now known as PTSD, post traumatic stress disorder. PTSD not only troubles those who have it but those who live with that person who suffers from it. And so it goes, hand to hand, heart to heart, life to life. We pass on our pleasure or we pass on our pain. Perhaps mental health parity will help us to “break the chain” and free not only one, but several generations.