Changing the name of the "war on drugs" has not yet resulted in
any changes in the drug-use habits of Americans. However, treatment advocates
are hopeful that a new approach is coming and will bring better results.
The overall U.S. level of illicit drug use remained level at about 8
percent as it was in the prior year, according to the 2008 National Survey on
Drug Use and Health (NSDUH), the results of which were released in
The results of the national sample survey of about 67,500 people were
extrapolated to population estimates. It identified several areas of progress,
including significant decreases in the misuse of prescription drugs between
2007 and 2008 among people aged 12 and older.
Progress also was made in curbing methamphetamine use among people aged 12
and older. The number of users dropped sharply from approximately 529,000
people in 2007 to 314,000 in 2008. In addition, the extent of cocaine use
decreased from 1 percent, or 2.4 million, in 2006 to 0.7 percent, or 1.9
million, in 2008.
Promising results also were found among the population of 12- to
17-year-olds, who are heavily targeted by prevention advocates. These youth
had a significant decline in overall past-month illicit drug use, from 11.6
percent in 2002 to 9.3 percent in 2008. There also were significant decreases
in the current nonmedical use of prescription drugs from 3.3 percent in 2007
to 2.9 percent in 2008.
"That's somewhat encouraging, given the substantial effort that has
been put into reducing prescription drug abuse among teens," Lizbet
Boroughs, associate director of APA's Department of Government Relations, told
Unfortunately, those reductions were offset by growing abuse of other
substances, according to the NSDUH. For example, the survey identified
significant increases in the rates of Ecstasy and LSD use among youth in
recent years. Past-year Ecstasy use in 2008 for teenagers was 1.4 percent; the
lowest level of past-year Ecstacy use in teens since 2002 was 1 percent in
2005. Likewise, the 0.7 percent of teens who reported using LSD within the
past year in 2008 was significantly higher than the lowest rate since 2002 of
past-year use of 0.4 percent reported in 2006.
One continuing problem highlighted by the SAMHSA survey, according to some
treatment advocates, is that it continues to show a vast gulf between the
number of people who need specialized treatment for a substance abuse problem
and the number who receive it. The survey found that 23.1 million Americans
need such care for a substance abuse problem, but only 2.3 million (about 10
percent) receive it.
"There are a stubbornly high number of people who need treatment and
can't get it," Alexa Eggleston, director of public policy at the
National Council for Community Behavioral Healthcare, told Psychiatric
News. "Hopefully, that is one area that the [Obama] administration
is committed to focus on."
Treatment advocates said the intransigent substance abuse statistics
highlight the need for a new federal approach to the problem.
"It's clear evidence that we are far from where we need to be,"
said David Rosenbloom, Ph.D., president and CEO of the National Center on
Addiction and Substance Abuse at Columbia University, in an interview with
Gil Kerlikowske, Obama's new director of the Office of National Drug
Control Policy (ONDCP), has voiced support for reexamining the government's
approach to the "war on drugs." For starters, he has said in
numerous media interviews that he wants to drop the reference to a"
war" because it creates a misunderstanding that the country is in
conflict with its own citizens.
"As we develop the Obama administration's first drug-control
strategy, we will emphasize a balanced approach that can respond to current
and emerging substance abuse trends. Improving substance abuse prevention and
treatment systems will be among our priorities," Kerlikowske said in a
statement when the NSDUH data were released.
To that end, Kerlikowske has undertaken a nationwide "listening
tour" that has sought comments from drug treatment and abuse-prevention
advocates, among others. For instance, at the June meeting of the National
Association of State Alcohol and Drug Abuse Directors (NASADAD) the drug czar
called for more funding for treatment and invited input to be considered for
the new national drug-control strategy expected to be announced in early
Substance abuse treatment advocates hope that the balanced approach
includes a drug-control strategy that places greater emphasis on and funding
for treatment and prevention over the interdiction and incarceration of drug
users emphasized in the Bush administration's annual drug plan.
There was little evidence of a new balance in the administration's Fiscal
2010 budget, which followed the practice of the Bush administration in
requesting that Congress cut funding for the main federal program for local
school districts' addiction-prevention programs. Funding for the Safe and Drug
Free Schools and Communities grant program was restored by Congress under
Bush, but legislators have supported the cut under Obama.
"That program is a large part of the prevention program of the
states," Robert Morrison, interim executive director of NASADAD, told
Conversely, the Fiscal 2010 budget proposed increasing addiction treatment
within the criminal justice system. Treatment advocates said they hope that
the proposal is a sign of the new direction that the Obama administration will
take in both its annual drug plan and the next federal budget. Another good
sign to treatment advocates: the appointment of A. Thomas McLellan, Ph.D., a
noted addiction researcher, as deputy director of ONDCP. McLellan has been
involved in some of the most important addiction research in recent decades,
including the development of the Addiction Severity Index and studies
comparing addiction with other chronic health conditions.
Treatment advocates said that they hope McLellan and others will push the
administration to support increased integration of mental health and substance
abuse treatment with general health care through demonstration projects and
increased funding, among other initiatives. Health reform proposals under
consideration would fund substance abuse treatment and other mental health
treatments through the medical-home treatment model and pilot programs that
coordinate treatment of multiple chronic illnesses.
ONDCP "clearly understands the need for treatment as the most
effective way to reduce the demand for illicit drugs," Rosenbloom
Further information on the 2008 NSDUH is posted at<www.oas.samhsa.gov/nhsda.htm>.▪