The widespread and unconstrained epidemic of drug abuse in Maine has included an unprecedented number of overdose deaths. As a result, Senator Angus King and Governor Paul LePage recently convened two separate forums in hopes of developing effective and comprehensive strategies to reverse this situation. Three individual working groups have been formed to focus on three specific areas of concern: law enforcement, education and prevention, and treatment and rehabilitation.
At the outset, however, it should be acknowledged that the state’s own accounting demonstrates that it has long neglected to invest as much as it should in the treatment of substance abuse.
U.S. Attorney Thomas Delahanty attended both forums and stated, “It’s a three-legged stool,” implying that attendees at both forums concluded that each of the above areas must receive major attention. Sagadahoc County Sheriff Joel Merry also attended both forums and stated, “If you have a person in jail, and they’ve done six, eight, nine months, and they’re clean, and they’ll even admit they want to stay clean, going back out into that environment is not conducive to staying sober. They need support: they might need counseling, addiction services. If they don’t have a job, they don’t have means to pay for it – and in most cases they don’t – they fall into a crack … . I’m not talking about giving them cash to buy drugs. I’m talking about giving them the ability to access services that will keep them sober.”
There now appears to be widespread agreement that treatment needs much more emphasis. Delahanty noted that while the governor’s forum had focused on law enforcement, “Even law enforcement is on board with treatment.” Similarly, Merry added, “I think overwhelmingly the people in the room agreed that it’s a multi-pronged approach that’s going to resolve this issue.”
In the past, the governor’s approach to Maine’s drug epidemic has focused on stronger anti-drug law enforcement and incarceration, while New England’s other governors focus on substantial increases in funding for treatment. The above remarks, however, clearly echo those of Maine Representative Mark Dion, former co-chair of the Criminal Justice and Public Safety Committee and former Cumberland County Sheriff, who told the Boston Globe in July 2014, “Overemphasis on enforcement without an equal commitment to treatment is just spinning the merry-go-round faster and faster … Jail doesn’t work, I can tell you that … .”
Before beginning to formulate comprehensive plans to reverse this epidemic, it might be worthwhile to review the three relatively recent studies of the total cost of alcohol and drug abuse in Maine conducted by the Office of Substance Abuse and Mental Health Services (formerly the Office of Substance Abuse) for the years 2000, 2005 and 2010 and published in 2004, 2007 and 2013, respectively. Each of these studies analyzed cost estimates for the following six cost areas: treatment of alcohol and drug abuse; morbidity; mortality/premature death; crime; medical care; and other related costs. The costs of criminal activity included law enforcement costs, judicial costs, correctional costs and other societal costs.
Total expenditures due to substance abuse in 2000, 2005 and 2010 increased from $618 million to $1.403 billion, 127 percent over that 10-year period. Lost earnings due to mortality increased from $140 million to $409.6 million, comprising the largest or second largest category of expenditure and accounting for 23-29.2 percent of the total cost. Criminal activity expenditures increased from $128.4 million to $343.4 million, comprising the second largest or largest category of expenditure and accounting for 21-24 percent of the total cost. In contrast, substance abuse treatment cost $19-$47 million, comprised the smallest category of expenditure and accountin for only 2.8-3.3 percent of the total cost.
In all three studies, criminal activity accounted for the largest or second largest cost of alcohol and drug abuse, ranging from 21-24 percent of the total expenditures. In contrast, expenditures for substance abuse treatment accounted for the smallest cost of alcohol and drug abuse in all three years, ranging from 2.8-3.3 percent of the total costs. In fact, expenditures on criminal activity over this 10-year period were eight to nine-fold greater than on treatment. Clearly, the state’s own accounting of the cost of substance abuse documents how imbalanced its “three-legged stool” has been in the past.
As indicated by Merry, in order to be effective, treatment must not be restricted to group counseling for substance abuse. Many individuals suffering from addiction to alcohol and/or other drugs have co-occurring mental health disorders that require additional, specific, individual counseling in this area as well. Furthermore, various case management services must be an integral part of the treatment program.
For example, housing is a major area of concern. Individuals suffering from addiction need to live in a safe drug-free environment in which abstinence must be adhered to. Such resources are severely limited in rural parts of the state and will need to be established. Obviously, these individuals must be employed in order to pay for such housing.
Similarly, assuming they don’t have appropriate health insurance, and most do not because they can’t afford it, they must be employed in order to pay for their individual and group counseling. Therefore, access to job training and/or re-training is
an important and integral support service.
Lastly, before someone suffering from addiction is released from prison, a comprehensive, individualized, pre-release plan that includes the above support services needs to be put in place routinely.
What, then, of the “three-legged stool”? The three studies cited above clearly document that given the magnitude of the problem confronting our state, Maine’s
expenditures for substance abuse treatment has been a very short “leg,” which explains in part why the stool has been unable to stand as an effective approach to dealing with addiction.
Moving forward, we need to ensure that the governor and legislature are committed to reversing this situation. Stated simply, the state cannot afford to turn down millions of dollars of Federal funding for expansion of its Medicaid program (MaineCare) that would help defray the costs of effective substance abuse treatment.
Similarly, the state must increase its efforts to secure Federal grants supporting substance abuse treatment and case management services.
At the end of the day, however, the state must commit itself to a substantial increase in its funding of substance abuse treatment and case management.
Dick Dimond is a retired physician from Southwest Harbor, the steering committee chair of the Hancock County Adult Drug Treatment Court and a board member of the Acadia Family Center, Mount Desert Island’s only licensed drug and alcohol treatment agency.