From the London Tablet, July 22, 2012:

The death of Eva Rausing, the wife of billionaire Tetra Pak heir Hans Kristian Rausing, has grabbed the headlines in the same way as the tragedies of singers Amy Winehouse and Whitney Houston. People are both horrified and fascinated to learn that rich, often talented individuals have been unable to free themselves from the grip of substance abuse. Such cases disprove the Coalition Government's view that, with appropriate help, addicts can give up drugs quite quickly. They also highlight particular issues facing women and addiction.

The Government, however, takes the view that with the right help, people can make a speedy recovery. In England, it has introduced a system that will pay drug agencies according to the rate of success with their clients. In some areas, up to 50 per cent of the contract value is withheld until the agency can demonstrate a client's abstinence from Class A drugs, such as cocaine and heroin. The problem with this strategy has been highlighted by Dr. Clare Gerarda, chairwoman of the Royal College of General Practitioners, who has pointed out that it takes a long time for someone to be drug free—and that often this will never be achieved.

While social deprivation is not in itself the cause of addiction, it creates a sense of helplessness so that people cannot picture a positive future for themselves. The deep-rooted issues are such that millions of pounds need to be invested in regenerating our inner cities, creating jobs and homes. Sadly, in this time of austerity, there is no chance of this happening in any meaningful way. The price of a payment-by-results system will be that those with entrenched problems will not receive help. Instead, their situation will only get worse.

The reality of mental health as a cause of addiction is a much bigger problem than governments are prepared to accept. The sad truth is that most people who take drugs and alcohol are victims of mental which prevents a logical decision-making. The money given to services helping people with heroin problems has remained static, but residential services are in decline, particularly those that support women and young families. Alarmingly, charities supporting people with mental-health issues, such as Mindm have seen greater demand for services--but simultaneously face a 5.7 per cent reduction in funding.

There is vexing inconsistency in the points above that should cause politicians and mental health professionals to pause. On the one hand, there is a societal and Christian responsibility to offer help to those with alcohol and substance abuse problems. With such assistance, many are able to become clean and manage sobriety. As the fine points of what will be reimbursed under a national health care plan are worked out in the United States, decisions will have to be made concerning what kind of treatment will be reimbursed, and the length of such treatment. On the other hand, the Tablet article brings in clear focus the fact that even unlimited financial resources often do not help a person to overcome these problems. In our country, the sad case of Mary Kennedy reminds one of British heir Eva Rausling. Finding the right balance between appropriate funding for alcohol and substance abuse in Obamacare, while not breaking the bank, needs to be a key priority.

William Van Ornum

 

Comments

David Smith | 7/27/2012 - 2:16am
Medical treatment of individuals versus health care for statistical groups.  We're stuck firmly in the latter.  Since that's the way it is, we can't avoid setting up models of outcome and funding treatment regimens according to how well they produce the desired outcomes.  Kind of like No Child Left Behind for sick people - no patient left untreated.  Fairness by the numbers.  Everyone gets six months, or a year, or twenty-five visits, then back on the streets.  If that doesn't do it, repeat the treatment, if the patient survived the first round.

As for addiction, it should be an accepted truth, I think, that all bodies are different, some more prone to falling into the ditch than others, some less able to climb out on their own, none perfectly susceptible to computer modeling.  But, generally, flexibility is out, because it's unpredictable, and measurement is the ultimate measure.  Most patients will survive, some will flourish, all will be closed out.
JANICE JOHNSON | 7/26/2012 - 8:47pm
Another factor to consider in this discussion of the costs and benefits of drug treatment is the effect drug usage has on the rearing and parenting of children.  Having worked for a number of years in Child Protective Services, I'm familiar with the destructive and sometimes , tragic, results of parental drug abuse.  Many if not most of our cases involved drug abuse.  I agree with Dr. Clare Gararda and Ed that short-term programs don't work.  Rehabilitation or staying clean is a lilfe-time journey with starts, failures and re-starts.  We had clients who went through drug treatment 2 or 3 or more times before it took.  A motivator for parents is to be clean and have their children returned to them. 

In 1997 San Diego County instituted the San Diego Adult Drug Court Treatment Program.  I believe it has had a good measure of success.  It is for non-violent felony drug using offenders;  it includes mandated drug tx, rigorous court supervision, sanctions and has ancillary services of job training, eucation and health referalls. There is on-site mental health management services.  After the participant completes the first four phases of the program, he/she is slate to enter the six month after-cae program.  In cases involving children, the CPS workers work closely with the Drug Court.
Funding is from county, state and feds.

On the private side, the Catholic Diocese initiated a comprehensive program for the homeless, including mentally ill and addicted people, some years ago. Due to the efforts of the "hustler priest", Fr. Joe Carroll, it has continued to grow and grow and is called Fr. Joe's Villages.

These are only two examples (and Ed's is another) of programs that are doing a commendable job of dealing with  drug addicted people.  One hopes that Catholics will monetarily support such programs in their communities and that the fedral gov't in its cost analysis will take into account the lives of the innocent children who can be damaged for life , living in homes with addicted parents.
David Smith | 7/27/2012 - 10:12pm
Happy Birthday, Janice.  So good you're still here to enjoy it.

It's odd how health care has taken over the lion's share of the national budget and, at the same time, become a growth industry.  That seems morbid to me, but, of course, it wasn't planned - it just happened.  Humans, for all their vaunted intelligence, often seem thoroughly stupid when it comes to dealing with their technology.  They invent it and then they seem powerless to control it.

Recommended reading  :O)  :

http://www.amazon.com/Gods-Hotel-Hospital-Pilgrimage-ebook/dp/B005GSZHYU/ref=tmm_kin_title_0?ie=UTF8&qid=1343441373&sr=8-1 
JANICE JOHNSON | 7/27/2012 - 5:33pm
David,  Your comments give me a lot to think about and some of them hit home.  I agree that a medical system that relies on statistical group norms does not take into consideration individual differences and the need to tailor treatment plans to the individual.  Using a cost-benefit analysis, there are some groups in our society, that are not deemed to be as "beneficial" as others.  Eugenics has crreeped its ugly head already into our "progressive" thought.  Only a very few fetuses with Down Syndrome are allowed to live.  Anothe example is the elderly who use up a lot of medical care just to keep them alive and who receive little honor or respect in our cultulre.

Today, as I celebrate my 76 th birthday, I am truly amazed that I am staill alive.  For the past ten yrs or so I have been living with a serious heart condition that is exacerbated by stress.  My family life is very stressful.  In Jan. I had a severe episode and was hospitalized for9 days, 6 of them in ICU.  I had excellent care, from the time I was picked up, unconscious, by paradmedica from my home until the date of my discharge.  All the hospital had was my driver's license with my name and age.  The trauma team saved my life.  I was discharged with a combo pacemaker-atrial defibrilator.  As you can imagine, the cost was horrendous.....tens of thousands of dollars.  My insurance covered it all.  I wonder what will happen if and when I have another episode.  In a costj-benefit analysis I would lose out.  Have I already used my share of the medical pot??
ed gleason | 7/26/2012 - 6:37pm
My wife and I volunteer at a Franciscan recovery program for men. It's a one year live-in program, the first six months, the men earn their keep working in Franciscan charities mostly cooking and serving homeless. Next six months they learn resume, life coping skills and get jobs, paying one third for keep, a third for savings and a third walking around money; less than half graduate and the program recognizes that slips and relapse is part of recovery.
Yes it's a long process but the length is necessary. Short 30 day programs are in my opinion useless. 
This Franciscan program does not receive nor wants government money support.