For Our Health & Safety: Joining Forces to Defeat Addiction

Executive Summary & Complete Report

One in nine Californians suffers from an addiction to alcohol or other drugs. But few addicts suffer alone. Drug addiction underlies the abuse and neglect of more than 100,000 children in California and is a factor in a majority of domestic assaults.

Eight in 10 felons who are sent to prison abuse drugs or alcohol. But the costs are not limited to the criminal justice system. Some $11 billion is spent from the state General Fund responding to the problems created by abuse or addiction. The expenditures and economic losses to individuals, corporations and public agencies that result from abuse and addiction in California are estimated to top $32 billion.

Much of the public resources are spent countering illegal drugs. But at least half of the health consequences, half of the violence and half of the economic losses are attributable to the abuse of alcohol the drug that most of our children will abuse first.

A majority of Californians have come to realize the insidious nature of addiction, as well as the ineffectiveness, disparate and at times overly punitive response to those trapped in addiction. Proposition 36, approved by voters, reflected a clear choice one supported by academic research and practical experience that treatment can be a cost-effective, socially responsible and humane solution.

But the voter initiative did not go far enough. It did not make sure that the State was strategically using prevention, treatment and enforcement tools to reduce the consequences of addiction. And it did not ensure that the publicly-funded treatment programs perform to their potential to change lives. Those tasks still await state and local policy-makers and program administrators.

In this report, the Commission recommends how state and community leaders could embrace the will of voters and employ sound science to better respond to one of the most costly and harmful problems facing California. Specifically, the State must develop a strategy that uses prevention, treatment and law enforcement where those tools have proven they can do the most to reduce the consequences of abuse and addiction. That strategy must be developed, implemented and monitored by a council of talented and committed professionals and political leaders. In turn, state and community officials must be given clear direction to make treatment programs grow in quality and quantity.

The consequences of abuse and addiction are so severe, and the potential for treatment so great, that the ultimate goal should be to ensure quality treatment for everyone who could benefit. This goal cannot be obtained by government action alone. Rather, civic leadership will be essential to muster public and private resources, build public understanding and support, and engineer the necessary changes in treatment and other supportive programs.

In addition to refocusing policies on treatment, Proposition 36 provided additional funding and gave local officials a clear mandate. In many counties, the challenge has reinvigorated judges, attorneys, treatment providers and others who understand the problem. They had been saddled by conflicting mandates, restricted funding and narrowly defined responsibilities, but the voters defined for them a clear and common purpose.

The State needs to reinforce that victory by establishing an overarching drug and alcohol policy focused on the shared goal of reducing the cost and misery of addiction, and it should align government and community-based resources toward that end. A top priority must be to stop the intergenerational infection of drug and alcohol abuse, and to target those whose addiction most injures others, especially our children.

Reducing abuse and addiction needs to be a government-wide fight. While individual drug control programs may be excellent, the overall effort is unfocused and undisciplined. Treatment clearly one of the best responses is undervalued and under-used. And the stakes are too high not to honestly measure how well policies are working and then expand, modify or abandon policies based on the evidence. Through a statewide council, California will have a mechanism to direct resources to the most effective responses.

But treatment programs also have not been managed in a way that fully seizes the potential to heal lives. In documenting the benefits of treatment, researchers also have revealed the need for providers to faithfully replicate proven strategies. Social service workers frustrated by the complex difficulties of troubled families know they need to tailor the services those families need to become safe, healthy and self-sufficient.

Conquering addiction also will require public leaders to look beyond government. Employers, health care providers and insurance carriers if they want to hold down costs and have a healthy workforce will have to help workers who abuse alcohol or drugs. Foundations and philanthropists who want to heal communities will have to help the addicted recover. Some of this expanded treatment will be publicly funded, some treatment will be privately funded, and some treatment will be self-supporting, like the thousands of Alcoholics and Narcotics Anonymous groups that provide peer support every hour of every day somewhere in California.

If you are concerned about public safety, address addiction. If you are worried about the cost of government, address addiction. If you are worried about abused children, homelessness, struggling families, address addiction. If you are worried about economic productivity and prosperity, address addiction. Drug and alcohol abuse is not the source of all problems, but it is a cancer in our communities that is sapping our resources and limiting our potential.

In his 2003 State of the Union speech, President Bush declared that the addiction of some is worth the attention of all: For those who are addicted, the fight against drugs is a fight for their own lives, the President said. Let us bring to all Americans who struggle with drug addiction this message of hope: The miracle of recovery is possible and it could be you.

The Commission was sincerely impressed by the committed and earnest individuals working in state and local agencies, as well as for private providers. Some of them were candid even adamant about the shortcomings of current treatment and other drug control efforts. It is clear that they want to change lives and are making personal sacrifices to stay in a field that is undervalued. The following recommendations are intended to help them help California.

Michael E. Alpert, Chairman

The Little Hoover Commission is a bipartisan and independent state agency charged with recommending ways to increase the efficiency and effectiveness of state programs. The Commissions recommendations are sent to the Governor and the Legislature. For more information, visit the Web site at: www.lhc.ca.gov.