DAVE MARASH, ABC NEWS (VO) According to a survey of public opinion polls going back almost 50 years, scenes like this define what most Americans know about drug addiction. TV, these polls show, is where most Americans learn what they know or think they know about drugs. This review of a half century of polling published today by JAMA, the Journal of the American Medical Association, reveals some interesting patterns. Most Americans agree drug use has reached dangerous levels but, they say, not in their own backyards. Eighty—two percent call drug abuse a serious problem nationally, but just 27 percent see it locally. And while 43 percent of parents see a national crisis of kids abusing drugs, just eight percent found the crisis in their own children’s schools. And with government statistics showing drug abuse dropping significantly over the decade of the ’90s, only 15 percent of Americans polled see the situation improving while 58 percent think America’s drug problems have never been worse. (on camera) And what about drug treatment? Well, few Americans seem to believe that it works. Just 19 percent of those polled gave drug treatment strong support. Skepticism about drug treatment programs is epidemic in America.

     1ST CITIZEN I can’t imagine how addicts would benefit from treatment. I think the old—fashioned way of going cold turkey would be the best way to do it.

     3RD CITIZEN I think they should be put in jail. I think they should be treated for the crime that they commit like everybody else.

     4TH CITIZEN I think a first—time offender, I would definitely opt for treatment. Second time, third time, jail. (Clip of doctors—scientists meeting)

     DOCTOR Around the turn of the century, narcotics were very widely used.

     DAVE MARASH (VO) This week in Washington, some three dozen top doctors and scientists gathered to tell the country most of what it knows about drugs is flat wrong. Their message—drug addiction is like many other chronic diseases, no more mysterious, no less serious than heart disease, asthma, diabetes or hypertension, and no more likely to select as its victims poor people or racial minorities.

     JEFFREY MERRILL, UNIVERSITY OF PENNSYLVANIA The real demography of the drug addict of today is a white, middle—class, educated individual or the children of those white, middle—class, educated individuals. It is the neighbor next door or maybe it’s somebody in your own house but it’s not somebody who is located in another community of another race or of another ethnic group.

     DAVE MARASH (VO) Even more revealing, the doctors’ report says many, if not most addicts are no more responsible for their sickness than sufferers from heart attacks or strokes.

     DR ALAN LESHNER, NATIONAL INSTITUTE ON DRUG ABUSE An analogy here is to lung cancer. People gave themselves lung cancer if they got lung cancer from smoking, but once they have it, we treat it as lung cancer. The same is true with addiction. Prolonged drug use changes the brain in fundamental and long—lasting ways and we know that those brain changes actually are the core, the essence of the compulsion that characterizes all addictions, you know, the compulsion to use drugs. And that makes it, at its essence, a brain disease.

     DAVE MARASH (VO) Treating drug addiction, the doctors say, means not counting cures, but measuring slow, subtle recoveries that add up to useful lives.

    

FOR MORE INFORMATION:

Physicians Leadership Group Dr. David Lewis of Brown University Phone: 401-444-1818

DR DAVID LEWIS, BROWN UNIVERSITY It’s a chronic disease with its ups and its downs and abstinence may not occur easily or ever, but there’s functional improvement, there’s decrease in crime, there’s better health.

     DAVE MARASH (VO) Modest goals, modest results. But Dr Lewis insists realistic expectations for drug treatment will be repaid well over time in functioning lives.

     DR DAVID LEWIS So I’d say the percentage is better than 50—50 or 50 percent when someone comes to treatment that treatment will help, and as repeated treatments take place it goes up and up and up and starts to get in 70, 80, 90 percent.

     CAROL SHAPIRO (PH) A lot of times people go through detoxification many times and I think one of the things we’re learning with the disease is relapse is very common.

     DAVE MARASH (VO) Carol Shapiro runs La Bodega, a New York City drug treatment center based on healing addicts through their families. The overwhelming majority of American drug addicts have health insurance, not that this means their insurance offers much coverage for drug treatment. Just two percent of today’s full—time employees are covered for inpatient rehabilitation and just one percent have full coverage for outpatient treatment.

     CAROL SHAPIRO I think it’s a travesty that insurance would not pay for drug treatment like we would pay for any other illness.

     DAVE MARASH (VO) Senator Paul Wellstone wants insurance companies to start thinking of alcohol and drug addiction as a chronic illness and remove the limitations on their coverage that have become a part of the managed care era of the 1990s.

     SEN PAUL WELLSTONE, (D), MINNESOTA And we’re saying that if in a health insurance plan you have substance abuse coverage, treat that, pay for that the same way you would anything else. Treat it the same way you would any other kind of illness. Don’t discriminate against people.

     DAVE MARASH (VO) Wellstone says this would cost an additional $1.35 a year per subscriber, an increase the insurance industry says could force some customers to drop their health insurance policies entirely. Still, Dr David Lewis, director of the physicians’ campaign, insists whoever pays for it, full coverage for drug treatment is a bargain.

     DR DAVID LEWIS It decreases health costs and complications of addiction. It decreases injury markedly. It increases productivity and it’s a great anti—crime measure.

     DAVE MARASH (on camera) Getting drug addicts into treatment can, the doctors claim, preempt their criminal careers and do so for a fraction of the annual $25,900 per person cost of incarceration. Getting the American public to recognize this, the doctors say, is their biggest challenge in helping America deal effectively with its national drug abuse problem.
     I’m Dave Marash for Nightline in Washington.

     TED KOPPEL When we come back, a congressman who became a believer in drug treatment after he was forced to confront his own alcoholism and the chief judge of New York State, who spearheaded efforts to bring drug treatment courts to New York.


     (Commercial Break)


     TED KOPPEL It was 1981 when then Minnesota state senator Jim Ramstad had his last alcohol blackout. His arrest for disorderly conduct was front page news. Seventeen years later, Representative Jim Ramstad is cosponsor of a bill in the US Congress to oblige private insurers to cover treatment for drug and alcohol addiction. He joins us here in our Washington bureau. And joining us from our New York bureau, the chief judge of the state of New York, Judith Kaye, who oversees the state’s seven drug treatment courts.
     And you’d better start by telling us, Judge Kaye, what a drug treatment court does.

     JUDITH KAYE, CHIEF JUDGE NEW YORK STATE (New York) Well, what a drug treatment court does is to try to break the recycling, the cycling and recycling of non—violent substance abusers through the criminal courts of the state of New York.

     TED KOPPEL By doing what?

     JUDGE JUDITH KAYE By offering an intensive judicial supervision, drug treatment, case counseling, a very, very rigorous program for those willing to go into it with the cooperation of the district attorney, defense counsel, numerous others and at the end of a year or two years, the person, we believe and we see, will no longer be recycled through the system but will go on, hopefully, to be a productive member of society.

     TED KOPPEL Now, in some states, is it not true, and obviously it is not in New York, but in some states is it not true that there is no option here for a judge? In other words, some state laws are so rigorous that if someone has used certain drugs, they are obliged to be sent to prison, aren’t they?

     JUDGE JUDITH KAYE Well, true, but this is a nationwide movement now. Indeed, 48 of the 50 states, Puerto Rico and Guam all are involved in this drug treatment court movement. We’re finding very, very promising success with this experiment.

     TED KOPPEL Congressman Ramstad, I can understand and I think most Americans have become, over the years, sympathetic to the notion that alcoholism is a disease. I’m not sure they’re quite ready to believe that drug addiction is a disease.

     REP JIM RAMSTAD, (R), MINNESOTA (Washington) Well, unfortunately there’s a greater stigma in some quarters attached to drug addiction. The fact is that whether your drug of choice is alcohol, as mine was, or marijuana or cocaine or whatever, it’s all the same, it’s all about chemical abuse and chemical dependency. If a person is totally chemically dependent then he or she does suffer from a disease that’s long been recognized by the American Medical Association as such and we as policymakers have to start treating substance abuse, chemical dependency as a disease.

     TED KOPPEL That’s going to be a problem, Judge Kaye, isn’t it because it’s a very slippery slope and very easy to get to the point where then the logical extension of all of that is to decriminalize drug use?

     JUDGE JUDITH KAYE Oh, I don’t think so at all and there are many offenders, violent offenders in particular who should be punished with incarceration.

     TED KOPPEL No, no, no. That’s too easy, judge. I’m not talking about violent offenders. I’m talking about simply someone who is a user of drugs. If there’s another crime involved, obviously that’s no problem. But let’s say the only crime is the use of crack or the use of cocaine or the use of heroin. If you were to say that in each of those instances we are going to treat those people as though they had heart disease or emphysema or cancer, then is it not logical at some point that you would say if, indeed, this is a chronic disease we shouldn’t be sending people like that to jail.

     JUDGE JUDITH KAYE Fair enough, but we’re not going to treat every single non—violent offender, substance abuser who comes through the criminal courts as diseased. Many of them are and it’s just not right to incarcerate diseased people who will simply come out the other end as substance abusers again and be recycled through the system again. The real problem is to identify those who are suffering from the disease of substance abuse and help them help themselves to cure the disease.

     TED KOPPEL Congressman Ramstad, let’s move to an area that I know is very near and dear to your heart and that is the notion of legalizing or making mandatory that insurance companies would have to pay for the treatment of, and are you talking about both drug and alcohol addicts?

     REP JIM RAMSTAD That’s right. We’re talking about substance abusers who are covered by insurance policies. We do not believe they should be discriminated against vis—a—vis people with other diseases or surgical services. And all our legislation, the Substance Abuse Treatment Parity Act does is provide for parity, saying you cannot erect barriers for treatment for chemical dependency that you don’t have for physical diseases. You have to treat them the same. Right now there are higher co—payments, higher deductibles, limited treatment stays. It’s alarming, Ted, that over the last decade because of this phenomenon, these barriers that have been created by the insurance companies, 50 percent of the treatment centers in America have closed. Sixty percent of adolescent treatment centers have closed. People don’t have access to treatment. Right now there are 26 million Americans suffering the ravages of chemical addiction, 10 percent of our population and 16 million of them are covered by insurance policies which have these barriers. We need to knock down those barriers and we need to provide access to treatment for those addicts/alcoholics.

     TED KOPPEL Judge Kaye, you were giving me the impression before that some sort of a distinction has to be made, though, in your courts even, that you will not simply accept the claim of every drug addict who comes through your court that he or she is sick, addicted.

     JUDGE JUDITH KAYE That is true.

     TED KOPPEL All right. Now how do you make that distinction and if you care to address it, having made that distinction, does that mean that those people who don’t qualify in your court also wouldn’t qualify for insurance coverage?

     JUDGE JUDITH KAYE Well I don’t know the answer about insurance coverage, but in the court system of course we make judgments all the time. That’s what judges do. We make the very fine judgment as to which of these people would benefit from the program, which of these people, in effect, suffer the disease of substance abuse and will merely, well, they’ll be marching to a drumbeat—drugs, crime, jail, drugs, crime, jail. And those are the people we’re looking for, the people who we can help to break this terrible recycling, terrible for the courts, terrible for the defendants, terrible for all of society.

     TED KOPPEL Congressman Ramstad, I know you want to get in here. We’re going to take a short break and I’ve got a question I want to ask you when we come back. More, in a moment.


     (Commercial Break)


     TED KOPPEL And we’re back once again with the chief judge of New York State, Judith Kaye, and with Minnesota Representative Jim Ramstad.
     Congressman Ramstad, you heard the judge say before the break that she and other judges and district attorneys make sort of ad hoc decisions as to who should or should not qualify for treatment rather than jail, but you can’t make laws that way. I mean when you’re making legislation, you can’t sort of leave it up to the insurance company to decide well this person ought to go to jail but this person deserves treatment.

     REP JIM RAMSTAD Well, first of all, let me say as chairman of the House Law Enforcement Caucus and as one who has certainly followed a tough law and order stance, I don’t think the two are mutually exclusive, that is, incarceration and treatment. We have to deal with both, Ted, and I do not support decriminalization of drugs. I think that sends exactly the wrong message to our young people, makes the jobs of parenting, it would be a disaster, I believe. But having said that, I think what we need to do is to, if you look at the population in the American prisons, 1.2 million people incarcerated tonight in America, 80 percent of them are there because of drugs and/or alcohol. Now, we’ve got to very, at the very outset concentrated on people already in prison because most of those prisoners at some point are going to get out and if we don’t deal with the underlying drug and alcohol problem when they’re in prison, we’re just going to have more hardened criminals when they’re released.

     TED KOPPEL But you understand, Congressman, better than most that society doesn’t really want to hear that. Society does not want to spend money on rehabilitation. Society wants to spend money on warehousing. Get those people off the street, get them off my block.

     REP JIM RAMSTAD Well, that’s part of our job as policymakers, we have to educate and I agree with you, Ted, that America right now is numbed to the pervasiveness of this drug and alcohol problem. We need to do a better job of educating them and we need to also, I must say the level of understanding of this problem and of treatment is much higher in the Minnesota legislature than it is in the Congress of the United States a few blocks from here.

     TED KOPPEL Let me come after you for a moment because I think you’re, the beginning of your answer was a little bit facile. In other words, I understand it’s politically advisable to say that you are not in favor of the decriminalization of drugs or the legalization of drugs and I understand why you say that. But if, indeed, we are taking the position, if these doctors and scientists take the position that what you are dealing with is not criminals but people who have a disease, then on what basis are we sending those people to jail, assuming, of course, that they haven’t held somebody up, that they haven’t killed somebody, that they haven’t injured somebody? In other words, if another crime has been committed while they were under the influence of drugs, different story. But simply the drug user.

     REP JIM RAMSTAD I committed disorderly conduct during my last alcoholic blackout, as you mentioned at the top of this program. I went into treatment. I didn’t go to jail. Judge Kaye deals with first offenders, non—violent property offenders for the most part, who are addicts, and sends them to treatment. We have to deal, I think as Judge Kay pointed out, on a case by case basis at the judicial level with non—violent first time offenders who happen to be addicts or alcoholics. We need to deal with their underlying problem of their addiction or they’re going to come back as more hardened offenders later on.

     TED KOPPEL And yet, Judge Kaye, in every other respect, discretion is being taken out of the hands of judges. It’s three strikes and you’re out, it’s mandatory sentencing. Why is this going to be the exception across the nation?

     JUDGE JUDITH KAYE Well, not everything is mandatory. As you point out, some things are, but by and large, what judges do is tailor made and depends very much on the exercise, the individual exercise of discretion by judges and ...

     TED KOPPEL And so if I get a good judge, I’m lucky. If I get a bad judge or an intemperate judge, I’m unlucky, right?

     JUDGE JUDITH KAYE Oh, no.

     TED KOPPEL That doesn’t sound like a very good system.

     JUDGE JUDITH KAYE No, it is a good system. We do depend enormously on the discretion of judges and at the same time the enforcement of the law and here we are finding an effective way to enforce the law and at the same time to help people who are sick and not criminals but ill people.

     TED KOPPEL Again, I just want to come back one more time, Congressman, to the notion of this legislation that you and Senator Wellstone want to pass here because you can leave certain things up to the discretion of judges, but the insurance companies are going to want something definite. They’re, you know, you’re not going to be able to leave this up to the discretion of insurance companies as to whether someone is or is not sick. How are you going to define that?

     REP JIM RAMSTAD Just like any other disease. Medical doctors at treatment centers make a diagnosis just like they do for heart disease or diabetes or kidney disease. They diagnose people either chemically dependent, that is sick with the disease of alcoholism and drug addiction or not. So that’s up to the local physicians, the chemical dependency professionals who make these diagnoses every day.

     TED KOPPEL Congressman Ramstad, Judge Kaye, thanks very much indeed.

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