Cuts to substance abuse treatment coincide with cuts to substance use prevention

Earlier this week, a Seattle Times opinion piece describes how  “ . . .Washington’s nationally lauded chemical-dependency treatment community is in critical condition, and it is fading fast.”

“Just this month, a 41-year-old inpatient treatment center in Madrona and a detoxification facility in Everett are closing. Other facilities are teetering on the brink, downsizing, merging or shedding jobs to stay above water. Recovery Centers of King County is losing $20,000 a month on outpatient care.”

“It’s gotten so bad, so quickly, that state regulators are scrambling to ensure some smaller rural counties don’t lose their sole treatment facility. I’ve heard it described as the state’s most serious crisis in chemical-dependency treatment in a generation.”

Toward the end of the article, a treatment provider points out that many of the patients in her detox center (which is closing) are young.  “When she looks around the facility, 'It looks like high school.' Prescription painkillers and heroin are surging, and hook the young. 'They look like babies.'"  Even prior to current cuts in treatment funding, the majority of Medicaid-eligible adolescents who needed substance abuse treatment were not able get the help they needed. 

This is a particularly bad time to lose treatment providers because painkillers and heroin are not the only drugs for which adolescents and young adults seek help.  In fact, marijuana is the primary drug for which adolescents seek treatment and it is about to become much more available throughout the state.   Teen marijuana use rates are expected to increase.   

During the marijuana legalization debate, proponents of I-502 promised increased funding for substance abuse prevention and treatment.  Not only has promised funding not yet materialized, but funding has been cut for both.  In addition to treatment funding cuts, the statewide Community Mobilization Program, a science-based prevention program, was eliminated from the state budget in 2013.  Efforts to get funding back into the state budget failed.  In his opinion piece, Jonathan Martin writes about the state legislature and treatment funding: “Unbelievably, I hardly heard a peep about this in the three-month legislative session, let alone a proposed fix.”  The same can be said about prevention.  Not a peep. 

Marijuana dependence and treatment

As we, as a state, move forward with creating a commercial marijuana market, it is important that we understand marijuana, its use, and consequences.  While this blog mostly focuses on substance abuse prevention, it's useful to take a look at intervention, harm reduction, and treatment, too.  A 2007 article from the Addiction Science and Clinical Practice journal entitled "Marijuana Dependence and Its Treatment" is a good starting point.

Here are a few excerpts:

Adolescent marijuana use
Approximately half of the individuals who enter treatment for marijuana use are under 25 years of age. These patients report a distinctive profile of associated problems, perhaps due to their age and involvement in other risky behaviors (Tims et al., 2002). Adolescents who smoke marijuana are at enhanced risk of adverse health and psychosocial consequences, including sexually transmitted diseases and pregnancy, early school dropout, delinquency, legal problems, and lowered educational and occupational aspirations.


Racial disparities
During the past decade, marijuana use disorders have increased in all age groups. Contributing factors may include the availability of higher potency marijuana and the initiation of use at an earlier age. Among adults, marijuana use disorders increased despite stabilization of rates of use. An increased prevalence of disorders among young adult African-American and Hispanic men and African-American women appears to account for the overall rise among youth (Compton, 2004)

Is marijuana unique? A large part of the general population has had personal experience with marijuana, and most have not become addicted. (Ten percent of the U.S. population reports using marijuana in the past year and 6% report using within the past month.) Many find it perplexing to contemplate how someone else could become addicted to a drug they themselves have tried and can easily set aside or stop using. Accordingly, they think marijuana dependence must qualitatively differ from dependence on other drugs, such as heroin and cocaine, and require unique treatment approaches.

People who develop problems with marijuana may indeed be different from those who do not, but this phenomenon has been observed with other substances of abuse. A comparison with alcohol use and dependence provides a case in point. The great majority of Americans have tried alcohol and continue to drink alcoholic beverages regularly. However, only an estimated 10 to 15 percent of alcohol drinkers develop problems, and only some of these problem drinkers seek treatment. This is also true of those who have tried cocaine or heroin (Anthony, Warner, and Kessler, 1994).


Note: Two of this article's authors conduct research with the University of Washington's Teen Marijuana Check-Up.