COURT HOUSE – In June 1971, President Richard Nixon declared “war on drugs” in this country. After 44 years and $1 trillion spent confronting substance abuse at all levels of government, the question remains: Are we winning, losing, or are we mired in a stalemate?
Analysis
Should we continue our current strategies to incarcerate offenders at rates unsurpassed even in Russia and China? Or should we refer them for treatment, or both?
Should we legalize or de-criminalize the use of certain illegal substances, and would that mean we have given up and lost our “war?” What is the nature and extent of the problem of substance abuse in this country, state and Cape May County, and what, if anything, can or should be done about it?
Answers to these and countless other questions are either unknown or subject to debate depending on one’s point of view. Meanwhile families are torn apart, substance abusers’ lives are ruined and society in general suffers a reduced quality of live and considerable financial losses.
No one can credibly argue that he or she knows what the future holds, or if the tools and strategies now in use to combat this cancer of addiction are ever going to be successful.
One thing is clear. We can never attempt to win or be successful in the war on drugs if we do not get to know the enemy.
Latest Information
The New Jersey Department of Human Services, Division of Mental Health and Addiction Services recently released its 2014 aggregate substance abuse treatment statistics for the State and each county in New Jersey.
The Herald has conducted an analysis of this data in order to bring clarity and perspective to the whirlwind of anecdotes, assumptions and biases that sometimes guide and influence our opinions and decision making as citizens, government leaders and human beings.
As is often the case, often those assumptions and anecdotes are not based in fact.
The Herald’s analysis of data released by the DHS will focus on the heroin and opiate problem that has been identified as the most serious threat to the communities in Cape May County.
Perspective of Data Analyzed
First, it must be understood that the data collected by the DHS (Department of Human Services) refers only to treatment statistics, and does not purport to represent a measure of the substance abuse/usage problem directly.
It can fairly and carefully be used as an indirect measure of the substance abuse problems actually being treated and reported by treatment providers throughout the state.
No law enforcement data was collected; again, the data reflects treatment information not arrests or criminal justice crime reports.
This treatment information can be analyzed, in aggregate (no names used) to provide that needed clarity to determine where the treatment is occurring (by county), for what kinds of substance problems, by whom (demographics), and includes some additional insights such as percentage of abusers who also suffer from mental health issues.
Treatment options included in this analysis include outpatient, intensive out patient, partial hospitalization, long and short term residential, detox both in and outpatient, etc. The statistics below reflect all types of treatment options.
What DHS Learned
Statewide Analysis
Beginning with statewide patterns of treatment, there were 65,553 individuals treated for substance abuse, including alcohol, in 2014, compared to 73,036 treated in 2012 and 72,627 in 2013.
The 2014 statistics indicate that of the 65,553 treated, 15,673 clients were treated for alcohol abuse, 28,653 for heroin and other opiates, and much smaller numbers (3,317) for cocaine usage.
This data would seem to indicate a downward trend in treatment statewide. Naturally, this cannot be interpreted as a downward pattern of usage/abuse, but only a pattern of treatment. These statistics can mean fewer resources exist for those seeking treatment, or that fewer users are actually seeking treatment.
If other statistical indicators of substance use and abuse were to replicate these downward patterns, then this would be good news. Absent any indication of an actual decline in usage, the declining pattern of treatment is cause for concern if it is believed that treatment is better than incarceration as a tool to fight that war on drugs. As always, more study is required to validate what we think we are seeing in these statistics.
The statewide age and gender demographic presents few surprises: 35 to 44- year-olds represent the highest percentage (20 percent) of those being treated.
The next highest group was 25 to 29 years at 19 percent. It seems that the older the demographic, the lower the percentage of people who are in treatment.
Again, this data does not directly measure abuse, but only those seeking treatment; this distinction does bear repeating. The gender trends are also not so surprising. 32.4 percent of all those seeking treatment were female, 67.6 percent were male.
A statistic worthy of additional consideration is that 59 percent of all those being treated were also suffering from mental health problems. As to successful completion of their programs, aggregate statistics indicate that approximately 50 percent of those attending actually completed their program; 23 percent dropped out before completion while the rest failed to complete for various administrative reasons.
Arrest data indicates that in 2014, 1,866 clients were arrested within 30 days of treatment, or 3 percent.
This does not reflect the total number of persons arrested who had been in programs, just those who were arrested within 30 days of discharge. Providers reported that 17 percent had a problem with criminal behavior; providers also reported that 15 percent continued drug usage after discharge.
County Treatment Figures for Heroin and Other Opiates
Cape May County treatment providers (with a population of approximately 95,897 according to 2013 data), reported that heroin and other opiates accounted for 50.1 percent of total admissions in 2014.
When compared to the heroin problem in Atlantic County, where the population is 275,862 and Ocean County whose population is 583,414 the statistics would seem to present similar percentages of treatment reports for heroin/opiates.
Atlantic County providers reported heroin and other opiates at 54.1 percent, while Ocean County providers reported heroin and other opiates at 56.1 percent of the total individuals in treatment.
When comparing raw numbers of heroin/opiate abusers in treatment in Cape May County to those in Ocean and Atlantic counties, using population as a key variable, it appears that Ocean County providers with six times the population of Cape May County reported just three times the total heroin and opiate abusers in treatment as Cape May County providers reported.
This seems to indicate a reduced rate of heroin or opiate treatment (usage?) in Ocean County compared to Cape May County.
In contrast, when comparing Cape May County to Atlantic County, again using population as a key variable, it appears that Atlantic County providers with 2.8 times the population of Cape May County reported just under twice the number of abusers in treatment, which indicates a slightly lower rate of treatment (usage?) than Cape May County.
These comparisons may seem to indicate that Cape May County has a larger heroin/opiate problem than Ocean County, and slightly less a problem than Atlantic County, but again caution must be used when analyzing treatment reports because these statistics are only indirect measures of the drug problem we seek to understand.
Conclusions
Historians have reported that the first use of opiates was recorded by the Sumerians who lived in what is now southern Iraq in 5000 B.C. As for alcohol, it is first mentioned in writing in 3500 B.C. although it was surely in use long before then.
Substance abuse is clearly not a new phenomenon and not limited to any particular part of the world or historical era. As we look at the effects of substance abuse in Cape May County and the smaller communities within its borders, consider the following:
Heroin represents the most serious threat to Cape May County based on treatment figures that show that it constitutes 50.1 percent of all admissions.
Marijuana places second and cocaine a distant third. Males are more likely to be in treatment; 68 percent of all clients are male.
Abusers are more likely to be young adults with the highest age bracket consisting of 35 to 44-year-olds; most clients fall within the 22 to 44-year-old range.
Population differences between counties will explain the wide disparity in raw numbers of persons in treatment as indicated in the data from DHS.
Although Cape May County seems to have a higher rate of treatment than Ocean County, this can be a good thing if treatment rates are viewed as an indication of availability of services, or the same can be used to interpret this data as an indirect indication of a larger opiate problem in Cape May County than Ocean. Atlantic County’s data seems to be relatively similar to Cape May County.
Mental Health Prohlems
Finally, and maybe most importantly, DHS reported that nearly 60 percent of all those in treatment were considered to have mental health problems.
The problem of a lack of comprehensive and effective inpatient and outpatient mental health services in this country has been part of the national public policy debate for decades.
The U.S. Department of Health & Human Services has reported that a third of all those with health insurance have no mental health coverage at all.
The department also reports coverage for mental health treatment when it is available is not comparable to coverage amounts for traditional medical ailments.
It could be fairly argued that the lack of insurance coverage, and therefore availability of mental health treatment to all citizens, including abusers, in this country has contributed significantly to the addictive behaviors that substance abusers engage in.
As a society, we may want to debate whether a significant investment in psychiatric and other mental health services for all citizens, as well as those at risk for substance abuse would result in fewer addicts self-medicating with illegal drugs and alcohol because they do not have access to quality and affordable mental health treatment.
Prevention vs. Mitigation
Counseling after addiction is important, but does nothing to prevent the onset of addiction, and as old Ben Franklin once said, “A stitch in time saves nine.”
The debate over this and other prevention/mitigation strategies will continue, but as billions of dollars continue to be spent on our war against drugs, the lack of a silver bullet to solve the problem has been proven over the years.
It might also be considered that an integrated strategy that includes significantly improving the mental health system as a preventative tool, along with other strategies including strengthening and supporting families, youth programs, community and faith-based programs, law enforcement, specific drug/alcohol counseling and chemical maintenance programs must all have a place in this war.
To contact Jim McCarty, email jmccarty@cmcherald.com.
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