FIGURE 2.1 Federal drug abuse treatment spending, 1981-1997 (millions of dollars). SOURCE: ONDCP (1996, 1997)

communities because of moral disapproval and fear that it will encourage those needing treatment to stay and may attract additional addicts to their community. Similarly, some clinicians still encourage patients to reject methadone maintenance in favor of the less-effective methadone detoxification treatments. Others provide methadone doses that are too low to be fully effective and encourage patients to end maintenance treatment prematurely. Some criminal-justice agencies referring probationers for treatment refuse permission for them to receive methadone maintenance.

The stereotype that drug abusers could change their behavior if they were sufficiently motivated is inconsistent with understanding the complex, multiple factors involved in addiction. When policymakers view drug abusers as untreatable or undeserving of public support, treatment programs, insurance coverage and training programs may be underfunded or abolished.

Dispelling the Myths About Addiction (IOM, 1997a), p. 140.

So, consider the director of the treatment program described at the beginning of this chapter who learns of new research showing that naltrexone improves outcome in alcoholic patients and in heroin addicts on probation. His program is funded for interpersonal treatments by relatively inexpensive counseling staff. He cannot buy the expensive new medication, nor hire a physician to prescribe it, nor a nurse (or pharmacist) to dispense it. The director of such a program may well view the research that determined the effectiveness of naltrexone as impractical.

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