Sen. Angus King and Gov. Paul LePage recently convened separate forums to discuss Maine’s widespread and unconstrained drug abuse epidemic, and to begin to formulate effective, comprehensive plans to reverse this situation. As a result, three working groups have formed to focus on law enforcement, education and prevention, and treatment and rehabilitation.
U.S. Attorney Thomas Delahanty attended both forums and afterward told the Bangor Daily News, “It’s a three-legged stool,” implying that attendees at both forums concluded that each of the above areas must receive major attention. But an accounting of how Maine has dealt with the cost of drug abuse shows how imbalanced the state’s three-legged stool is. The state has long neglected to invest as much as it should in treatment for those with addictions.
But there’s widespread agreement that treatment needs more emphasis, said Delahanty.
“Even law enforcement is on board with treatment,” he said.
And Sagadahoc County Sheriff Joel Merry pointed out that effective treatment is all-encompassing. Inmates with addictions who are leaving jail “need support,” Merry said.
“They might need counseling, addiction services. If they don’t have a job, they don’t have means to pay for it — and in most cases they don’t — they fall into a crack … I’m not talking about giving them cash to buy drugs. I’m talking about giving them the ability to access services that will keep them sober,” he said.
In the past, the governor’s approach to Maine’s drug epidemic has focused on stronger anti-drug law enforcement and incarceration, while New England’s other governors focus on substantial increases in funding for treatment. But even those with law enforcement backgrounds point out that such efforts are fruitless.
“Overemphasis on enforcement without an equal commitment to treatment is just spinning the merry-go-round faster and faster,” former Cumberland County Sheriff and state Rep. Mark Dion of Portland told The Boston Globe in July 2014. “Jail doesn’t work, I can tell you that.”
Before beginning to formulate comprehensive plans to reverse this epidemic, it might be worthwhile to review three relatively recent studies of the cost of alcohol and drug abuse in Maine conducted by the state’s Office of Substance Abuse and Mental Health Services. The studies determined the total cost to the state of drug and alcohol abuse for 2000, 2005 and 2010. Each analyzed cost estimates for alcohol and drug abuse treatment, morbidity, mortality/premature death, crime, medical care and other related costs. The costs of criminal activity included those related to law enforcement, the judicial system, corrections and other costs to society.
From 2000 to 2010, total expenditures because of substance abuse increased to $1.403 billion from $618 million — a 127 percent increase over that 10-year period. Lost earnings because of mortality increased from $140 million to $409.6 million in that time, accounting ultimately for 29.2 percent of the total cost — the largest cost category in 2010.
Criminal activity expenditures also increased in that period — to $343.4 million in 2010 from $128.4 million in 2000, ultimately accounting for 24 percent of the cost. Substance abuse treatment costs grew as well, but the numbers pale in comparison — they increased to $47 million in 2010 from $19 million a decade earlier. By 2010, treatment accounted for only 3.3 percent of the total cost.
In all three studies, criminal activity accounted for the largest or second largest cost category. Meanwhile, across all three studies, substance abuse treatment was the smallest cost category, ranging from 2.8-3.3 percent of the total. In fact, the growth in criminal activity costs in this period was eight-to-ninefold greater than the growth in treatment costs.
As Merry noted, in order to be effective, treatment must not be restricted to group counseling for substance abuse. Many individuals suffering from addiction to alcohol and/or other drugs have co-occurring mental health disorders that require additional, specific, individual counseling. Furthermore, various case management services must be an integral part of the treatment program.
Housing, for example, is a major area of concern. Individuals suffering from addiction need to live in a safe, drug-free environment in which they adhere to abstinence. Such resources are severely limited in rural parts of the state and will need to be established. Obviously, these individuals must be employed in order to pay for such housing. Similarly, assuming they don’t have appropriate health insurance — and most do not because they can’t afford it — they must be employed in order to pay for individual and group counseling. Therefore, access to job training and/or re-training is another important and integral support service.
Lastly, before someone suffering from addiction leaves prison, he or she needs a comprehensive, individualized, pre-release plan that includes the full range of required support services.
What, then, of the “three-legged stool?”
The three studies cited above clearly document that, given the magnitude of the problem confronting our state, Maine’s expenditure for substance abuse treatment has been a very short “leg,” which explains in part why the stool has been unable to stand as an effective approach to dealing with addiction.
Moving forward, we need to ensure that the governor and Legislature are committed to reversing this situation. Stated simply, Maine cannot afford to turn down millions of dollars of federal funding for expansion of its Medicaid program, which would help defray the costs of effective substance abuse treatment. Similarly, the state must increase its efforts to secure federal grants supporting substance abuse treatment and case management services.
At the end of the day, the state must commit itself to a substantial increase in state dollars spent on substance abuse treatment and case management.
Dick Dimond is a retired physician from Southwest Harbor and the steering committee chair of the Hancock County Adult Drug Treatment Court. He also is a board member of the Acadia Family Center, a drug and alcohol treatment center in Southwest Harbor.