Wednesday, April 18, 2007

Statement to County Council
Steve Coulter, MD
Chair, Treatment Committee, AODAAC
April 16, 2007

Hi, I'm Doctor Steve Coulter. I serve on AODAAC, "ay-DAK," the Alcohol and Other Drug Abuse Advisory Council. Our chair, Dawn Levinson, couldn't be with us; she's recently delivered a healthy baby boy, and I'm happy to attempt to fill her shoes here. I chair the body's Treatment Committee. I am a family physician by training. I've probably provided medical care to some of your friends or family.

Let me first thank this County Council for saving my life. Literally. I am in recovery from alcoholism myself. In my darkest hour, this county provided treatment that saved my life. Some of you personally voted to authorize funding for these programs. Some of you have been supportive of such funding. I thank you all.

But I've been saddened to witness some poor outcomes. At least three people I befriended while in our "continuum of care" are dead today, because they couldn't get into the kinds of programs that saved me. This is a problem that serves nobody's interests. It especially doesn't serve the interests of the taxpayers.

Nobody costs our society more than addicts and alcoholics in active addiction. They suffer, their friends and families suffer, the whole community suffers. And the taxpayer ends up funding their prosecution and imprisonment when they inevitably commit crimes. This happens when treatment isn't available. Treatment works to change the lives of these people and the paths of destruction that surround them.

There are many ill-informed cynics who don't think addiction is a treatable disease. I and dozens of my friends are living proof that it is, and that treatment works. For those who aren't persuaded by mass anecdotes (and I respect them) there is also a mountain of solid research evidence to support my assertion. I'll be happy to discuss that mountain of research, but not with the current time limitations. Suffice it to say, for one point, that the taxpayers of California have recently managed to save about two billion dollars so far by an initiative to shift sufferers of this disease from the criminal justice system into clinical treatment.

Of course, that can't succeed if treatment slots aren't made available. In this county, we currently have a crisis of lack of access to treatment for the most severe cases. Acute detox, rehab and residential care are impossibly difficult to access. We've had this crisis for years. But those mired in active addiction don't make good political advocates for themselves, and other segments of our county have been shy about speaking up for them. Those in active addiction or early recovery often don't get treated very well, ethically, or even in respect to their civil rights in our society. If nobody else speaks up to fix this problem, the taxpayers would be wise to do so. I'm also a taxpayer; I'm here, in part, to make the taxpayer's argument for more treatment over the status quo.

I'm thrilled to see that initiatives have just been passed by the State legislature to advance the approach of treatment over imprisonment, and that bills are expected to be signed by our new Governor. Progress is being made.

Among your challenges as a legislative body is the task of choosing cost-effective programs that address this continuously-unfolding tragedy. It wouldn't be hard to waste huge amounts of dollars in programs that aren't very effective. My advisory body has some cost-conscious suggestions to make.

In terms of prevention, after-school programs have the potential to steer out adolescents clear of drugs, alcohol, delinquency, crime and gang activity, in part by providing structured supervision while parents are at work. These need support.

In terms of treatment, expansion of existing treatment programs is essential, but creation of cost-effective approaches can leverage this investment. In particular, efforts to support sober housing options have the potential to bring proven, highly cost-effective approaches to clients in treatment. Too often, we send clients back into the same neighborhoods and dysfunctional homes where they couldn't stay sober in the first place. Providing low-cost housing in sober group homes permits those in recovery to supervise each other's recovery, when they haven't been able to supervise themselves. Solid research supports such an approach, and I've provided you with a report and supporting study for this initiative.

Montgomery County controls all alcohol sales locally. It would make sense to modify business practices to reduce the availability of the cheapest forms of alcohol, and to use any resulting increased revenue to support treament efforts. The resulting changes should prove appealing to the entire county community, especially including the taxpayers.

Thank you.

This document on the Web:

Reference: Sober Housing initiative:

Supporting research study:

AODAAC Official Home Page:

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