Drug treatment is big business, and the drug treatment industry is turning to Madison Avenue techniques and grand coalitions to ensure that it gets even bigger. Organized into the Demand Treatment! coalition, a bevy of strange bedfellows is mobilized to increase the number of people receiving drug treatment services. The question for drug reformers is to what degree Demand Treatment! advocates for treatment on demand and to what degree it advocates for treatment rooted in the coercive apparatus of the criminal justice system, or whether it makes any distinction between the two.
The list of sponsoring organizations (http://www.jointogether.org/sa/action/dt/involved/cosponsors/) is not reassuring. While it includes organizations such as the American Bar Association, the Legal Action Center, the Hepatitis Foundation and Physician Leadership on National Drug Policy, it also includes such drug war stalwarts as the Community Anti-Drug Coalitions of America and criminal justice professional organizations such as the National Association of Drug Court Professionals. In addition, the entire federal addiction bureaucracy is on board: the Center for Substance Abuse Prevention, the Center for Substance Abuse Treatment, the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.
The initiative's "partners," however, do not, for the most part appear to be involved in coerced treatment programs. In Pittsburgh, the Coalition for Leadership, Education and Advocacy for Recovery is educating consumers about quality treatment through medical, religious and criminal justice communities within the city and county and is developing new screening and referral programs in hospital emergency rooms and the corrections system. In Nashville, initiative partners will produce a country music CD, "Songs of Hope, Awareness and Recovery for Everyone," to raise funds and awareness of treatment issues.
In Indianapolis, however, Drug Free Marion County, the recipient of a $120,000 Demand Treatment! grant from the Robert Johnson Wood Foundation, will be involved in increasing treatment demand by, among other things, working with the euphemistically-named Employee Assistance programs, which drug test workers and assist them out the door if they refuse treatment upon testing positive.
At a Demand Treatment Leadership Institute meeting in Denver in September, the organization turned to marketing specialists to "sell" the need for addiction treatment to policymakers and the public. Peter Mitchell, a senior marketing specialist for the Academy for Educational Development told attendees lessons from commercial marketing could be applied to what he called social marketing.
While commercial marketing is intended to persuade people to buy certain items, social marketing is aimed at behavioral change, said Mitchell, according to Boston University School of Public Health's Join Together Online treatment news service. "We're trying to get people to reject tobacco or drugs, use seat belts, use condoms, talk about sex, etc.," he explained.
Mitchell advocated a hard-headed marketing approach to increasing the perceived need for drug treatment. Treatment providers need to define the size of the current market share, who the target audience is, and what the goals of the marketing campaign are, he said. Mitchell, who gained fame as the creator of the "Truth" anti-smoking campaign, also called for campaigns with a gritty, urban edge. Earlier campaigns had attracted mainly "nerds," he said, but the Truth campaign made being against big tobacco seem hip and rebellious. "We gave the kids a way to make fun of adults," he explained.
Dr. David Lewis, head of Physician Leadership for National Drug Policy (http://center.butler.brown.edu/plndp/) endorses Demand Treatment! despite concerns raised about coerced treatment. "PLNDP is not endorsing specific policy prescriptions here, we don't take any position on specific approaches," he told DRCNet, "but we do work with Demand Treatment."
Lewis acknowledged that PLNDP's 1997 position paper on drug policy advocated using the interface between the criminal justice and the health systems to reduce supply and demand and specifically mentioned drug courts, but said, "In 1997, people were optimistic about treatment," Lewis said. "Drug courts are at the interface, but the major emphasis of our group is what happens with voluntary treatment, excessive regulations around methadone maintenance, things like that."
For Lewis, the need to redress the existing disparity between resources for criminal justice and resources for prevention and treatment in current state and federal drug budgets is central in the group's alliance with Demand Treatment. "There was a sense that the policy is unbalanced, and we work with these groups to address that disparity," he said.
The question of coerced versus voluntary treatment is unresolved within PLNDP, said Lewis. "Some members say all coerced treatment is bad, while others argue that rehab beats jail. I think California's experience under Proposition 36 is showing that something like drug courts can exist in a way that is not so negative. We try to look at what the data shows, to temper the discussion. Everything is not black and white."