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hello. i'm ivette torres, and welcome to another edition of the road to recovery. today we'll be talking about addiction treatment and how policymakers can have a positive impact in their community. joining us in our panel today are: dr. terry l. cline, administrator, substance abuse and mental health services administration, u.s. department of health and human services; congressman danny k. davis, 7th district of illinois; paul samuels, president, legal action center; pat george, kansas state representative, district 119. dr. cline, we're spending an estimated $484 billion in health care costs due to addiction. how many people are affected by this problem in our nation? this is a huge issue that permeates every sector of society.

we know that there are approximately 22 million people across the united states who are struggling with substance abuse and dependence. that's about 9.1 percent of the population. it's huge. so the problem, one would say, is really widespread around the country, pat. well, as dr. cline pointed out, approximately 10 percent of the population has an abuse problem but it actually affects about 75 percent of our population. and so there is seldom a person that i meet that doesn't have some connection, whether with an immediate family person or somebody that they work with, some relationship of some type, that doesn't have a problem with addiction. congressman davis, in your district, how do these problems manifest themselves, specifically? well you know, i come from a small area and county that has about 5 million people. and one study suggested that there were about 800,000 people who use drugs and that there were about 300,000

who suggested that they use them regularly or whenever they can get them. seventy-five percent of all the people that the chicago police department arrests test positive for drug use. now that doesn't mean that they're all addicted, but it does mean that they're using drugs. it's an enormous problem. i have some statistics here that note that in the health care system alone, problem drinkers spend four times as many days in the hospital, paul, as those individuals that don't have an addiction problem. yes, alcohol and drug problems are probably the least noticed, but most important health care problem we have in this country. as you're saying, it has a huge impact on the health care system. it's also important to note that, when you put alcohol and drug problems together, it cuts across all-despite the stereotypes-it cuts across

all ethnic and racial lines, socioeconomic lines, urban and rural. this problem is everywhere. dr. cline, beyond the health care costs, i mean, are we talking about the criminal justice system, as congressman davis just mentioned? are we talking about traffic accidents? what other areas? it's hard to imagine an area in both the public and private sector that is not impacted by substance abuse. and when we look at untreated substance use in our country and we look at the impact, it's phenomenal. we have the $484 billion number that you were talking about as both the public and the private sector. then you have lost productivity for people and their jobs. if you're an employer and you have a small number of employees, and they're only there part of the time or they're only functioning at about 30 percent of their capacity, there is a cost to you as a business person. of course, there are costs to the family, automobile accidents, juvenile justice, foster care,

criminal justice system, private psychiatric hospitals, private general hospitals. the impact is huge; it is everywhere. complicating the scenario of addiction treatment, we have individuals that suffer both from a mental illness and also have an addiction treatment, which is called co-occurring conditions. how does that complicate the scenario, dr. cline? well, the good news is we know so much more about this today than we did even 5 years ago. there once was a time when these illnesses were treated separately. we now know that they frequently travel together and that really should be the expectation, not the exception, that someone has a co-occurring disorder and is struggling with that. a recent study found that about a quarter of all the hospital stays in general hospitals involved people with either a mental illness or a substance abuse disorder - a quarter of all general hospital stays. that's about 7.6 million hospital stays out of 32 million.

complicating again this whole issue, kaiser permanente out of california has done a study of almost 18,000 of their families. and as we talk about the affected entities- community, workplace, and everything-really, the bottom line is that families are the most adversely affected, and the children of those individuals that have an addiction problem. and they came up with an adverse childhood experience factor, and they noted that basically what we're creating in this society is an ongoing problem for ourselves because the children of individuals who have an addiction problem then become problematic themselves or become addicts. right, paul? addiction is a family illness. it has a huge impact not just on the individual but the family, as you're saying. that's the bad news. the good news is that studies also show that when the individual with the alcohol or drug problem gets treatment or gets care, that helps the family,

and the medical costs for the rest of the family members go down, not just for the individual who's getting their addiction treated. congressman, what types of services are available in your district for the individuals, the 800,000 individuals, that you spoke of? well, you know, i think when you think of the individual families, but it also goes beyond that. i'm saying almost anyone who comes into contact or have any ongoing relationship with an individual with an addiction problem are negatively affected. whether it's the number of phone calls that you get, or whether it's the "help me," or whether it's the coming by, or whatever it is, i mean it affects so many people. and so there are lots of different programs. there are programs that treat individuals with specific problems, there are things like alcoholics anonymous, there are mental health centers, there are individual not-for-profit organizations and groups who have programs,

there are faith-based programs- almost every kind, but not enough. dr. cline, what does the system look like in terms of what the federal sector offers communities? unfortunately, the system is very fragmented and, as the congressman reflected, there are a lot of outstanding programs that are doing incredible work across the country. what we lack in the united states is a very coordinated system of care for people who are struggling with substance abuse or addictions. it's not coordinated in any singular kind of way. there's not a comprehensive public health approach to substance abuse and addiction as we see for most other illness categories. that just has been absent here and we haven't seen that. so there is a patchwork. there are some areas, and it sounds like the congressman's area is very fortunate to have a wide range or continuum of services, which is important because there are different paths to recovery for different individuals.

but in many areas, there are no services at all and someone might actually need to travel hundreds of miles away from their family if they were able to access services at all. pat, let's go to the state level. how does the state contribute to ameliorating some of the problems with addiction? i want to touch on a couple things paul was talking about-family, and you brought up how it goes generation to generation. and i'm a living example of that. my father, i'm glad to say, is just celebrating 39 years of recovery, and myself also in recovery. and you bring that around to what helped us personally get into recovery, it's this continuum of care. and as dr. cline spoke of, it's so fragmented though. some people are lucky enough to be able to get in the system and to have a follow through on what they need.

and i know we'll talk little bit about the treatment process, but it's no different at the state level than it is at the federal level. we have different organizations, different agencies doing different things instead of bringing them under one umbrella. i was fortunate to serve on the blueprint panel that was headed up by former governor dukakis and coordinated with the join together group out of boston university. and that was one of our glaring findings was the fragmentation of care at the state level and also at the national level, there is very little coordination. and to get the most bang for the buck, as congressman davis will testify, you know, that's what we're looking for in the way of policy is: what can we do with the amount of money that we have available? talk to us a little bit about your own recovery. what was your experience like in a family that was living with a person who had an alcoholism problem?

well, it's interesting. plus, my mom, i think she has a direct ticket to heaven because about the time my father got into recovery is when i took my first drink at the age of 13. fortunately i had some structure. i think i would not have come out of my teenage years alive, but i was involved with sports so that gave me some structure. but as soon as i got out of college, the drinking and drugs increased to fill this hole that i had. and i was lucky enough, as i mentioned, my father who had gone to treatment in 1968, at a place called valley hope association, and from that time he has remained sober, as i mentioned. well, my drinking and drugging went on. i was in treatment three times, and as we all know here that the relapse is part of it, just like it's part of a lot of other medical conditions. but i was lucky enough, fortunate enough,

that i had some people-again, mainly my mom- who didn't give up on me. and shortly thereafter i went to treatment again and began a continuum of care: outpatient, alcoholics anonymous, attending counseling sessions after my 30 days of treatment. so i've been fortunate enough now to enjoy about 15 1/2 years of sobriety. very good, and we congratulate you on that. and when we come back we're going to talk a little bit more about what you just stated: how do we get all of the various sectors of society that have a responsibility to offer addiction treatment to coordinate all the services? we'll be right back. [music]

the ability to contribute to your own health and well-being, the health and well-being of your family, the health and well-being of larger society, is a very positive thing. and the treatment does work. it works both psychologically and it works physically. it works by returning investment for the larger community. for every dollar spent on treatment, $7 in terms of benefits occur. so that individual makes a community safer, healthier, not only for themselves but for everybody else. the benefits from society are that by providing treatment for a person that's addicted to drugs, you can integrate that person as a productive member of society. so rather than having to spend money in order to maintain that person under control because of the problem with drug addiction, you have a person that becomes productive and contributes to everyday society needs. what is the cost of drug and alcohol addiction?

i lost my job. i lost my home. i lost my health. i lost my self-respect. i lost my freedom. if you have a drug or alcohol problem, remember, treatment is effective and recovery is possible. for information on drug and alcohol treatment referral for you or someone you know, call 1-800-662-help and see what you can save. i got my life back. if someone you love has a problem with drugs and alcohol. [whispering] he's not expecting this. [whispering] yeah, but it's the right thing. there is something you can do. [whispering] do you think he'll be okay with this? [whispering] shh! here he comes. [shouting] congratulations! you can celebrate his recovery every chance you get. for drug and alcohol treatment and referral for you or someone you know, call 1-800-662-help. [music]

i heard a gentleman mention that he wanted to be alive when he died, and that truly reflects my life before recovery because i was walking dead. you know, it pretty much destroyed any family life, my business associations, my personal life. it was all gone. and through efforts of a few people that were still in my life, mainly my family, my mom, who helped me get into treatment and then to recovery work afterwards, become an active member of alcoholics anonymous, and did some post-counseling. through that i became alive again. [music]

the addiction treatment and recovery caucus is a group of members of the u.s. house of representatives who have come together because they want to educate themselves as well as other members of congress about how important it is to have policies that make it possible for even more americans to get into long-term recovery. through the members of congress, through their staffs, the caucus helps educate and serves as a promoter of legislation to give more people access to treatment and recovery. we've got to reach out to those people and make mental health treatment more accessible and make chemical dependency treatment more accessible. so if you'd like to find out more about the issues that congress is taking a look at as well as issues before

state legislatures and city councils, faces and voices of recovery has a regular e-newsletter where we send out updates about what's going on when it comes to recovery-friendly legislation and building opportunities for people to get into long-term recovery. feel free to go to our web site at www.facesandvoicesofrecovery.org and you can sign up for our e-newsletter and become part of the growing recovery advocacy movement around our country. congressman davis, we've talked about the level of effort that is necessary, that we've got a lot of people who need addiction treatment. we've talked about the need to coordinate services. how does that start to happen? well, you know, i come from an area that has a tremendous amount of need, as well as many health care institutions and facilities. i actually have more hospitals and hospital beds in my congressional district than any other district in america.

i also have 5 medical schools and more than 20 colleges and universities. and so obviously we spend a great deal of time looking at health issues and health needs. when it comes to addiction and mental health, and we've arrived at the point where we recognize that something is needed that we call "treatment on demand." that is to say that, when individuals who are addicted decide that now is the time that they're ready for treatment, services ought to be available for them, because if they have to wait 6 months, or if somebody says, "come back in 90 days," chances are they will have changed their mind. and while i'm not a professional in the business, i'm told that in order for treatment to be most effective, it ought to begin when people decide that they are ready for

it, as opposed to somebody else trying to steer them towards it. paul, does that happen in every sector of every state of every community? can i just walk up and say, "i need treatment. can i get it?" unfortunately, not at all. congressman davis is really one of our great champions in congress and he's absolutely right that we need to move to the point where in this country people can get treatment if they need it. samhsa does a great job of identifying what's going on out there and doing great surveys, and the numbers are really disturbing. as dr. cline mentioned, we've got about 23 million people with alcohol and drug dependence and abuse problems in this country, but barely 2 million of them get treatment. that's only about 10 percent, so the other 90 percent- we're talking about 21 million people- don't get care that they need. those numbers are unimaginable for any other illness. if there were 21 million people not receiving care for heart disease or cancer or something else,

there would be a human cry across the land. we need to get to the point where there's a human cry across the land about the fact there are 21 million people who need addiction treatment, and we need to get them that care. and to do that everybody needs to work together. congressman davis said this when he talked about, "we have arrived." i think that's part of that increasing awareness. there is this arrival, this increased awareness in our country, about the significant impact of substance abuse on families and all these other sectors. these are huge numbers, but it has been hidden away in some way. people have been fearful to talk about it. thank you for sharing your story, which i think is very, very powerful. people have been afraid to discuss their own concerns about that for themselves or family members, and i think we have arrived and we understand more about the brain and how it functions. we understand more about the chemistry involved. we understand more about treatment and recovery more than we've ever known before. so i agree. we have arrived and it's time for those numbers

to shift and change. to personalize that, because i'm in recovery, i work with a lot of families and people that need treatment. my background is in the car business, in sales. treatment on demand is just like when you're selling a car or selling something else, when someone's ready to buy the car, you'd better be there ready to sell because somebody else is going to be. i found that doing interventions it's well-known around the community that i am in recovery. also i serve on the valley hope board and so i'm able to kind of get through the maze, as paul was referring to a little bit. we make it too hard to get into treatment. but when i'm working with parents or spouses, i tell them when you get a bit of an opening, or if i'm out doing an intervention and i get just a crack that that person wants to go to treatment, we load up and we are off to treatment right then because

congressman davis said 6 months-i'm thinking sometimes 6 hours is too long because the alcoholic, the addict mind, works in a mysterious way. and they can, as i did many times, talk myself into or out of many things. and so that treatment on demand is a very real thing and we need to find ways to make that happen to a lot more people. if i'm out there and i'm of the opinion that the federal government should really be doing it all for me- it should be coordinating, it should be giving all the money- how accurate is that? well, i would say it's not very accurate. there is certainly a role for the federal government. one of the things we know is that states are very individualized. and that's one of the things that we value in our country is that individual differences in states, and states have different structures, different governments, different resources. we certainly see that even within states. some are county-based, some are more centralized. so there is definitely not a one-size-fits-all

solution to this. so what the federal government's role is, is to help facilitate dissemination of best practices, evidence-based practices. we want to make sure that the most effective treatments possible are getting into the hands of people who then can deliver those. we want to help states develop the infrastructure so they can begin to meet that need so one day hopefully people will be able to get treatment on demand when they're ready in the moment and not wait until that window of opportunity has closed. so there's a great role to coordinate and marshal, facilitate, disseminate information for the federal government. but the key is really partnership. its partnership with the federal government in one role, with the states in a different role, with those local communities in yet another role. when we come back, i want to get back to congressman davis. i know you wanted to comment on something that has already been said, and we will have an opportunity when we come back. [music]

drug and alcohol addiction-you lose your way. but there is a way out. you can find direction, find support, treatment, find yourself and your life-your direction home. for drug and alcohol treatment referral for you or someone you know, call 1-800-662-help. nice job. hey, man. how's it going? to a person recovering from substance use,

what you say comes through loud and clear. daddy, daddy, i'm so glad you're home! if you know someone in recovery, give them support. and if you know someone who needs help, give them this number: 1-800-662-help. [music] society clearly benefits in many, many ways when you consider the investment that needs to be made to treat addiction. substance abuse takes its toll on what little we have available in terms of health services but, more importantly,

addiction is really one of the main reasons that young people and even middle-aged people are not able to experience a fulfilling and enjoyable life. [music] faces and voices of recovery was very fortunate to be able to be in a partnership with join together and cadca when hbo released its series called addiction, bringing together legislators to watch the show and then having the legislators hear from people in long-term recovery, family members, judges, and other people in the community, about the issues that were part of the hbo documentary.

there are more treatments available, there is better understanding, there is more acceptance that this is a medical condition with real medical solutions than there ever has been. we ask for your support as well in the area of passing a strong parity bill through the united states congress that will end the discrimination in insurance coverage towards those with mental illness so that we no longer have insurance practices in this country charge higher deductibles, co-pays, and premiums for mental illnesses as opposed to other physical illnesses. i am living proof, grateful living proof, that treatment works and recovery is possible. but too many people don't have access to treatment. too many people don't have the access to treatment that patrick kennedy and i had. that's why congress must-must-break down the barriers to addiction treatment.

well, policymakers have a tremendous opportunity to talk about the fact that people can and do recover from addiction. they can be an important player in terms of building alliances with the business community, with the judicial branch, with people in communities around the country, to demonstrate that it makes sense to stop discriminating against people who are in recovery and to make it possible for even more americans to enjoy the reality of long-term recovery. congressman davis, i want to come back to you because you had something at the tip of your tongue that you wanted to say. well, when we were talking about the partnership effort that is required, i was thinking that the real responsibility of government and the responsibility of individuals in leadership positions, the responsibility of leadership is to lead. and it's difficult to lead where you don't go, or to teach what you don't know.

and leadership means that you bring together those resources that are required in order to impact positively on a problem. and so the partnerships, the coalitions, the group action, bringing public and private, state and local and federal resources all together, then putting those into a system becomes the most effective way of doing it. and of course we've got to convince people that it makes a difference. i mean, there are many people who still don't believe that you can really help individuals who have addiction problems, or individuals who have mental illness problems. and they just don't believe it. they think it's going to be re-occurring, that it's going to be coming back. that's why it's so good when you can see someone who will say,