The argue that the $3 million annual investment in Insite saves nearly $18 million due to and estimated 84 avoided HIV infections.
This begs the question, what else could be done with $3 million that would also prevent 84 HIV infections?
Dawn Farm's annual budget is just over $3 million. We'll serve more than 2000 people this year in 140 transitional housing beds, 49 long term residential treatment beds, 18 detox beds, outpatient services and corrections outreaches. This is pure speculation, but I suspect that in a high-HIV environment like Vancouver, I suspect we'd prevent at least as many infections and save much more by moving people into recovery.
Which is a better investment of scarce resources?
If low-threshold drug-free treatment and recovery support services were proven to provide a similar or better return on investment (as measured by reductions in disease transmission), would Insite supporters resist shifting resources toward those programs? I suspect they would. If so, then it's not just about HIV, is it? What then? Values?
6 comments:
Does it have to be either /or? Insight serves people who may not be interested in or ready for recovery services. Why not fund both.
It should be both/and rather than either/or.
The one caveat for me is that question of values. Professional helpers who believe that addicts can't recover or view addictive drug use as a lifestyle choice not to be interfered with should not be working with addicts. A harm reduction program like Insite could adopt a recovery orientation. (http://addictionandrecoverynews.blogspot.com/2008/06/more-on-recovery-in-uk.html)
And, while you did catch me in a moment of zero-sum thinking, the reality is that services to addicts are woefully underfunded. Questions about the allocation of resources are important.
Thanks for the comment!
Actually before we decide whether is should be either/or or both, in a world of increasingly grave financial constraints, we need to be clear which represents best value for money and best overall outcome.
One issue is the lack of data so that we can make meaningful comparisons.
The longer I've worked in addictions (both harm reduction/maintenance and in abstinence services) the more I've come to realise the relative importance of supportive reoovery communities and the relative unimportance of treatment. (And I write as someone utterly committed to treatment).
I don't see enterprises like Insite or the ones we have here in Europe as ranking this on a priorities list, yet it is arguably the most important thing to help clients move on.
As we've agreed before, having a recovery orientation in any sort of treatment facility is achievable. It's just a matter of will.
And by the way, welcome back. It's been a relative famine in the blogosphere.
Thanks for the comment. I'm still working on getting the new site up. ARGGGHHH! Too many people were asking me to comment on the Washington Post commentary and I couldn't shut up once I started.
You need both types of help because the are aimed at to totally different things...surely the injecting rooms are there for people who are not at a stage that they can or want to stop: if they don't want to stop its still important to minimise HIV transmission etc...its a public health intervention not drug treatment intervention.
For many drug free treatment is simply not an immediate option..and if the only option leads to high levels of overdose death
I couldn't disagree more with this, "surely the injecting rooms are there for people who are not at a stage that they can or want to stop".
This might be a reasonable assumption if treatment of adequate quality, intensity and duration was available in a timely manner. This simply isn't the case. Addicts hate their lives. They don't like being addicts. They want a better life, even if they are unsure about recovery. They need hope and exposure to people who have overcome addiction. Public health measures focused on disease containment are hardly hopeful interventions.
Are you suggesting that drug-free treatment increases overdoses? If so, it's hard to take this as anything other than a specious argument.
Look at opiate addicted health professionals--a group that receives long term treatment followed by sustained recovery monitoring. (http://www.professionalshealthnetwork.com/files/36970200.pdf) Their outcomes are excellent.
Why do we have so little hope for other opiate addicts?
Again, I have no quarrel with harm reduction programs that seek to engage clients into recovery, develop outcome measures around this goal and advocate for treatment on demand followed by sustained recovery monitoring and support.
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