RWJF - President's Message 2000

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    It is a real paradox that as a nation we are willing to spend lots of money to try to cure patients with diseases that have dismal prognoses, such as pancreatic cancer and amyotrophic lateral sclerosis (ALS), yet we dismiss substance abuse treatment programs with higher success rates—15 to 20 percent cured, or as high as 90 percent in the case of returning Vietnam veterans addicted to heroin. Somehow we have to overcome this double standard.
    Our concern for substance abuse by youths often clashes with ideas of how young people become adults. Lifetime addictions often begin with youthful experimentation—that’s why so much effort is going into preventing substance abuse by young people. But such experimentation is also seen as a rite of passage. We often have trouble distinguishing when that early smoke or drink is just “kids being kids,” from when it is a warning sign of serious trouble. We are dealing with substances that require us to try to draw a line between the natural adolescent tendency to experiment, the natural human tendency to seek pleasure, and the need to prevent harm. It is difficult to imagine a social consensus anytime soon on where to draw that line.
     A sense of futility also plagues the issue. I have been struck by the pervasive sense of hopelessness that I have encountered when talking to editorial boards and others. “Why bother?” they say. “It is hopeless.” Substance abuse has not been a field with easy or obvious fixes. And substance abuse is often so entwined with other life problems that it is easy to get overwhelmed and to despair that the task is beyond us.
    The field also has a leadership problem. At the grassroots level, there is a striking lack of leaders—particularly in tobacco and illegal drug use. We don’t have parents’ groups up in arms over youth smoking or families that have been devastated by drug abuse mobilizing for more treatment or prevention programs.
    Recently, many families which have members with mental health problems have overcome their sense of embarrassment and stigma and formed powerful advocacy groups. Perhaps new knowledge about genetic contributions to mental illness made it easier for parents to overcome their previous reticence, knowing that poor parenting did not “cause” their children’s illness. My hope is that similar advocacy groups will soon appear on behalf of those afflicted with substance abuse.

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