Costs of crime attributed to illicit drug abuse were estimated at $59.1 billion and $19.7 billion for alcohol abuse. These figures include reduced earnings due to incarceration, crime careers, criminal victimization and the costs of criminal justice and drug interdiction.

Addiction-related issues are costly in other ways than just dollars and cents. Many alcoholics and addicts have limited to no access to treatment, suffer ruined lives and the loss of support from loved ones, engage in criminal behavior, develop addiction-related mental illnesses or suffer premature death from overdoses or health conditions associated with the progression of their disease.

Alcohol- and drug-related deaths, according to the same study, totaled more than 132,000. Suicide claims an estimated 9,000 lives and is the second leading cause of death for persons between the ages of 15-24. Although many suicides are not reported the National Center for Health Statistics records between 25,000 and 30,000 suicides annually. Of that figure, 20-35 percent had a history of alcohol abuse or were drinking before their suicides. A U.S. Department of Education, 'Youth & Alcohol: Selected Reports to the Surgeon General' (1993), cites a study of youth suicide, which reports that drug and alcohol abuse was the most common characteristic of those who attempted suicide (70 percent).

Alcoholism and drug addiction are important issues in Congress because of statistics like those above. As Congress searches for answers, it must debate levels of funding for drug-abuse treatment and prevention programs, incarceration versus treatment for drug-related crimes and substance-abuse parity. In the face of these issues, new coalitions of alcohol and drug counselors, researchers and now consumers and their families, are banding together to create policies based on knowledge. This is akin to the process undertaken by people in the mental-health field in the last 10 to 15 years, by which they've managed to shed misconceptions and stereotypes. Alcoholism and drug-addiction treatment and prevention advocates hope to do the same.

There are three major issues currently facing substance-abuse treatment advocates in Washington. They are 1) being heard, 2) increasing access to treatment and other services and 3) fighting stigma.

Being heard, is critical. A message favoring treatment cannot simply be carried by people in the treatment and/or recovery community alone. We need more voices. Therefore, NAADAC tends to work in coalitions, not only with other treatment organizations, but also with sympathetic prevention and mental-health organizations and newly emerging consumer groups.

Advocacy lends power to influencing laws made by Congress. Here are issues affecting the addiction field and how constituents can learn to speak out at the right time to show their support.

Many, if not all, of the issues facing advocates revolve around increasing access to treatment and other services. Parity is one of these issues. Sufficient numbers of people must register their views with all of their members of Congress (two Senators, one Representative) at the right time. For example, Congress passed a parity bill in 1996 to require insurance companies to pay the same benefits for mental-health treatment that they paid for other diseases. Alcoholism and drug-addiction treatment were specifically excluded from coverage. Senator Paul Wellstone (D-MN), a co-sponsor of that bill had wanted AOD treatment included. However, Senator Pete Domenici (R-NM) the other co-sponsor, said he would lose seven Republican votes needed to pass the bill if alcoholism and drug treatment were included. According to staffers, Senator Wellstone, received only three letters regarding substance abuse from constituents in the preceding month and decided that he could not risk consensus on Mental Health parity for such little constituent interest. Senator Wellstone later became the champion of alcoholism and drug-addiction parity but it is important to know that even a legislator who takes the issue seriously must hear from his/her constituents. Since the 1996 law passed without including substance abuse, alcohol-and-drug treatment advocates have increasingly recognized that we need to seek ways to avoid being left behind. Since insurance is the major way that Americans provide for healthcare, it is an obvious place to begin focusing on alcohol and drug treatment as well.

Currently, more than 70 percent of people who use illicit drugs and 75 percent of individuals who are alcoholics, are employed. Unfortunately, most employer-provided insurance policies today, if they cover alcoholism or addiction at all, require patients to pay large cost-sharing fees, co-payments and deductibles. Additionally, they offer less overall coverage for number of visits or days of coverage and annual/lifetime dollar expenditure limits for treatment than for other chronic recurring diseases. For example, a typical insurance plan might cap lifetime medical benefits at $1,000,000, but the same plan might cap substance-abuse treatment lifetime benefits at only $25,000 or $50,000.

Treatment advocates have asked Congress to write a law to ensure that insurance policies which cover alcoholism and drug addiction will do so to the same extent as other similar chronic, relapsing diseases such as diabetes and hypertension. This concept has had some success at the Federal level. In 1998, the House measure attracted nearly 100 co-sponsors in less than a year. The Senate created a bipartisan bill attracting sponsorship over a broad range of ideology, and both the House and Senate held hearings in which parity was discussed.

In addition, when the Clinton Administration expanded the Federal Employee Health Benefits Plan to include parity for Mental Health, advocates convinced them to keep substance abuse as part of the package. General Barry McCaffrey, director of the Office of National Drug Control Policy has repeatedly called for increasing parity to ensure that treatment becomes more available to people who need it. Parity has also been discussed within the Department of Health and Human Services.

Tipper Gore, Vice President Al Gore's wife,  made mental health a cornerstone of her activities and mental-health parity was clearly on her agenda. Alcohol- and drug-treatment advocates need to work with mental-health advocates to ensure that substance abuse needs to be a part of that package.

Progress on the parity bill currently before Congress has slowed considerably this year for many reasons. Mainly, Congress seems to be waiting for the election to clarify the general direction of the electorate on issues like healthcare, and consequently they do not seem likely to pass major healthcare legislation this year to which parity could be attached. Advocates are looking for ways to energize the issue and may turn to parity laws at the state level to create momentum. Kentucky passed a parity bill just this year, which includes substance-abuse coverage. One key at the state level is to work with the often well-organized mental-health advocates. Cooperation in this area may help to make them allies in other areas as well.

Parity is not the only issue, of course. Rather, it is only the beginning of a longer quest for inclusion, both in the public and private systems. Parity will not help those who do not have insurance and it won't solve problems of access for those who have insurance, but who have been prevented from getting benefits. Still, parity has a symbolism beyond bringing more coverage to people affected by alcoholism and drug addiction. Passage of a parity bill would begin to signal that policymakers understand that alcoholism and drug addiction are diseases deserving equal coverage under insurance.

Can there be a more American 'crime' than to lose oneself in alcohol and drugs? Even as we, as a nation, consume gallons of alcohol, abuse prescription drugs and flirt with illegal drugs, we are repulsed by the consequences of our behavior — the obliteration of our identity and self. Addiction directly conflicts with American ideals of work, individualism, responsibility to community and families and our closely held religious ideals. It is no wonder that alcoholism and drug addiction are stigmatized and that our response has typically been to deal with addiction almost solely in terms of crime.

An emerging issue that is a direct consequence of stigma is that of new laws and rules preventing people convicted of a felony from serving as alcohol and drug counselors or accessing payment from insurers, even when they are shown to be in recovery. Often the felony committed was a direct result of their addiction, as is the case of many incarcerated individuals who have committed crimes directly or indirectly drug-related.

The annual costs of incarceration without treatment compared to treatment for addicts, according to figures derived from the Department of Justice and the Center for Substance Abuse by the Physicians Leadership on National Drug Policy follows:

Funding for alcoholism-and substance-abuse treatment

Congress does three things to decide who will receive funds. First it creates the agencies that will be allowed to receive money and then tells these agencies how they want the money to be used. This is called 'authorization.' After an agency is authorized (to exist), Congress usually sets a deadline of between three and five years for the agency to operate. At the end of that period, Congress evaluates the agency to see if it is accomplishing its goals. If it is, Congress may then 'reauthorize' the agency.

Finally, when the agencies to be funded are authorized and spending limits are set by the budget, Congress will actually disburse the money. This is called 'appropriations.' Unlike reauthorizations and the budget, appropriation is something that Congress does every year.

Members of both the House and Senate Appropriations Committees on Labor, Health and Human Services and Education are given an overall amount of money to spend for alcoholism- and drug-dependence issues each year. The level of funds for the committees is decided by the Senate and House leadership based on the budget. The committee then further divides into subcommittees which will hold hearings on the various programs they plan to fund. These hearings will combine topics in the same general area.

This process can be difficult for stigmatized groups. For example, legislators may hear about alcoholism and drug addiction sandwiched between people who are there to discuss more popular causes such as cancer and children's diseases. For this reason, advocates need to speak out. Members of the committees need to receive letters that let them know that there is a constituency for funding treatment for these diseases.

SAMHSA, NIAAA and NIDA, the Office of National Drug Control Policy and as much as possible, the Justice Department.

Currently a reauthorization bill has passed in the Senate, but is being held up in the House over disagreements about exactly what programs SAMHSA should fund. Initially SAMHSA was not reauthorized because the formula by which it sent money to the states had become obsolete. The formula problem was solved independently during last year's appropriations process. However new issues have come up which are delaying the bill. For example, the faith-based treatment initiatives (often called 'charitable choice') and co-occurring disorders were controversial during the Senate reauthorization process.

NAADAC is working to pass a bill that allows funding to be granted to religious institutions as charitable choice calls for, but ensures that they must meet the certification and licensure processes in the state.

Parity and reauthorization are the most important issues regarding access. Advocates are also beginning to focus on under utilized sources of addiction treatment funding such as Medicaid, the federal insurance program for people in poverty. In Medicaid and in all questions of access, stigma and misunderstanding are part of the general terrain.

Advocates in Washington can help by alerting fellow advocates to the issues and advising them on how to effectively communicate their concerns. Newsletters and e-mail lists exist that constituents can use to find out when to send a letter, make a phone call or visit members of Congress. The most effective means of reaching Congress is by a telephone call to staff members.

In politics, persistence pays off. Advocates for alcoholism and drug-addiction treatment are learning that lesson. The main thing is to get out there and tell anyone who will listen what you want. Then, you'll have the satisfaction of knowing that Washington is working for you. G

William McColl, Esq. is executive director of NAADAC, The Association for Addiction Professionals. He holds his J.D. from the University of Maryland and has worked in the alcohol and drug treatment field since 1983.