TIP/TAP Series: The NIMBY Syndrome

As the TIP/TAP columns of the past several issues have explained, these manuals are put together and distributed by the Department of Health & Human Services, Center for Substance Abuse Treatment (CSAT) as recommended guidelines and protocols for all U.S. substance abuse treatment programs.

"All neighborhoods in the United States today have witnessed or suffered the tragic effects of alcohol and other drug abuse" begins page 1 of TAP 14, Siting Drug and Alcohol Treatment Programs--Legal Challenges to the NIMBY Syndrome. While many Americans understand and worry about the extent of the growing drug problem, there is still plenty of "community opposition--commonly known as the NIMBY (not in my backyard) syndrome--" when it comes to opening a treatment center in their own neighborhood.

"The NIMBY syndrome is not new...," and along with substance abuse treatment centers, NIMBY has delayed or stopped the openings of many "health and social service facilities, including homeless shelters, group homes for the mentally ill, halfway houses for ex-offenders..." and health facilities for patients with AIDS.

TAP 14 explains that while some localities try to use zoning ordinances to stop a clinic from opening, this is discriminatory and may be unlawful. "Federal disability-based antidiscrimination laws (including the Fair Housing Act, the Rehabilitation Act and the Americans With Disabilities Act), the equal protection clause of the fourteenth amendment..., and many individual State laws have been used successfully to overturn the actions of local governments" that attempt to stop the opening of drug abuse programs. The entire TAP 14 manual concerns zoning requirements, legal challenges, review of case laws, and gives suggestions, examples, and case studies.

Community opposition to methadone treatment clinics seems to be based on the fear that clinics will draw drug pushers, thieves, and other criminals, and property values will decline. "In reality, treatment programs pose no legitimate danger to the health or welfare of residents. . .nor do they draw pushers to the area. In fact, (clinics) improve neighborhoods by helping people get well" (TAP 14, p. 1). TIP 1, State Methadone Treatment Guidelines, says "Despite more than 25 years of research and practical experience in methadone maintenance treatment of opiate addicts, the public lacks knowledge of the scientific efficacy of methadone maintenance treatment" (p. 125).

This is where community education comes in. It is important that "local decision makers and residents understand that treatment programs help communities by reducing many of the costly problems associated with active alcohol and other drug abuse and that treatment enables former users to return to productive lives" (TAP 14, p. 45). People need to learn about and understand methadone maintenance treatment (MMT): that MMT "encourages abstinence and prevents (patients) from relapsing"; that patients on MMT do not get high from their daily dose of medication, but rather are able to function normally and return to jobs; that clinics monitor "(patient) drug use through urinalysis..."; and discourage any loitering outside of the clinic by patients (TAP 14, p. 45). Additionally, MMT is "associated with substantial improvements in public health and employment and a reduction in HIV risk and criminal behavior" (TIP 1, pg. 125).

In TIP 20, Matching Treatment to Patient Needs in Opioid Substitution Therapy, there is an entire chapter on cost effectiveness of methadone treatment. It lists numerous studies that show the benefit and savings to communities of methadone maintenance treatment when compared to costs such as imprisoning drug users, hospitalizing addicts for health problems resulting from illicit drug use (like HIV/AIDS, HCV, TB, etc.), and costs due to lost productivity and illness, including paying for illicit-drug-using addicts on welfare, Medicaid, Aid to Families with Dependent Children, and for foster care of children of mothers/fathers in prison. When you add in the costs of crime resulting from illicit drug use, the cost of treatment sounds better and smarter all the time!

"Substance abuse treatment can greatly reduce health care costs. . . . For every dollar spent on treatment, more than $7 in future costs were saved." With treatment, ". . .criminal activity declined by two-thirds and hospitalizations by one-third," and use of alcohol and other drugs declined "two-fifths." Also, after treatment began, "States averaged an increase of more than 70% in the number of (patients) employed." Arrests of patients dropped dramatically, decreases ranging from "50% to 90%" in various states (pp. 97-98). Again, the TIP/TAP books cite numerous studies to back up these amazing figures. The public just needs to hear about them.

Costs of different kinds of treatment are compared too, showing that methadone maintenance treatment is the most cost effective of all of them. For example, "the treatment costs per day were residential $61.47; social model $34.41; outpatient drug free $7.87; methadone (maintenance) $6.37; and methadone (detox) $6.79." It also points out that because of the "high recidivism or relapse rates" with the chronic disease of addiction, the best cost benefits come with long-term treatment. "When patients dropped out of treatment, most relapsed to drug abuse within one year, often returning to previous criminal patterns to support the addiction. Therefore, patients should be encouraged to remain in treatment" (p. 99).