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Notes -
I think a difficulty is that providing treatment at the scale required is expensive and the people using the services that do exist are generally indigent and therefore cannot contribute to those programs. The ROÍ for treatment is also mostly to the individual getting treatment, not the public as the new rehabbed patient is likely to be replaced with someone else. So from the public tax point of view, rehabbing druggies is a cost sunk, and a relatively expensive one. Getting the public to approve of enough taxes to fully fund rehabs is running against the problem that there’s no large scale benefit to paying that tax. So there won’t really be enough money for enough treatment centers to make rehab a viable part of the program. What it leaves is “decriminalize drugs.” Which brings with it homelessness and street crime.
This, plus the fact that we have no idea how to do "treatment" that actually works. Scott posted loooooong ago that honest studies on rehab for alcoholism fail to beat a placebo. The end goal of most rehab studies for harder drugs like potent opioids isn't even "stops using potent opioids"; it's "maybe uses potent opioids slightly less and gets up to criminal mischief slightly less often". The true believers in the idea that we're just going to "apply 'treatment' directly to the forehead", if we just try hard enough politically and decide to spend enough money, and that it will magically convert addicts into non-addicts/non-users, are just banging their heads against reality.
Scott's post is worth re-reading.
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