A PRIVATE/GOVERNMENT, COLLABORATIVE RESPONSE TO ALCOHOL & DRUG ADDICTION

The New Zealand Retreat

An affordable, Not-for-Profit, 30-Day Recovery Retreat in Auckland, solidly grounded in 12-Step Programs, for those seeking a time-out to deal with their or a family member's Alcoholism and/or Other Drug Addiction.

February 2010

INTRODUCTION

New Zealand has a serious alcohol & drug addiction problem compared with the rest of the OECD world. About 15%-18% of our adults (14 years & up) have the disease of addiction. That compares with a figure of 13% in Australia and notional figures for most of other OECD countries –the US and Europe – of 10%-12%.

Early in 2009 Business and Economic Research Ltd (BERL) reported that drug and alcohol abuse is costing the country $7 billion dollars annually (2006 figs.). For those with the disease, stricter laws and prohibition don’t work. What does work is “recovery.” This involves complete abstinence and interaction/involvement with the “recovery community” - a group of people who have recovered from drugs and alcohol by remaining abstinent and involved with a 12 Step programme.

New Zealand’s current infrastructure for treatment for recovery from drugs and alcohol is based on the concept of a publicly funded “medical model”. It is outdated and inordinately expensive per recovery success. The high cost, though undocumented, is indicated by low recovery success rates (maybe 15%) and overly long rotations within DHB-financed treatment facilities. It also seems to be the case that Government recurrent funding comes with a host of expensive, time-consuming regulations/restrictions that, though normal practice, further reduce the efficiency of the recovery process. The high cost per success of the Kiwi approach to treatment limits recovery to too small a number of affected alcoholics and addicts.

Newer, “best practice” treatment approaches in the US and Canada suggest that combined public and private (including inpatient) financing of private, not-for-profit treatment facilities - with heavy involvement of the recovery community – are much more cost effective. In order to avoid the expensive “boiler-plate” regulations/requirements, the Government collaboration is best given through capital or start-up costs only. These collaborative approaches have higher recovery rates (about 50%) and much lower costs per recovery. Adopting newer treatment approaches would not decrease overall resources devoted to treatment, but would allow successful treatment of a significantly greater number of alcoholics and drug addicts for the same amount of resources.

Stepping Stones Recovery Trust is seeking start-up financing of $1.3 million, through a collaboration of private and public sources. We will establish a residential recovery centre, the New Zealand Retreat of Auckland. This will be a cost-effective, 30 patient; 30-days-per-stay, facility. One can use BERL data to calculate that each recovery can increase GDP by around $11,000 annually – meaning that it makes good sense to “invest” resources in more efficient treatment for greater numbers. This Retreat Approach to recovery assumes that half-way houses and a larger, more engaged recovery community must also develop if these investments in recovery are to bear fruit. 

Facts about Addiction

Susceptibility is inherited and/or activated by family/neighbourhood lifestyles. About 15%-18% of Kiwi adults have the disease – high by OECD standards. The prevalence and onset of addiction can not be altered significantly by preventative measures such as legislation or government, political, or religious decrees. Imagine the sterility of passing legislation to ban diabetes.

Primary Characteristics of the Disease The disease is characterized by the inability to stop drinking/using, coupled with denial of this fact. Those affected by the disease also have a false belief that self-treatment will allow coping with their addiction while living a “normal” life. Sooner in some and later in others, untreated disease manifests itself by continual drinking/using, anti-social/illegal behaviour, hopelessness, violence towards family, friends and self, suicidal thoughts and finally, insanity and death.

Emphasis on Prevention or Recovery? OECD countries with better records in dealing with addiction problems have maintained their addiction prevention apparatus, but have markedly increased resources and attention devoted to expanding more efficient treatment infrastructure so as to make it more accessible. What has emerged is a consensus regarding a Best Practices approach to recovery – one that takes a shorter time and has an about 50% recovery effectiveness rate. This is a much higher effectiveness percentage than is achieved in New Zealand.

Best Practices for Recovery

Addiction is easily diagnosed Diagnosis usually occurs following criticisms/confrontations by friends, families, the law, etc. Occasionally self-diagnosis occurs. More frequently diagnosis occurs as the result of observations by addiction experts, following interviews or observation. Diagnosticians are professionals. Most work for pay: Many come from within the Recovery Community.

Addiction is eminently treatable Although self-diagnosis is conceivable, but rare, self-treatment doesn’t work. Best Practices for dealing with the disease involve more widespread diagnosis and one-on-one and/or group “talking therapies” or counselling regarding how to willingly maintain complete abstinence from alcohol and drug use. Sustained abstinence is usually and most economically achieved by becoming an active member of the Recovery Community.

Who is Responsible for Treatment In OECD countries with better treatment success records than New Zealand, dealing with addiction problems is seen as much a private (individual/family/workplace), as a government responsibility. In addition, the Recovery Community must play a major roll in treatment if high recovery success rates and lower costs per success are to be achieved. Involving the Recovery Community has, in other OECD countries, caused the locus of treatment of the disease (the “treatment infrastructure”) to move away from medical facilities, in favour of not-for-profit enterprises (NGOs) narrowly focused on facilitating recovery.

Funding for Addiction Treatment These addiction NGOs are collaborative enterprises. They get some public and some private (benefactor) grants and subsidies to get started. Once started, they tend to be self-supporting through patient charges. The “capital” or infrastructure nature of government collaborative contributions allows relief from imposition of expensive, recurring, per-patient “red tape” regulations and requirements that are borne by the private NGOs. In their place would be more “market-like,” outcome assessments that would encourage increased efficiency. Patient fees may be subsidized – but not fully paid – by trust funds/contributors and/or private (corporate, family, etc.), per-person grants or soft loans. Greater effectiveness occurs when the addicts/alcoholics themselves pay at least a portion of the treatment cost, even if they have to borrow the money to do so. 

The Size & Cost of New Zealand’s Alcoholism and Drug Addiction Problem

New Zealand’s Addiction Problems, (mostly to alcohol) seem to be amongst the worst in OECD countries, relative to our population. So suggests a narrowly focused, carefully defined, March 2009 study commissioned by the Ministry of Health from BERL Economics (www.berl.co.nz - “Costs of Harmful Alcohol & Other Drug Use”). The Report suggests that something like 650,000 of Kiwis over 14-years old, nearly 18% of New Zealand’s adult population, is in the “high risk” alcohol and drug misuse category. This compares with a notional OECD addiction norm of 10%-12% and a figure of 13.6% for Australia (!).

Measuring the annual cost to the economy of this alcohol and drug abuse is contentious: Someone’s cost is always someone else’s income. Economists (the BERL people) therefore measure costs as consumable output (GDP) not produced because of alcohol and drug abuse. BERL calculated (2006) GDP foregone due to the disease to be about $7 billion or 4.5% of GDP annually – the same as our annual farming output. Were we suddenly, but impossibly, to attain universal recovery, each “average” Kiwi family would have almost $6000 more in income each year. Total recovery would mean the public sector would get about $3 billion more annually in tax collections (of all kinds) and the private sector $4 billion in extra income.

Is Investing in Recovery Sensible?

The magnitude of potential gains to GDP due to increased recoveries raises the question: Is recovery a good investment? In theory the answer is “yes”. An illustration, using averages and the BERL cost figures, would suggest that each recovery success adds roughly $11,000 annually to GDP. For investors seeking a 10% gross return, this GDP gain would warrant an investment of $110,000 per recovery.

In practice, rather than theory, this investment is problematic for private investors. The GDP gains resulting from recovery can’t be captured by the investor. Most of the increased income from recoveries accrues to individuals, their families/friends and society. This is the public good nature of recovery. It provides a reason why recovery is considered a government responsibility. It is used to argue for public funding, and for tax exemptions for altruistic private contributors and trusts.

Because the investment yields from recovery can’t be captured, this (approximate) investment figure of $110,000 becomes a measure of efficiency. If costs per recovery exceed by large amounts the $110,000 figure, each recovery will result in opportunity losses to GDP. And, recovery will be available only to a few – the rich, and those who benefit from lucky access. This is essentially the present situation in New Zealand: publicly-financed (and private “spa”) treatment approaches are simply too expensive per recovery.

Costs per recovery are too high because treatment periods are too long per person and recovery rates for those entering the treatment infrastructure are too low in New Zealand. Excessive annual expenditures per person treated significantly exceed the $11,000 per recovery annual GDP gain. This means, from an economic viewpoint, the cure is worse than the disease. And it appears, in line with other countries, that efficiency can not be improved by the public sector “doing better.” Publicly financed treatment success rates are low (a guess would be about 15% in New Zealand) partly because of (necessary) government “red tape,” but also because most Alcoholics/Addicts see public financing as always available, allowing them to play at or draw out recovery. They erroneously see publicly financed (and even grossly expensive private facilities) as “drying out” or regenerative tools that will enable them to control their drinking/doping, rather than remain abstinent: They don’t “own” their responsibility to remain abstinent.

Costs per recovery for publicly financed treatment in New Zealand appear to average about four-six times those of the most efficient, overseas, not-for-profit Recovery NGOs. The highest recovery success rates attained in the world so far – by Best Practices NGOs in the USA - are equal to about 50%. And, these success rates occur with only 30-90 days of intensive treatment, followed by active participation with the Recovery Community. Although there are no follow-up studies here in New Zealand (these would be good University research projects), DHB success rates in New Zealand appear to be something like 15%, usually for costly, longer residential stays. It is clear that efficiency considerations argue for private, not-for-profit, fee-based provision of treatment initiatives.

The Proposed New Zealand Retreat of Auckland: A Prototype

The Concept This is a request for public/private contributions for financing the start-up costs for The New Zealand Retreat of Auckland – a Best Practices, not-for-profit Recovery NGO patterned after the most successful Recovery NGOs in the world. Our proposal is to establish The New Zealand Retreat in Auckland as a 30-bed, 30-day, not-for-profit facility where alcoholics and drug addicts (“guests”) can reside and take a time-out to become steeped in the recovery liturgy. The Retreat will also accommodate all-important Family Programmes. During these 30 days guests will be induced to establish a longer-term recovery path in a viable 12-Step Program such as Narcotics Anonymous or Alcoholics Anonymous. We will charge each guest $5,900 per 30 day stay. The guests themselves must provide at least 10% of this fee: The rest can come from trusts, charitable contributions, family, employers and/or low-interest loans from revolving loan funds.

The Retreat will closely resemble - indeed is imported from - a very successful one in the urban setting in St. Paul, Minnesota, USA – an area with a similar, diverse cultural/ethnic and age make-up to New Zealand (Web = http://www.theretreat.org). The essence and actions implicit in our 30-day program will be those of the 12-Step addiction recovery programmes. Key aspects of efficiency and effectiveness are heavy participation of the Recovery Community and the emergence of ancillary facilities such as Sober Houses, Family Programmes, etc.

Contribution Requests The start-up costs for the Retreat are estimated at $1.3 million. Contributions of this magnitude will allow us to become financially self-sustaining in about 40 months, while renting a premise and feeding and treating, in 30-day intervals, an increasing number of guests: beginning at 6 and ending up at 30 per 30-day period. This amount includes $200,000 to establish a low-interest, revolving loan fund for borrowed guest payments. A rough estimate of the cost of purchasing our present premises would be an additional $2.25 million.

If historical averages apply regarding New Zealand’s public/private division of GDP, this $1.3 million start-up investment would come 40% ($520,000) from the public and 60% ($780,000) from the private benefactors and trusts. The origin of the $5.900 per guest fees would depend on the use by the public and private sectors respectively. However, in each case, efficiency considerations require that at least 10% ($590) come directly from the prospective guest.

Necessary Ancillary Recovery-Related Enterprises

Related Infrastructural Investment is Required Once The Retreat is up and running, the expected 50% success rates require the emergence of ancillary, recovery-related enterprises. The lessons from elsewhere suggest that these will emerge as a response to needs. This is nature of successful private ventures and the result of heavy involvement of a vibrant and innovative Recovery Community. We can expect to see after-care residence houses, job networks, etc., spring up in response to perceptions by the Recovery Community of the needs of Retreat graduates. These should be encouraged via tax exemptions. An interesting additional wrinkle would be to give special Government emphasis/subsidies to private investments in treatment infrastructure and to recognize the importance of such investments in the Government’s migrant investment scheme.

This document was financed by Stepping Stones Recovery Trust (SSRT) with support from its wholly owned, not-for-profit subsidiary, The New Zealand Retreat of Auckland (NZRA). Drafting was overseen by Roger Green (CP, DAPAANZ-NZ, IC&RC/AODA(Int) and CEO). The document received formal NZRA Board approval on 4 February 2010. The primary author is Dr. Robert Myers (PhD-econ), a Trustee of SSRT and Board Member of NZRA (dr.rbmyers@gmail.com).

The Need

Our board is not surprised to learn that there are some 650,000 alcoholic/addicts in New Zealand. There are probably less than 200 beds that offer effective multidisciplinary evidence based treatment and none for the model we are introducing! We are seeing the phenomenon of the progressive nature of this disease not only in the individual but spilling over daily in our culture. We realized that it is getting worse and will continue to do so until really effective, tried and true (yes there is very effective treatment in other countries) recovery programmes are made available en mass that are affordable. En mass effective treatment needs to happen together with public education similar to that on the recent drive to educate the NZ culture about other mental illnesses specifically depressive conditions (The John Kirwin led TV campaign) We realized that unless this happens we see NZ as a nation going down the path of the Roman and Greek Empires and disintegrating in a cesspool of death, mayhem and lawlessness. It is happening. Just watch the media!!

The two components needed to begin to reverse this very serious situation are:

1. Wholesale population-wide education that if a person has the symptoms of addiction he or she has a treatable disease as nominated by the World Health Organisation, and various medical bodies around the World.
2. The introduction of wholesale affordable effective treatment as is the case in the UK, USA and Canada by people who understand what is required.

Yes just two components WIDESPREAD EDUCATION & WIDESPREAD EFFECTIVE TREATMENT for a widespread disease.

We notice and contend that all this other legislation reference drinking age, access to alcohol and other drugs (both legal and across the counter) policing, drink drive regulations etc is not worth the paper it is written on IF the above two scenarios are not in place. We realized and know that legislation alone NEVER stopped the spread of addictive disease. (Does anybody ever remember hearing of prohibition in the USA last century?)

We wrote as a board and as individuals to the Law Commission for submission to the Government last year as requested and we were not heard. There is NO emphasis on the above two components in the new “legislation” that has recently been introduced by the Government. The beat has been totally missed!

This disease is as progressive in the community as it is in the individual. After all it is proven to be a family disease. For every one person with this primary disease five others are directly affected and carry all the symptoms of the consequences of addiction except often the lack of a compulsion to drink or use. The total figure of those affected directly and negatively then has to be 3.25 million and add .650 million and we have the entire population seriously affected. DO WE HAVE A SERIOUS PROBLEM HERE?!!! IT CONTINUES TO REAR ITS UGLY HEAD IN OUR DAILY LIVES and will go on doing so. Roger Green, Treatment Director, The New Zealand Retreat.

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