Even small government incentives can help tackle entrenched social problems
By Leonard A. Jason
As the federal bureaucracy continues to struggle with philosophical issues of the appropriate role of government, many Americans feel that our political parties are incapable of providing credible solutions to the nation’s burgeoning societal and economic problems.
Those who advocate for expanding or at least maintaining government programs to address entrenched social problems and inequities must contend with an escalating national debt and a resultant conservative backlash over out-of-control government spending. At the same time, many are increasingly dissatisfied with underwriting government programs either because they increase taxes, are perceived as creating dependence rather than autonomy, or both. Clearly there is a need for a new middle ground that can help reconcile the polarities that threaten to cripple our nation.
In the near future, the overwhelming budgetary crisis will constrain our ability to address intransigent national problems. The roots of this disaster began when presidential and legislative decisions led to an expansion in defense spending, while at the same time reducing taxes. In addition, the recent banking and housing crisis reduced revenues and caused a sharp rise in spending on safety-net programs. A further challenge stems from Medicare and Medicaid expenditures, which have long been rising dramatically and are expected to continue to do so over the next few decades as millions of baby boomers retire, creating unprecedented federal budget problems.
Yet there are ways for society to address critical social and health care concerns without massive government outlays, and precedent exists for government leveraging small investments to motivate significant social change. For example, a significant and pervasive health and economic challenge facing America is alcohol and substance abuse. Approximately 22 million Americans meet diagnostic criteria for drug and alcohol dependence, including 18 million just for alcohol abuse disorders. Annual costs of alcohol abuse alone are estimated at $235 billion dollars in direct treatment and lost productivity.
For many substance abusers, treatment begins in a detoxification program, with a time-limited therapeutic program typically following. However, these programs are becoming shorter and less effective as funding has decreased. For many addicted persons, basic detoxification does not lead to sustained recovery. Instead, these individuals repeatedly cycle through social service delivery and criminal justice programs, driving up costs without any sustainable benefit. The missing element for many patients is a supportive, cohesive setting following treatment for substance abuse. A society that returns its most vulnerable members back into socially high-risk settings upon discharge from treatment can expect to be plagued by an ever-expanding array of social problems.
How then can the average person address these types of social problems when the government and other large institutions have failed?
Oxford House is the largest successful communal-living, self-help alcohol and drug abuse recovery program in the nation, with a network of recovery homes in almost every state. These houses are governed, operated, and paid for by the people who live in them. There is no external, professional staff. With over 10,000 residents across the country, Oxford House exemplifies a grass roots effort to transform our society’s way of dealing with addiction. It expands upon the Alcoholics Anonymous approach by providing former addicts a place to live and a 24/7 support network. In some states, Oxford House residents can borrow $4,000 in government loans to cover the first month’s rent and security deposit, which has to be paid back over two years. One study showed that Oxford House residents had less substance abuse, were less likely to commit crimes, and found better jobs than those in traditional aftercare.
The productivity and incarceration-reduction benefits yielded an estimated $613,000 in savings in a recent study. These findings suggest that there are significant societal benefits for these types of lower cost, non-medical, community-based care options for those battling addiction.
The Oxford House movement has continually evolved through experimentation and trial and error for more than three decades. This is compatible with evidence-based practices that focus on incrementally improving outcomes. Similarly, successful companies use this process to create great products: not with one brilliant idea, but a core product with a succession of improvements.
This broadening self-help movement demonstrates what is possible when people are given the power and responsibility to make their own decisions. Yet, these benefits are not readily available to the homeless, those with chronic health conditions, or those who are released from addiction treatment facilities, prisons, or mental institutions. These individuals often have no voice and are excluded from the basic rights that would empower them to affect their own recovery.
They need supportive, recovery-based environments where they can participate in society and, most importantly, retain some dignity. Those involved in the Oxford House movement and others such as Alcoholics Anonymous are providing democratic environments to the disenfranchised in neighborhoods and communities throughout our country. History has shown that it often takes a grassroots initiative to radically challenge the system or status quo, and this approach can greatly ease the financial burden of addressing major problems facing our nation.
Leonard A. Jason, professor of clinical and community psychology at DePaul University and director of the Center for Community Research, is the author of Principles of Social Change published by Oxford University Press. He has investigated the self-help recovery movement for the last 20 years.