Victor Capoccia says he got into the drug treatment arena "sideways."
Recently named director of a drug addiction program of the Baltimore-based Open Society Institute, Capoccia was teaching planning and community organizing at Boston College's school of social work when he got involved in health planning programs for the Boston area in 1979.
That work took him to the Boston Department of Health and Hospitals, working on HIV and AIDS programs, which eventually led to running a community-based drug and alcohol treatment program.
When the time came to decide between remaining with that program or returning to academia, Capoccia stayed in the community, running the program for the next decade.
"I loved it," he says. "Essentially, what I loved about it was that the people there were ready for change and committed to the work they were doing."
Capoccia, 64, who became the head of the addiction prevention and treatment team at the Robert Wood Johnson Foundation in 2001, blends altruism and pragmatism in his approach to drug treatment.
"I came from the health care field," he says. "If you follow the principles available in that field, you can build strong, relevant treatment organizations."
As the George Soros-funded Open Society Institute program seeks to find a model that can work nationwide, one of the places it will be studying is Baltimore.
"From what I've seen, the two communities that stand out as local governments that had the most focus and concern and movement on the drug problem are Baltimore and San Francisco," Capoccia says.
"There were concerted efforts in both instances from leadership, both political and administrative, from health departments that focused on the issue and helped build a sense of collaboration and interdependence among health care organizations and between health and law enforcement in really positive ways," he says. What is the most basic thing that people need to know about drug addiction?
At its root, addiction is a health issue. Treatment is not here to address the messy effects of addiction; we are here to treat all the different dimensions of alcohol and drug abuse that have been demonized, to say that people with a health condition ought to have that condition treated. They should not be jailed or shunned or put aside until their condition is so acute that they are a hopeless case. Like any other health condition, their condition should be addressed.
My experience in the health department shows that if you treat addiction, you have all these other spillover effects, not just on crime, but on HIV rates, on hospitalizations, on emergency room visits. In Boston, something like 30 percent of the calls that came in for emergency medical services involved either mental health or addiction-related issues. They are brought to emergency rooms, which is an incredible inefficiency and waste. Imagine if someday the EMS system could accurately triage people and take those needing it to the mental health or addiction treatment systems. But isn't it true that treating addiction is not like treating an upset stomach, that people try and fail to kick these habits, that it is a matter of will, not just of medicine?
That is true of diabetes, it is true of hypertension, and a lot of chronic diseases. A person with hypertension can think, "Wow, that steak and french fries look good. I'll have some," even though if he takes his blood pressure after that meal, he can watch it go up. Or the diabetic thinking, "Damn, I ought to get up and exercise. Maybe tomorrow." Actively ingesting drugs is the same thing. People are choosing a set of lifestyle behaviors that are negatively impacting them just as those with diabetes or hypertension or other chronic conditions often do.
Using that chronic illness framework, you realize that this is a condition you have to learn to manage. It is not a case of finding a cure, that it's here today and gone tomorrow. It is a process of mitigation, of reducing the harmful effects, reducing the behaviors associated with those harmful effects.
The pattern is pretty clear: For the behavior to change, it takes multiple interventions with longer intervals between them, leading to prolonged if not permanent periods of being alcohol- and drug-free. So you cannot look at relapses as failures, just an expected part of the treatment pattern, as with so many chronic diseases associated with lifestyle behaviors. But it seems so hit-and-miss. Do we know what works, which drug treatment programs do the job better than others?
The clinical approach to any health care issue ought to be based on some empirical research that says, for instance, we've tested and demonstrated that exercise relative to diabetes is a good thing, or that certain medicines have positive effects on hypertension.