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Alcohol is easy to obtain for those who have problems. (Photo by Paul Bersebach, Orange County Register/SCNG)
Alcohol is easy to obtain for those who have problems. (Photo by Paul Bersebach, Orange County Register/SCNG)

Hey, Gov. Newsom. I’ve been in Dallas with some of the best addiction doctors and researchers in America these last few days. There’s so very much going on here – which we’ll expand on in coming weeks – but we implore you to keep these thoughts at the forefront as California embarks on its plan to spend $6.4 billion helping and housing homeless and mentally ill folks.

What kills most?

We can buy the drug that kills more Americans than any other at the grocery store. Legally. Every day of the week.

While overdose deaths from fentanyl and its sinister cousins have seized the spotlight for years — some 112,000 Americans died from drug overdoses in 2023 — alcohol-related diseases kill many, many more people — 178,000 Americans every year, according to the National Institute on Alcohol Abuse and Alcoholism.

In California, a record-breaking 11,000 people died of drug overdoses in 2022. But nearly twice that many — 19,335 — die from alcohol-related diseases every year in the Golden State, according to a recent number crunch by the California Department of Public Health.

There are medications that can help treat alcohol use disorder. They’re not fabulous, experts at the American Society of Addiction Medicine’s annual conference said, but they’re a tool in the toolbox that can help address the most widespread and pernicious addiction in America.

“Everything right now is opioids, and it’s great we’re trying to prevent overdoses, but alcohol is not gone. Alcohol causes more related deaths than opioid overdoses,” said Dr. Julio Meza, director of UCLA’s Addiction Medicine Fellowship, who we chatted with before the conference began.

“Before 2020, the main reasons for a liver transplant at UCLA were Hepatitis C, tumors and then alcohol. Now at UCLA, the main reason for a liver transplant is alcohol.”

General practitioners! Family doctors! Talk to your patients about their drinking. More addiction treatment from front-line physicians is critical.

As a founding partner of the PlumpJack Group, the wine, food and hospitality company that includes three Napa Valley wineries, we hope you’ll take this to heart, Gov. Newsom.

What is treatment?

Ask folks on the street what addiction treatment is and they’ll say “detox” or “AA.”

Detox is not treatment. Twelve-step programs like Alcoholics Anonymous are not treatment.

Detox is designed to remove drugs from the system — best done under the watchful eye of medical professionals, unlike how it’s often done in California, sometimes to tragic results. But that’s only the first tiny step. Research has found that some 90% of folks who detox from opioids use again within five days. Overdoses and death are too often the aftermath.

The link between Adverse Childhood Experiences (ACEs) and substance use (SAMHSA)
The link between Adverse Childhood Experiences (ACEs) and substance use (SAMHSA)

There are several excellent medications for opioid use disorder that dramatically reduce cravings and subsequent use. But in California, nearly half of treatment centers don’t use them, according to data from the Substance Abuse and Mental Health Services Administration. And only 1 in 5 people diagnosed with opioid use disorder take these medications.

That’s insane! Please fix this! Ensure that the folks we’re trying to help through Proposition 1 (and, really, everywhere else) have access to life-saving medications from the get-go, and for as long as they need them, which might be forever.

If you want to be cold about it, that could save money in the long run. A decade ago, about one of every nine acute care patients at UCSF were substance users, said Dr. Marlene Martín, associate professor of clinical medicine at UCSF. Today, that’s about one of every three.

And please, don’t mistake sobriety for recovery, the experts cautioned. While the peer support of AA and other 12-step programs can be absolutely essential, they are not in and of themselves recovery. Sobriety is a step on what’s often a life-long road. The 30-60-90-day treatment model so prevalent now — largely because that’s what insurance will pay for — has it all wrong.

Serious as a heart attack

We need to stop treating addiction like a heart attack and start treating it more like diabetes, the ASAM experts said.

“Addiction treatment is set up on an acute care model. It works really well for acute conditions, where you go for treatment and are ‘cured.’ This is what we’ve done in addiction for a long time,” Dr. Elizabeth M. Salisbury-Afshar of the University of Wisconsin, Madison School of Medicine and Public Health, told her colleagues.

But chronic conditions like diabetes — and addiction — are not cured in the ER. They require long-term management and, often, life-long medication.

By Elizabeth Salisbury-Afshar, MD, MPH
By Elizabeth Salisbury-Afshar, MD, MPH

“The way we determine success is by a urine test. Positive or negative. Acute care model. It doesn’t work for chronic conditions,” she said as her colleagues erupted in applause.

Insistence on abstinence

Folks who’ve had long-term success on methadone lose privileges, and have their medication reduced, if they raise a glass of chardonnay to toast a grandson’s graduation. This, too, is nuts.

Harm reduction efforts — clean needle exchanges, fentanyl test strip distribution, supervised consumption sites (a nicer way to say safe injection sites, which might be more palatable in a presidential campaign) – are often gateways to treatment, the experts said.

Substance Abuse and Mental Health Services Administration
Substance Abuse and Mental Health Services Administration

But a punitive mindset – which sees users as criminals – dictates punishment rather than compassion. It’s important to remember that folks who turn to substances to cope have often endured terrible trauma – and the more trauma they endured as children, the more likely they are to use, SAMHSA has found.

Homeless people — the people Prop. 1 is supposed to help and house — have high rates of addiction, SAMHSA found.

This is where harm reduction comes in. “Meet them where they are, work like hell to get them somewhere better,” said Dr. Corey Waller, chief medical officer at BrightView Health.

Alas, Gov. Newsom, you vetoed a major harm reduction bill — allowing safe injection pilot sites in Los Angeles, Oakland and San Francisco — in 2022, even though you said you were “very open” to the idea as a candidate in 2018. In your veto message, you worried that supervised sites might “induce a world of unintended consequences.”

One might argue that’s precisely what our present approach has done.