Tuesday, December 16, 2008

Regarding the Selection of Directors of the Office of National Drug Control (the Drug Czar) and the Substance Abuse and Mental Health Services Agency

It was reported that Representative Ramstad has been lobbying to head up SAMHSA, the Substance Abuse and Mental Health Services Administration, with greater support from mental health and substance abuse professionals. The concerns that led to our sign on letter opposing Rep. Ramstad's possible selection as the next Drug Czar are even more applicable to his selection to head SAMHSA where he could do even more damage to the treatment of people with substance use disorders. For this reason I sent a note to the more than 350 signers of the first letter asking if they would support an ammendment to the original letter to express our str ong concern about Rep. Ramstad being selected for either agency, ONDC or SAMHSA. The support was unanimous and the letter was ammended. The ammended letter is posted below and the first version of the letter remains up on this blog.


December 16 2008

Dear President-Elect Obama,

As substance use and mental health professionals treating patients with substance use disorders, we are concerned about reports that you may be considering Congressman James Ramstad as our next “Drug Czar”, the director of the Office of National Drug Control Policy, or as director of the Substance Abuse and Mental Health Services Administration (SAMHSA) . This country needs leadership in these agencies that supports evidence-based policies and that will make decisions based on science, not politics or ideology. We have reason to believe that Congressman Ramstad is not that person.

While we applaud Representative Ramstad for his courageous and steady support for expanding drug treatment access and improving addiction awareness, and honor his own personal and very public triumph over addiction, we have strong reservations about his candidacy for these positions.

In his twenty-eight years in the U.S. House, Rep. Ramstad has consistently opposed policies that seek to reduce drug-related harm and create common ground on polarizing issues. Rep. Ramstad voted in 1998 in favor of making permanent the federal funding ban on syringe exchange,, in 2000, he voted to prohibit the District of Columbia from spending its own locally raised funds on syringe exchange programs, and in 2007, he voted against lifting the same DC ban, despite decades of research showing that syringe exchange programs reduce the spread of HIV/AIDS, save lives, save money, and do not increase drug use. Rep. Ramstad has also consistently opposed congressional efforts to stop the arrest of patients with HIV/AIDS, cancer, and other illnesses who use prescribed medical marijuana to ease their pain and suffering in states where it is legal.

Unlike you and Vice-President-Elect Biden, Rep. Ramstad has also failed to cosponsor any legislation eliminating the sentencing disparity between crack cocaine and powder cocaine, despite the fact that there were three different crack/powder reform bills in the 110th Congress. A number of recent studies have found that long prison sentences are one factor driving disproportionate rates of HIV/AIDS infections in communities of color. A primary task of the next Drug Czar should be to deal with this and other issues related to over-incarceration.

We need leadership that is committed to reducing the harms associated with both drugs and punitive drug laws. Leaders who support:

  1. Treatment interventions across the spectrum of readiness to change such as: Recovery Readiness, Motivational Interviewing, and other interventions which do not require abstinence for active substance users just beginning to work on their substance use; substitution treatments like methadone and buprenorphine (the most proven effective treatments for opiate dependent patients); and abstinence-focused in- and out-patient treatments for those working toward abstinence and recovery

  2. Integrated treatment for patients with co-occurring psychiatric, medical, and lifestyle problems – a group that makes up the majority of patients with serious substance use disorders

  3. Syringe exchange programs to halt the spread of HIV/AIDS and hepatitis C,. This is an intervention that has been proven to dramatically reduce the transmission of infectious disease and reduce drug use in the injecting population without increasing drug use

We need a new bottom line for U.S. drug policy so that treatment is more available and substance abuse and dependence are treated as the health issues they are, not criminal issues. To paraphrase former Baltimore Mayor Kurt Schmoke, we need a surgeon general not a military general or police officer.

We need leaders at ONDC and SAMHSA who welcome and encourage new ideas and research and who are committed to reducing the number of nonviolent offenders behind bars. These leaders should be fully committed to major sentencing reform. There should also be greater emphasis on educating our judges, prosecutors, and parole and probation officers to the complexities of substance use disorders and the process of change and recovery. When patients in treatment for substance use disorders "slip" it is more the norm than not; as an expected part of the process of change, it should not lead to automatic termination of treatment and incarceration. These decisions need to be made in conjunction with the clinical staff working with these patients who have the expertise to make them.

Our leadership on drug policy and treatment must understand that there are many roads to recovery and recovery can take different paths. We strongly believe that our views are in the best interests of individuals struggling with substance use disorders and all Americans and we hope they will be considered in your choices for these critically important positions.

Thank you.


Andrew Tatarsky, PhD
Founding Executive Board Member and Past President, Division on Addictions, New York State Psychological Association

Debra Rothschild, PhD
Past President, Executive Committee, Division on Addictions, New York State Psychological Association

Howard Josepher, LCSW
President & Chief Executive Officer, Exponents

Alexandra Woods, PhD
Officer, Executive Committee, Division on Addictions, New York State Psychological Association

Julie Barnes, PhD
Executive Board Member, Division on Addiction, New York State Psychological Association

Click here to view the additional signatures to this letter