This piece will focus on the government's role in addiction recovery. Or what role the government should play. But before we can examine the role of government, a couple of stipulations are in order. 

First, recovery is the answer to addiction. Preventing addiction is important and does work, but when someone develops an addiction – the focus must shift to a recovery-oriented system of care. 

Second, recovery is an “inside job.” Despite the sincerest efforts of loved ones, therapists, Judges, and cops, ultimately, the person with an addictive disorder must become internally motivated to take the recovery journey because there is nothing – no punishment, threat, or abundance of well-meaning love – that can compete with the incredible power of addiction. 

Power – that’s the word! Where is the power to “fix” addiction? Who’s got it, and how should it be used? Power is the ability to make something happen – from a light bulb to stripping someone of their civil liberties – power makes it so. The government’s power is derived from its money and legal authority, all of which is sourced from the people they serve. 

This past November, we participated in the biennial ritual of a general election whereby the people granted authority to govern by casting votes. The winner will take office and the Nevada Legislature will convene in regular session in Carson City beginning February 6, 2023, for exactly 120 days to make two years’ worth of public laws, taxes, fees, and budgets. 

Individual feelings or experiences aside, everyone is paying something towards the system to address some point of the addiction/recovery dichotomy. Further, our voice in the process is not limited to our vote – there is a critical role for citizens during the legislative session to shape the role of government in using its power – money, and authority to address addiction in Nevada. 

State Money 

Health Services constitutes Nevada’s largest public expense – representing 45% or $13 billion of the biennial budget in FY 21 – 23.1 Of this, only 1.6% - or $221 million - was spent to “Reduce prevalence of risky & addictive behaviors.”1 Of those dollars, less than 1% was spent on “Substance Abuse Programs” - $1.5 million, while $140 million was spent on “Specialty Courts” and “Youth and Juvenile Correction.”1

At this point, let’s note that all three branches of government are now exercising power. The Legislature makes the laws enforced by the executive branch (from the Governor to the Police), and the judicial branch decides how laws are applied and runs the “specialty courts” to address cases where substance misuse was a mitigating factor in the commission of a crime. They’ve all got the power and this amount of money to address addiction – or more specifically – substance “abuse” that has come to the attention of the police and courts while a comparatively tiny amount - the 0.7% or $1.5 million out of $13 billion - was spent on “Substance Abuse Programs.”1

It is also important to note that this analysis is based solely on a snapshot of the state’s budget and does not consider the money spent privately to address addiction or its collateral individual and social consequences. 

Many people with addictive disorders will encounter “the law” at some point, but others will find recovery in other ways. For example, many working people may have private insurance through jobs or family that can help if treatment is needed and available. And if all they need is treatment – and it’s available – the system may never count them. And this is the point where we must beg off to look at the much broader and more complicated picture of addiction and recovery in Nevada. 

The scenario of accessing insurance benefits works only if someone has insurance. Addiction is chronic and gets worse. Later recurrences of use will occur at times when the person is not housed, working, and certainly not insured. At this point, the system will kick in, and in Nevada choices are limited.

Public Health and Addiction

For many people affected by addictive disorders, the addiction itself may be the easiest to resolve. Addiction is chronic, complicated, and its ravages are as varied as the lives it affects; that’s why a community-based recovery-oriented system of care is the best because it considers any relevant particulars applicable to a person seeking recovery in the community they live. 

Addressing recovery through the lens of the Social Determinants of Health2 and the Eight Dimensions of Wellness3 ensures that those affected have the best chance of becoming internally motivated to sustain their own recovery.2,3 Housing and meaningful work are necessary details without which recovery is most imperiled. The most successful public health partnerships incorporating these elements have the most excellent chances for success - most specialty court programs addressing addiction operationalize these essential details. But Nevada’s deficiency in providing services for mental health has been a long-standing problem.

In October 2022, the United States Department of Justice wrote, “For the last five years, Nevada ranked last in the nation in children’s mental health based on prevalence of illness and access to care among children.”4 For many advocates for recovery, this fact is well known; ironically, the ire of the federal government is encouraging because it suggests that system changes and funding could force the state to improve.

It shouldn’t take a federal government investigation and potential litigation to compel the state to serve its people better. But addiction is chronic and complex; the longer it lingers, the fewer choices remain. Also, the impact of addiction isn’t appreciated in the early stages of recovery. Many need to hit a “focusing point” or “sufficient bottom” to realize there are choices. 

Power is authority and money – the federal government has both and can use them over our state to force change. But, like any addiction, the solution is recovery - not coercion, and nothing can make the state want to support recovery until the state is willing to face the harmful effects of its historic negligence. 

The power of recovery is awesome – and transformative for those who have experienced it. Looking forward to the next legislative session, advocates have the power to compel those vested with the people's authority. Additionally, the state has more money through tax revenue and billions of federal grant dollars resulting from the devastation of the pandemic.

Hope plus action creates opportunity. The 82nd Legislative Session isn’t just about hope – it’s about taking action to invest in a better future. It’s noble to hope that people don’t experience addiction – hope that we can prevent it – hope that this overdose isn’t the last. With abundant resources available to the state, though, it is possible to elevate recovery to improve our system for generations to come. But that can only happen when the people direct their government to do so. 

Every citizen is invited: – get to know your Legislator; they want to hear from you – give them a person to call who represents the numbers they read and hear. Use your power because every bill the Legislature considers begins with these words: “THE PEOPLE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS.” Be the powerful people of recovery, so addiction is no longer the authority. For more information on the Nevada Legislature, find your representatives, and see what the state is working on visit: https://www.leg.state.nv.us 

*Trey Delap is the Principal Director for Group Six Partners, LLC, a public affairs consulting firm providing the full range of policy services from analysis to legislative advocacy. Trey’s expertise is in strategy, reducing stigma, and promoting recovery. He can be reached at 702-772-9735 or trey@groupsixpartners.com 

REFERENCES:

1. Nevada’s Transparent Government. “Activity Budget: 2021-2023 Biennium (FY22-23)” State Budget. State of Nevada. (2022, December 14). From http://openbudget.nv.gov/OpenGov/ViewPPBBSummary.aep

2. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. “Social Determinants of Health.” From https://health.gov/healthypeople/objectives-and-data/social-determinants-health

3. Substance Abuse and Mental Health Administration (SAMHSA). 2010. “Eight Dimensions of Wellness.”

4. United States Department of Justice. 2022. “Investigation of Nevada’s Use of Institutions to Serve Children with Behavioral Health Disabilities.” From https://www.justice.gov/crt/case-document/file/1540506/download