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DONALD J. KURTH, MD:
Influencing Public Policy on Successful Addiction Treatment
The field of addiction medicine faces an uphill battle in legal circles where public policy is decided, according to Donald J. Kurth, MD, a national figure in substance abuse treatment and an elected public official.
Part of the problem is this: Addicted patients suffer from a chronic disease not unlike hypertension, diabetes or asthma, but insurance companies routinely and systematically deny them access to medical care. Yet when adequate treatment is provided, the success rate for recovery from addiction is very high and similar to that of other chronic diseases - about 70 percent. But, while the National Institute on Drug Abuse says that addiction treatment of less than 90 days is equal to no treatment at all, insurance companies routinely authorize only 5 to 7 days, or even 24 hours, of treatment. When patients undergoing such grossly inadequate treatment fail to remain abstinent, insurance companies then lament.
This, says Dr. Kurth, "is not a treatment failure; it's a public policy failure. Insurance companies are in business to make profits for their shareholders, but it is our job as citizens to make sure they provide the care we are paying for and that that care is provided in a way that makes medical sense."
Dr. Kurth is associate professor and chief of service in addiction medicine in the Chemical Dependency Unit of Loma Linda University Behavioral Medicine Center and a newly named fellow in The Robert Wood Johnson Foundation's Developing Leadership in Reducing Substance Abuse program. He plans to use his three-year fellowship to influence national public policy on the treatment of addiction, which affects 40 million Americans.
Kurth seems perfectly suited to this work. He has lectured around the country on national drug policy, written drug policy for the American Society of Addiction Medicine, participated in California initiatives for substance abuse treatment instead of incarceration, initiated grassroots lobbying efforts at the state and national levels, and is an elected public official- city councilman of the City of Rancho Cucamonga, California (pop.: 140,000).
"Through practice and scientific research, we as physicians have gained an understanding of the disease of addiction, but many of our legislators still think of it as a moral or criminal issue," he says. "As physicians we have failed to educate our legislators regarding addiction. We understand the need to 'medicalize' addiction, but some legislators still continue to want to criminalize this disease.
"In order to develop more meaningful legislation to stop the stigmatization, discrimination, and criminalization, we must educate our lawmakers to understand addiction as a disease. This fellowship will allow me to educate and organize physicians from across the nation to come to Washington, D.C., to learn the basics of grassroots advocacy and begin to educate lawmakers as to the victory over the disease that is now within our reach, if we just hold out our hands to grasp that success."
Kurth's life story is remarkable. Both of his parents were hospital corpsmen in the U.S. Navy during World War II. He was raised in the New Jersey suburbs. "I was the apple of my parents' eyes," he says. "My childhood was like Tom Sawyer's. I fished, hiked, and played in the woods. My grades were good as a child."
But during adolescence in the 1960s, Kurth became addicted to drugs and barely graduated from high school. Homeless and addicted, Kurth recovered from addiction through treatment and turned his life around. Despite his success as a physician and medical school professor, he has never forgotten his past. "My eyes have seen a side of addiction that very few have seen and come back to tell the tale," he says. "I know what it is to suffer the agony of addiction-related cancer and the long road back after a year of surgery and chemotherapy. But mine is not a tale of woe. It is an odyssey of recovery and victory over the disease."
While addicted, he flunked out of two different colleges, but after treatment he was able to achieve an Ivy League education at Columbia University, graduating cum laude and Phi Beta Kappa. He went on to complete medical school at the Columbia University College of Physicians and Surgeons, one of the oldest, most renowned and selective medical schools in the country.
He was awarded a surgical fellowship to study at the prestigious Nuffield Orthopaedic Centre at Oxford University in England, completed a surgical internship at Johns Hopkins University Medical Center, trained in orthopedics at UCLA Medical Center, subsequently became board certified in emergency medicine.
He went on to reorganize the emergency department at Serra Memorial Hospital, organized an urgent care center in Rancho Cucamonga, California, and was elected to serve as President of the Board of Directors of Cucamonga County Water District, a California special district with a $50 million annual budget. In 2002 he was selected to serve on the city council of Rancho Cucamonga.
As a member of the public policy committee of the California Society of Addiction Medicine, in 2000 he helped put the question of treatment instead of incarceration for addicts on the ballot in the form of Proposition 36 in California. Voters passed it with a resounding 61 percent of the vote.
"My experience as an elected public official has taught me the importance of grassroots advocacy," he says. "When I suggested meeting with our legislators to discuss free access to addiction treatment, I was told that physicians simply did not do that sort of thing. Undaunted, I began to visit Washington, DC, alone, without funding or support, and to visit legislative aides. Initially I was scorned and criticized by my colleagues for my willingness to roll up my sleeves and get involved in the political process. But I have helped to teach fellow physicians in the California Society of Addiction Medicine how to change public policy to benefit our addicted patients. Within a few months, we were asked to support Proposition 36. Against stiff prison guard and probation officer opposition, the initiative passed and treatment instead of incarceration is now the law in California."
The Developing Leadership in Reducing Substance Abuse Program, sponsored by The Robert Wood Johnson Foundation, is designed to encourage and support emerging leaders in the field of substance abuse prevention and treatment. Each LRSA Fellow receives $75,000 over a three-year period to develop and implement a program to fast track his or her career development and enhance experience and expertise in an issue area. The fellow selects a mentor and participates in educational programs and networking opportunities throughout the fellowship. LRSA Fellows work across a range of disciplines, including education, policy development, research, clinical treatment and political and legal advocacy.
The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. It concentrates its grantmaking in four goal areas: to assure that all Americans have access to quality health care at reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social and economic harm caused by substance abuse - tobacco, alcohol and illicit drugs.
For additional information on the Developing Leadership in Reducing Substance Abuse program, please visit the Web site: www.SALeaders.org.
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DONALD J. KURTH, MD, FASAM
Fellow, Developing Leadership in Reducing Substance Abuse
Donald J. Kurth, MD, FASAM, is Associate Professor and Chief of Service
in Addiction Medicine at the Loma Linda University Behavioral Medicine
Center in Southern California.
Homeless and addicted in the late 1960s, Dr. Kurth was able to recover through treatment and turn his life around, graduating cum laude and Phi Beta Kappa from Columbia University, where he earned a BA in pre-medicine. He went on to earn his MD at Columbia University College of Physicians and Surgeons, and completed a surgical fellowship at Nuffield Orthopaedic Centre at Oxford University in England. He completed his surgical internship training at Johns Hopkins University Medical Center in Baltimore and later trained in orthopedics at UCLA Medical Center. Dr. Kurth subsequently became board certified in emergency medicine and served as Medical Director of the Emergency Department of Serra Memorial Hospital in Los Angeles, California.
He was later elected to public office as President of the Board of Directors of the Cucamonga County Water District, and in 2002 was selected to serve on the City Council of Rancho Cucamonga, California.
Currently, he also serves as President of the California Society of Addiction Medicine and Board Member Alternate representing California at the American Society of Addiction Medicine. Dr. Kurth is certified in addiction medicine by the American Society of Addiction Medicine (ASAM), and has been awarded the title of ASAM Fellow, an honor bestowed on only 300 addiction physicians worldwide.
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