This was published in the Baltimore Sun on 1/10/26
Secretary Hegseth has ordered 35 alleged drug smuggling boats blown up in the last four months, and 123 people have died. Assuming every one of these boats was packed with the drugs usually transported on these routes, the impact of these strikes on the drugs available on our streets was negligible. They destroyed about 0.02% of the cocaine entering the country this year and none of the fentanyl or methamphetamine.
The fact is, it is impossible to eliminate drug abuse by reducing supply. Fentanyl production, for example, requires only rudimentary chemistry knowledge, a precursor chemical imported from China, and a working kitchen. Once manufactured, a pinhead of fentanyl powder is enough to kill someone.
Meanwhile, 767 Americans – two jumbo jets full of people – die of drug or alcohol abuse every day. My daughter was almost one of them.
So I understand the longing for simple solutions and someone to blame. I too desperately want to find a way to help many more people recover from drug and alcohol addiction.
It’s taken me 17 years to figure out how to do so.
In 2008, I was thrown into a world no parent wants to join. During a visit home from college, my 19-year-old daughter had a car accident and was air-lifted to shock trauma. When the tests showed severe alcohol poisoning, we discovered that she was regularly drinking enough alcohol to potentially kill herself.
Thus began the five most frightening years of my life. There were more trips to the hospital, a DWI, and terrifying calls from friends. In between, Karina attended three residential rehabs and two outpatient programs. She lived in sober group homes for several years.
However, she kept relapsing. And each time she needed additional treatment, I spent days trying to find a rehab which could prove their treatment worked. But since rehabs weren’t following up with their patients after treatment to learn how they were doing, I never got the success rate data I craved. Instead, I was forced to choose where to send her based on how nice the sales person was on the phone.
We are very blessed that Karina eventually recovered. She’s now the loving mom of four little girls with a thriving career. But it was sheer luck. Haunted by how close we came to losing Karina, I started a research company to track rehab success rates. Ten years later, we’ve followed up with 40,000 patients after treatment from over 100 treatment centers. We’ve learned a lot.
Our most disturbing finding is that the average addiction treatment center today is no more effective than rehabs were three decades ago. By comparison, because the SEER Registry has been tracking cancer treatment results since 1973, five-year survival rates for many cancers have at least doubled during a similar 30-year period.
We’ve also learned that the effectiveness of rehabs varies dramatically. Among the best rehabs, more than 50% of patients report that they’re not using alcohol or illicit drugs one year after treatment; at the worst, less than 20% of patients do. We’ve also found that success rates vary almost as much by the health insurance a patient has as they do by the rehab they attend.
The main reason more people aren’t recovering from addiction is that no one is measuring and holding organizations accountable for their outcomes. Rehabs providing highly-effective treatment aren’t being rewarded and health insurance companies choosing the cheapest providers or kicking patients out of treatment early aren’t being penalized.
It is still true that only a tiny fraction of rehabs are investing in measuring their outcomes. Fortunately, we’ve discovered a second source of truth. Since people in the throes of addiction use medical services very differently than those who aren’t, we can predict the effectiveness of a rehab by analyzing the anonymized medical claims and death registry data for patients who attended it.
The nonprofit Karina and I started, Conquer Addiction, is preparing to estimate the effectiveness of all major providers and insurance companies across the U.S. Once we’re done, we’ll invite rehabs and insurers with good results to publicize them so families can confidently choose effective rehabs to attend. And since what gets measured gets managed, we expect these annual estimates will drive the entire industry to improve.
There will, of course, still be crucial needs for more treatment facilities, affordable housing, and effective prevention campaigns. But by focusing on measuring and improving quality at existing treatment programs, we can save a large number of lives quickly and inexpensively.
And without murdering anyone on the open seas.
