An Ethical Vermont Addiction Policy

Photo by Nancy Stevens

A measure of the Vermont legislature’s commitment to Vermonters’ well-being is the extent to which it commits the money earned from licensing and taxing addictive substances and behaviors into education, prevention, treatment and recovery programs.

As the legislature considers an act projected to harvest millions from online sports betting, it should also assess the damage gambling addiction will cause, what the State’s moral obligation to its citizens is, and how it might prevent or remediate that damage.

As many as 10 million Americans live with a gambling addiction. The act of gambling itself is legal in most jurisdictions. 33 states have now legalized online sports betting, including 24 jurisdictions that allow online betting, which often makes it easier for people to rationalize risky gambling behaviors. Most people who have a gambling addiction don’t see it as a problem, however. For example, only 21 percent of incarcerated individuals diagnosed with a gambling addiction ever thought their gambling was a problem.

Betway is the largest online gambling firm in the world, with revenues of $1.4B and profits of $255.6M. Below is their stated commitment to remediating the addiction they enable and profit from:

“In 2020 and 2021, Betway’s charity contributions reached over £300,000 ($370,000). Those donations included Gamble Aware, Trust, Bet Blocker, Red Card, Gambling Therapy and BetKnowMore,” $370,000 is less than one and a half of one percent of profits.(.0014%).

How much of the projected $5-10 million in revenue Vermont hopes to harvest from online gambling will be invested in education and addiction recovery resources?

How a government understands and manages addictive substances and the human and societal damage from addictive disorders is a powerful signal about science, money, and the mission of government to advance the well-being of its citizens.

Governments intersect with addiction in four ways:

  1. through statutory regulation
  2. through law enforcement
  3. through “sin” taxation/revenue generation and
  4. through their investments in prevention, education and addiction recovery programs.

Governments are quick to regulate and tax, but perennially struggle with the law enforcement side, while too often ignoring investments in addiction recovery. It’s more convenient to simply see regulation and taxation as a new revenue source for other priorities.

Government’s struggle to manage addictive substances extends back centuries to the early 1800s when the British East India Company grew and harvested opium in India to be sold in China, addicting an entire population and leading to the Opium Wars.

Since then, state and federal governments have continued to try and regulate addictive substances and behaviors. This goes back to the Volstead Act, the lofty goal of which was to end alcoholism by illegalizing the brewing or sale of alcohol. But the “revenuers” could never put an end to the burgeoning homebrew industry.

My Morrisville uncle Mandoza Couture remembered relatives running pot liquor from Canada in the ‘30s on Lake Champlain.

Admitting defeat in 1932, the federal government reversed course, repealed the Act, and decided to simply regulate the sale of liquor, deriving income through taxation. This model seems to have won out.

Like Reagan’s 1986 “War on Drugs” and Nixon’s earlier 1971 effort, simply prohibiting addictive substances has been an accelerating failure.

In a conversation with Nora Volkow, Director of the National Institute on Drug Abuse a decade ago, Dr. Volkow  ̶  the granddaughter of Leon Trotsky  ̶  explained to me that addiction is a psychological and/or physiological dependency on chemicals either introduced into the body (alcohol, tobacco, drugs, sugar/refined carbs) or by certain behaviors such as exercise, hypersexuality, and gambling that stimulate the body to produce chemicals on which the psyche becomes dependent, like endorphins, dopamine, or adrenalin.

Substance addictions warranting regulation and treatment are alcohol, pharmaceutical and street drugs, tobacco and cannabis, and sugar and refined carbohydrates (junk food).

Physiological addictions warranting our attention are certain eating disorders such as anorexia, gambling, and hypersexuality.

Some of the initiatives, costs, and social impacts of addiction:

 Vermont’s Title 18 addresses the possession and control of regulated drugs and tries to differentiate between street and pharmaceutical distribution, but, I would argue, fails catastrophically, as we have seen in the Purdue/Sackler/ Johnson & Johnson scandals, among others. For one thing, at the enforcement level, “doctor feelgood” is treated differently from the street-level cocaine seller.

According to the U.S. Dept. of Health and Human Services (SAMHSA), as of Jan 4, 2023, “Among people age 12 or older in 2021, 61.2 million people (or 21.9% of the population used illicit drugs in the past year.” Vermont is not immune: 2021 data shows a 33% increase in drug overdose death from the prior year. 4.57 percent of Vermont residents self-reported using an illicit drug other than marijuana in the past month (the national average was 3.6 percent).

Also according to the Centers for Disease Control (CDC), “Nearly 17% of adults binge drink and 6% report heavy drinking. During 2015–2019, excessive alcohol use was responsible for more than 140,000 deaths and 3.6 million years of potential life lost each year, on average.”

Alcoholics Anonymous and residential treatment programs have been somewhat effective at treating those who can acknowledge their addiction, but there are not enough residential programs to deal with the volume of alcoholic patients.

Vermont’s Alcoholic Beverage Tax assesses a 10% tax on the serving of alcoholic beverages. How much of the revenue it produces is used for treatment of alcoholism, especially when Vermont leads the nation in underage drinking?

Over the last 20 years, we’ve been quite effective at reducing tobacco addiction through education and punitive taxation, although the marketing of vaping products has spawned a new threat to our young people. The response is a bill in the legislature, S.18, to “ban the retail sale of flavored cigarettes, e-cigarettes, and e-liquids.

Another bill tied to addiction that’s adrift in the Legislature is H.372 / S.125, “This bill proposes to repeal the prostitution laws that currently prohibit ‘indiscriminate sexual intercourse’ and consensual engagement in sex work for hire by adults while retaining strict prohibitions and felony criminal penalties for human trafficking of persons who are compelled through force, fraud, or coercion to engage in sex work,”

Vermont is not immune to human trafficking. Since its inception the Vermont Human Trafficking Hotline (1-888-984-8626) has identified 96 cases of human trafficking in Vermont. 156 victims were identified in these cases.

Turning to perhaps the most prevalent addiction, according to the CDC, “From 1999 through 2017, US obesity prevalence increased from 30.5% to 41.9%. During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%.” Some 20% of Vermonters are clinically obese.

In terms of eating disorders, one quarter of Vermonters are obese (a Body Mass Index (BMI) over 30). Although evidence suggests that taxing sugar-sweetened beverages (SSBs) is an effective way to reduce obesity, Vermont tried and failed in 2014-2016 to pass an SSB tax foiled by opposition from the beverage industry.

At the peak of my own food addiction, I weighed just shy of 500 pounds and had to weigh myself on a grain scale at the local Agway to record my actual weight before entering an addiction treatment facility that treated eating disorders. It had been years since I knew my actual weight, as most scales stopped at 250 or 300 pounds. Since then, the prevalence of obesity has caused scale manufacturers to redesign their products.

In desperation, after years of trying to lose weight and failing, I signed into a 30-day addiction treatment facility and began to understand the genesis of my addiction. By abstaining from refined carbohydrates – sugar, flour, and wheat – I was able to lose some 240 pounds safely over the course of two years. The first few weeks were hard, but, in time, the compulsion to keep eating subsided with abstinence, as it does in recovery from alcohol, tobacco, and opioid abuse.

Americans consume on average 60 pounds of sugar a year –  mostly from high-fructose corn syrup. Look at a five-pound bag of sugar and imagine eating it in 30 days. Try to find sugar-free tomato sauce, crackers, or soups in the grocery store. Common ketchup is 28% corn syrup. Mexican drug cartels put heroin in candy to get young people addicted. How is adding sugar to everything any different?

The $75B diet industry has a 90% failure rate, as most weight lost is soon regained. Knowing that many refined foods can be addictive, we could treat the addiction more effectively through early childhood intervention, nutritional education, and expanding access to residential treatment.

In framing a coherent health policy for Vermont, we must understand and tally deaths from the full range of addictions. A death by drug overdose is horrendous, but so are deaths resulting from morbid obesity, smoking, and alcohol or from the personal or family tragedies of gambling or human trafficking. Each must be accounted for in the annals of morbidity and mortality and public policy must take all into account as we struggle to reduce the tragedy of addiction.

While it’s imperative to focus on reducing deaths from drug and alcohol overdoses, we’re shortsighted if we don’t acknowledge and tally the devastating effects of all substance and behavioral addictions Vermonters experience and reinvest the revenue generated from taxation into education, prevention, and recovery.

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