Health care reform has made it easier for people who are abusing drugs or alcohol to get treatment, but fear keeps many people from walking through the recovery center doors.

"A primary initiative of President Obama’s health care reform is to go after the early stages of abuse, before it reaches chronic addiction. That’s a brand new development. Now we have to erase the stigma associated with seeking help," said Alan Johnson, 57, president and chief executive officer of Hina Mauka, Hawaii’s largest drug and alcohol treatment agency, and chairman of the Hawaii Substance Abuse Coalition, a hui of about 20 treatment programs.

Johnson’s own family history—alcoholism killed his maternal grandfather and he, his mother and siblings struggled with alcohol abuse at various points in their own lives—helped inspire the career change that brought him to Oahu in 1995.

"I had a successful business career, but I was divorced, I was questioning what I was doing with my life," said Johnson.

He left a lucrative job in the Seattle area to embark on a nine-month "spiritual journey" that ultimately brought him to Hawaii, where he met his second wife, Patti, a licensed counselor who helps the severely mentally ill. They married in 1997 and he helped raise her two children, now grown.

"I came here because I wanted to help people, and it helped me, too. I have a very happy life."

QUESTION: We’ve had a lot in the paper lately about "ice" usage in Hawaii, but I’d like to start off with a finding that got a little less attention, regarding alcohol use. Among people 18 and under, 40 percent of all treatment admissions were for alcohol abuse, up nearly 35 percent from 2006. Could you talk a little bit about you’re seeing?

ANSWER: Well, among minors, it’s always been marijuana and alcohol. And from an overall community perspective (among all ages), alcohol is still the No. 1 drug, when you count both abuse and addiction. According to the last survey they’ve done, which was several years ago, almost 90,000 people in Hawaii have an alcohol problem and/or other drugs problem, but the lion’s share of that is alcohol. It’s just that when you get down to alcoholics and addicts, there’s more meth addicts that are having more severe consequences right away and more of them are coming into treatment.

Q: What are some of the approaches for alcohol abuse, especially for people who are not seeking treatment, in terms of outreach, public service campaigns, etc.?

A: In the past, we have been not oriented toward those are just abusing—only toward those who are really hitting more chronic illness. … If you weren’t chronic, you came to treatment and we said, "Sorry, you don’t meet the criteria for chronic, you don’t get treatment." All that is changing right now as we speak. Health care reform is opening the doors for the insurance companies to say, "Hey, let’s do something about those who have an abuse problem, too." And especially HMSA (Hawaii Medical Service Association) is saying, "We now recognize they’re the major users of the emergency care and the high-level costly care, and if we could get treatment for those folks who are abusing, then we could help that, too." That’s a major shift.

Q: (Referring to the 90,000 figure) Is that worse or better than in the past?

A: Probably about the same. The total number of people has not changed for almost 10 years. The difference is that those who are coming to the chronic stage is greatly increased.

Q: The chronic stage of any drug? Ice, marijuana, alcohol?

A: Yes, that’s correct. That has been rapidly going up. If you’re under 45 today (and a substance abuser), you’re probably not just using one. You may choose alcohol, but you’re probably using marijuana or meth or something else secondarily.

Q: And it’s that multiple use that contributes to getting to the chronic stage quicker, or are there other factors?

A: The drugs are just more sophisticated. Marijuana, for instance, is 300 times more potent than when I was younger. You hardly saw addiction 20-30 years ago with marijuana, and now almost a third of the people we treat have addiction with marijuana. It’s so potent.

Q: A big part of your approach at Hina Mauka is to have people who recovered come back and talk to those who are still there.

A: Yes. … We are more and more asking folks, not while they’re in treatment—but after treatment and if they feel comfortable—we’re asking them to come and speak out about this, because that’s one of the best ways to eliminate stigma. We have a lot of folks who are in a professional field, and very rarely do those folks come forward because they’re so worried about the stigma and that it would hurt their career somehow. And we’re trying to say, "No, let’s change that," because the stigma is all about shame.

Q: That was my next question: How willing are the alumni to come out and speak?

A: There are those few who are very grateful and very brave who say, "Yes, I want to do that." But the majority do not. So we’ve done the Recovery Walk, and we’re having recovery picnics, having folks come together who are in recovery but don’t have to proclaim it. But at least they’re seen as a group out in the public, so that they can get used to the idea that it’s OK.

In order to reach the people who are abusing, we’ve got to reduce the stigma and educate the public about what addiction is. One of the best ways to do that is have someone come forward and say, "I was abusing, I was an addict, and now I live a wonderful life in recovery."

Q: That includes yourself, right? You’ve been open about your family history of alcohol abuse.

A: Yes, that’s correct.

Q: What do you think of this anti-meth campaign that’s on TV, focused on young people?

A: We did ask our students who are in treatment, and I would say about half of them thought it was a really good idea and about half thought it was not a very good idea.

I think the ones who love the scare tactics the most are the parents. Some of the kids look at it and say, "That’s not true. I don’t see a lot of my friends look like that." On the other hand, some say, "Maybe it will help some of my friends to quit."

If you are asking whether that (scare tactic) is defined as a best-practice prevention method, the answer is absolutely not. It is not a best practice.