A report released last month, "Substance Use and Abuse in Durham County," produced by the Partnership for a Healthy Durham in collaboration with Duke's Center for Child and Family Policy, is the first attempt to compile data detailing the human and financial costs of using drugs, both illicit and legal.

The report, which is online at www.healthydurham.org, provides a baseline against which the effectiveness of future prevention and treatment efforts can be judged.

The statistics can be summarized without numbers or meaningless comparisons to other communities. Substance use and abuse is implicated in too many preventable deaths from overdoses, motor vehicle accidents, cancer and AIDS, and in too much suffering from domestic violence, child neglect and abuse, homelessness, crime and incarceration.

The report did not include an accounting of the financial cost, which might begin with the bills for 1,822 drug-related emergency room admissions in one year.

In 12-step treatment programs, madness is defined as doing the same old thing while expecting a different outcome. By this definition, it would be madness for Durham to fail any longer to provide the necessary prevention and treatment programs.

Although prevention strategies are generally supported, opposition to adequate funding of treatment is heard in such statements as, "They did it to themselves," and its corollary, "They chose to start, so it's up to them to stop."

The 25 percent of North Carolina adults who are obese, and the larger percentage who are overweight, should be thankful that we are not subjected to this vindictiveness. We, too, did it to ourselves, but rather than being castigated for committing two of the seven deadly sins (gluttony and sloth), our "lifestyle diseases" are treated with compassion, enabling us to unashamedly continue healthy, happy and productive lives.

Requiring substance abusers to fix themselves is as cruel and dangerous as denying treatment to patients who develop Type II diabetes secondary to obesity, demanding instead that they display "self-control" and lose weight through diet and exercise.

Whether it's called "withdrawal" from an "addictive" drug or an "adverse event" following discontinuation of a medicine that produces "dependence," it hurts -- hurts far worse than the headache shared by the humbled caffeine addicts I joined in a desperate search for a cup of coffee after Hurricane Fran knocked out the power to our brewing machines.

Without medical supervision, withdrawal can kill. For example, users of Klonopin (prescribed to reduce anxiety or prevent seizures) risk status epilepticus, a potentially fatal prolonged seizure, when they abruptly quit using.

While substance abusers are "doing it to themselves," their irresponsible, unproductive and destructive behavior hurts everyone around them. Should we not have compassion for the families bearing the financial burden imposed by a member purchasing drugs and incurring medical and legal costs?

Some day you could suffer from "dependence," the euphemism for addiction that can occur even if you use only prescription drugs as directed by your physician.

Consider recent revelations in the case of the powerful painkiller OxyContin.

Last month a federal judge imposed fines of more than $634.5 million on the manufacturer and three of its top executives, subsequent to a May hearing in which a guilty plea of felony misbranding of OxyContin was entered on behalf of Purdue Frederick Co., while the executives pleaded guilty to a misdemeanor charge of misbranding OxyContin.

A statement by U.S. Attorney John L. Brownlee after the pleas summarized the crimes succinctly: "Purdue Frederick ... and the three executives have admitted that Purdue fraudulently marketed OxyContin by falsely claiming that OxyContin was less addictive ... when there was no medical research to support these claims."

Purdue's fraudulent marketing included misleading physicians by drafting an article, later published in a medical journal, erroneously advising that when used at a particular dosage OxyContin could be discontinued abruptly without producing withdrawal symptoms.

Imagine yourself experiencing withdrawal, desperately searching the streets for OxyContin to relieve your suffering. Would you want to hear, "You did it to yourself," or want compassion instead?