Transcript Drug Abuse Treatment for Criminal Justice Populations

Drug Abuse Treatment for
What Do We Know?
Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse
Drug addiction is a brain disease
that affects behavior
Decreased Brain Metabolism in Drug Abuse Patient
High
Control
Cocaine Abuser
Decreased Heart Metabolism in Heart Disease Patient
Low
Healthy Heart
Diseased Heart
Sources: From the laboratories of Drs. N. Volkow and H. Schelbert
Although Treatments For Addiction Are Available,
They Are Not Being Widely Used By
Those Who Need Them
Location TX Received
In 2005 An Estimated
23.2 Million Americans
Were Dependent On or Abused
Any Illicit Drugs or Alcohol
But…Only 3.9 Million (17%)
of These Individuals
Had Received Some Type of
Treatment In the Past Year
Self Help Group
2.1
1.5
Outpatient Rehab
Inpatient Rehab
1.1
Outpatient Mental
Health Center
Hospital Inpatient
1.0
0.8
Private Doctor’s
Office
Emergency Room
0.5
0.4
Prison or Jail
0.3
0
.5
1.0
1.5
2.0
Numbers in Millions
Source: 2005 NSDUH, National Findings, SAMHSA, OAS, 2006.
2.5
U.S. Adult Offender Population
Drug use involved in > 50%
of violent crimes and 60-80%
of child abuse/neglect cases
(NIJ, 1999)
Corrections officials estimate
70-85% of inmates need drug
treatment (GAO, 1991)
68% of jail inmates report
regular drug use (BJS, 2005)
Substance Dependence Or Abuse
Among Jail Inmates by Age
80
70
60
50
40
30
20
10
0
ALL
24 or younger
DEPENDENCE
25-34
35-44
ABUSE
45-54
55 or older
Source: Substance Dependence, Abuse and Treatment of Jail Inmates, 2002, DOJ, BJS, 2005.
Continuity of care is essential for drug
abusers re-entering the community
Delaware Work Release TC (Crest) + Aftercare
100
Drug-Free an Arrest-Free 3 Years After Release (N=448)
69 *
80
Drug-Free
Arrest-Free
55 *
60
35 *
27 *
40
29
28
17 *
20
5
0
* p < .05 from Comparison
Martin, Butzin, Saum, & Inciardi (1999), The Prison Journal
Through Over Three Decades
of Scientific Research We Have
Learned An Enormous Amount
About Drug Abuse and Addiction
and Its Treatment in
Criminal Justice Populations
Partial Recovery of Brain Dopamine
Transporters in Methamphetamine (METH)
Abuser After Protracted Abstinence
3
0
ml/gm
Normal Control
METH Abuser
(1 month detox)
METH Abuser
(24 months detox)
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.
10
HYPERTENSION
9
Symptom Severity
Addiction Treatment
Does Work
8
7
6
5
4
3
2
Drug
Type I Hypertension Asthma
Dependence Diabetes
0
Pre
During
10
During
During
Post
ADDICTION
9
Symptom Severity
50 to 70%
50 to 70%
1
30 to 50%
100
90
80
70
60
50
40
30
20
10
0
40 to 60%
% of Patients Who Relapse
Relapse Rates Are Similar
For Drug Dependence &
Other Chronic Illnesses
Evaluation of A Hypothetical Treatment
8
7
6
5
4
3
2
1
0
Source: McLellan, A.T. et al., JAMA,
Vol 284(13), October 4, 2000.
Pre
During
During
During
Post
Source: McLellan, AT, Addiction 97, 249-252, 2002.
Medications are an important part of
treatment for many drug abusing offenders
Maryland Prison Study: Treatment Linkage
and Opiate-Free One Month Post Release
80%
70%
60%
50%
40%
30%
20%
10%
0%
-10%
69%
In Treatment
60%
C vs. C+M, C vs. C+M p< .001
49%
40%
29%
Urine Test Positive
C vs. C+M p< .01
9%
N=166
C
C+T
C+M
C = Counseling Only;
C+T = Counseling & Treatment Referral;
C+M = Counseling & Methadone Started in Prison
Preliminary Analysis: Tim Kinlock, et al., 2006