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Drug Abuse Treatment for Criminal Justice Populations

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					Drug Abuse Treatment for



   What Do We Know?

         Nora D. Volkow, M.D.
         Nora D. Volkow, M.D.
                Director
                 Director
    National Institute on Drug Abuse
    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
      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
                                                                            Location TX Received
    In 2005 An Estimated                            Self Help Group
                                                    Self Help Group                                             2.1
                                                                                                                2.1
   23.2 Million Americans                          Outpatient Rehab
                                                   Outpatient Rehab                                 1.5
                                                                                                    1.5
Were Dependent On or Abused                          Inpatient Rehab
                                                     Inpatient Rehab                        1.1
 Any Illicit Drugs or Alcohol                                                               1.1
                                                  Outpatient Mental
                                                  Outpatient Mental                         1.0
                                                                                            1.0
                                                      Health Center
                                                      Health Center
 But…Only 3.9 Million (17%)                       Hospital Inpatient
                                                   Hospital Inpatient                 0.8
                                                                                      0.8

     of These Individuals                           Private Doctor’s
                                                    Private Doctor’s
                                                             Office
                                                              Office
                                                                                0.5
                                                                                0.5
 Had Received Some Type of                         Emergency Room
                                                   Emergency Room              0.4
                                                                               0.4
  Treatment In the Past Year                           Prison or Jail
                                                       Prison or Jail         0.3
                                                                              0.3
                                                                        0
                                                                        0     .5
                                                                               .5     1.0
                                                                                      1.0         1.5
                                                                                                  1.5     2.0
                                                                                                          2.0     2.5
                                                                                                                  2.5
                                                                            Numbers in Millions
                                                                            Numbers in Millions
      Source: 2005 NSDUH, National Findings, SAMHSA, OAS, 2006.
      Source: 2005 NSDUH, National Findings, SAMHSA, OAS, 2006.
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
                   ALL                DEPENDENCE
                                      DEPENDENCE                  ABUSE
                                                                  ABUSE

          24 or younger           25-34        35-44       45-54       55 or older
Source: Substance Dependence, Abuse and Treatment of Jail Inmates, 2002, DOJ, BJS, 2005.
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)

 80                                                                                      69 *
                      Drug-Free                          Arrest-Free
                                                                                  55 *
 60


                                             35 *
 40
                                   27 *                        29           28
                            17 *
 20
                  5
                                           +




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                                                                      C rop
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                                                                                  C
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            R
           C



          C




                                                                               C
                                                                        D

* p < .05 from Comparison
* p < .05 from Comparison          Martin, Butzin, Saum, & Inciardi (1999), The Prison Journal
                                   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                        METH Abuser
                               (1 month detox)                   (24 months detox)

         Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.
                                                                                                                 Evaluation of A Hypothetical Treatment
                                                                                                                 Evaluation of A Hypothetical Treatment
                                  Relapse Rates Are Similar                                              10
                                                                                                                                HYPERTENSION
                                                                                                                                HYPERTENSION
                                   For Drug Dependence &                                                     9




                                                                                          Symptom Severity
                                                                                          Symptom Severity
                                                                                                             8
                                    Other Chronic Illnesses                                                  7
                                                                                                             6

                            100
                            100                  Addiction Treatment                                         5


                             90
                             90
                                                     Does Work                                               4
                                                                                                             3
% of Patients Who Relapse
% of Patients Who Relapse




                             80
                             80                                                                              2
                                                                                                             1
                             70
                             70
                                                                 50 to 70%


                                                                              50 to 70%
                                                                 50 to 70%


                                                                              50 to 70%
                                                                                                             0
                             60
                             60                                                                                     Pre       During     During     During       Post
                                     40 to 60%
                                     40 to 60%




                                                                                                      10
                             50
                             50                                                                                                       ADDICTION
                                                                                                                                      ADDICTION
                                                     30 to 50%
                                                     30 to 50%




                                                                                                             9
                             40
                             40                                                                              8




                                                                                          Symptom Severity
                                                                                          Symptom Severity
                             30
                             30                                                                              7
                                                                                                             6
                             20
                             20                                                                              5
                             10
                             10                                                                              4

                              0
                              0     Drug     Type I Hypertension Asthma
                                                                                                             3
                                     Drug     Type I Hypertension Asthma                                     2
                                  Dependence Diabetes
                                  Dependence Diabetes                                                        1
                                                                                                             0
                                           Source: McLellan, A.T. et al., JAMA,                                    Pre       During     During      During      Post
                                           Source: McLellan, A.T. et al., JAMA,
                                              Vol 284(13), October 4, 2000.
                                               Vol 284(13), October 4, 2000.                                     Source: McLellan, AT, Addiction 97, 249-252, 2002.
                                                                                                                 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

                                            In Treatment
                                        C vs. C+M, C vs. C+M p< .001


                                            Urine Test Positive
                                        C vs. C+M p< .01



                                         N=166


    C = Counseling Only;
    C+T = Counseling & Treatment Referral;
    C+M = Counseling & Methadone Started in Prison
                                              Preliminary Analysis: Tim Kinlock, et al., 2006

				
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posted:7/18/2013
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