# Presentation: 413980

## TREATMENT SERVICES

**             **
**    **

**    ****in the **

## Drug Use Correlates with Crime

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**70**

**80**

**90**

**100**

**Atlanta**
**Birmingham**
**Chicago**
**Cleveland**
**Dallas**
**Denver**
**Detroit**
**Ft. Lauderdale**
**Houston**
**Indianapolis**
**Los Angeles**
**Miami**
**Minneapolis**
**New Orleans**
**New York City**
**Omaha**
**Philadelphia**
**Phoenix**
**Portland**
**St. Louis**
**Salt Lake City**
**San Diego**
**Seattle**
**Washington DC**

**Percentage of Male Arrestees**
**Testing Positive for Any Drug in 1998**

***Source: 1998 Arrestee Drug Abuse Monitoring Program (ADAM)***

***Drug Use Correlates with Crime***

## How Can We Break the Cycle

***How Can We Break the Cycle***
***of Drugs and Crime?***

## Treating Drug Abuse and Addiction

**Treating Drug Abuse and Addiction**
**Can Help!**

## We’ll Talk More About This Later...

## What It Is That We Are Treating

***For Now, Let’s Talk A Bit About...***

## How Does the Compulsion

***That Characterizes ***
***Addiction Come About?***

## Prolonged Drug Use Changes

**the Brain In Fundamental**
**and Long-Lasting Ways**

## Source: Wang, G-J et al., Neuropsychopharmacology, 16(2), pp. 174-182, 1997. 

***Source: Wang, G-J et al., Neuropsychopharmacology, 16(2), pp. 174-182, 1997. ***

## Dopamine Transporter Loss After

**Comparison Subject       METH Abuser**

**Dopamine Transporter Loss After**
**Heavy Methamphetamine Use**

***Source: Volkow, N.D. et al., Am J. Psychiatry, 158(3), pp. 377-382, 2001. ***

## Dependence of Verbal Memory on Striatal  DAT

**R = 0.70**
**p < 0.005**

**R = 0.64**
**p < 0.01**

**Interference recall**

**Delayed recall**

***Source: Volkow, N.D. et al., Am J. Psychiatry, 158(3), pp. 377-382, 2001. ***

## DAT Recovery

***DAT Recovery***
***with prolonged***
***abstinence from***
***methamphetamine***

**Normal Control**

**Methamphetamine Abuser**
**(1 month detoxification)**

** ****Methamphetamine Abuser **
**(24 month abstinent) **

**        ****[C-11]d-threo-methylphenidate          **

***Source: Volkow, N.D. et al., Journal of Neuroscience, in press.***

## Slide 13

## Slide 14

## We Do Know that the Brain 

**Circuitry Involved in Addiction**
**Has Similarities to that of **
**Other Motivational Systems **

**We Don’t Know the Exact Switch**
**BUT...  **

## Slide 16

## Natural Rewards Elevate Dopamine Levels

**Natural Rewards Elevate Dopamine Levels**

## Slide 18

## Drugs Usurp 

**               ****Brain Circuits**

**                                                  **
**                           ****and **
**                           ****Motivational Priorities **

## Cocaine Craving:

**Cocaine Film**

**Erotic Film**

**Cocaine Craving:**
**Population (Cocaine Users, Controls) x Film (****cocaine****, ****erotic****)**

**Garavan et al A .J.  Psych 2000**

**IFG**

**Ant Cing**

**Cingulate**

**Signal Intensity (AU)**

**Controls      Cocaine Users**

## Addiction Is A Brain Disease

**Addiction Is A Brain Disease**
**Expressed As Compulsive Behavior**

**Both Developing and **
**Recovering From It Depend on**
**Behavior and Social Context**

***This is why we say.....***

## That’s Why Treatment Is Essential!

**That’s Why Addicts Can’t Just Quit**

## Let’s talk about

***Let’s talk about***
***Treatment:***

## We’ve Identified Some of the

**We’ve Identified Some of the**
**Fundamental Principles**
**that are Important for**
**Drug Abuse Treatment**

## Slide 25

## Medications Like Methadone Help to 

**Medications Like Methadone Help to **
**Stabilize An Addict’s Brain’s Chemistry**
**and Change their Brain Back!**

## Metabolite Levels in Control Subjects and 

**In Short- and Long Term**
** ****Methadone Maintenance Treatment (MMT) Subgroups**

**9**

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**11**

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**13**

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**% Metabolite Level**

**Short-term**
**MMT**

**Long-term**
**MMT**

**Control**

**%PCr**

**%PDE**

******

*******

*****

**Source:  Kaufman, M.J. et al., Psychiatry Research: Neuroimaging Section 90, pp. 143-152, 1999.**

## We’re Beginning to Understand

**We’re Beginning to Understand**
**the “Black Box” **
**of Drug Addiction Treatment**

## Treatment Process and Outcomes Model

**Modified from: Simpson, 2001 (**_**Addiction**_**)**

**Treatment Process and Outcomes Model**

**Supportive**
**Networks**

**Personal Health Services**

**Social Support Services**

**Sufficient**
**Retention**

## Slide 30

## Slide 31

## Treating Drug Abuse and Addiction

**Treating Drug Abuse and Addiction**
**Can Help!**

## Percent Offenders Arrest-Free 3 Years After Release CREST Work-Release Therapeutic Community and Aftercare

**Percent Offenders Arrest-Free ****3 Years After Release**** CREST Work-Release Therapeutic Community and Aftercare**

**Comparison**

**(n=210)**

**CREST**

**Completers +**

**Aftercare***

**(N=69)**

**Martin, Butzin, Saum, & Inciardi, 1999, **_**The Prison Journal**_

- *p<.05 significantly different from comparison group

## Outcomes at 12 Months: 

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**49.7**

**33.9**

**44.9**

**40.2**

**38.9**

**8.2**

**Outcomes at 12 Months: **

**Reincarceration (N=715)**

**(N=36)            (N=97)**

**Wexler, H.K., De Leon, G., Kressel, T.G. & Peters, J.  (1999).  The Amity Prison Evaluation: Reincarceration Outcomes.**
_**Criminal Justice and Behavior**_**, 26(2), 147-167.**

## Outcomes at 24 Months: 

**Outcomes at 24 Months: **

**Reincarceration (N=263)**

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**67.1**

**43.3**

**57.5**

**48.8**

**60.0**

**14.0**

**Wexler, H.K., De Leon, G., Kressel, T.G. & Peters, J.  (1999).  The Amity Prison Evaluation: Reincarceration Outcomes.**
_**Criminal Justice and Behavior**_**, 26(2), 147-167.**

## Percent Returned to Prison within

**3 Years Post-Parole**
** **
**     ****Wexler, H.K., Melnick, G., Lowe, L., & Peters, J.  (1999).  Three-year Reincarceration Outcomes for Amity In-Prison   **
**     ****Therapeutic Community and Aftercare in California.  **_**The Prison  Journal**_**, 79 (3), 321-336.**
** **

**Control**

**(No Tx)**

**Treatment**
**Exposed**

**(N=189)**

**(N=289)**

**(N=73)**

**(N=154)**

**(N=62)**

**Prison**
**Dropout**

**Completed**
**Prison TC**

**Completed**
**Amity Aftercare**

**75.0**

**69.0**

**82.0**

**79.0**

**27.0**

**% Reincarcerated**

## Slide 37

## Slide 38

## This Is All Great

***BUT...***

## How Can We As A Nation

***Make Optimal Use of the Advances***
***Being Made in Science?***

## DRUG ABUSE and ADDICTION

**We Need To Let Science Move Us**
**Toward a New National Discourse on**
**DRUG ABUSE ****and**** ADDICTION**

## Principles

**Principles**
**of the**
** ****Discourse**

## Principles:

**Principles:**

**No simplistic**
**polarizing of issues**

## We Need to Stop Polarizing

**We Need to Stop Polarizing**
**Drug Abuse and Addiction**
**Related Issues!**

## In Framing A 

**In Framing A **
**Drug Abuse and Addiction Strategy**
**the Answer Has To Be**

## Principles:

**Principles:**

**No simplistic**
**polarizing of issues**

**No more simplistic**
**metaphors**

## No More 

**No More **
***“******War on Drugs”***

## Principles:

**Principles:**

**No simplistic**
**polarizing of issues**

**No more simplistic**
**metaphors**

**Employ comprehensive**
**public health/public**
**safety-like strategies**

## The Good News...

## Approaches to Addressing 

***Approaches to Addressing ***
***Drug Abuse and Addiction***

- and

***We Are Moving Toward***
***A Better Blending of***

## Percentage of Correctional Facilities Providing

**Substance Abuse Treatment, 1997**

**Source: SAMHSA, Substance Abuse Treatment in Adult and Juvenile Correctional Facilities:**
**Findings from the Uniform Facility Data Set 1997 Survey of Correctional Facilities, 2000.**

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**90**

**100**

**Total**

**Federal**

**State**

**Jail**

**Juvenile**

**Percent**

**(n=7,539)**

**(n=129)**

**(n=1,183)**

**(n=3,114)**

**(n=3,113)**

**40%**

**94%**

**61%**

**34%**

**37%**

## We Don’t Know Much About

**the Quality of the Programs**
** ****Being Used...**

**Or the Number of Slots **
**Being Provided**

***The Problem is...***

## If Treatment Access and Quality Are Inadequate It Won’t Work!

***The Problem is...***

## Moreover, There Are Special

**Barriers For Using Medications in **
**Criminal Justice Populations**

## Misperceptions About Addiction

**Misperceptions About Addiction**

## Fear of Using Medications In Prison

## Misunderstanding About Methadone

## Slide 58

## Slide 59

## Metabolite Levels in Control Subjects and 

**In Short- and Long Term**
** ****Methadone Maintenance Treatment (MMT) Subgroups**

**9**

**10**

**11**

**12**

**13**

**14**

**15**

**16**

**% Metabolite Level**

**Short-term**
**MMT**

**Long-term**
**MMT**

**Control**

**%PCr**

**%PDE**

******

*******

*****

**Source:  Kaufman, M.J. et al., Psychiatry Research: Neuroimaging Section 90, pp. 143-152, 1999.**

## Science Is Enabling Us

**Science Is Enabling Us**
** ****To Address The Full Complexity of**
**Drug Abuse and Addiction!**

## Let’s Use the SCIENCE  

***Let’s Use the ******SCIENCE ****** ***
***To Help Get It Right!***

## Slide 63