will come to order good afternoon and thank you all for being here today's hearing will examine methamphetamine treatment programs their veiled billet effectiveness for addressing the needs of meth victims and their communities i'm very concerned about this issue i fear there is currently a treatment vacuum when it comes to meth despite the fact that the meth epidemic has swept across the country especially devastated our nation's west western states and were areas i'm worried that effective treatment for meth addiction is not available where the people need it the most because the communities most affected are the least equipped in their treatment capable it is to handle the special needs presented by meth users and off repeated assertion is that meth addiction cannot be treated that is incorrect it can be treated we'll hear from successful treatment recipients but the availability of effective programs across the nation is difficult to measure moreover without strong leadership from the white house office of national drug control policy and aggressively tackling the scourge of meth federal measures to address the treatment vacuum will languish despite the tremendous toll this drug is having on our nation the meth epidemic has touched every state in the country draining resources causing serious environmental damage and destroying lives sam says drug abuse warning network known as dawn showed that in the early to mid ninety's methamphetamine use was on the rise in the treatment episode data confirm this treatment admissions for meth use grew through the ninety's increasing five fold between ninety two and two thousand and two the most recent treatment episode data show that fifteen states have higher rates of admission for amphetamine use largely meth than for heroin or cocaine in just those fifteen states there were over one hundred two thousand and missions from fathoming treatment versus seventy three thousand combined for admissions of heroin and cocaine nationwide there were more than one hundred fifty one thousand emissions from vitamin treatment to say that meth is highly addictive is an understatement and it presents unique clinical challenges for treatment math produces a short intense rush followed by a long lasting sense of euphoria addiction to meth is caused by the way the drug alters the brain and leads the users to compulsively seek more math chronic use of the drug also leads to increased tolerance prompting user to take higher or more frequent doses of the drug to get the same effect moreover meth users may also developed severe psychotic and paranoid behavior meth users who do seek treatment often relapse and continue chronic m are currently no medications that demonstrate effectiveness in treating meth addiction but intense behavioral interventions have proven fact is the largest controlled study of meth treatment conducted by the center for substance abuse treatment demonstrated positive post treatment outcome for sixty percent of the treatment sample which reported no meth use and which had urine samples that tested negative for meth none the less traditional treatment programs for alcohol and marijuana are inadequate for dealing with the unique clinical challenges presented by this drug such treatment program sometimes the only treatment option available in communities hardest hit by the meth epidemic result in very poor post treatment outcomes for meth users and this represents our greatest challenge how do we ensure that our federal treatment efforts are addressing the meth epidemic measurable ways in the areas hardest hit by the scourge in many cases very rural areas i look forward to hearing from our witnesses today about the current state of meth treatment options how prevalent how effective and by what measure in the areas where we are falling short i hope our witnesses are prepared to offer some solutions we have by the way had meth treatment witnesses at least six field hearings with us gathered reports of both affective ness the mix and availability in those areas oregon arkansas minnesota immediately come to mind where we've had meth treatment witnesses at our hearings i'm particularly interested in the discussion with our administration witnesses who are present the information on federal of the nationals to the drug abuse nih to the national institutes of health and charles curry administrator of the substance abuse and mental health services administration samhsa and i'm most pleased to say a fellow whose are one of two hooters testifying today  treatment provider side and the recovered meth user side this includes a second hoosier witness leah he's done director for noble county in indiana of the order far beyond center for human services richard ross an associate director of integrated substance abuse programs at u russell cronkite a recovered meth addict there and aaron that noble also recovered addicts and their son joy binkley mr michael harle president and c e o of identity a incorporated mr pat fleming director of salt lake county substance abuse services we welcome all of you i also want to say for the record that malia holst has been our committees subcommittees clerk and today as her last hearing she was been our clerk since april fifth two thousand and four as cheerfully endure the countless schedule and witness changes during the time for hearings here in washington and throughout the united states she is exchanging her time here in the subcommittee for much better things she is getting married later this summer and then she and her husband will be attended dallas the illogical seminary i want to salute her diligent work and consistent ours mr chairman i want to thank you for calling this hearing but i want to start off by saying that i am concerned about the title of the hearing the chairman and i get along very very well we're very good friends and we just about ninety nine percent of things we do in a bipartisan manner but when we say the availability and effectiveness of programs to treat victims of the mathematica demick i have never heard that word use with regards to the people from my district who suffer from cocaine addiction when addiction crack cocaine addiction they're all victims i think we have be very careful with the use of war it's because there is no one in this congress who will fight harder for it to make sure that those who have been victimized by any drugs properly treated the second thing i want to say before i forget i want to thank you mr kerry for your service i understand you'll be leaving your position you have indeed been a breath of fresh air  wherever your journey may take you i am so i feel that we have been so blessed as a nation to have you at the helm of your agency and i just want to take this moment to salute you and thank you chairman again i want to thank you for this hearing on the national institute on drug abuse night and defines drug addiction generally as a chronic relapsing disease characterized by compulsive drug seeking and drug use and binaural chemical and my lack ular changes in the brain numerous studies demonstrate the efficacy of the drug treatment and reducing drug use and related problems and behavior including criminal activity unemployment for health and engagement and risky sexual or drug can solve consumption behaviors that may result in faction which with h hepatitis and other dangerous communicable diseases unfortunately limited public funding for drug treatment puts the benefits of treatment out of reach for many individuals who need and seek treatment but cannot afford to pay the cost out of pocket of the twenty two million americans with substance use disorders in two thousand and three approximately three million people receive treatment leaving an estimated nineteen million americans without treatment services closing the so called gap should be a leading priority of our national drug control strategy and nowhere absolutely nowhere is the need for expanded access to treatment more clear or more compelling than any kind in the context of what has been described as a national meth epidemic methamphetamines is a very potent and highly addictive stimulant drug it has very limited medical use and as a schedule two controlled substance it can be obtained legally only by prescription can be snorted swallowed injected or smoked and it is frequently taken in combination with other drugs in contrast to cocaine which is quickly removed and almost completely metabolized in the body methamphetamine has a much longer duration of action and a larger percentage of the drug remains remains unchanged in the body this results in prolonged stimulant effects some meth users experience psychosis that persists months after the drug has been stopped also because methamphetamine affects the contraction of blood vessels it can result in heart attacks and strokes in relatively young patients meth use is also linked to risky sexual behaviors in creating increasing the risk for transmission of infectious diseases including h like other intravenous drug users those who inject the drug risk contracting h i v when they share contaminated equipment and methamphetamine psychological effects may also increase the likelihood of hiv transmission and accelerate its progression according to the two thousand for national survey on drug use and how nearly twelve million americans have used methamphetamine at least on it has characterized the abuse of methamphetamine as an extremely serious and growing problem once concentrated in a few western states meth use as expanded geographically and to move more diverse to move into more diverse populations the fact that meth can be manufactured from chemicals arrive from retail products has contributed to the spread of small clandestine labs and these labs contribute to a set of additional problems including costly environmental damage and child endangerment and the glad the resulting burden on state and local law enforcement and social services agencies has been enormous according to night methamphetamine addiction can be treated successfully using currently available behavior treatments and neither is currently investing in the development of new medications for methamphetamine addiction and also is pursuing the development of an immunization strategy for the treatment of methamphetamine overdose and in general study shows that clinically appropriate treatment provided by qualified and trained staff is effective  stopping methamphetamine use and that outcomes for meth users are comparable to outcomes to cocaine and heroin use its it is vitally important that we expand funding for programs that support effective treatment services for meth addiction these programs include the substance abuse prevention and treatment block grant the foundation of our public treatment funding infrastructure and programs of regional and national significance such as charted a capacity expansion it is important to note that states have achieved commendable results in block grandsons according to the national association of state alcohol and drug abuse direct in colorado eighty eighty percent of methamphetamine users were absent at discharge in f y two zero three in iowa it's a two thousand and three study found that seventy one point two percent of methamphetamine use is where absent six months after treatment and in tennessee over sixty five percent of methamphetamine users were absent six months after treatment mr chairman we must also provide adequate funding to support the vital research efforts of night on which has devoted an increasing amount of funding to meth research unfortunately as i have noted previously the administration has chosen to devote the climbing percentage of drug control funding to demand reduction programs over the past six years i hope that today's hearing when crea a recognition of the importance of treatment in addressing addiction and related problems and in turn to a reversal of the trend towards the imput sizing domestic prevention and treatment relative to supply reduction efforts abroad y other important hearing and i'm so glad we have a distinguished panel before us today in my part of the country in western north carolina we've been severely affected by methamphetamine use and now now that state law and federal law has acted curbing the availability of it we're still dealing with ongoing repercussions of how to treat people that have been addicted to it and such a harmful destructive and nasty drug that we as a society and as government policy makers we have to make sure that we have the right policies in place and make sure that our treatment dollars are going in the right direction and that there are treatment dollars of vailable to change and so it's important that as a committee we actually look at the veil ability and effectiveness of these treatment programs current current treatment initiatives in western north carolina have shown just as strong  results in actually and in a recent study from two thousand to two thousand and five in my region alone method and admissions to treatment programs have doubled just in three short years and that is being experienced around this one example in my district is through the matrix model it's from what i understand only evidence based program for attacking meth addiction and it's been effective i don't think it's been  largely understood in the community but i look forward to hearing your testimony today about what we should be doing here in washington and in our communities to make sure that the treatment programs are available and i appreciate you taking the time to be here to make your voices heard here in washington d c with this important committee which we serve on and thank you again mr chairman for holding this hearing for ongoing fight to make sure that we have effective drug control and a limb a nation  as well as treatment programs throughout this country thank you mr chairman thank you and i want i want to clarify briefly mr cummings point because i think you raised a very fair point there's a certain amount of sensitivity that we treat methamphetamine differently right now because it's predominately white users and different than urban areas and i think it's very important in the title here i would refer to the crack epidemic that hit it is an epidemic with victims at the same time this isn't like a hurricane where individuals just get hit they also choose to participate so you are simultaneously a victim and somebody who made a personal decision to do this and i absolutely  believe that any distinctions that we would have that would be part of officially different we shouldn't refer to one group as being overwhelmed by a tide and another group bring it upon themselves and that in my hometown the number one there is very little math in my hometown in fort wayne it is around us but it's crack it's heroin it's marijuana and occasionally oxycontin and we need to make sure that we treat everybody regardless of their racial background regardless of their income the same way whether it's in treatment or that we argue that in fact the administration has been less responsive to royalties in the meth thing and we've focused on that here but this committee will continue  long term to make sure that we focus on all the different narcotics yes and i want to i just want to take a moment to thank you for saying what you just said and that means that means a lot to me personally and i'm sure it means a large anybody listening to this hearing thank you we have seen our urban areas ravaged and we need to work together with how to rebuild this and suburban families destroyed in there and rural areas and all these things are need to be a focus of this committee i ask and as consent all members have five legislative days to submit written statements and questions for the hearing record that any answers to written questions provided by the witnesses also be included in the record so ordered to ask unanimous consent that all exhibits documents and other materials referred to director of the national institute for drug abuse national institutes of health and the honorable charles curry administrator of the substance and mental health services administration department of health and human services mr crewe also be joined by dr wesley clark director the center for substance abuse treatment responded in the affirmative thank you for being with us today again i think this might be your first time we've met in my office but welcome to our committee and chairman souter ranking member cummings and distinguished members of the subcommittee thank you for the opportunity to appear before you today to discuss the response to treat needs of populations affected by madam said   as a chemical is a serious unique national problem it is one of the few drugs that can be sent with little expertise or equipment its production can result in significant personal and environmental contamination as a drug messes one of our greatest public health challenges it is highly addictive it can promote brain damage it's heavy medical and psychological toll on individuals can impact their children families communities and the criminal justice system at a national level with co operative efforts of the administration and congress there is a historic nine reduction in teenage drug use over the past four years of specific reference to methamphetamine there is at least a thirty percent reduction in the number of meth lab incidents in meth positive workplace tests in life time among youth over the past two years there's also a significant increase in twelve graders who disapprove of using amphetamines the administration's recently released  control strategy outlined meth treatment initiatives a fifteen percent reduction in meth use a fifteen percent reduction in prescription drug use and a twenty five percent reduction  domestic meth labs over the next three years are the stated goals what or the meth treatment programs that are available in general twenty five percent of the federal budget is targeted billion dollars for the block grant the funds are for treatment providers many of whom provide treatment for abuse and dependence of meth states that elect to prioritize meth treatment can target the money for this population initiative are programs of regional and national significance the zero seven budget request three hundred seventy five million for effective screening and treatment programs which include access to recovery and screening brief center fanchon and referral to treatment these discretionary grants provide flexibility and services for regional and rural needs access to reach covering the zero seven budget request areas sensual recovery support services generally reimbursable through conventional federal treatment resources for example meth addicts require intensive relapse prevention training which is fact early detection and intervention in general medical setting position to identify meth users that enter hospital or clinic vironment seeking treatment for reasons reasons other than for meth abuse the forth program our drug courts the seven budget request sixty nine million dollars for drug programs a fifty nine million dollar increase over the zero six level drug courts effectively divert nonviolent low level of spenders away from prison into supervised treatment and reduced rearrest rates by over fifty percent of the old adult drug court planning initiatives the national drug court institute estimated that ninety two percent were rural a significant proportion of a senses that they will treat are meth related this cohort can cummings and recovery from meth addiction are feasible and possible treatment programs are flexible and adaptable to meth the screening brief intervention and referral to treatment and drug courts identify and help meth abusers or addicts who do not come forward for treatment but come forward for other reasons medical and or legal and then they are steered into treatment and the access to recovery and block grants provide the treatment the president's drug control policy is characterized by vigilance flexibility adaptability and innovative strategies to address emerging drug threats are alternative is to eradicate meth use and provide meth users the opportunity for a renaissance in their lives thank you and i welcome questions from the the problem of drug addiction director of the national drug abuse that phones eighty five percent of all of the research related to drugs we have long recognized the problem of methamphetamine we recognize it not just because it's a very is the recent why they can produce addiction and of all of the drugs of abuse that we know methamphetamine is the one that is most potent in increasing dopamine in the brain it is at least three times more effective than cocaine increasing dopamine in the brain and it is believed that these may be one of the reasons about why it is sold in these from human studies we know that people that get exposed affect their ability to exercise cognitive control and the ability to think clearly however one of the good news indeed is that some of these changes appear to as was mentioned many people believe that methamphetamine cannot be treated though that is extremely difficult to treat and yet we know as has been mentioned before that it can be tre rates of success there are several programs behavioral interventions that have been shown to be effective in the treatment of methamphetamine addiction you're going to be hearing specific early of a with dr rick ross on the magic's model which has been very there all their interventions motivational incentive interventions prevention of relapse that have also shown very positive results however one of the things that we need to recognize in order to be cesspool in the treatment of methamphetamine as is the case for all leadership thank you mr chairman for those kind words and also ranking member cummings for your words earlier that they mean quite a bit the partnership that we've had has been invaluable and i appreciate this opportunity to i'd like to focus on in my oral testimony is our role to more effectively address this issue to officially align and focus our prevention resources and i'd like to begin with prevention samhsa law launched the strategic prevention framework in two thousand and four the framework advances community efforts to prevent drug use using a risk protective factor approach whether we speak about abstinence or rejecting drugs including math tobacco alcohol promoting exercise and a healthy diet we're really working towards the same objective reducing risk factors that exist in the community and exist in an individual's life and promoting protective factors by the end of this school year nearly forty states will be implementing this new approach i'm pleased to say that there are many states that have taken s p f and have definitely aligned it in addressing the methamphetamine issue indiana is one state that i would point out in presenting the award to governor daniels in indianapolis of strategic prevention framework you made a point to say that this is going to be a central element in addressing the math issue in indiana and again we shape strategic prevention framework so that it will address the local needs and work in partnership to address those priority needs that are identified locally and by states and the success of the framework rust a large part of the tremendous work that comes from grassroots community anti drug coalitions and the anti drug coalition effort is very much tied to and we view it as part and parcel of strategic prevention framework and that's why i will continue to work with o and d c p to administer the drug free communities program and this program currently supports approximately seven hundred sixty five community coalitions across the country in terms of treatment sampson's supports treatment and your doctor while several those efforts and again primarily our substance abuse prevention and treatment block grant is a major vehicle and is foundational as has been mentioned here before appropriated nearly one point eight billion dollars the block grant provides forty percent of all state funding for public substance abuse services we also support treatment through competitive grants public and nonprofit private entities apply directly to sampson for targeted treatment funds subcommittees well acquainted with both a block grant and our discretionary grant portfolio let me discuss one program in particular and his two thousand and three state of the union address president bush resolved to help people with a drug problem who sought treatment but could not find it he proposed access to recovery a t r a new consumer driven approach for attaining and obtaining treatment and sustaining recovery through a state run voucher program state interest in access to recovery is overwhelming sixty six states territories and tribal organizations applied and competed for ninety nine million dollars in grants and f y o four we funded grants to fourteen states and one tribal organization in august two thousand and four i'm pleased to say that again there were states who identified methamphetamine as their number one growing problem tennessee and wyoming and they targeted their access to recovery funds to address that issue because the need for treatment  methamphetamine treatment need alone has demonstrated president bush proposed one hundred million dollars for a new cycle of access to recovery grants in the two thousand and seven request of that twenty five million will be focused exclusively on methamphetamine a t r use of vouchers coupled with the state flexibility and executive discretion to target emerging drug trends such as math is creating profound positive change in substance abuse treatment financing and service nineteen million dollars in our budget targeted exclusively toward methamphetamine in terms of treatment and prevention in our proposed zero seven budget that number is thirty four million dollars in terms of increased emphasis and effort toward methamphetamine to help ensure the latest science based services are being provided to people with substance use disorders a true partnership has emerged between sampson and the national institute on drug abuse the result of this collaboration was the development of a treatment strategy for methamphetamine addiction the matrix model which congressman mchenry mentioned earlier and you'll be hearing more about from a dr ross and an other cognitive behavioral protarchus are available on the set of two d v d s produced treatment for stimulant use disorders again giving direction of methamphetamine our national network of addiction technology transfer centers also are critical in our efforts to provide training workshops and conferences to the field regarding methamphetamine i want to stress that these entities are available to states to treatment providers in their region to have the resources and technical assistance that's a scary in order to gain the expertise and the knowledge around addressing methamphetamine recently sam finance to conferences and methamphetamine for states sansa paid for states to bring fifteen people each including state and local officials and providers to hear experts in the field of methamphetamine treatment and research on a well received and much needed opportunity to learn and share information about methamphetamine in conclusion we are striving to do our part sampson to make methamphetamine and continue to make it the priority it needs to be especially in areas of this country where as you say mr chairman the intensity of the consequences of methamphetamine are overwhelming we've been building systemic change also so that no matter what drug trend emerges in the future because we don't know what's going to emerge as we go along we need to be agile we need to be flexible we need to be ready that states and communities will be equipped to address it immediately and effectively and our goal is always to try to reach it before it hits a crisis level mr chairman mr cummings m ms fox as has been mentioned before i'd like to ask if i have a few additional moments to to discuss this being my last appearance in this capacity before you as you know i've submitted my resignation to the president  ill be leaving my current post in sampson on august and i want to express my appreciation to the dedication of all of you mr chairman mr cummings and we've been in many hearings together field hearings and definitely appreciated your ongoing leadership and unwavering support for those people who have addictive this disease in their lives and who are looking to attain and sustain recovery in the pathway s and this committee has stood strong in terms of ensuring that addiction is addressed in this country at times when the public interest in addiction has faded and it comes in waves you've been  wavering you've kept it at the top of the list of priorities my ten years administrator sampson i've also found the subcommittee to be both supportive of what we're doing and at the same time appreciate you keeping our feet to the  fire in terms of bringing on the data what we need to be addressing and i think that's true partnership and i think it's been invaluable to us and as one would expect for khan from congress so it's it's been an honor working for you and with you and and it's been the highest privilege for me to be in this position and this is your your subcommittee has been one of the very very great highlights of my tenure here thank you very much thank you very much for a comment that's the best phrase i've gotten from the executive branch and it's because you're leaving i got further comments on this are there medical differences between methamphetamine it's really unusual because we have two simultaneous tracks going on the united states the mom and pop labs where people are home cooking with their own chemicals and the crystal meth that is the bulk of the users the chaos is caused in the political problem is greatest in the areas where strong environmental damage they're blowing up families they're tying up d task forces all day long while they wait for somebody to come in and the political pressure is on those individuals and those individuals tend to be more predominantly rural that the crystal meth moves into into some into some cities particularly if it moves into cities like minneapolis st paul maha portland but not we haven't seen massive intrusion into cities but does the crystal meth behave on the brain differently than the home cooked and are the chemicals any substantially different do they or does the same treatment process basically work for everybody who uses some form of methamphetamine yeah  we've actually to document the differences between these two compounds and we really don't see a difference so based on the pharmacology it's unlikely to have much of a difference your concern of course asked to do more any comment you can pick it up in the follow up here do you expect as we the state took the lead and started to control pseudoephedrine which is been the fundamental ingredient in the home cooking that partly pushed people over to crystal meth as we've seen in oklahoma start to see and in oregon some degree pushing people to the internet that we have heard rumors one i believe was in the hearing in north carolina that people have started have looked for obviously and the question is are they finding substitute agree on things other than pseudoephedrine that they can mix in and emulate methamphetamine do you believe that's possible or do you believe that by world because the creativity for example with regard to cocaine is what created crack cocaine versus cocaine hydrochloride and there was an enormous difference the basic cocaine was the same but crack cocaine unable to cocaine to be smoked and that enables a rapid bolus of cocaine to enter the brain cocaine hydrochloride which is just a different form was not smokable because if you heated up the entire molecule fell apart so creative chemistry is what we always have to worry about and i don't mean creative in a very positive sense need to look at some recent behavior in terms of what drugs have done the importation issues but also unscrupulous behavior is also an evolving issue mr com that the addiction is very quick and one of you mentioned i think maybe new mexico how fast it is how long it takes for one type of drug situation because i hear that a lot of young women who say they try to crack cocaine and and thought it was just be a one time thing next thing you know they're on it and particularly from women i'm just curious correctly one would have to compare the transition from smoking but once you start to smoke occasionally you become very fast and that i'm not knowledge of any data and i was actually trying to find out if there was so i do not know if i ta because the coalition is gives an opportunity to form leadership and focus on the particular substance abuse drug issues that are  that particular community and strategic prevention framework the reason that the fits so well with the anti drug coalitions is what we expect communities to do is to first  assess all the resources that that community already have going toward drug prevention efforts then embark upon a process of assessing what are the risks back to that community you know is it a transient community is a community that doesn't have a sense of neighborhood connectedness all those things add to to risk factors that could promote substance abuse and there's a list of many others and once they've been barked upon a process of assessing the risk factors that exist as well as protective factors that  can be existing that community they can then make collect the decisions and again the ideal coalition not only brings together concerned parents and school systems but city government brings together  a range of nonprofit organizations brings together boys and girls club and and all those entities that work together they can make informed decisions and we have a list of registry of effective programs  communities that care has a list of evidence based programs for prevention and they can actually begin to make decisions to invest for prevention dollars into addressing those risk factors and if math inside of me is really the emerging problem and is in a community or is the problem and it's overwhelming the resources they can really put an emphasis on that locally in there and we have again technical assistance and resources to help them do that but the  dollars so i think clearly we would say we would agree one hundred billion wasn't enough one hundred million is what was appropriated if we would have had two hundred million we probably could be up to thirty states during that first cycle which could have made it a more tremendous difference and as we as we move ahead we proposed two hundred million the second one hundred million it's been staying at pretty much one hundred million so clearly i think the administration would be in agreement that you need to do more especially in that interest you're exactly right sixty six states and territories were clamoring for it and were only able to make those awards i think we would have been hopeful by now with the original access to recovery plan we would have perhaps up to three to four hundred million dollars if you recall i think the goal was to add significant amounts of additional dollars to to to the treatment budget if you go back to the first year of the first term i think that we could make a tremendous impact on access and access to recovery approach because a state would get an award somewhere around seven to eight million dollars per year if we put that same amount of money into the block grant that gets dispersed i mean if we put access to recovery dollars to battle methamphetamine because in indiana for example or as they did tennessee in wyoming meth is is undercutting so many things in the lives of our people we need to address it they could make much more  impact with a seven and a half million dollar grant than if they end up getting an extra half a million in their block grant so i think those are the types of issues that have to be under consideration in assessing  legislation here and that has had a enormous effect on eliminating the small labs in these rural communities in western north carolina now we certainly have a problem still because tennessee doesn't have as strict of a law about sudafed or in north carolina and so you have some traveling over the mountain across the lines you also have those coming from south carolina tennessee over into my and buy three boxes of of sudafed and i talked to a police officer this weekend who deals with this and he said that they they treat sudafed now like you would treat cocaine or marijuana  they hide it in their automobiles it is a drug in and of itself and in a normal commodity for them to trade in but having said all that the issue that we're dealing with because we've cut down on these labs so much is at the expense of all labs now and the dealing with the property damage and the chemicals you have left the expenses have migrated over to these met addicts addicts who the law enforcement continually have to deal with because you can you can throw them in jail and once you get back on the street they're back on it so that leaves open question for this hearing which is treatment so my question to the whole panel is what what type of partnerships do we need with law enforcement and with treatment facilities because it seems like there's a disconnect law enforcement once to stem the demand but i'd like to hear your feedback on what we can do to stimulate that partnership with pleasure i think that drug courts for a very ideal solution to some of the issues that you've raised drug courts offer a choice of treatment or prison for low level criminal offenders an amazing result of they've had in the community where this exists the difficulty is actually getting what is a pilot project in essence a north carolina state court and the other issue is that else can you say i would say that all of these in terms of the extending drug courts the president's proposal to increase the budget by more than fifty million criminal justice system but it's an extraordinary opportunity not only is going to be increasingly costing our nation but we're actually missing the opportunity of helping those that are afflicted that unfortunately end up with occurring there if you haven't already where there's a philosophy emerging that every court needs to be a drug court eighty to ninety percent of the individuals in the criminal justice system and this is why not as project is so critical have a drug and or alcohol problem over fifty percent of the individuals who are arrested are under the influence at the time of eros and what we find is drug courts have demonstrated this but what we find is that if people are engaged in treatment while they're in prison and you have a literally captive audience so you can you could force treatment there and and the continuity which nora stressed is so critical for attending a center recovery recidivism goes down so i think again there's a lot we can do in growing drug courts but i think the point you're making is we need to also do some urgent things now in the current justice system and i want to command what i'm finding in the justice system to be a role in light and went in terms of more and more understanding this more and more reaching out for help and and again that heightens the awareness as well so i think it's an ongoing process i think it's bringing the models of what's working and making it more the norm in our prison and court system thank you thank  you judge kramer from noble county in indiana told me over the weekend that he was going to convert to drug court it's not like the federal government has to all the time fund that it's nice to have the actual federal funding but this is something that can be done in the process has been implemented if that people are committed i want to ask a couple other medically related questions in looking at treatment for math does why the individual is the reason the individual has chosen to take math make a difference if the solutions are largely behavioral for example in some areas we've learned that math usage is often driven for weight loss particularly among women it seems to be more prevalent there in other areas it may be truck drivers who are trying to stay awake others may be people working on a factory assembly line trying to increase their work others may just be looking  high of some sort does why you got involved in mast impact the treatment process you're very perceptive here because in general a lot of the community has always waited for the magic bullet that would cure that they've been terribly disappointed well it's not surprising because if you do not address the issues that lead up person to take the drug that as you pointed out many times as not just to get  better and perform better however with repeated administrations the problem gets compound that because your mental disorder is not treated and can be very right but you start to become that ordinary important and that's one of the things with on workplace drug testing which is proven the very fact that the employer's environment encourages them issues in this case a stimulant then the person is being rewarded for misusing stimulus i had a done not recently but a while ago more than sixty percent of the people who use methamphetamine took it initially because it was available and that's a very important factor the second issue that i think is important with regard to treatment of comes is that the age of onset and the amount of use can have an enormous influence on whether or not treatment is successful so that the earlier a child or an hour an adolescent or a a young adult is identified with regard to methamphetamine a far higher probability that they will be successfully treated and that is why i think that being able to identify people who don't show up with a problem but show up sporadically in emergency rooms and trauma centers or even in college screening such as what our administration is planning with regard to the  program is going to have an enormous influence on catching people before they progress to addiction one of the things that became apparent in major league baseball as we did the hearings in this room is is that  steroids well serious problem are more common in fact that some baseball teams actually had the pills available in the locker rooms not necessary authorized by the team itself but certainly had shut it down to their training and called them different names and we've been trying to address this question could you describe a little bit of the medical differences between amphetamines and methamphetamine and some of the range  its ability to increase dopamine as well and it's ability to increase norad's reynold in which is the all the property that's associated with enhanced alertness that they were referring to you need to stay awake for many hours what if there are kids doing in college they are taking an an amphetamine both of them are highly dangerous when abuse inappropriately amphetamine can be highly dangerous cocaine on the other hand is less potent than the fs i mean but because it has very unique it goes in and out of the brain very rapidly that methamphetamine more than we hear in other drugs users tend to be paranoid and and behave differently of law enforcement approach is more likely to be violent as you were describing this with with the different potential cold during the dependencies and masking other things is it the drug that's causing the paranoia or were to some degree they were already paranoid and it got exaggerated in other words they may be attracted to a person cases paranoia and the underlying sciri is schizophrenia is a disease where there's too much don't mean not necessarily being produced but there's too much activity in the brain and set a means parallel that of by producing accessed opening so there is a very clear parallel between the two in fact emergency room physicians have someone comes in with psychosis and they want to career a lot on co occurring dependencies and that this is the first hearing in all the hearings we've had on meth i think we've had ten now or more in the subcommittee where the subject of  occurring dependency may have led to somebody using other words it isn't just that they want to get a faster piece rate or stay awake or get high that some individuals may have actually kind of self for scribed this thinking it was because it mascot's it's their other symptoms it may have actually made it worse is there a study to that effect is this common  is it in certain areas of the country more what are we looking at here because of it and in fact if it if it makes disease more severe there's a potential but not the type of the problem as well as mental illnesses and there's a range of mental illnesses and and i could be key is the term co occurring sometimes they do co occur and we have the data demonstrate that in many times when they do co occur what we've found in our systems is that we have failed those individuals because we're either treating one or the other disorder is that a ball in a in a particular sort of where our knowledge ing it and many times the disorders get worse if you're not treating both and so again we know more today than ever before about i think in general you do have situations where people may have an underlying bipolar disorder schizophrenia that's been on diagnosed and the use of drugs or substances has been a form of self medication and you see that in and they may be treated for addiction and if that goes on diagnosed it's likely that they're going to be going back need need to be sorted out but the key is i think having an understanding of primary health care settings and mental health settings and substance abuse settings that we need to do an assessment around the co occurring  issues and make sure any doors right door to assure people are receiving the appropriate treatment at the appropriate level depending on the nature of the co occurring disorders in any additional comment and that could you also address if it i have not gotten it if they had not smoke so that consensus right now self draw has not been shown to produce a schizophrenia or a psychosis that is a reversible i think some of our best evidence linking the use of drugs with ultimate consequences is with regard to alcohol in a study that began in the one nine hundred forty s and  to this day of cohort of harvard graduates as compared with other workers in the boston area it was found that people who negotiated alcohol use during their youth in adolescence and subsequently had a much higher incidence of depression consequently than people who did not and that's true whether or not you graduated college or whether or not you did not go to college treatment protocol for cocaine meth addiction that is being marketed aggressively by a los angeles based health care services management company some addiction there's something something unique about methamphetamine its nature that draws people from the beginning as opposed to cocaine and other words in the african american population and the question for many years people say well the cast to do with the way that kids are brought up in their families but recently for example we've known that african americans have a gene that goes for the broad thing that were are is partly because it can't be smelled disease and that's why they're in the national forests and elsewhere they could find the a gradient but neither crystal meth nor the home cook meth has been very prevalent the big cities but in our hearing and in minneapolis and you need to look at minneapolis because in hennepin county we had testimony from the drug court and the i think it was the head of the state drug treatment that in one neighborhood in minneapolis an african american distribution organization switched to crystal meth and all of a sudden sixty percent of the people hitting the emergency room in the drug court were african american it isn't clear where that sustained itself whether it was a brief because  distribution group change but that's the only hearing we've had in the country where we saw it hit an urban area in the distribution change all of a sudden in the whole city one neighborhood took over the drug addiction problem in the whole city of minneapolis now the question is is this going to repeat itself there's been a little bit in new orleans a little bit in detroit my understanding is almost in portland have started to see it in the minority community but there should be starting to get enough of a sample to be able to test the  it's that we have our first urban exposure even in my own home district fort wayne has no mass elkhart has has cracked south bend it is still cocaine and heroin even in  where the whole area around the city of warsaw went to the lake which may be as twenty thousand people there's no meth in the town in the bigger city it isn't a question of minority majority populations to some degree there seems to be an urban rural phenomena to this even personal map but this is the big challenge because in anticipating where this drug is going to move if there is indeed a biological difference then that makes a big difference where the drugs going to move if there is not a biological difference but as a indeed you dealing with multi factorial issues the data show that black and african american people who present for treatment only zero point one percent are users but that's still zero point one percent is not zero and i think that's a key of color african american communities should not assume that this is not going to be a problem because it hasn't been a problem the fact is you have to america has been spared problem it should recognize that the problem can come and percent which is the largest among native hawaiians and other pacific islanders so what we're dealing with here is combination of access biology in terms of genetics preference to importation one hundred one hundred fifty people you can be riding down the street and all of a sudden you see people coming from everywhere and then if you hang around long enough you see them lined up straight in a row and sometimes on a main thoroughfare and if you watch long enough what'll come what will happen is a drug dealer along with his other his comrades will come and give them samples and everybody stands there and it's like it's almost like somebody says at one o'clock at northam monro this is going to happen and they are they don't want time they are disciplined they stand straight in as well organized they've got lookouts everywhere and this can be and i'm told in broad daylight now what am i what am i when i get into drug sales people are very sophisticated they are some of the most brilliant people probably out there they can actually operate in a prize under the nose of the f b i the local police the state police and they get and they do it very effectively and what are they trying to get money so says to me that if they can come up with and by the way they all they and they and what they too is that the reason why they're giving out these samples of course is to say my product is better than your product so come back tomorrow and you'll you can buy it today is free and so it seems to me that somewhere in this country somebody would say you know over there in indiana they got this stuff call meth is working and is making people high and guess what it stays in your system a long time and so maybe you can get better bigger bigger bang for your buck i mean just logical these people out to make money and so i just and so i wonder what it is that we keep that person from coming over and at lease if they can do this in the tell us what we've got to deal with i just cannot am i can't believe you know the reason why i make all of it would dr vocal was saying and humans out here it makes a lot of sense but i gotta tell you a lot of people don't think it's going to get to the city's ideal i do just because of the profit yes just to add on to this if one gives animals access to men instead of maine or inside of maine or any of the emerging drugs they will self administer it as robustly humans if not more so in fact some of them will kill themselves with on limited access so this is a biological property our human and our  coercive as well as the treatment aspect so there are consequences to failing and what is so interesting in a number of areas in our society such as the medical community  because of an impairment their relapse rate is much lower because the consequences are the loss of their medical license and in the department of mandatory drug  relatively small yet united states time you separate out mandatory entrance in arkansas it was mandatory going into the drug court in other states is voluntary going to the drug court also that the number of drugs you're dealing with also a critical question is if you catch him earlier catch him late even in some of our counties the drug court judge tends to get them earlier in math then the judges some of the other judges we have one judge in one of my counties who has that person is coming up for the third since of cooking meth and they haven't been prosecuted yet on the first one that and that makes the measurement difficulties very difficult but as we get more experience of drug courts the emergency rooms of the great minds for information to try to do this and  appreciate the service of all of you thank you for being patient with our questions today thank you for making it in a form that we can understand it was very informative to each of us and we thank for that of the second panel could come forward and remain standing so that the incorporated and pat fleming director of salt lake city substance abuse chairman actually i'm very encouraged some of the things i've heard today and specially for the progress in the drug courts for nearly twelve years i had the honor to serve our nation as executive chef of blair house the president's guest house my tour of duty i served presidents ronald reagan george h w bush and bill clinton as well as nearly every world leader of this year are today on the author of two successful cookbooks my work has appeared in several top food magazines and i continue to contribute food related articles publications like the washington post and rather than write the latest celebrity chef trend cookbook i've chosen to write cookbooks that encourage quality family time promote a sense of community and foster traditional american family values like a return to sunday dinner and return to family picnics that continue today with my career as a public speaker and working with the faith based organizations community organizations for the purpose of encouraging families and family values in the sense of community my family value message is not a marketing plan in august my wife and i will celebrate our thirty fourth anniversary she works for fairfax county school system here where the parents of three grown adult children but the one subject i have not spoken about publicly and something that i generally do not talk about at all is that i was addicted to methamphetamine or speed crystal meth during my adolescent years indeed you'll be hard pressed to find anyone that i worked with in washington d c or worked in the hospitality industry over the last thirty years who didn't believe that such that was even possible find no pleasure in telling or even recalling the self imposed tell but it's so far removed from my life but the epidemic squeaking in our country has compelled me to come forward and tell my story is a story of restoration and redemption staying up for days and weeks on end without sleep is no excuse from reality meth addiction is self destructive it is a slow suicide and it's also a visible call for help i knew full well the risks and downside of methamphetamine use we  say speed kills speed thrills it was a catch phrase my spiral into this hell of meth addiction was severe self mutilation chaos psychotic exit episodes and a frightening and violent hallucinations and dementia i came very close to pulling the trigger to end the madness that my life had become i know those who did i know those who died by the needle we were not the children of unfortunate circumstances the los angeles community where i grew up with similar to local communities surrounding washington d c like arlington falls church were middle class and upper middle class families my parents friends were real estate brokers doctors contractors school teachers dentist business owners executives and engineers for companies like douglas northrup and h i'm not one who believes that drug addiction is a disease per se it is an illness yes it's not something that you can catch like a community of disease like measles or chicken pox is a certain self inflicted part to this disease i do understand the idea and that is why or to sort of let people off the hook in counseling and provide an emotional short term feel better fix but those who have such a low self image that they are willing to engage in this kind of deadly behavior do not need to have additional deal dumped on them but the loss of her responsibility while attractive in the short term can also take away the impetus for change if we are simply can creatures of our genetic make up predisposed to some disposition or some unfair twist of fate we're sadly condemned and unable to rise above our very circumstances equally i'm concerned as has been expressed here today that some might suggest that method that i mean addiction cannot be effectively treated clearly my life is evidence to the contrary years between one hundred sixty five and one hundred seventy found me in and out of the juvenile court system and eventually the california youth authority i owe a lot to some very dedicated counselors and to a parole officer who was more concerned about seeing me delivered and keep me locked up my road to recovery began with a very simple act though and uncle finding me days my body reduced to that of some sort of holocaust survivor simply put his arm around me and bide me and to have something to eat there was no scolding no lecture no condemnation just loving concern serve with a bowl of peaches today i applaud groups like casa who foster the values found around the family table and the quality companies to support their efforts it does take a village and effective drug treatment program especially for the highly addictive methamphetamine must be comprehensive faith in god the support of my church my family dedicated schoolteachers and community organizations like the y m c a coupled with a viable quality psychological counseling and a state run system that worked brought me to a place of transformation and renewal in one nine hundred seventy one of the first jobs i took as a real result my life was that of a prep cook you have to start somewhere still without a high school diploma little consistent work experience in a trouble adolescence i faced many challenges people were not eager to hire me but only takes one exception in the first half that i worked for had a policy of hiring the worst applicants his thought was that if you gave someone a second chances someone had given him the person would rise to that opportunity and work harder than someone with other choice his views carried over throughout my career being an executive chef like any business manager is part babysitter part marriage counselor part drug counselor part cop part coach and part psychologist working with lower income employees here in washington d c area before i joined blair house who had limited training limited educations and limited opportunities was a challenge and met those challenges by listening and recognizing outside influences faced by employees also affected their performances when i was in the hospitality industry i found that many of my employees were affected by the social plagues like domestic violence and substance abuse many of the employees that i had working for me hotels in washington d c and atlanta became involved in methamphetamines and fetta means because they're working two jobs support their families i personally paid employees rent or cover their time off for treatment to compensate for the limited resources that were available rather than lose otherwise good employees the social fabric of america is changed too often teachers are no longer part of the communities where they work most cannot afford to be the lack of affordable health care means a family whose children struggle with addictive behavior often have few outlets for professional treatment i know families who have mortgages their lives lost their homes and spent their life saving to save a child i know families who seen their children relapse into the frightening hell of drug addiction simply because the thirty day maximum for mental health treatment and the twenty allowable follow up counseling sessions are run out these are the ones with health care to my knowledge fairfax county one of the country's most of fluent communities has only one facility available for these kinds of programs according to recent washington post article americans feel more and more isolated and have fewer people that they feel they can confide on in times of difficulty robert putnam has chronicled these alarming social trends and monumental work bowling alone  revival of the american community i'm concerned learned about the mixed messages that we seem to be sending out today we have a lock him up and throw away the key mentality too often much specially a concern about this when it comes to juvenile justice fourteen fifteen and sixteen year olds are not adults i do believe we should have little tolerance for those who manufacture and distribute dissed dangerous drugs for profit in this truly the love of money is the root of all evil those who market their which is brew of toxic chemicals for the sake of profit are a pariah on society and should be dealt with accordingly but those who support a habit must be treated as a victim and a perpetrator i truly wonder sometimes with a focus on interdiction rather than on treatment if i would  have the same opportunity to rebuild and reclaim my life thirty five years ago as i have i was fortunate my arrests and convictions all took place before my eighteenth birthday because i successfully completed my parole without incident for five years for my relation the california youth a my juvenile record was expunged as it should have been the difficulties of my adolescence behind me i was allowed to rebuild my life rise to the top of my craft where i provided for my family and serve my country with honor and distinction trustworthiness is not having about having lived a perfect life it's about honesty and integrity i believe to be fully redeemed we must be fully restored william penn believed that and when he and his followers laid plans for philadelphia the first american city they built a penitentiary rather than a then a prison it was a place of solitude where one could consider their actions come to penzance and return to society i'm not a recovered act addict is simply one slip away from a mission i'm a highly successful professional a father a husband married thirty four years a church member a member of my community who long ago almost another life ago struggled with addiction because i struggled with self doubt self hatred self destruction and a dissolution moral crisis addiction is a symptom of the deeper plague to effectively treat addiction we must have a comprehensive plan to address the root causes left untreated those causes will only reappear in service of a different form i'm here by god's grace to be sure but i'm here because those around me cared enough to come alongside me an offer help my story is one of success i'm one for whom the system worked for the unconditional love of family community government resources family doctor faith based organizations and self determination and good counsel came together to save a life fourteen years my wife and i met together we wanted to get how we wanted to help to get help to stop hurting ourselves and our children treatment i went into four different treatment programs but each program was set up for single adults that's going to bring the children with me so i kind of concentrate on the treatment itself i kind of stop worrying about my wife still being in the situation that i have left i kind of stop worrying about my children what was happening to my children for treatment to work you need time and space to think about you but i kind of think about me i could only worry about my family so after many years of use and trying to get  daughter who is one with another child welfare took our baby away but child welfare along with the family court program places in the broadway family treatment program and i went into the women and children program i wanted to the men's program i can't tell you how i want to sell to do treatment as a family in the family treatment program i knew that my wife and children were safe and healing i could focus on my own treatment but i could also heal with my family and bridge way we did family therapy couples counseling my parenting classes i learned how to communicate with my wife how i how to harm her you see before our relationship was based on drugs but now we know how to talk to each other love each other we also know how to be parents when i was using math my daughter casey looks so scared our daughter summer lived with her grandmother she was very attached to her grandmother but today our daughter katie is a beautiful spark in our she is doing well in school and  offer summer has been returned to our custody seven months ago she is insufferable from us we are a family we have a support system made up of wonderful people from our family court and our family treatment program they all work together to help us explain and to help our family get plain and stable our social circle is made up of other parents in recovery we are blessed i'm working in construction we tend charge we still go to therapy and we have a we are a family with faith and hope thank you thank you earn it yes good afternoon thank you for the honor of speaking with you today my name is noble i'm here with my husband daughter casey i'm a wife a mother and a recovering addict i grew up in an alcoholic home i smoked marijuana for the first time at the age of seven of first drink alcohol as age of fourteen and i began using cocaine and methamphetamine at the ripe age of seventeen no one plans to have the disease of addiction take over their lives and no one plans to end up in prison for methamphetamine abuse no one plans to give birth to a tiny baby born with drugs in their system no one plans to have their children tell them that they don't want to have anything to do with their mother no one plans for these sayings i know i didn't when i was using meth i felt dead most the time all i did was breathe in and breathe out i had no motivation the world was a very dark place i had no hope our no faces anything or anyone every day i would wonder why i just didn't die i was so angry at god the world and mostly at myself my taste in my hair were falling out and other people had custody of my children my husband and i were homeless and sleeping in our car did i believe that family treatment could help me with all that was wrong in our lives how could it i had tried saying all adult programs but i never succeeded in staying clean the programs were very short term there were only ninety days at most i was not helped as a mother who had the shame and guilt because of my addiction my children were not provided services we could not heal together as a family after years of prison and inappropriate single adult treatment programs my addiction to mass got worse i gave birth to my daughter summer summer was born addicted to myth she was removed from my customer custody by child welfare at that point however a miracle happened my children are referred to a comprehensive family treatment program we entered into bridgeway counseling and the division of family services my husband made a commitment to do the same bridgeway had just opened a man's residential treatment center next to the women's center we were we were the first married couple to be in treatment at the same time it helps to know that we were doing this a part but also together our addiction to our family apart so you see we needed to find our solution as a family receive services i didn't even know i needed i saw psychiatry as to help me with my depression and i could sleep better thank more clearly it was like someone turned a lot on in my head and my mind wasn't constantly raisen anymore bridgeway we started family therapy i got counselling for past domestic violence and sexual abuse i didn't think i had issues in these areas until i finally opened up to my counsellors and was truthful with myself we took parenting classes went to meetings and attended church the division of family services brought our see she's a beautiful little girl with big blue eyes that can see right through you i want her to only see good things in me today and that's what she does she gives me strength and courage after thirty days of doing broadway's reges residential program my family and i transitioned into bridge ways intensive outpatient program to beginning of our sobriety was not easy but maybe it shouldn't be maybe we needed to work and struggle we entered into a shelter i came to bridge way during the day we've been as a whole family part just a huge trailer for five hundred dollars and i have to tell you we love that trailer it is our first sober home as a family my husband and i voluntarily joined a family safety drug court in order to have more structure and more support and to allow division of family services to the be an even bigger part of our lives we had nothing left to hide we only wanted our family back together we only wanted to stay sober we only wanted to make our children smiles often as we could we also continue receive the family based treatment services family counseling therapy and parenting classes  at bridgeway our family is not an exception there are hundreds of parents like us who are clean sober and stabilized because of family treatment programs but there are also many families in need of family treatment and the waiting list are long there are only two family treatment programs in the whole state of missouri so many families get lost to the disease of addiction my beautiful little summer with blue eyes has been reunited with us now she has been with us for seven months and i'm sure those of you who are parents can feel the light of having all your children next to you bring you the light is with me today is with me here in washington d c is here with me every moment i know that being a parent is not just a right today it's a privilege it's it's a struggle but it's the best kind of struggle we continue to go to meetings we continue to meet with the court we continue to make sober friends and we begin for the first time to be sober heroes to our children thank you thank you i no idea about drug addiction or the symptoms thereof it wasn't until the end of elementary school that i realized something was very wrong my mother was acting very strange and she had to be placed into treatment multiple times for drug abuse i was not able to be with her during those times in treatment a short time afterwards she went into prison from that moment till about a year ago i completely stopped talking to my mother i did not want anything to do with her i felt betrayed i lived with my father during my mother's incarceration after getting out of prison my mother was still using drugs it wasn't until i learned that my youngest sister summer was about to be put up for adoption that i felt i had to do something about this issue i joined my family in the family treatment program a bridge or a family treatment program help rebuild my family and heal my mother's issues throughout the experiences of my mother's addiction and recovery i cannot leave my family because that would not have helped me or my family i felt that i may not have done as well without their support we now can have birthday parties graduation parties and events such as those just as an enormous family and would have surprisingly to most my at home issues have not affect me academically throughout the years i have maintained a high grade point average at the end of high school i had around a three point eight grade point average perfect attendance and was involved with multiple groups and organizations including leadership d j for the school radio station have also recently began working as a driver for pizza hut i've been accepted to southeast missouri state university with two scholarships so i'm still looking for more additional funding i will begin southeast missouri state and the fall i plan on becoming a physics teacher so i'm majoring in physics education thank well thank you for your testimony and dr ross and we appreciate you being here today i just want you know i'm not going to sing happy birthday to you but we thank you for coming on your earth day maybe as a concession when u c l a comes to notre dame this fall  to lose i'll do at least at least do a clapping your and your memory of your birthday and that you would come before the committee on your birthday thank you very much for joining us we're looking forward your testimony thank you chairman souter i want to thank you for the effort you put in to address this problem of methamphetamine in the united states for twenty years and southern california we've been wrestling with this problem and trying to get some attention until your efforts it's been somewhat challenging this committee has been a breath of fresh air and giving us some assistance in attention to this problem my name is i'm a professor u c l a and for the last thirty years have done work in the field of drug abuse from one thousand nine hundred eighty three until nine hundred ninety eight i ran a nonprofit organization called the matrix institute in southern california that was and we were asked by the health director in san bernardino county in one thousand nine hundred eighty six to come and open a clinic because of a methamphetamine epidemic in san bernardino in hundred eighty six we had several other clinics at the time that were seeing hundreds of cocaine users since that was the peak of the cocaine epidemic but in san bernardino county methamphetamine was already a severe health problem the clinic we  in that clinic in the late ninety's i went back to work i started at u c l a and i went back to work to u c l a and i've been there now for ten years overseeing a portfolio of research but for fifteen years i sat in a chair and saw one patient right after another half of them being cocaine users half of them being methamphetamine users and we started to put together some treatments and developed a treatment model that has since become known as the matrix model that you've heard of and we've collected some data on now that i'm a so called methamphetamine expert i spend about one hundred days a year traveling around the country talking about methamphetamine and the problem and the treatment and i do hear some very interesting  questions and myths but of course the one that's the most interesting is this issue about methamphetamine users being untreatable the the term i frequently hear is that fewer than five percent of methamphetamine users get better i think that initial reference came from a rolling stone article in one thousand nine hundred one nine hundred ninety seven where that that's where that figure came from it was a one of our better scientific journals in my written testimony i give you some data on this comparability between treatment of methamphetamine users and other treatment of other substance use disorders but in short we've run three controlled clinical trials and we've analyzed three large datasets where we've looked at meth users and cocaine users and we looked at the data in every way we can possibly think of to look at it and we found absolutely no evidence of any difference between those groups in fact we think that the treatment for stimulant users probably is the outcome is better than it is for heroin addiction except that heroin addiction we have medications like methadone and buprenorphine which we don't have for stimulants but there's no evidence that i can find or that any of my colleagues have been able to find that meth users are any less responsive to treatment than any other patient populations now there are some slightly different issues that often need to be discussed in treatment and that's what we've tried to program into our treatment materials and sam has valuated these in a large scale trial but in general across the board our treatment outcome data for cocaine users meth users alcohol users are all very comparable and we can't see any systematic difference why is the myth occurred i think probably it's it's developed because during the eighty's when we saw large numbers of cocaine users in urban centers and neither responded and developed the set of training materials and these training materials were were disseminated in where there were cocaine problems people became quite skilled at using these imperatively based treatments however in rural areas where there really wasn't much of a cocaine problem in the eighty's and ninety's they continued pretty much to use treatment methods that had been developed for alcoholics in the sixty's and seventy's and just never gained any exposure to these new treatment strategies when the meth users started showing up in the ninety's and this century they didn't know what to do with them they'd never seen patients like this before in the urban centers they had and they had adopted these treatments that have been useful so i think the issue is not so much that one addiction is any more difficult than the other but that one group of treatment providers in geographic areas had never seen anything like this and so they were really struck with the difference between their meth users and their alcoholics which had been their standard patient population i do think that the materials that sampson has developed really are quite excellent and the disseminated the dissemination of those materials and the training that goes on is going to be critical to getting the communities affected by methamphetamine providing effective treatment i think that is a big need there are a couple of things i would like to mention a couple of points that i think have not been mentioned three months ago we had data presented from san diego county san diego was also one of the cities that was packed early by the met problem the data they're presenting from san diego the epidemiologic data suggests that right now the rates of meth use and admissions to treatment and emergency room visits are higher today than they have been any time in the last twenty years this epidemic does not go away on its own it's not one where it peaks and then you see a drop off we haven't seen any evidence in hawaii or in portland oregon of any reduction in use we've seen a reduction in labs with the precursor controls but not in use and not in the extent of the problem i think that what you're doing with these hearings and getting attention to this problem is important because i think it's going to continue to spread into the east coast and into the urban centers and i think it's going to persist in areas where it's been a problem for some time that's what the san diego data tell us secondly if you look at the net the federal data on drug trends and you look at adolescents the monitoring the future data you would think that there is no problem of meth use among adolescents the california treatment data would suggest otherwise and california in the last dataset that we looked at almost a third of adolescents entering treatment were primary meth users in some places the male admissions were over fifty percent that is if you look at alcohol marijuana and everything coming into treatment we were seeing fifty percent of the girls coming in for methamphetamine dependence i think that we have to watch out that we don't let the same thing happen with the adolescent drug trends that we did with the adult drug trends where we look at these surveys and say well i guess there's not a problem there are treatment data in california would suggest very differently that adolescents are using methamphetamine they are becoming dependent on methamphetamine and that should be a priority because as you heard dr volkow say it affects adolescents brains more profoundly we're not sure about the recovery from meth for adolescents although the story was very hopeful it is a concern for us so i do think the paying of some attention to this problem with the lessons is important appreciate the opportunity to speak to you i'm a big fan of this committee in the work that you've done and i'd like to thank you all for taking this up thank you very much system it's good to see you thank you for coming from indiana to be with us today and look forward your testimony mr chairman and members of the committee thank you for inviting me to participate in this hearing for most method and send me an abuser's treatment options in rural areas may be few and far between for the bowen center even with the ongoing support of our local coordinating council county judge michael kramer and the indiana division of mental health and addiction we are still having difficulties with the full implementation of the matrix model due to the following barriers the first barrier to the availability of methamphetamine treatment in rural areas is the absence of qualified and experienced staff staff recruitment and retention of individuals is very difficult even with constant recruitment openings are continuous as a result of the absence of qualified staff rule areas have been left recruiting and training from within this process is very lengthy and expensive especially as most rural areas are not experiencing the cocaine epidemic so treatment starts to feel like an uphill battle until rule areas have enough qualified experienced staff reviving the services the outcomes for treatment will be affected the next barrier summarized by dr thomas freezes the state training alone is insufficient if the funding necessary to deliver these treatment recommendations is not available treatment is not cheap but it is less expensive to treat methamphetamine abusers and it is to incarcerate them according to the principles of the drug addiction treatment research based guide it states that conservative estimates indicate that for every dollar spent treatment forty seven dollars a returned in reduced crime criminal justice cost and theft the noble county jail has a third of its population incarcerated for methamphetamine related crimes and in ten months spent one tenth of their medical budget on oral and dental damage from the use of methamphetamine for most methamphetamine abusers the cost of treatment is very high many have lost everything due to their use and did not have the money for food and shelter let alone treatment those individuals with managed care may not be covered due to legal difficulties and even if they are covered the limitations of managed care make effective treatment extremely difficult effective treatment should also include family therapy and case management which is an additional cost the lack of funding for these services is yet another barrier another barrier is transportation transit systems do not exist in rural communities and even if they do exist the cost is prohibitive many individuals like a driver's license vehicle and even the money for gasoline women present another interesting challenge as they are typically the primary caregiver and run the risk for pregnancy they also have higher rates of mental health concerns poverty and lack the skills necessary for employment in indiana forty seven percent of the individuals abusing methamphetamine are women and the research shows that women are less likely than their male counterparts to access services women are also in need of childcare service which is an additional cost and barrier one way to increase the effectiveness of treatment is to have separate for programs for men women and adolescents and in rural areas employ any one program is difficult three separate programs is almost impossible due to the effects of methamphetamine on the brain treatment needs to be a long term intensive and comprehensive it needs to include time for some as amphetamine but also medical psychiatric a mental health issue another barrier in real areas is a difficulty recruiting and retaining psychiatrists with the use of the matrix my treatment is effective in summary my recommendations for rural communities are first the continued support of the substance abuse prevention and treatment was grant development of community based interventions for the prevention and treatment of alcohol and drug abuse communities its resources for personnel recruitment retention and training provide resources for child care for those involved with treatment the committee i don't want to i have written testimony here and i don't want to read it because i think that you could read it yourself so i would like to comment on what i do have in my testimony and try to make those points that either you've asked questions  about or that that i have direct experience and i'll just get a little bit of my background on the present executive director of the dance incorporated were the largest freestanding for your program in the state of pennsylvania and were soon to be the largest program problem the state of maryland and also in in and we're also located in delaware we service an awful lot of people on a given day we've been in existence is one nine hundred sixty we have ninety one programs and fifty one locations about two thousand three hundred people a day are in outpatient and residential programs in community and about sixteen hundred of those people are behind the walls in prison additionally we have four hundred in one thousand nine hundred twelve that are not addicted but are in treatment with their parents we have six programs that are for women and their children and and their family members so we're pretty serious about doing this this month will open up additional program in the apartheid section of  baltimore exactly by the way right across the street from our facility is where they used to have those lines that congressman cummings talked about i've observed those lines how those lines still exist but they do not exist in  your treatment program because one of the things that addicts don't like to be around is jails and treatment programs so if you could while they are actively addicted when they're not addicted that's the place that you'll find them  i'm presently also the present of therapy can use america which has represents seven hundred programs in thirty two states including puerto rico and the virgin islands i've been witness many of our many of our t ca members are located in places like the central valley of california where one hundred percent of their treatment admissions are methamphetamine our treatment programs have been treating these people probably since one thousand nine hundred fifty eight so just like to know that it depends on where you live in the country on whether or not your admission is for methamphetamine and i think there was an earlier discussion in regards to the economics of this where it's more available the treatment emissions go up and where it's cheaper treatment the missions go up so i think there's many many variables and i think that the scientific panel gave you a lot of history about that but i can tell you that as a counselor i gave you all my credentials i want to give you a little bit different perspective as a counselor and i think i heard a little bit of this before i didn't see different in regards to the outcome for methamphetamine addict the challenges were different the etiology of the disease was a little different but what was really necessary was long term treatment in order for people to heal some of the psychosis that was talked about may continue some of it was some of my clients continued for years beyond that not as not as great but you  stay there with them you had to get in there and be with them and the longer the addiction was the longer you're going to appen spend time in treatment what i had added to this was an attachment that's when a sow's and in state of washington there's a recent study been done where the save for every addict there's a cost offset of about two hundred ninety six dollars per person when you treat them and if methamphetamine treatment a stimulant treatment is actually more cost effective than other treatments for other diseases not much that's a difference of twenty let me say one thousand dollars per day today that you save so you save money and you provide treatment and that's what i want to discuss the problem is that there are giant holes in our national treatment network it does not ounce in the right places throughout the country you heard about the rule areas you heard about the lack of family treatment for some reason as a as a society we have not invested the kind of money in treatment programs as we invested in the criminal justice system or in the prison system and i can attest to that because i have more people on a daily basis behind the walls that i'm treating some on some days and i do in the community we've got a real problem here that we need to address and it didn't just happen today it's not at the doorstep of this committee it's been it's been a problem for many for the last decade or so that what we've done is we've consistently leveled off our treatment and we've added things to our treatment system such as managed care it is not managed care it's managed cost and what it's done is it's reduce the length the state of treatment so our treatment system is more damage today than it was ten years ago right now if you're a crack addict i mean in philadelphia sometimes the decisions on whether you're not going to get treated are made on wall street they're not being made where they need to be made they're being made based on profit and loss and short term profit and loss not long term profit and loss mind you're going to have to use the criminal justice system people don't wake up one day and say you know what i'd really like to get treatment for my long term prac addiction or my long term methamphetamine addiction they don't even psychotic when you're first talking to him so you don't have to use outside forces to get them to the treatment door and when you do it needs to be the proper treatment for the proper length of stay and i can tell you that we provide therapy to communities we've been doing a long time there's a tremendous coughs all say it's a lot cheaper than any other way of treating them and it's also a lot cheaper a way to provide the help by doing it long term and doing it right the first time instead of spending tons of money on the on the effects of the addiction pennsylvania alone spent three point four billion dollars not treating addiction on the one that you're on everything but the treatment itself so you've got it and i think that you can see that there's a catch to study in two thousand and one that shows that across the nation now the workforce problem is tomorrow you said you know we need to put up a treatment system now we're going to do it now it's going to take ten years you can't do it right away we're going to have to use that to target the capacity we're going have to follow these epidemics but think about it long term and her win in philadelphia in the southern and the southeast pennsylvania i have programs in the middle of pennsylvania it's moving together what happens in power spur of the state capital when i got to epidemics and i don't have any more treatment programs i don't any more staff matter fact most of my staff are getting ready to retire some of them or the crack i mean the methamphetamine folks that i used to treat in the early seventy's because pennsylvania's southeast corner was where the du pont allied chemical all the major precursors to make man methamphetamine was and we had an epidemic and what we did is we moved the labs to southern california into san diego and made that now called crystal city is what they call what they call san diego so what we did is we just moved it so that's what we did we made it illegal to sell those precursors were counting pennsylvania and we moved to mexico and they moved it right back across the border eighty percent of the canada they're going to make it they're going to make an american were ever ever there's profit in this we've got to reduce the demand and reduce demand are going to need the fact of law enforcement affective treatment and effective prevention and right now we don't have  treatment system to handle this epidemic that's what they're telling you we don't have the workforce we don't have the facilities and we need help but it's going to require a long term plan there's no magic cure and by the way if you're looking for a magic cure for methamphetamine i would guarantee you that that same drug that we come up with will end up getting abused and we'll change the molecule so that our clients look for a magic cure do not look for a magic cure look for long term hard won solutions just like the family these folks have had to do we've had to work hard at it given the right resources to do it it takes time it takes effort i'm sorry for being so passionate about this but i talk to people and we have many people that succeed we have a lot of people doing really well but i also have the  pleasure to speak to families who can't get their kids into treatment and they passed away and we have people dying from this epidemic so please think about a long term plan for this i have a lot of stuff in my testimony i really don't think you need to hear that i think i think my i'm not going to read my whole statement either because i think a lot of it's been repeated treatment for methamphetamine does work just know that you've got proof of this sitting at this table it works our big issue that we have in the united states of america right now is our capacity we have one funded slot for every four people that need treatment that's really what our big issue is what i'd like to talk a little bit about is give you a little bit of an idea of what we do in salt lake county and how we've talked to our elected officials to get our local elected officials t pony up some dollars to help us with this issue we have been rocked by methamphetamine we already were on the ropes in our treatment system our treatment system was already under pressure and the methamphetamine hit and we're really are hurting right now it is an epidemic in utah as an epidemic in salt lake county just about everybody that we get in there is using meth in some way shape or form we've got to deal with this when i have talked to all of our national organizations a national association of counties the national association of state  alcohol and drug directors and national association of county behavioral health directors i have been talking about this for ten years and it's so nice to have the national organizations in the congress looking at this issue because we definitely need help in this country with this i had twelve thousand admissions in my treatment system where the largest largest treatment system in the inner mountain west at twelve thousand emissions a year i have forty eight thousand people in salt lake county that need to be in treatment now as you know the burden of providing substance abuse treatment in the united states of america has been put on the back of the taxpayers seventy five percent of all of the services we provide the united states are publicly funded that is the first place we've got to look we cannot do that any longer i know congress will be dealing with health care reform in the next three four five six years you definitely need to include this is part of the health care system substance abuse treatment  needs to be treated as part of a disease it's a disease a chronic disease it needs to be treated like a disease you've got to deal with it that way second thing i think you need to do and i'm going to give you some very specific here because i think it's really important i don't have very much time with you  by the way i have to catch a plane at six of his many questions i would appreciate those so i can get out of here the block grant all due respect mr curry i think he has done a wonderful job i want more money grant everybody has said that today here we need two hundred fifty million more dollars in the block grant to put a two billion dollars now sounds like a lot of money but it's not a lot of money in terms of some of the things we're spending money on on these days and i think what we need to do is if you want to earmark some money in the block grant to emerging drugs whatever you want to do go ahead and do that that's fine but the short term solution is to get more capacity we know what to do we know how to treat this drug we can do it but we need the money to help us with this and then the second thing i'd say is if you can work something in to the health care reform package that starts to provide primary health care as for substance abuse treatment in the very beginning i think what you'll start to see is maybe less demand on the black ran less demand on the taxpayer finally the thing i'd like to say to you right now is methamphetamine has really rocked women in utah and salt lake in utah and what we see is as we have now women using methamphetamine at higher rates than we have men using methamphetamine that doesn't happen with any other drug it does not happen with any other drug and this is really worrisome to me i've been doing this for nineteen years and i am very scared about that trend because what happens is families fall apart without their mothers they really do we've started for family treatment programs similar to the ones that knoebels are talking about they are very very effective finance those with medicaid if i don't have medicaid i'm going to lose three of those four programs so when congress is dealing with the medicaid issue i know it's real simple to say optional services we're going to cut this we're going to cut that just there are faces that are connected with that so i think it's got to be a three we've got to have health care and think about this is health care if you get it in health care we've got to have money in the short term in the block grant two hundred fifty million dollars and we've got to have medicaid there especially for women with thirty penned in children that's how we pay for this  i look at the obituaries every day and in salt lake it's kind of interesting our obituaries all have pictures of a picture of that individual next to the obituary and i've gotten pretty good reading between the lines and obituaries to see who's dying of o verdoses and i'll tell you it is just staggering when you see how many people pop up in the salt lake tribune every day and this so i will conclude i am just so tickled that you're dealing with this issue it is a major national issue for us but we need some leadership on this and we don't need discretionary dollars i know people talk about the voucher system they talk about put money in discretionary discretionary dollars are not what we need we need foundation dollars the block grant is the foundation if congress puts money into the block grant our state legislature will put money in and my county council put money in what the block grant we don't have anything so i just urge you to really pay attention to that and thank you very much thank you do you have any questions directly from mr fleming he is not going to make it in rush hour unless he is out of here in the next five minutes that thank you for coming in from salt lake we'll look for if we have some additional questions we'll some of them to you in writing  let me let me first thank each of you for coming for being with us in this one day it's as you can see a very diverse hearing and very helpful at the personal testimonies which are always very helpful we move into the into a hearing process part partly it's good to hear success stories because sometimes when you go through this business it just seems like you jump from one failure to another we're going to get blown up on the border because of terrorism coming in we have child abuse here and spouse abuse here and and all different kinds of crime and of course we don't know how to pay for health care and we  ll securities m s pensions are a mess it just seems like we just jump from one issue to the next so having some encouragement that in fact some of the money that that taxpayers are investing works is is very helpful to here  horowitz that's a first let me get a kind of a factual thing down left over from the the first panel that it let me start with you said that in in in do you agree dr  his characterization that a lot of this early started over by philadelphia and in delaware county and then moved to san diego and that's why you saw some of this is a to go earlier because that's a historical factoid that i hadn't heard you know i didn't i wasn't aware that that it might rated like that but yes in the early eighty's philadelphia and the philadelphia area was the leading area of methamphetamine abuse independence in the united states and i didn't know what had been done i don't know jersey arco all those companies were right there the chemists were there to the actual precursors were there and there was a drug addict there when what happened is they hooked up with a chemist and they started to make  it and also they first started to hijack it because they were making legal impediment but as time went on they started making it out in the community as it as they are doing the same thing now as you were restricting it restricting  formulas to each other so any they were recruiting chemists students at a high school to make it so it got really really complicated the motorcycle gangs the warlocks and the pagans took over the distribution of the drama up and down the east coast and they started to and they fanned out with that so what happened is they there was a series of hearings those drugs became legal to do was involved they made those drugs illegal in the united states and all i forget i think it's two p i don't know the scientific to be two i think there's what they call the street and that was then moved to mexico and about it was very soon a couple of years later you would see and we were lucky because we got cocaine to take its place so i want to let you know it didn't mean addiction go away i just switched chemicals is what we did one of the and we reason i want to and we gave this plague to san diego that given the fact that philadelphia and san diego are not usually considered rural areas out national right did the african american community or other minority communities use meth at that time i can with first moved to san diego  would get cut in half i mean to cut the purity in half and they doubled the price so if you were living in the suburbs you pay ten dollars a bag and you got half you got the develop the thing so what happened is in the inner city where would sell it very similar to today it was more powerful and cheaper methamphetamine was being was was actually suburban drug that was moving in towards the city and if you lived outside it was ten dollars for what they used to call quarter of a teaspoon which would have been a quarter of a teaspoon of it in the inner city though that would be cut in half and you would cost you twenty dollars if you so so what would happen is it was trading going on the suburban he addict i mean i'm sorry methamphetamine speed freaks used to call monsters crank and had all kinds of names would trade for her win because they would trade it because it really had to do with who controlled the drug traffic the people mind the the white motorcycle gangs and the suburban kids control the it had more to do with the availability of the i have a million theories of why one different than the other don't know why but i can tell you the theory that it's different it's thrown right out the window when you talk about crack cocaine because crack cocaine although it's not as long lasting as the same effect and it decimated the inner city so i wouldn't get hung up as much in the type of drug as i would in the treatment we need long term ok quality treatment it's not drug specific as much but it but it but it is addiction because what happens is people switch from one drug to another anyway so you better look at drug addiction as a holistic kind of a view and if you don't you're going to constantly have problems then you need to train our whole workforce who haven't seen methamphetamine a long time on what the effects are there's different models that you can use but they're really they're really techniques that can be integrated into a treatment program or not you really need a treatment model that's adaptable across the whole country that can be adapted to whatever does new epidemic you have i the same counselors treating her on right now that i had treating cocaine that i had treating methamphetamine problem is a get involved in tiring and we don't have in the in the home cook or group is that it tends to be more family you know the words historically the models are enablers and and users whereas when they're cooking because you can turn people in and less their whole family is either involved or at least you may have the kids not as they may be in voluntarily involved but we've had testimony at low hearings where even the kids are often recruited to get the chemicals or to participate in the cooking is that require different models of treatment obviously we heard today about family treatment could you describe a little bit how your matrix model works and how it might be different in impact the family to a greater degree are the fact people cook in their homes and you're seeing fifty percent of the users are women heroin is about three or four to one men to women and so you're seeing many more women get involved which obviously affects the children to do any kind of treatment and not have a family component with methamphetamine would would is not supported by any evidence you have to work with the family the family either has to be brought into treatment as was described here which is preferable or at least be able to be inform them and get them understanding the addiction so that they can provide appropriate support to the addict in his in his or her recovery and so really means participation in methamphetamine addiction in the african american community i would be interested to see if there was any statistics at some point of whether or not there was less methamphetamine use in an italian american community and one of the reasons is because the strong stronger sense of family a stronger sense of community in general and as chairman was just stating you know methamphetamine use is isolating it's not necessarily you don't get together pass a pipe around because it's so damaging been heroin addicts for fifteen years and been successful brokers on wall street and you don't necessarily notice that they're having this kind of a problem so part of it with you as an adolescent with extreme acne that came as a result of that with this great weight loss with this psychosis that came around people in the community who surrounded themselves around my life and helped me through the process part of that whole process of course involve long term psychological counseling it was not something that could happen overnight i was fortunate i guess that we can use that term fortunate in that i was arrested and i was entered into the california youth authority and so i had this long term care which was provided by the state as a youth offender and you know other people may not have had that so i think when we start looking at these kinds of programs or want to see somebody who can really be regenerated and brought back into society and become really the poster boy for success you have to start looking at part of it is you  to walking with a crutch to getting physical therapy to having a long term care before they can really run again at full speed so it's not something that's going to happen overnight i was one of those suburban speed freaks in california again i wonder whether or not this how much of this loss of community the loss of community support we see that in data all over the country plays an effect on these kinds of epidemics that are really now it's all been a lot of doors in my life i have a life now so and less sympathetic and empathetic because they feel as if some i made a choice and and you know it's a real tough it's a tough it's a tough  they see their property values going down they see their families destroyed they say to me congressman i go out there i bust my butt i work hard every day i can't come into my house at the end of the day and expect everything to be in place and then you know it's hard for me to get excited as much as i'd love to provide funding for drug drug treatment i don't have a lot of sympathy because i go through for you to go out there and bust your butt trying to get treatment for and these are people who i would normally think would be sympathetic but they get tired and i think and what i said to a graduating class of african american antics recovering x the other day for drug what i said you've got to understand the public is saying ok i mean a lot of the public is saying you made a choice and they're getting less and less tolerant of funding bad choices and i think that's something that and i just wonder as you go through i mean what you also maybe you have is that ever hit  me when you and you mr holiday and i'm a south of the family in a minute do you do you get any of that out in the mean when you're moving around into your hundred conferences and all that kind of those are not the kind of everyday people that you talk to you know th those are exactly the people i talk to and yes i think that there is a city factor going on with that however if you if you look at california the in two thousand the california voters in a voter initiative pass proposition thirty six which put six hundred million dollars into the treatment system as opposed into the jail system if you make it a choice between treatment and you document the treatment works and particularly if you hook it with the criminal justice system the drug court movement in my thirty years of working in this field is the most encouraging movement i've seen because it uses the leverage of the drug of the court system to push people in the door as was said earlier by someone doctor mr curry i think the people will wake up one day and say gee i think i want to get sober that happens in response to something in response to some pressure and i think that the california voters anyway six years five years ago were willing to put their money into treatment as opposed to the prisons the voters in california are very sick of building prisons where we're the champs when it comes to building prisons and one of of the places i went was minnesota where they're starting to see  the i mean more than starting to see the epidemic their basic model for wanting to put money into treatment was they didn't want to replicate california's experience with having to build so many prisons so i do think that there's a petite i do think people are tired of having to deal with the problems in their communities but when you have to when push comes to shove and they have to choose and say how are we going to deal with this i think there is a recommend a recognition on the public's part th but i had the same time i know the damn members of this congress who i mean if i hear this right i notice the other people here and it's something that we may have to deal with even more so later on as budget stuff gets tighter and tighter and because i think that i think you're right that when you match that with prison building more prisons and makes a lot of sense but i've got to i've got to get back to something though why do you all think it man with women with methamphetamine it's basically pretty much forty seven percent if i remember of women why is that but i would point to three factors you've heard of weight loss as being an important one the rates of depression among women in the general public are much higher and methamphetamine is a very useful and i depressant when you first start taking it and finally mrs knoebels comments about the role of the woman in today's society being a  mother being taking care of the house getting a job having to take kids to things methamphetamine can help you do all that stuff for a while and so it's a drug that does have good functional value for a while and many of the women we talked to didn't get involved in it as a party drug they got involved in it to get things done to control their depression to be able to work a sixteen hour day and take care of all their responsibility you take care when you go take a nap i mean heroin is not a nod a earlier with people who are opposed to treatment say it's a waste of money or you could take my record and ask her if she wants me to live next to her and then not a person with shit i've done in my life or you could take  family you got three point average going to a physics teacher go to college you made it through all this with all the activities did the ads or any of it and i drug programs a teacher why what what help change you well you know i see the ads on t v and you know there's so much other things on t v it's just another thing that's on t v i don't really pay attention to it you know there's the programs you know i was in teenage health consultants dealt a little bit but you know that was my my home experiences to kind of let me know that that's not good that's not what i need to do because you know i just a negative effect on the whole family and you can even see people outside the family looking in kind of stuff that our folks do when they're addicted would make anyone not want to fund anything so we're pretty aware that what you need what we need to do is educate the public the treatment works i think people are frustrated and most people have this one out of four families with this so a lot of times when you're talking to people who say i'm really frustrating when they're talking about somebody that they know or in their own family that's how much this is a part of our culture and i think i think if we can get across to people that this is a generational disease i think it's been it's right here in front of it's a generational disease and it will grow prevention that you talked about earlier is important but it's really the decisions that kids are making before the age of eleven years old so we're going to target and many of the kids that we're talking about are kids who have addiction in the family i got five hundred of them i see every day half of them are going to become c e o s and are going to be just like young man right here they're going to say you know what i'm not going to let it happen to me i'm going to work as hard as i possibly can not to let it happen the other fifty percent or sixty percent are going to end up with problems sells for biological or environmental or for what other other reasons this is a generational disease that we've got to stop somewhere and i agree you're going to need all  thing may be a choice but then it's not a choice and then what you but what you just said is so powerful if this is starting with is starting with our kids then that means that we as adults are doing something wrong and some kind of the line right became wrong and wrong became right and that's what you teach your children and that's what i taught my children to family the family based treatment programs the opportunity to talk on that around  that we will continue to try to work for additional treatment funds but i want to give this this your leaders in the treatment movement and this is one of the facts that you have to face every single politician is also going out and talking to people and i have family experiences there is no one i have ever met in any prison or any treatment program who hasn't said that they've been through multiple treatment programs if you oversell treatment you will not convince the elected officials or the voters to do this it's starting to happen in drug court that short term data that says there's an eighty five percent success rate is not convincing when we start to get long term data this is a hard business and as we heard today it's not going to be there's going to be recidivism with it and that that you can't take artificial statistics and partly overselling of treatment will result in people and then also there are different types of drug addicts that the drug addict is violent they're going to have a different opinion about treatment versus locking up then then treatment and that's what they've shown to but i think that we're moving into a more sophisticated period in drug courts are starting to illustrate that and if we can get new ones approaches then the last thing is sometimes when you have an epidemic that hits the news because there's also fatigue in news coverage fatigue in what c s i and law and order can cover for that year or two and when we have a new phenomena come up you find more willingness of the general public particularly when you see something like meth where they see labs blowing up in children getting damaged in the type of problems we have an opportunity right now to move the whole treatment debate as part of the meth debate and one of my frustrations with  lack of understanding that because like you say these things may not exactly repeat themselves but they rhyme there are nuances to the differences they're different but to some degree to avoid the fatigue we have to have new angles with it so thank you very much for your personal testimonies today for shedding so much light and i've sat through so many of these hearings and yet everyone is like today we've learned so many different angles with this and it's been tremendously helpful to us and hopefully it will be to