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METHAMPHETAMINE TREATMENT: AVAILABILITY

AND EFFECTIVENESS OF PROGRAMS TO TREAT

VICTIMS OF THE METHAMPHETAMINE EPIDEMIC

HEARING

BEFORE THE

SUBCOMMITTEE ON CRIMINAL JUSTICE,

DRUG POLICY, AND HUMAN RESOURCES

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

JUNE 28, 2006

Serial No. 109–223

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

CHRISTOPHER SHAYS, Connecticut

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

GIL GUTKNECHT, Minnesota

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

CANDICE S. MILLER, Michigan

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

JON C. PORTER, Nevada

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

CHARLES W. DENT, Pennsylvania

VIRGINIA FOXX, North Carolina

JEAN SCHMIDT, Ohio

BRIAN P. BILBRAY, California

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

BRIAN HIGGINS, New York

ELEANOR HOLMES NORTON, District of

Columbia

———

BERNARD SANDERS, Vermont

(Independent)

DAVID MARIN, Staff Director

LAWRENCE HALLORAN, Deputy Staff Director

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

SUBCOMMITTEE ON CRIMINAL JUSTICE, DRUG POLICY, AND HUMAN RESOURCES

MARK E. SOUDER, Indiana, Chairman

PATRICK T. MCHENRY, North Carolina

DAN BURTON, Indiana

JOHN L. MICA, Florida

GIL GUTKNECHT, Minnesota

STEVEN C. LATOURETTE, Ohio

CHRIS CANNON, Utah

CANDICE S. MILLER, Michigan

VIRGINIA FOXX, North Carolina

JEAN SCHMIDT, Ohio

ELIJAH E. CUMMINGS, Maryland

BERNARD SANDERS, Vermont

DANNY K. DAVIS, Illinois

DIANE E. WATSON, California

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

MAJOR R. OWENS, New York

ELEANOR HOLMES NORTON, District of

Columbia

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

J. MARC WHEAT, Staff Director

MALIA HOLST, Clerk

(III)

C O N T E N T S

Page

Hearing held on June 28, 2006 ............................................................................... 1

Statement of:

Cronkhite, Russell, recovered meth addict; Darren and Aaronette Noble,

recovered meth addicts, accompanied by Joseph Binkley; Richard A.

Rawson, Ph.D, associated director, Integrated Substance Abuse Programs, UCLA; Leah C. Heaston, MSW, LCSW, ACSW, SAP, Noble

County director, Otis R. Bowen Center for Human Services, Inc.; Michael B. Harle, MHS, Gaudenzia, Inc.; and Pat Fleming, director, Salt

Lake County Substance Abuse Services ..................................................... 31

Binkley, Joseph ......................................................................................... 38

Cronkhite, Russell ..................................................................................... 31

Fleming, Pat .............................................................................................. 46

Harle, Michael B. ...................................................................................... 43

Heaston, Leah C. ....................................................................................... 41

Noble, Aaronette ........................................................................................ 36

Noble, Darren ............................................................................................ 35

Rawson, Richard A., Ph.D ........................................................................ 39

Madras, Bertha, Deputy Director, Office of Demand Reduction, Office

of National Drug Control Policy; Nora D. Volkow, M.D., Director, National Institute on Drug Abuse, National Institutes of Health, U.S.

Department of Health and Human Services; and Charles G. Curie,

M.A., A.C.S.W., Administrator, Substance Abuse and Mental Health

Services Administration, U.S. Department of Health and Human Services, accompanied by H. Westley Clark, M.D., J.D., M.P.H., CAS,

FASAM, Director, Center for Substance Abuse Treatment ...................... 7

Curie, Charles G. ....................................................................................... 11

Madras, Bertha .......................................................................................... 7

Volkow, Nora D., M.D. .............................................................................. 9

(1)

METHAMPHETAMINE TREATMENT: AVAILABILITY AND EFFECTIVENESS OF PROGRAMS TO TREAT VICTIMS OF THE METHAMPHETAMINE EPIDEMIC

WEDNESDAY, JUNE 28, 2006

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON CRIMINAL JUSTICE, DRUG POLICY,

AND HUMAN RESOURCES,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The committee met, pursuant to notice, at 2 p.m., in room 2154,

Rayburn House Office Building, Hon. Mark E. Souder (chairman of

the committee) presiding.

Present: Representatives Souder, McHenry, Cummings, and

Foxx.

Staff present: J. Marc Wheat, staff director and chief counsel;

Michelle Gress, counsel; Malia Holst, clerk; Tony Haywood, minority counsel; and Jean Gosa, minority assistant clerk.

Mr. SOUDER. The subcommittee will come to order.

Good afternoon, and thank you all for being here. Today’s hearing will examine methamphetamine treatment programs, their

availability, effectiveness for addressing the needs of met victims

and their communities.

I am very concerned about this issue. I feel there is currently a

treatment vacuum when it comes to meth. Despite the fact that the

meth epidemic has swept across the country, and especially devastated our Nation’s western States and rural areas, I am 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 capabilities to handle the

special needs presented by meth users.

An oft-repeated assertion is that meth addiction cannot be treated. That is incorrect. It can be treated. We will 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 this 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. SAMHSA’s Drug Abuse Warning Network [DAWN],

showed that in the early to mid-1990’s, methamphetamine use was

2

on the rise. The treatment episode data confirmed this: treatment

admissions for meth use grew through the 1990’s, increasing fivefold between 1992 and 2002.

The most recent treatment episode data show that 15 States

have higher rates of admission for amphetamine use, largely meth,

than for heroin or cocaine. In just those 15 States, there were over

102,000 admissions for amphetamine treatment, versus 73,000

combined admissions for heroin and cocaine. Nationwide, there

were more than 151,000 admissions for amphetamine treatment.

To say that meth is highly addictive is an understatement, and

it presents unique clinical challenges for treatment. Meth 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 leaves the users to compulsively seek more meth. Chronic use

of the drug also leads to increased tolerance, prompting the user

to take higher or more frequent doses of the drug to get the same

effect.

Moreover, meth users may also develop severe psychotic and

paranoid behavior. Meth users who do seek treatment often relapse

and continue chronic meth use. There are currently no medications

that demonstrate effectiveness in treating meth addiction. But intense behavioral interventions have proven effective. The largest

controlled study of meth treatment conducted by the Center for

Substance Abuse Treatment demonstrated positive post-treatment

outcomes for 60 percent of the treatment sample, which reported

no meth use and which had urine samples that tested negative for

meth.

Nonetheless, traditional treatment programs for alcohol and

marijuana are inadequate for dealing with the unique clinical challenges presented by this drug. Such treatment programs, sometimes the only treatment option available in communities hardest

hit by the meth epidemic, result in very poor post-treatment outcomes for meth users. This represents our greatest challenge: how

do we ensure that our Federal treatment efforts are addressing the

meth epidemic in 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 at least

six field hearings with scattered reports of both effectiveness, the

mix and availability in those areas. Oregon, Arkansas, Minnesota

immediately come to mind where we have had meth treatment witnesses at our hearings.

I am particularly interested in the discussion with our administration witnesses who will present the information on Federal efforts for developing, supporting and measuring meth treatment

systems and programs. The administration witnesses comprising

our first panel are Dr. Bertha Madras, the Director for Demand Reduction at the White House Office of National Drug Control Policy;

Dr. Nora Volkow, Director of the National Institute on Drug Abuse

[NIDA], National Institutes of Health; and Charles Curie, Administrator of the Substance Abuse and Mental Health Services AdminVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
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istration [SAMHSA], and I am most pleased to say a fellow Hoosier, one of two Hoosiers testifying today.

Dr. Clark, are you with Mr. Curie? I wanted to make sure I introduced you as well. I didn’t see you on my list.

Witnesses on our second panel will present on-the-ground perspectives of treatment, both from the treatment provider side and

the recovered meth user side. This includes a second Hoosier witness, Leah Heaston, director for Noble County in Indiana of the

Otis R. Bowen Center for Human Services; Richard Rawson, associate director of integrated substance abuse programs at UCLA; Russell Cronkhite, a recovered meth addict; Darren and Aaronette

Noble, also recovered addicts, and their son Joey Binkley; Mr. Michael Harle, president and CEO of Gaudenzia, Inc., and 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

subcommittee’s clerk, and today is her last hearing. She has been

our clerk since April 5, 2004, and has cheerfully endured 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 on the subcommittee for much

better things. She is getting married later this summer, and then

she and her husband will be attending Dallas Theological Seminary. I want to salute her diligent work and consistent Christian

witness in the time we have had with her on the subcommittee.

She has been a tremendous asset.

Now I would like to yield to Mr. Cummings.

Mr. CUMMINGS. Thank you very much, and I too extend my best

wishes to Malia. I want to thank her for her service to our committee and to this great country of 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

are very good friends and we do just about 99 percent of the things

we do in a bipartisan manner.

But when we say the availability and effectiveness of programs

to treat victims of the meth epidemic, I have never heard that word

used with regard to the people from my district who suffer from cocaine addiction, heroin addiction, crack cocaine addiction. They are

all victims. I think we have to be very careful with the use of

words. Because there is no one in this Congress who will fight

harder to make sure that those who have been victimized by any

drug are properly treated.

The second thing I want to say before I forget, I want to thank

you, Mr. Curie, for your service. I understand you will be leaving

your position. You have indeed been a breath of fresh air. Wherever your journey may take you, I feel that we have been so blessed

as a Nation to have you at the helm of your agency. I just wanted

to take this moment to salute you and thank you.

Mr. Chairman, again, I want to thank you for this hearing. The

National Institute on Drug Abuse [NIDA], defines drug addiction

generally as a chronic relapsing disease, characterized by compulsive drug-seeking and drug use, and by neurochemical and molecular changes in the brain. Numerous studies demonstrate the effiVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
4

cacy of drug treatment in reducing drug use and related problems

and behaviors, including criminal activity, unemployment, poor

health and engagement in risky sexual or drug consumption behaviors that may result in infection with HIV, 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 22 million Americans with substance use disorders

in 2003, approximately 3 million people received treatment, leaving

an estimated 19 million Americans without treatment services.

Closing the so-called treatment 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 in the context of what has been described as

a national meth epidemic.

Methamphetamine is a very potent and highly addictive stimulant drug. It has very limited medical use, and as a Schedule II

controlled substance, it can be obtained legally only by prescription.

Meth 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 unchanged in the body. This results in prolonged stimulant

effects.

Some meth users experience psychoses that persist 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, increasing the risk for transmission of infectious diseases, including HIV. Like other intravenous drug

users, those who inject the drug risk contracting HIV when they

share contaminated equipment, and methamphetamine’s psychological effects may also increase the likelihood of HIV transmission

and accelerate its progression.

According to the 2004 National Survey on Drug Use and Health,

nearly 12 million Americans have used methamphetamine at least

once. NIDA has characterized the abuse of methamphetamine as

an extremely serious and growing problem. Once concentrated in a

few western States, meth use has expanded geographically and it

is moving to more diverse populations. The fact that meth can be

manufactured from chemical derived 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 neglect.

The resulting burden on State and local law enforcement and social services agencies has been enormous. According to NIDA,

methamphetamine addiction can be treated successfully using currently available behavior treatments. NIDA is currently investing

in the development of new medications for methamphetamine addiction.

NIDA also is pursuing the development of an immunization

strategy for the treatment of methamphetamine overdose. In genVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
5

eral, studies show that clinically appropriate treatment, provided

by qualified and trained staff, is effective in stopping methamphetamine use and that outcomes from meth users are comparable to

outcomes for cocaine and heroin users.

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 targeted capacity expansion.

It is important to note that States have achieved commendable

results in block grant funds. According to the National Association

of State Alcohol and Drug Abuse Directors, in Colorado 80 percent

of methamphetamine users were abstinent at discharge in fiscal

year 2003. In Iowa, a 2003 study found that 71.2 percent of methamphetamine users were abstinent 6 months after treatment. And

in Tennessee, over 65 percent of methamphetamine users were abstinent 6 months after treatment.

Mr. Chairman, we must also provide adequate funding to support the vital research efforts of NIDA, which has devoted an increasing amount of funding to meth research. Unfortunately, as I

have noted previously, the administration has chosen to devote a

declining percentage of drug control funding to demand reduction

programs over the past 6 years. I hope that today’s hearing will increase the recognition of the importance of treatment in addressing

addiction and related problems and in turn, to a reversal of the

trend toward de-emphasizing domestic prevention and treatment

relative to supply reduction efforts abroad.

I anxiously look forward to the testimony of our witnesses, and

with that, Mr. Chairman, I yield back.

Mr. SOUDER. I thank the gentleman.

Mr. McHenry, the vice chairman of the subcommittee.

Mr. MCHENRY. Thank you, Mr. Chairman.

Thank you, Mr. Chairman and ranking member, for putting together this important hearing. I am so glad we have a distinguished panel before us today.

In my part of the country, in western North Carolina, we have

been severely affected by methamphetamine use. And now, now

that State law and Federal law is curbing the availability of it, we

are still dealing with the ongoing repercussions of how to treat people that have been addicted to it. It is such a harmful, destructive

and nasty drug that we as a society and as Government policymakers, 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 available to effect change.

So it is important that as a committee we actually look at the

availability of and effectiveness of these treatment programs. Current treatment initiatives in western North Carolina have shown

strong results. Actually, in a recent study from 2002 to 2005, in my

region alone, meth admissions to treatment programs have doubled, just in 3 short years. It seems, now that is being experienced

around this country, largely in rural areas.

6

So it is important that we look at the best way to treat these

meth addicts. One example in my district is through the Matrix

Model. From what I understand, it is the only evidence-based program for attacking meth addiction. And it has been effective. I

don’t think it has 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.

I appreciate your taking the time to be here to make your voices

heard here in Washington, DC, with this important committee

which we serve on. Thank you again, Mr. Chairman, for holding

this hearing, and for your ongoing fight to make sure that we have

effective drug control and elimination, as well as treatment programs throughout this country.

Thank you, Mr. Chairman.

Mr. SOUDER. Thank you. I want to clarify briefly Mr. Cummings’

point, because I think he raised a very fair point. There is a certain

amount of sensitivity that we treat methamphetamine differently

right now because it is predominantly white users and different

than urban areas. I think it is very important.

In the title here, I would refer to the crack epidemic that hit Fort

Wayne as 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.

I absolutely believe that any distinctions that we would have

that would be artificially different, we shouldn’t refer to one group

as being overwhelmed by a tide and another group bringing it upon

themselves. In my hometown, there is very little meth in my hometown of Fort Wayne. It is around us, but it is crack, it is heroin,

and it is 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 is in

treatment or what.

We argue that in fact the administration has been less responsive to rural areas in the meth thing, and we focused on that here.

But this committee will continue long term to make sure that we

focus on all the different narcotics.

Mr. CUMMINGS. Will the chairman yield?

Mr. SOUDER. Yes.

Mr. CUMMINGS. Mr. Chairman, I just want to take a moment to

thank you for saying what you just said. That means a lot to me

personally, and I am sure it means a lot to anybody who is listening to this hearing. Thank you.

Mr. SOUDER. We have seen our urban areas ravaged, and we

need to work together on how to rebuild this, and suburban families destroyed and rural areas. All these things need to be a focus

of this committee.

I ask unanimous consent that all Members have 5 legislative

days to submit written statements and questions for the hearing

record, and that any answers to written questions provided by the

witnesses also be included in the record. Without objection, it is so

ordered.

7

I also ask unanimous consent that all exhibits, documents and

other materials referred to by Members and the witnesses may be

included in the hearing record, and that all Members be permitted

to revise and extend their remarks. Without objection, so ordered.

Our first panel is composed of the Honorable Bertha Madras,

Deputy Director for Demand Reduction of ONDCP; the Honorable

Dr. Nora Volkow, Director of the National Institute for Drug

Abuse, National Institutes of Health; and the Honorable Charles

Curie, Administrator of the Substance and Mental Health Services

Administration, Department of Health and Human Services. Mr.

Curie will also be joined by Dr. Westley Clark, Director of the Center for Substance Abuse Treatment at SAMHSA.

Would each of you stand and raise your right hands, and I will

swear you in?

[Witnesses sworn.]

Mr. SOUDER. Let the record show that each of the witnesses responded in the affirmative.

Thank you for being with us today, again. I think this might be

your first time, Ms. Madras. We met in my office, but welcome to

our committee, and Dr. Volkow and Mr. Curie have been here

many times. We very much appreciate your leadership in this

issue, as well as Dr. Clark has been here numerous times.

Ms. Madras.

STATEMENTS OF BERTHA MADRAS, DEPUTY DIRECTOR, OFFICE OF DEMAND REDUCTION, OFFICE OF NATIONAL DRUG

CONTROL POLICY; NORA D. VOLKOW, M.D., DIRECTOR, NATIONAL INSTITUTE ON DRUG ABUSE, NATIONAL INSTITUTES

OF HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN

SERVICES; AND CHARLES G. CURIE, M.A., A.C.S.W., ADMINISTRATOR, SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION, U.S. DEPARTMENT OF HEALTH AND

HUMAN SERVICES, ACCOMPANIED BY H. WESTLEY CLARK,

M.D., J.D., M.P.H., CAS, FASAM, DIRECTOR, CENTER FOR SUBSTANCE ABUSE TREATMENT

STATEMENT OF BERTHA MADRAS

Ms. MADRAS. Chairman Souder, Ranking Member Cummings

and distinguished members of the subcommittee, thank you for the

opportunity to appear before you today to discuss the Federal response to treatment needs of populations affected by methamphetamine.

As a chemical, meth is a serious, unique national problem. It is

one of the few drugs that can be synthesized with little expertise

or equipment. Its production can result in significant personal and

environmental contamination.

As a drug, meth is one of our greatest public health challenges.

It is highly addictive, it can promote brain damage, its heavy medical and psychological toll on individuals can impact their children,

families, communities and the criminal justice system at a national

level.

With cooperative efforts of the administration and Congress,

there is a historic 19 percent reduction in teenage drug use over

the past 4 years. Of specific reference to methamphetamine, there

8

is at least a 30 percent reduction in the number of meth lab incidents, in meth-positive workplace tests, in lifetime meth use among

youths over the past 2 years. There is also a significant increase

in 12th graders who disapprove of using amphetamines.

The administration’s recently released Synthetic Drug Control

Strategy outlines key meth treatment initiatives. A 15 percent reduction in meth use, a 15 percent reduction in prescription drug

use and a 25 percent reduction in domestic meth labs over the next

3 years are the stated goals.

What are the meth treatment programs that are available? In

general, 25 percent of the Federal budget is targeted to treatment.

Four major programs can impact meth abuse and addiction treatment. The first is the Substance Abuse Prevention and Treatment

block grants. The 2007 budget requests $1.7 billion for the block

grant. The funds are for treatment providers, many of whom provide treatment for abuse and dependence on meth. States that elect

to prioritize meth treatment can target the money for this population.

A second initiative are programs of regional and national signifi- cance. The 2007 budget requests $375 million for effective screening and treatment programs, which include Access to Recovery and

Screening, Brief Intervention and Referral to Treatment. These discretionary grants provide flexibility and services for regional and

rural needs.

Access to Recovery, the 2007 budget requests $98 million. There

is a 25 percent setaside specifically for ATR meth initiative, and

$5.4 million targets programs in rural areas. ATR funds essential

recovery support services, not generally reimbursable through conventional Federal treatment resources. For example, meth addicts

require intensive relapse prevention training, which is covered by

ATR.

The third program is Screening, Brief Intervention and Referral to Treatment. The 2007 budget requests $31.2 million. This program provides grants for effective early detection and intervention

in general medical settings. It is positioned to identify meth users

that enter hospital or clinical environments, seeking treatment for

reasons other than for meth abuse.

The fourth program are drug courts. The 2007 budget request

$69 million for drug court programs, a $59 million increase over

the 2006 enacted level. Drug courts effectively divert non-violent,

low-level offenders away from prison into supervised treatment and

reduce re-arrest rates by over 50 percent.

Of the 2005 adult drug court planning initiatives, the National

Drug Court Institute estimated that 92 percent were rural. Of

these, a significant proportion of offenses that they will treat are

meth-related. This cohort can be steered into treatment by the drug

courts.

In conclusion, I would like to state that substance abuse treatment works, and so effectively stated by Ranking Member

Cummings, treatment and recovery for 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 reaVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
9

sons, 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. Our ultimate objective 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 subcommittee.

Mr. SOUDER. Thank you.

Dr. Volkow.

STATEMENT OF NORA D. VOLKOW, M.D.

Dr. VOLKOW. Good afternoon. It is a privilege for me to be here,

and to be given the opportunity to present how science can help us

combat the problem of drug addiction.

As Director of the National Institute of Drug Abuse, that funds

85 percent of all of the research related to drugs, we have long recognized the problem of methamphetamine. We recognize it not just

because it is a very potent stimulant drug, but because of the data

showing that it is one of the most toxic of illicit drugs.

So as the Director of this Institute, I see it as our responsibility

to develop the science and the knowledge that will allow us to combat this problem.

What do we know about methamphetamine? We have learned

significantly over the past 5 years, actually past 20 years. As Mr.

Cummings was mentioning, we recognize it as one of the most potent of the stimulant drugs, probably it is the most potent. We

know that methamphetamine can be taken by smoke, snort, injection. And what we have seen is that over the past years, we have

seen a shift from the use of methamphetamine through the routes

of administration that are not just the most toxic, but also the most

addictive, that is smoking and injection. And this in turn may account in part for the increase in the numbers of medical emergencies, as well as treatment-seeking addiction from the use of

methamphetamine.

We know that methamphetamine, like other drugs of abuse, predominantly affects dopamine cells, increasing the concentration of

this chemical in the brain, this chemical that is crucial in allowing

us to perceive pleasure, regulate and motivate our behavior. This

chemical is also crucial in allowing us to think properly.

It is believed that the effects of drugs of abuse, all of them, to

increase dopamine is the reason why they can produce addiction.

Of all the drugs of abuse that we know, methamphetamine is the

one that is most potent in increasing dopamine in the brain. Indeed, it is at least three times more effective than cocaine in increasing dopamine in the brain. And it is believed that this may

be one of the reasons about why it is also so addictive.

Indeed, from human studies, we know that people that get exposed to methamphetamine may become addicted even faster than

when they take cocaine. In the case of methamphetamine, addiction has been reported to occur 1 to 2 years after initiation of use,

in contrast to an average of 3 years for the case of cocaine.

10

The large increases in dopamine induced by methamphetamine

are not only linked to its highly addictive potential, but also its

toxic properties. These large increases in dopamine damage the

dopamine cells themselves, and the consequences of course relate

to the function of dopamine. These individuals are less able to experience pleasure from natural reinforcers. But they also affect

their ability to exert cognitive control and the ability to think clearly.

However, one of the good news in this is that some of these

changes appear to be reverted with protracted detoxification. This

is extraordinarily important, because it further highlights the importance of initiating treatment and of initiating treatment at early

stages, so that we can maximize the recovery of that individual.

As mentioned by Mr. Cummings, there are many other toxic effects of methamphetamine. Methamphetamine does not just go into

your brain, it does damage to the blood vessels, so you can just end

up with a stroke and be paralyzed. But it also affects other organs.

One of the ones that has attracted a lot of attention is seeing young

individuals with myocardial infection because of the toxic effects of

methamphetamine to the myocardium.

Because of these adverse effects, as was mentioned, many people

believe that methamphetamine cannot be treated, or that it is extremely difficult to treat. And yet, we know, as has been mentioned

before, that it can be treated. And in fact, the comparisons with cocaine show similar rates of success.

There are several programs, behavioral interventions, that have

been shown to be effective in the treatment of methamphetamine

addiction. You are going to be hearing specifically from Dr. Rawson

on the Matrix Model, which has been very successful. There are

other 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 successful in the treatment of methamphetamine, as is the case

for all other drugs of abuse, is that addiction is a chronic disease,

which means that treatment is not going to be a one shot and you

are going to be cured. It will require repeated treatments, and relapse does not necessarily mean failure of treatment. It needs that

treatment needs to be reinstituted. But it highlights the importance of continued interventions.

At NIDA, as I say, we feel an obligation to develop also not just

better behavioral interventions, but also medications that can help

those afflicted with addiction. In the case of methamphetamine, we

have some very promising compounds, both from the results in the

laboratory animals, but also from pilot studies in humans. This includes, for example, anti-epileptic medications, such as GVG or

topiramate, which has been actually showing very promising results in clinical studies on methamphetamine abusers.

Certain anti-depressant medications, such as Welbutrin, which is

currently also used for the treatment of nicotine addiction, also has

shown positive signals in methamphetamine treatment. And finally, we are also evaluating the use of medications that can improve alertness and cognitive performance, such as modafinil.

As mentioned by Mr. Cummings, we are also developing immunization strategies, such as monoclonal antibodies, that can be used

11

for those that are suffering from overdose, and thus can be acutely

saved. But we are also investigating the feasibility of developing a

vaccine for methamphetamine that can prevent relapse, using similar strategies as those used for the vaccine for cocaine and for nicotine, which also are showing some very promising results.

NIDA indeed has long recognized the danger of methamphetamine abuse and has actively supported research on these and related drugs. This research continues to help us elucidate the effects

of these drugs in the brain, which is very important, because of

course this leads us to new targets for medication and treatment.

At the same time, we can never, never under-emphasize the importance of this knowledge to develop better prevention strategies.

Thank you for allowing me to share this information with you,

and I will be happy to answer any questions you may have.

Mr. SOUDER. Thank you very much.

The last statement of this panel is from Mr. Charles Curie. I also

want to commend you for your years of service in Pennsylvania and

then at the national level for the last 5 years. I look forward to

working with you as you move on to other endeavors. I am sure

you will continue to stay involved in this field, but we thank you

very much for your leadership.

STATEMENT OF CHARLES G. CURIE

Mr. CURIE. Thank you, Mr. Chairman, for those kind words, and

also Ranking Member Cummings, for your words earlier. They

mean quite a bit. The partnership that we have had has been invaluable. I appreciate this opportunity to testify one last time in

my current capacity to this very important subcommittee.

Mr. Chairman and Ranking Member Cummings, Mr. McHenry,

I am Charles Curie, the Administrator of the Substance Abuse and

Mental Health Services Administration [SAMHSA], within the U.S.

Department of Health and Human Services. I am pleased to say accompanying me today is Dr. Westley Clark, the Director for our

Center for Substance Abuse Treatment, the able Director, very able

Director, within SAMHSA.

And I am pleased to be able to present, with my colleagues Dr.

Madras and my long-term colleague and friend, Dr. Nora Volkow,

SAMHSA’s role in addressing the methamphetamine addiction crisis that this country faces. First, I also would ask that my written

testimony be placed in the record, which is much more detailed

than my oral testimony. What I would like to focus on in my oral

testimony is our role to more effectively address this issue.

To efficiently align and focus our prevention resources, and I

would like to begin with prevention, SAMHSA launched the Strategic Prevention Framework in 2004. The Framework advances community efforts to prevent drug use, using a risk and protective factor approach. Whether we speak about abstinence or rejecting

drugs, including meth, tobacco, alcohol, or promoting exercise and

a healthy diet, we are really working toward the same objective: reducing risk factors that exist in a community and exist in an individual’s life and promoting protective factors.

By the end of this fiscal year, nearly 40 States will be implementing this new approach. I am pleased to say that there are

many States that have taken SPF and have definitely aligned it in

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addressing the methamphetamine issue. Indiana is one State that

I would point out. In presenting the award to Governor Daniels in

Indianapolis, on the Strategic Prevention Framework, he made it

a point to say that this was going to be a central element in addressing the meth issue in Indiana. Again, we shaped 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.

The success of the Framework rests in large part on the tremendous work that comes from grass roots community anti-drug coalitions. The anti-drug coalition effort is very much tied to, and we

view it as part and parcel of Strategic Prevention Framework. That

is why we will continue to work with ONDCP to administer the

Drug-Free Communities Program, and this program currently supports approximately 765 community coalitions across the country.

In terms of treatment, SAMHSA supports treatment, and you

heard Dr. Madras highlight several of those efforts. Again, primarily our substance abuse prevention and treatment block grant

is a major vehicle, and is foundational, as has been mentioned here

before. Appropriated at nearly $1.8 billion, the block grant provides

40 percent of all State funding for public substance abuse services.

We also support treatment through competitive grants. Public

and non-private entities apply directly to SAMHSA for targeted

treatment funds. Since the subcommittee is well acquainted with

both the block grant and our discretionary grant portfolio, let me

discuss one program in particular. In his 2003 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 [ATR], 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 was overwhelming. Sixty-six

States, territories and tribal organizations applied, and competed

for $99 million in grants in fiscal year 2004. We funded grants to

14 States and one tribal organization in August 2004. I am pleased

to say that again, there were States who identified methamphetamine as their No. 1 growing problem, Tennessee and Wyoming,

and they targeted their Access to Recovery funds to address that

issue.

Because the need for treatment is great, as methamphetamine

treatment need alone has demonstrated, President Bush proposed

$100 million for a new cycle of Access to Recovery grants in the

2007 request. Of that, $25 million will be focused exclusively on

methamphetamine. ATR’s use of vouchers, coupled with the State

flexibility and executive discretion to target emerging drug trends

such as meth, is creating profound positive change in substance

abuse treatment financing and service delivery across the Nation.

In short, the ATR initiative has helped all of us operationalize recovery in both public policy and public financing.

I am also pleased to point out that while in fiscal year 2006 we

had $19 million in our budget targeted exclusively toward methamphetamine in terms of treatment and prevention, in our proposed 2007 budget that number is $34 million, in terms of increased emphasis and effort toward methamphetamine.

13

To help ensure the latest science-based services are being provided to people with substance abuse disorders, a true partnership

has emerged between SAMHSA and the National Institute on Drug

Abuse [NIDA]. The result of this collaboration was the result of a

development of a treatment strategy for methamphetamine addiction. The Matrix Model, which Congressman McHenry mentioned

earlier, and you will be hearing more about from Dr. Rawson, and

other cognitive behavioral approaches, are available in a set of two

DVDs produced by our Pacific Southwest Addiction Technology

Transfer Center. Dr. Clark has them. They are on sale in the lobby

after the hearing. [Laughter.]

And our treatment improvement protocol [TIP] No. 33, the treatment for stimulant use disorders, again, giving direction on 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 necessary in order to gain the expertise and the knowledge

around address methamphetamine.

Recently, SAMHSA financed two conferences on methamphetamine for States. SAMHSA paid for States to bring 15 people each,

including State and local officials and providers, to hear experts in

the field of methamphetamine treatment and research, and a wellreceived and much-needed opportunity to learn and share information about methamphetamine.

In conclusion, we are striving to do our part at SAMHSA 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 have been building systemic change also, so that

no matter what drug trend emerges in the future, because we don’t

know what is going to emerge as we go along, and 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. Our goal is always to try to reach it before it hits a crisis

level.

Mr. Chairman, Mr. Cummings, Mr. McHenry, Ms. Foxx, as has

been mentioned before, I would like to ask, if I have a few additional moments, to discuss this being my last appearance in this

capacity before you. As you know, I have submitted my resignation

to the President and will be leaving my current post in SAMHSA

on August 5th. I want to express my appreciation to the dedication

of all of you. Mr. Chairman, Mr. Cummings, we have been in many

hearings together, field hearings. And I have definitely appreciated

your ongoing leadership and unwavering support for those people

who have addictive disease in their life and who are looking to attain and sustain recovery in the pathways you give.

This committee has stood strong in terms of assuring that addiction is addressed in this country. At times when the public interest

in addiction has faded and comes in waves, you have been unwavering. You have kept it at the top of the list of priorities. In my

10 years as Administrator of SAMHSA, I have also found this subVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00017 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
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committee to be both supportive of what we are doing and at the

same time appreciate your keeping our feet to the fire, appreciate

you in terms of bringing, based on the data, what we need to be

addressing. I think that is true partnership, and I think it has been

invaluable to us, as one would expect from Congress.

So it has been an honor working for you and with you. And it

has been the highest privilege for me to be in this position. Your

subcommittee has been one of the very, very great highlights of my

tenure here. Thank you very much.

Mr. SOUDER. Thank you very much for your comments. That is

the best praise we have gotten from the executive branch and—it

is because you are leaving, I guess. [Laughter.]

Nevertheless, it is appreciated.

Let me ask a technical question first, and maybe Dr. Volkow or

Dr. Clark and Ms. Madras, Mr. Curie, if any of you have any further comments on this. Are there medical differences between, in

methamphetamine, it is really unusual, because we have two simultaneous tracks going on in 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 it has

caused and the political problem is greatest in the areas where it

is doing environmental damage, they are blowing up families, they

are tying up drug 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.

The crystal meth moves, some into some cities, particularly if it

moves into cities like Minneapolis-St. Paul, Omaha, Portland, but

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 substantially different? Or does the same treatment process basically work for everybody who uses some form of

methamphetamine?

Dr. VOLKOW. One of the things, methamphetamine is a racemic

mixture. A racemic mixture is when the compounds have a mirror

image one to the other. The ‘‘d’’ version of it is the most potent. The

methamphetamine that you get from home cooking, it has mostly

d-methamphetamine, but there is a little bit of the l-methamphetamine, very small amounts, 5, 6 percent. Whereas the methamphetamine that is coming from abroad is 100 percent pure.

Does this make a difference? I don’t think it does. Actually, we

are funding imaging studies to document the differences between

these two compounds and we really don’t see a difference.

So based on the pharmacology itself, it is unlikely to have much

of a difference. Your concern, of course, has to do more with impurities that may come in the manufacturing of the methamphetamine. That is where my concern would come in terms of treating

these patients, or what I would expect would happen to them.

Mr. SOUDER. Do you expect, and if anybody else has any comment, you can pick it up in the followup here, do you expect, the

States took the lead and started to control pseudoephedrine, which

has been the fundamental ingredient in the home cooking. That

partly pushed people over to crystal meth, as we have seen in

Oklahoma, started to see in Oregon, some degree pushing people

to the Internet.

15

We have heard rumors, one I believe was in the hearing in North

Carolina, that people have looked for, obviously, and the question

is, are they finding substitute ingredients, things other than

pseudoephedrine that they can mix in and emulate methamphetamine? Do you believe that is possible, or do you believe that by

controlling the pseudoephedrine we in fact will shut down the

home cooking?

Dr. VOLKOW. There is no doubt that control of the

pseudoephedrine has had a dramatic impact on the number of

small laboratories. Unfortunately, that has been taken over by the

importation of methamphetamine from abroad, including Mexico.

Could there be other sources for producing methamphetamine? To

my knowledge, right now, I do not know of any.

But I am not a chemist, and chemists can be incredibly creative.

So I do not know. My colleague, Dr. Madras, who is very much a

chemist, may be able to shed some light on that.

Ms. MADRAS. With regard to the precursors, ephedrine well could

serve as a precursor. So could another compound called

phenethylamine. I do think, I certainly agree with my colleague,

Dr. Volkow, that creativity is one of the major problems we face in

the chemical 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 molecule

cocaine was the same. But crack cocaine enabled cocaine to be

smoked. And that enabled a rapid bolus of cocaine to enter the

brain. Whereas cocaine hydrochloride, which is just a different salt

form, was not smokeable, because if you heated it 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.

Mr. SOUDER. Dr. Clark, did you have a comment?

Dr. CLARK. Not only must we deal with the issue of the precursors, you also have to deal with the issues of unscrupulous dealers,

if you will. We recently had an episode of phentenyl added to heroin, dealers may choose to add unrelated substances to products

and use that to advance their economic interests.

So what Dr. Volkow and Dr. Madras said is of critical importance, and we also need to look at some recent behavior in terms

of what drug gangs have done. The importation issue is a major

issue, but also unscrupulous behavior is also an evolving issue.

Mr. SOUDER. Mr. Cummings.

Mr. CUMMINGS. When I talk to young women who are crack addicts, they tell me that the addiction is very quick. And one of you

mentioned, I think it may have been you, Mr. Curie, how fast it

is, how long it takes for one type of drug, for you to become addicted, and then how slow it may be for others. I was just wondering, when you compare crack cocaine to methamphetamine, is that

a rapid addiction situation? Because I hear that a lot, young

women who say they tried crack cocaine and thought it would just

be a one-time thing, next thing you know, they are on it. Particularly from women. I am just curious.

Dr. VOLKOW. I had mentioned that, and indeed, there was a story

that specifically compared the course from occasional use to compulsive use between cocaine abusers and methamphetamine abusVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00019 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
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ers. That story did not distinguish between those subjects that

were taking cocaine, as cocaine, whether it is hydrochloride snorted

or injected, versus those that took it smoked. Effectively, as I mentioned, the routes of administration that are the most dangerous

are the smoked and the injected. The smoked is the crack cocaine.

But injected cocaine is also highly addictive.

And what you are saying is absolutely correct, and the transition

from snorting to smoking is what is actually associated with the

fast development into the addictive process. So to address the question correctly, one would have to compare the transition from

smoking occasionally. But once you start to smoke occasionally cocaine, you become very fast regular. And that I do not have knowledge of any data. I was actually trying to find out if there was. So

I do not know of a study that specifically has addressed that.

Mr. CUMMINGS. Mr. Curie, let me ask you this. You had talked

about, you said you were talking about risk factors in communities,

and you said you had worked closely, it was important to have a

close relationship with the anti-drug coalitions with regard to

methamphetamine. This is what we are talking about, of course.

What is it that they do that helps so much with regard to methamphetamine, and is that any different than other drugs? In other

words, what they do? Because we have been very strong proponents

of the anti-drug coalitions. We have been fighting pretty big time.

And I just wanted to know how that affects it.

Mr. CURIE. I think methamphetamine is the classic example of

why a community anti-drug coalition is so essential. Because the

coalition gives an opportunity to form leadership and focus on the

particular substance abuse, drug issues that are existing in that

particular community. Strategic Prevention Framework, the reason

that it fits so well with the anti-drug coalitions, is what we expect

communities to do is to first assess all the resources that community already has going toward drug prevention efforts, then embark

upon the process of assessing what are the risk factors in that community, is it a transient community, is it a community that doesn’t

have a sense of neighborhood, of connectedness. All those things

add to risk factors that could promote substance abuse. There is a

list of many others.

Once they have embarked upon a process of assessing their risk

factors that exist, as well as protective factors that can be existing

in that community, they can then make collective decisions. And

again, the ideal coalition not only brings together concerned parents and school systems, but city government, brings together a

range of non-profit organizations, brings together Boys and Girls

Club and all those entities that work together.

They can make informed decisions. And we have a list of a 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 their prevention dollars into addressing

those risk factors. If methamphetamine is really the emerging

problem in a community or is a problem and it is overwhelming the

resources, they can really put an emphasis on that locally, and we

have again technical assistance and resources to help them do that.

17

But the coalitions really give leadership and life and voice and

focus to combating and give that consistent voice to combating the

drug problem in the community.

Mr. CUMMINGS. You also gave some stats on Access to Recovery.

I think you said something like 66 States and jurisdictions requested funding, 14 of them got it. I just like the block grant situation so much better. When you tell me that 66 entities applied and

14 got it, that doesn’t, I mean, that means we have quite a few

folks, 52, to be exact, out there saying, what about us? And then

I think you mentioned too Iowa and another State that was geared

toward methamphetamine, Tennessee, I think you said.

Mr. CURIE. Right.

Mr. CUMMINGS. So would you consider that kind of competition

to get 14 out of 66, when people are having all these problems, if

you had to have a choice, would you rather see that in block grant

or see that in that competitive grant?

Mr. CURIE. That is a great question. I think that first of all——

Mr. CUMMINGS. Since you are leaving, I guess it is safe for you

to answer that. [Laughter.]

Mr. CURIE. I can say anything I want.

Mr. CUMMINGS. I wouldn’t have asked you that if you weren’t

leaving.

Mr. CURIE. I support the President’s proposed budget. And I do.

I think the question you are asking is, where can we get the

most value for our dollar in terms of addressing this issue.

Mr. CUMMINGS. That is right.

Mr. CURIE. If you go back to the original Access to Recovery pro- posal, the first time the President proposed it, it was for $200 million. So I think clearly we would say, we would agree, $100 million

wasn’t enough, $100 million is what was appropriated. If we would

have had $200 million we probably could be in up to 30 States during that first cycle, which could have made a more tremendous difference.

As we moved ahead, we proposed $200 million the second year,

got $100 million. It has been staying at pretty much $100 million.

So clearly, I think the administration would be in agreement that

you need to more, especially in that interest. You are exactly right,

66 States and territories were clamoring for it, and we were only

able to make those awards.

I think we would have been hopeful by now with the original Access to Recovery plan that we would have perhaps up to $300 million to $400 million if you recall, I think our goal was to add significant amounts of additional dollars to the treatment budget, if

you go back to the first year, the first term.

Mr. CUMMINGS. Right.

Mr. CURIE. I think that we could make a tremendous impact in

an Access to Recovery approach, because a State would get an

award of somewhere around $7 million to $8 million per year. If

we put that same amount of money into the block grant, that gets

dispersed, if we put like $100 million in the block grant, that gets

dispersed over 50 States and the territories, so it makes less of an

impact in States.

So if we want to target particular problems and a State wants

to make a case, that we want to use Access to Recovery dollars to

18

battle methamphetamine, because in Indiana, for example, or as

they did in Tennessee and Wyoming, meth is undercutting so many

things in the lives of our people, we need to address it, they could

make much of an impact with the $7.5 million 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.

Mr. CUMMINGS. Thank you, Mr. Chairman.

Mr. SOUDER. Mr. McHenry.

Mr. MCHENRY. Thank you, Mr. Chairman.

A couple of things are happening in my State. First of all, we

passed an effective meth bill in North Carolina at about the same

time we passed Federal legislation here. And that has had an enormous effect on eliminating the small lapse 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 pseudoephedrine as does North Carolina. So you have some traveling over the mountain across the

lines. You also have those coming from South Carolina and Tennessee over into my district to buy Sudafed because of some of the

restrictions and having it behind the counter. They are able to go

to a half dozen CVS stores and buy three boxes of Sudafed.

I talked to a police officer this weekend who deals with this, and

he said that 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 an enormous commodity for them to trade in.

But having said all that, the issue that we are dealing with, because we have cut down on these labs so much, it is not the expense of the labs now, and the dealing with the property damage

and the chemicals you have left. The expenses have migrated over

to these meth addicts, who the law enforcement continually has to

deal with. Because you can throw them in jail, and once they get

back on the street, they are back on it.

So that leads to the opening question for this hearing, which is

treatment. So my question to the whole panel is, what type of partnerships do we need with law enforcement and with treatment facilities? Because it seems like there is a disconnect. Law enforcement wants to stem the demand. But I would like to hear your

feedback on what we can do to stimulate that partnership.

Ms. MADRAS. With pleasure. I think that drug courts offer a very

ideal solution to some of the issues that you have raised. Drug

courts offer a choice of treatment or prison for low level criminal

offenders and certainly, this can be applied to methamphetamine

addicts as well.

What they do is partner the legal system with the treatment

community and treatment providers. They have been extremely effective, and the interesting thing is that the re-arrest rate for people who have gone through the drug courts is much lower, considerably lower. A comparison figure is 54 to 60 percent re-arrest rate

for those who have not been treated compared with 16 percent for

those who have.

Mr. MCHENRY. My State courts in North Carolina, we have a

drug court. I have visited a drug court, and it is an amazing result

that they have had in the community where this exists. The difVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00022 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
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ficulty is actually getting what is pilot project in essence in North

Carolina State courts and spreading that.

The other issue is that all law enforcement now in my State

wants Federal charges. And the Federal courts have not been as

equipped as that drug court is. So beyond that, what else can you

say? I would say that to all the panelists.

Ms. MADRAS. In terms of the extending drug courts, the Presi- dent’s proposal is to increase the budget by more than $50 million

for drug courts because of proven efficacy——

Mr. MCHENRY. Beyond drug courts.

Ms. MADRAS. Beyond drug courts, I think the second issue is that

screening people through medical systems is a very effective way

of identifying people who have methamphetamine addictions and

yet do not show up in any other venue. They do not appear for

treatment, they do not appear in the criminal justice system.

Mr. MCHENRY. My time is limited. Dr. Volkow, would you address that?

Dr. VOLKOW. I am glad you are asking that question, because I

think that we have an extraordinary opportunity through the

criminal justice system to touch a very, very large range of drugaddicted people, including those on methamphetamine. The problem is that it is almost ubiquitous by its absence. So from day one

when I took over, I started to recognize that there are very few

prisons and jail systems in this country that institute treatment for

drug addiction.

Well, we have two different cultures, and you are picking them

up. One of them is to protect and punish, and the other one is to

treat and to rehabilitate. So the challenge is to bring it together.

So we have a large initiative at NIDA, which we call NIDA Goes

to Jail. It has a multi-pronged approach, which one of them is to

start educating the judges about the problems of drug addiction,

the effects as a disease, but very important, about the treatment

and the treatment outcomes from the different perspectives.

The other approach to it is how do you bring these treatments

inside of this system that has been rejecting them. And it is not

automatic. So we created a network of prison systems that combines the criminal justice system with the academicians to develop

these treatments and apply them into the prison system, and very

important, to follow these individuals once they leave the criminal

systems. Because what research is showing is if you do not do the

followup, then a lot of these benefits are lost.

This is of course the only close partnership with the SAMHSA

and the criminal justice system. But it is an extraordinary opportunity that if we don’t use, not only is it going to be increasingly

costing our Nation, but we are actually missing the opportunity of

helping those that are afflicted, that unfortunately end up with

criminal behavior and in prison.

Mr. CURIE. I might just quickly mention, I endorse everything

that was just said. I think if you look at Cook County in Illinois,

there is a clear belief there, I recommend the committee take a

look at what is occurring there, if you haven’t already. There is a

philosophy emerging that every court needs to be a drug court.

Eighty to 90 percent of the individuals in the criminal justice system, and this is why NIDA’s project is so critical, have a drug and/

20

or alcohol problem. Over 50 percent of the individuals who are arrested are under the influence at the time of arrest.

And what we find is, and drug courts have demonstrated this,

but what we find is that if people are engaged in treatment when

they are in prison, then you have literally a captive audience, so

you can force treatment there. And the continuity, which Nora

stressed, is so critical for attaining recovery. Recidivism goes down.

So I think again there is a lot we can do in growing drug courts,

but I think the point you are making is we also need to do some

urgent things now in the current justice system. I want to commend what I am finding in the justice system to be a real enlightenment in terms of more and more understanding, more and more

reaching out for help and support. We have had Governors’ summits on methamphetamine in which we had law enforcement, the

judicial system, the community-based system of care, faith-based

community together. And those summits, I can give you a list of

all the States where they have been held, and again, that heightens the awareness as well.

So I think it is an ongoing process. I think it is bringing the models of what is working and making it more the norm in our prison

and court system.

Mr. MCHENRY. Thank you.

Mr. SOUDER. Judge Kramer from Noble County, IN told me over

the weekend that he was just going to convert to a drug court. It

is not like the Federal Government has to all the time fund it. It

is nice to have the extra Federal funding, but this is something

that can be done, and the process is implemented if the people are

committed.

I wanted to ask a couple of other medically related questions. In

looking at treatment for meth, does the reason the individual has

chosen to take meth make a difference if the solutions are largely

behavioral? For example, in some areas we have learned that meth

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 piece work.

Others may be just looking for a high of some sort.

Does why you got involved in meth impact the treatment process?

Dr. VOLKOW. Definitely. You are very perceptive here, because in

general a lot of the community has always waited for the magic

bullet that would cure the disease. They have been terribly disappointed.

Well, it is not surprising, because if you do not address the issue

that led a person to take the drug, that as you pointed out, in

many instances is not just to get high, you are very unlikely to succeed in getting that person rehabilitated properly. Particularly cogent, for example, is those situations where a person may be driven

to taking drugs as an attempt to auto-medicate an unrecognized

psychiatric disorder.

In the case of stimulants, for example, that may occur if you are

depressed, or for example, also if you have a problem with attention deficit disorder. Why? Because when you take these drugs, you

will temporarily feel better and perform better. However, with reVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
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peated administration, the problem gets compounded, because your

mental disorder is not treated and can deteriorate. But you start

to become addicted.

So it is extraordinarily important. That is one of the things that

research has shown about treatment, that it is a multi-pronged approach. Clearly, SAMHSA has followed that. You cannot just address this person is taking methamphetamine. You have to evaluate the uniqueness of the effects of methamphetamine in that person in each context and what drove them there.

So what you are saying is extraordinarily important vis-a-vis our

ability to have a successful therapeutic intervention.

Dr. CLARK. That is one of the first things we do in a clinical situation, having treated methamphetamine addicts and others, you

need to make sure you identify what the underlying issue is. One

of the reasons we have a work release program at SAMHSA is because indeed, if the employer’s environment, and we work with the

DOT on workplace drug testing, which has proven to be very effective, if the employer’s environment encourages the mis-use, in this

case, of stimulants, then the person is being rewarded for misusing stimulants.

I had a patient who said, ‘‘My job was to do emergency work

when things fell. And I had to sometimes stay up for 72 hours. Nobody asked me how I could stay up for 72 hours.’’ He was doing

cocaine, in this case. But the fact of the matter is, the job provided

incentives for the mis-use of a stimulant. And you are correct,

truck drivers have that. If I get rewarded for long hours behind the

wheel, then I am going to look for ways to do long hours behind

the wheel. So the employers have to play a role in it. The vectors

of value in a community have to be tied to recovery in order for

recovery to have meaning.

Ms. MADRAS. I would like to add, in terms of the causes, in the

surveys that were done, not recently, but a while ago, more than

60 percent of the people who used methamphetamine took it initially because it was available. And that is a very important factor.

The second issue that I think is important with regard to treatment outcomes 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 adolescent or 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 the

methamphetamine 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 SBIRT Program, is going to have an enormous influence on catching people

before they progress to addiction.

Mr. SOUDER. One of the things that became apparent in major

league baseball as we did the hearings in this room is that steroids,

while a serious problem, amphetamines are more common. In fact,

some baseball teams actually had the pills available in the locker

rooms, not necessarily authorized by the team itself, but certainly

hadn’t shut it down through their training, and called them different names. We have been trying to address this question.

22

Could you describe a little bit of the medical differences between

amphetamines and methamphetamine and some of the range? Historically this has been called crank, it has had different names in

its lifetime. Right now, everybody refers to it as methamphetamine.

In the opening testimony we talked about the category of methamphetamine and a little bit of the medical differences that we are

dealing with.

Dr. VOLKOW. All of these drugs are considered stimulants, because they activate the sympathetic system, which is one that allows you do the fight-flight response. Within the stimulants, there

are two categories, one represented by cocaine, and the other represented by amphetamine and methamphetamine. What is fascinating is in each one of these categories, you have a medication

that is used extensively in treatment on children with attention

deficit disorder.

So what are the differences and the similarities? Amphetamine

has been abused and continues to be a significant abuse problem

in several countries of the world, such as Japan. So there is an epidemic of amphetamine abuse. It can be very addictive, and it also

can be very toxic. And just like methamphetamine, it can produce

psychosis.

Now, how does amphetamine compare with methamphetamine,

and why is it that we can still use amphetamine properly to treat

children with attention deficit disorder? Well, to start with, when

we treat, we use a route of administration that is much less addictive. We use oral administration and we regulate and titrate the

doses. You never will administer an amphetamine for any other

route than oral.

Having said that, as I said, when you inject amphetamine, the

same amphetamine that you give to children to treat attention deficit disorder, you can crush and inject. It can produce a very intense

high, and it definitely is associated with addiction.

Now, if you compare amphetamine and methamphetamine in

terms, for example, they are quite similar pharmacologically. Methamphetamine is more potent than amphetamine itself, in its ability

to increase dopamine as well, and its ability to increase

noradrenaline, which is the other property that is associated with

enhanced alertness that they were referring to. You need to stay

awake for many hours, what are our kids doing in college? They

are taking an amphetamine to study for their exams without having to read, and they are going to perform better. Why? Because

it has neuradrenergic effects.

Will methamphetamine do the same thing? Yes, it will. But it

will be doing it for a longer period of time. So it is an issue of potency between methamphetamine and amphetamine. Both of them

are highly dangerous. When abused inappropriately, amphetamine

can be highly dangerous.

Cocaine, on the other hand, is less potent than the amphetamines. But because it is very unique, it goes in and out of the

brain very rapidly, it can lead to a repeated administration that

can be incredibly dangerous. Also, cocaine, different from amphetamine and methamphetamine, has local anaesthetic effects. And

that is particularly problematic vis-a-vis toxicity, because it can

23

lead much more easily to seizures. This is one of the reasons associated with medical emergencies with cocaine.

So while they are similar, there are unique characteristics. And

on top of them in terms of potency lies methamphetamine. And as

Dr. Madras stated, one of the things that makes it also so incredibly problematic is that it is very easy to synthesize. That is where

the move about pseudoephedrine becomes so very important, because as Dr. Madras said, and we have known that for many, many

years, availability is one of the most important variables driving

drug experimentation, which is of course the first step toward the

path of addiction.

Mr. SOUDER. One other question here that often have heard,

well, let me ask two questions. One is that methamphetamine,

more than we hear in other drugs, the users tend to be paranoic

and behave differently as law enforcement approaches, more likely

to be violent.

As you were describing this with the different potentially co-occurring dependencies and masking other things, is it the drug that

is causing the paranoia, or to some degree they were already

paranoic, and it got exaggerated? In other words, a person who is

more paranoic may be attracted to use this drug if they had a cooccurring dependency, such as ADD or other types of things.

Dr. VOLKOW. You know, it is a fascinating question, but there is

clear-cut evidence that amphetamines can produce psychosis. You

can actually do it, they have done it in the past where they were

doing experiments of giving some of these pharmacological agents

to normal individuals. This was reported, high doses of amphetamine, not just methamphetamine, can produce psychosis. So to

the question, if you are paranoid, are you more likely to take this

stimulant drug, in fact, you are not. Because it can make you really, really sick.

So when you have someone, for example, that has a vulnerability

for psychosis and they take one of these drugs, they get very, very

sick. So it becomes subversive. So the drug itself, what do we know

about why that drug can produce psychosis and why is it so much

more frequent than with cocaine? Because it can increase dopamine

so much more than cocaine. That is one of the elements.

The other element that is unique to amphetamine that does not

happen with cocaine is that the target, that is, where the drug

binds, which is a protein that is involved in recycling dopamine, so

dopamine is liberated, but it is immediately removed. Cocaine and

amphetamine and methamphetamine block it. But methamphetamine and amphetamine, cocaine does not do that, bring this protein inside the cell, decreasing its availability. And that appears to

be long lasting.

So what you have is, the protein is no longer there, even though

the drug may not be there, and there is no recycling process, so

dopamine stays longer. And that is really one of the reasons why

it is also so much more frequent to see psychosis with methamphetamine than with cocaine.

Mr. SOUDER. Ms. Madras, did you have a comment?

Ms. MADRAS. Just to add to Dr. Volkow’s excellent comments, in

schizophrenia, which is the ultimate form of psychosis, a blockade

of dopamine targets is what produces therapeutic benefit. So schizVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
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ophrenia is characterized by psychosis with, in many cases, paranoia. The underlying theory is that schizophrenia is a disease

where there is too much dopamine not necessarily being produced,

but there is too much dopamine activity in the brain. And amphetamines parallel that effect by producing excess dopamine.

So there is a very clear parallel between the two. In fact, emergency room physicians, if someone comes in with psychosis and

they want to diagnose a person as being schizophrenic, they have

to wait and make sure that they have not taken amphetamines in

order to make the diagnosis.

Mr. SOUDER. My last question is a direct followup on this, Mr.

Curie has made his whole career on co-occurring dependencies. And

this is the first hearing in all the hearings we have on meth, I

think we have had 10 now, or more, in this subcommittee, where

the subject of the co-occurring dependency may have led to somebody using. In 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-prescribed this, because it masks their

other symptoms, it may have actually made it worse.

Is there a study to this effect? Is this common? Is it in certain

areas of the country more? What are we looking at here? Because

in fact, if it makes disease more severe, this is a potential, another

type of the problem that we are tackling.

Mr. CURIE. I will make just a couple of general remarks and let

the scientists go into more detail with that. I think first of all,

stressing the fact that an addictive disease is its own disease, as

well as mental illnesses, and there is a range of mental illnesses.

And I think the key is the term co-occurring. Sometimes they do

co-occur, and we have the data to demonstrate that. Many times

when they do co-occur, what we have found in our systems is that

we have failed those individuals, because we are either treating

one or the other disorder instead of both, in a particular sort of

way or acknowledging it. And many times, the disorders get worse

if you are not treating both.

So again, we know more today than ever before about that. I

think in general, you do have situations where people may have an

underlying bipolar disorder, schizophrenia that has been

undiagnosed. And the use of drugs or substances has been a form

of self-medication. You see that. And they may be treated for addiction. If that goes undiagnosed, it is likely that they are going to be

going back with the medications.

I think you just heard excellent explanations too that many people do not have an underlying mental illness, but because of the

impact of the substances, psychosis did occur. So all those things

need to be sorted out, but the key is I think us having an understanding in primary health care settings, in mental health settings

and substance abuse settings, that we need to do an assessment

around the co-occurring issue, and make sure any door is the right

door to assure people are receiving the appropriate treatment at

the appropriate level, depending on the nature of the co-occurring

disorder.

Mr. SOUDER. In any additional comment on that, could you also

address if the drug can actually cause another psychosis, for example, will that last, even if they give up the drug? And then we have

25

crossed the other direction? In other words, you had co-occurring,

but then could actually the drug create a co-occurring instance?

Dr. VOLKOW. The question that you are asking is one that has

been challenging the whole research community. For some there

are some clearer answers than for others. It is clear evidence that

certain drugs can induce an anxiety disorder, given an individual

that otherwise would not develop it. The same thing with a conduct

disorder.

With respect to schizophrenia, this has been very controversial.

There is evidence, this has been for many years, particularly from

the European literature, showing that early exposure to cannabis

can indeed increase the risk of schizophrenia. There is an elegant

study that showed that it could actually trigger it in those individuals that have the genetic risk, that may or may not have gotten

it if they had not smoked.

So the consensus right now is that by itself, the drug has not

been shown to produce a schizophrenia or a psychosis that is irreversible. That doesn’t mean it doesn’t happen. The overall consensus is that it is likely to produce it in those that may have the vulnerability, because of your genes.

But again, what genes confer, what we know is the gene is not

going to be a death sentence that you are going to get schizophrenia. What a gene gives you is a vulnerability that when, combined

with the environmental factors, can determine whether you will develop the schizophrenia or not.

One of the most important environmental factors contributing on

whether you will develop the mental illness or not is the exposure

to drugs. Dr. Madras made a comment that is extremely salient,

which is the notion that early exposure to drugs in an vulnerable

individual is particularly problematic. So if you have the vulnerability and get exposed, that increases your risk of developing depression, of developing anxiety, of developing psychosis.

Ms. MADRAS. I think some of our best evidence in linking the use

of drugs with ultimate consequences is with regard to alcohol. In

a study that began in the 1940’s and persists to this day, of a cohort of Harvard graduates, as compared with other workers in the

Boston area, it was found that people who initiated alcohol use

during their youth and adolescence and subsequently had a much

higher incidence of depression consequently, than people who did

not. That was true whether or not you graduated college or whether or not you did not go to college.

So there are clear links. But some of the others with regard to

amphetamine and methamphetamine, as Dr. Volkow said, they are

more controversial. There is no question that acutely, drugs can induce a psychosis. But whether or not it is reversible I think remains to be determined.

Mr. SOUDER. Mr. Cummings.

Mr. CUMMINGS. Dr. Volkow, you earlier invoked the term ‘‘magic

bullet.’’ This Sunday’s New York Times Magazine ran an article entitled ‘‘An Anti-Addiction Pill.’’ The article discusses Prometa, a

drug treatment protocol for cocaine, alcohol and meth addiction,

that is being marketed aggressively by a Los Angeles-based health

care services management company called Hythiam. Some addiction medicine physicians who have administered this drug protocol

26

have reported encouraging results in reducing anxiety and drug

craving. But some scientists have expressed concerns about the aggressive marketing of the protocol without clinical investigation.

Can you comment on that for a moment?

Dr. VOLKOW. Yes, certainly, I will be happy to comment on it. In

the field of drug addiction, it has been very, very difficult to change

the culture to accept drug addiction as a disease. As you know, we

are treated differently. The insurance, private insurance, do not

cover for the treatment. Why? Because they say drug addiction

treatment does not work.

So it has become extraordinarily important for us to provide objective evidence of the effectiveness of treatment interventions. And

it is harmful to the field to promote a treatment without that evidence, because it serves to propagate, if the treatment, when the

studies are done properly, does not show effectiveness, it serves to

propagate the sense that treatment does not work.

So to my knowledge, and I have looked into the literature, there

is no randomized study that has proven the efficacy of Prometa.

There was a study that was recently reported last week in the committee on Problems of Drug Dependence meeting, where they

showed positive results. However, that is an open trial, and where

the placebo effect is likely to confound the results of that study.

So as of now, there is not yet evidence of a randomized study

that can attest for the efficacy of the treatment.

Do I support the utilization of treatments that are not evidencebased? No, I do not.

Mr. CUMMINGS. What are the possibilities or probabilities of a

pharmaceutical treatment for meth addiction analogous, say, to

methadone? What is the situation there?

Dr. VOLKOW. I am very confident, and I am not one of those people that just sort of says, to make a good feeling, that we will

have——

Mr. CUMMINGS. I kind of got that impression. [Laughter.]

Dr. VOLKOW. That we have some very promising compounds, if

only we could accelerate it faster into the clinics, that we will be

seeing a shift in the way of the treatments that we can offer to people that are addicted to methamphetamine.

For many years, we were very much married to the concept of

emulating the success with methadone, and now with

buprenorphine for heroin. And as of now, that type of strategy,

which is to provide a medication that actually accesses the same

targets as the drug that is being abused, but with different properties, which has been so successful in heroin, as of yet have not

yielded success for the treatment of methamphetamine overall.

That doesn’t mean it doesn’t work. But what we are doing in the

meantime, rather than just concentrating on that approach, we are

in parallel checking other types of strategies that for example address, can we interfere with the memories that are formed when

you become addicted to the drug, such that you do not desire the

drug when you are exposed to it. The notion of the vaccine that will

actually change and interfere with the ability of the drug to get

into your brain as a mechanism of protecting you against relapsing,

medications that can interfere with the responses of our body when

we are stressed, which is one of the factors that lead people to reVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
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lapse. Why? Because stress activates the same circuits that are activated by drugs. So it primes them, wanting you to want the drug.

So that is the other medication strategies that we are looking for,

while at the same time still keeping an eye on the possibility that

perhaps a molecule may work. But as of now, I cannot tell you of

any success in that particular type of strategy.

Mr. CUMMINGS. One of the things that I wonder about, and we

have touched on it a bit here, is what causes one population to use

a certain drug and another—these are all people that are trying to

get high. And so I look and I see, and one thing may be access, in

other words, if it is there and available. But it seems as if, and I

am just wondering, is it something unique about methamphetamine, its nature, that draws people to it from the beginning, as

opposed to cocaine? In other words, in the urban areas, I don’t hear

too much about methamphetamine in Baltimore. I am not saying

it is not on its way or not nearby.

But on the other hand, you go into the rural areas, and there it

is. A lot of very, very good people come up with great backgrounds,

the next thing you know, they are addicted. But it is almost like

you can put a wall between one drug and another. I am just wondering, is there any particular person that is prone to use methamphetamine as opposed to cocaine or crack cocaine?

Dr. VOLKOW. The reason why I jumped at your question is that

you touched on something I have been obsessing now for several

years. Because I think it is very important, to me, an opportunity

to understand what may be protecting a certain population, specifically in the case of methamphetamine. What has been intriguing

me is why there are such low rates in the African-American community.

Now, you could say, and these are the responses that I got from

people in the field, that it is perhaps of the market and the accessibility, that the urban territories are predominantly, they have

strong markets to deal with cocaine. And so there is a pressure and

an availability. Or there may be a culture that makes it negative,

not acceptable.

Yet at the same time, I cannot forget what we know from other

sources of drug addiction. For example, smoking is also much less

prevalent in the African-American population. And the question for

many years, people said, well, it has to do with the way that kids

are brought up in their families. But recently, for example, we have

known that African-Americans have a gene that encodes for the

protein that destroys nicotine, that does not do it very properly.

And as a result of that, they cannot metabolize nicotine properly.

And as a result of that, when they smoke, nicotine concentrations

are much higher and become aversive.

So this is a protection that helps decrease the number of people

that become addicted, that will smoke cigarettes, but also the

amount of cigarettes that they smoke. So I have always been very

intrigued about that possibility. There is no data, so this is purely

speculative. That yes, while environmental factors are extraordinarily important in addressing the question why one may favor

one, not the other, there may be other biological factors, such as

how do you excrete or metabolize the drug. And we know for example, that in African-Americans, kids treated with amphetamines for

28

attention deficit disorder require much lower doses. Why? Because

they excrete is less.

So it is plausible that it is a combination of factors, environmental and biological, that can determine the differences as we are

seeing right now, specifically with the methamphetamine, that we

are seeing very low rates of abuse.

Mr. SOUDER. I need to do a followup with that, because that

came up at one of our other hearings, where you made a similar

reference. And in our field hearings, the home cookers clearly are

in rural areas, partly because it can’t be smelled as easily. That is

why they are in the national forests and elsewhere, they can find

the ingredients.

But neither crystal meth nor the home-cooked meth has been

very prevalent in the big cities. But in our hearing in Minneapolis,

and you need to look at Minneapolis, because in Hennepin County,

we have testimony from the drug court and 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, 60 percent of the people hitting

the emergency room and in the drug court were African-American.

It isn’t clear whether that sustained itself, whether it was a brief

spurt because a distribution group changed. But that is the only

hearing we have had in the country where we saw it hit an urban

area and 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 has

been a little bit in New Orleans, a little bit in Detroit. My understanding is Omaha and Portland have started to see it in the minority community, too. But there should be starting to get enough

of a sample to be able to test the theory. Because we have our first

urban exposures.

Even in my home district, Fort Wayne has no meth. Elkhart has

crack. South Bend is still cocaine and heroin. Even in Kosciusko

County, where the whole area around the city of Warsaw-Winona

Lake, which maybe had 20,000 people, there is 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 phenomenon to this, even on crystal meth.

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 drug is going to move. If

there is not a biological difference but just a distribution difference,

then we have a different strategy toward trying to work it.

Mr. CUMMINGS. That is what I was trying to get to.

Dr. Clark.

Dr. CLARK. I think it is a combination of all the factors, that is,

what Dr. Madras and Dr. Volkow were stressing, that indeed you

are dealing with multi-factorial issues. The data shows that African-American people who present for people, only 0.1 percent are

users. But that still is 0.1 percent, it is not zero. I think that is

the key issue.

So what Mr. Souder pointed out, the chairman pointed out, is in

fact an issue. There is an access issue. The northeast does not have

29

a major methamphetamine problem. So you go to Maine, it does

not have a major methamphetamine problem. The African-American population in Maine is still really quite low.

So there is access, there are drug gangs, there are importation

routes, there are manufacturing routes, there are a host of issues

associated with this. Communities 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, if the African-American community has been spared the problem, it should recognize

that the problem can come. And as other communities, Asian communities, Hispanic and Latino community. The American Indian

and Alaska Native communities, very high prevalence rate compared to other ethnic groups, other than Native Hawaiians and Pacific Islanders, 2.2 percent, which is the largest among Native Hawaiians and other Pacific Islanders.

So what we are dealing with here is a combination of access, biology in terms of genetics, preference, gang activity, importation,

routes, etc.

Mr. CUMMINGS. Mr. Chairman, I know we have to get to our

other panelists, and I am going to be very brief. But let me say

this, that in my district, and I have literally seen this many times,

where 100, 150 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 it is on a main thoroughfare.

And if you watch long enough, what will happen is a drug dealer,

along with his comrades, will come and give them samples. And everybody stands there, and it is almost like somebody says at 1

o’clock at North and Monroe, this is going to happen, and they are

there on time, they are disciplined, they stand straight in a line.

It is well organized, they have lookouts everywhere. And I am talking about in broad daylight.

Now, what am I getting to? Drug salespeople are very sophisticated. They are some of the most brilliant people probably out

there. They can actually operate an enterprise under the nose of

the DEA, the FBI, the local police, the State police. And they do

it very effectively. And what are they trying to get? Money.

So it says to me that if they can come up with, and by the way,

what they do, the reason why they are giving out these samples,

of course, is to say my product is better than your product. So come

back tomorrow and you can buy it, today it is free.

So it seems to me, that somewhere in this country, somebody

would say, you know, over there in Indiana, they have this stuff

called meth, it is working, and it is making people high. And guess

what? It stays in your system a long time. So maybe you can get

a bigger bang for your buck. I mean, it is just logical. These people

are out to make money.

So I wonder what it is that would keep that person from coming

over and at least, if they can do this in the inner city, under the

eyes of the police, it seems like they would be doing it, we would

be seeing even more Minneapolis-type incidents, like the chairman

talked about, all over the country. And that is a concern, because

it does tell us what we have to deal with.

30

I just can’t believe, the reason why all of it, what Dr. Volkow was

saying, and you, Mr. Curie, it makes a lot of sense. But I have to

tell you, a lot of people don’t think it is going to get to the cities.

I do. I do. Just because of the profit.

Ms. MADRAS. Just to add on to this, if one gives animals access

to methamphetamine, or amphetamine, or any of the emerging

drugs, they will self-administer it as robustly as humans, if not

more so. In fact, some of them will kill themselves with unlimited

access. So this is a biological property of our human brains as well

as our colleagues in the mammalian kingdom.

Mr. CUMMINGS. Last but not least, drug courts. Do drug courts

have more effect—I think you were talking about this, Mr. Curie—

do we find that drug courts are more effective with regard to methamphetamine, or is it about the same as with other drugs?

Mr. CURIE. I know that Dr. Madras discussed that. I think in

terms of, I mean absolutely in terms of the impact overall with substance abuse we see drug courts being very effective, and we have

seen them be effective with methamphetamine in terms of getting

people in treatment. We know treatment works. I don’t know if we

have the actual data in terms of separating the meth—I guess the

Matrix study would have that, yes.

Mr. CLARK. In the SAMHSA research project, one project that

works as well as the Matrix Model was drug courts.

Mr. CUMMINGS. OK.

Ms. MADRAS. And in the Vigo County drug court system in Indiana, the recidivism rate was only 16 percent for meth users, which

means very, very high efficacy.

Mr. CUMMINGS. The reason why I asked that is you all talked

about how long it stays in the system. I think somebody used the

term ‘‘intense relapse.’’ And I was just wondering whether, when

you have intense relapse, when you have a cocaine addict in drug

court, as compared to a methamphetamine user, if the relapse is

less intense for the cocaine user, more intense for, of course, the

methamphetamine user. I just wondered how drug court affects

that.

Ms. MADRAS. One of the things the drug courts have that a voluntary admission into treatment does not is both the coercive aspect as well as the treatment aspect. So there are adverse consequences to failing. And what is so interesting in a number of

areas in our society, such as the medical community, the Department of Defense community, is that when you impose adverse consequences on relapse, you get a much higher treatment rate.

For example, physicians who are treated because of impairment,

their relapse rate is much lower, because the consequence is the

loss of their medical license. And in the Department of Defense,

mandatory drug testing leads to 1 to 2 percent positives, compared

to the rest of society. So the drug courts have a certain measure

of coercion with adverse consequences that has an added benefit,

compared with voluntary treatment.

Mr. CUMMINGS. I often say, and I will close with this, Mr. Chairman, that people do things for one of two reasons or a combination

of both: to gain pleasure or avoid pain. And it goes to what you just

said.

31

Mr. SOUDER. I thank you. We have had different people testify

at our meth hearings on drug courts. One of the things is, the sample size is really relatively small yet in the United States. By the

time you separate out mandatory entrance, in Arkansas it was

mandatory going into the drug court, in other States it is voluntary

to go into the drug court. Also the number of drugs you are dealing

with, also a critical question is, did you catch them early or catch

them late.

Even in some of our counties, the drug court judge tends to get

them earlier in meth than some of the other judges. We have one

judge in one of my counties who has, the person is coming up for

the third offense of cooking meth, and they haven’t been prosecuted

yet on the first one. That makes the measurement difficult, very

difficult.

But as we get more experience, the drug courts, the emergency

rooms are the great mines for information to try to do this. We 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. We thank you

for that.

If the second panel could come forward and remain standing so

that I can give you each the oath. Our second panel is Russell

Cronkhite, recovered meth addict; Darren and Aaronette Noble, recovered meth addicts, with their son, Joey Binkley; Dr. Richard A.

Rawson, associate director of the Integrated Substance Abuse Programs at UCLA; Leah Heaston, Noble County director of the Otis

R. Bowen Center for Human Services in Indiana; Mr. Michael

Harle, president and CEO of Gaudenzia, Inc.; and Pat Fleming, director of the Salt Lake County Substance Abuse Services.

If you will each remaining standing so we can give you the oath.

[Witnesses sworn.]

Mr. SOUDER. Let the record show that each of the witnesses have

responded in the affirmative. We thank you for coming today and

we will start with Mr. Cronkhite.

STATEMENTS OF RUSSELL CRONKHITE, RECOVERED METH

ADDICT; DARREN AND AARONETTE NOBLE, RECOVERED

METH ADDICTS, ACCOMPANIED BY JOSEPH BINKLEY; RICHARD A. RAWSON, PH.D, ASSOCIATED DIRECTOR, INTEGRATED SUBSTANCE ABUSE PROGRAMS, UCLA; LEAH C.

HEASTON, MSW, LCSW, ACSW, SAP, NOBLE COUNTY DIRECTOR, OTIS R. BOWEN CENTER FOR HUMAN SERVICES, INC.;

MICHAEL B. HARLE, MHS, GAUDENZIA, INC.; AND PAT FLEMING, DIRECTOR, SALT LAKE COUNTY SUBSTANCE ABUSE

SERVICES

STATEMENT OF RUSSELL CRONKHITE

Mr. CRONKHITE. Thank you, Mr. Chairman.

Actually, I am very encouraged at some of the things I have

heard today, especially for the progress in the drug courts.

For nearly 12 years, I had the honor to serve our Nation as the

executive chef of Blair House, the President’s guest house. In my

tour of duty, I served Presidents Ronald Reagan, George H.W.

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Bush and Bill Clinton, as well as nearly every world leader of this

era.

Today I am the author of two successful cookbooks. My work has

appeared in several top food magazines. I continue to contribute

food-related articles to publications like the Washington Post.

Rather than write the latest celebrity chef trend cookbook, I have

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 A Return to Family

Picnics. I continue today with my career as a public speaker and

working with faith-based organizations, community organizations

for the purpose of encouraging families and family values and a

sense of community.

My family value message is not a marketing plan. In August, my

wife and I will celebrate our 34th anniversary. She works for the

Fairfax County school system here. We are 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 will be hard pressed to find anyone that I

worked with in Washington, DC, or worked with in the hospitality

industry over the last 30 years who would even believe that such

a past struggle was even possible.

I find no pleasure in telling or even recalling this self-imposed

hell that is so far removed from my life, but the epidemic sweeping

our country has compelled me to come forward and tell my story.

It is a story of restoration and redemption. I come here today as

a private citizen with no connection to any party, political organization or advocacy group.

My spiral into the drug culture began in 1965 and soon my life

became a shattered mess that reflected the chaos of the turbulent

times. By 1967, just after my 14th birthday, while looking for a

better thrill, I fell into the frightening world of methamphetamine

into a desperate addiction that continued over the next 3 years.

Methamphetamine is different than other drugs. Using methamphetamine is not about escapism. Staying up for days and weeks

on end without sleep is no escape from reality. Meth addiction is

self-destructive. It is a slow suicide and is also a visible call for

help. I knew full well the risks and down side of methamphetamine

use. We used to say ‘‘speed kills, speed thrills.’’ It was a catch

phrase. My spiral into this hell of meth addiction was severe. Selfmutilation, chaos, psychotic episodes and 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, and I know those who died by the needle.

We were not the children of unfortunate circumstances. The Los

Angeles community where I grew up was similar to the local communities surrounding Washington, DC, like Arlington and Falls

Church. We were middle class and upper middle class families. My

parents’ friends were real estate brokers, doctors, contractors,

school teachers, dentists, business owners, executives and engineers for companies like Douglass, Northrop and Hughes.

33

I am not one who believes that drug addiction is a disease, per

se. It is an illness, yes. It is not something that you can catch, like

a communicable disease, like measles or chicken pox. There is a

certain self-inflicted part to this disease, to this illness. I do understand the idea and the desire 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 guilt dumped on them.

But the loss of personal responsibility, while attractive in the

short term, can also take away the impetus for change. If we are

simply creatures of our genetic makeup, predisposed to some disposition or some unfair twist of fate, we are sadly condemned and

unable to rise above our very circumstances.

Equally, I am concerned, as has been expressed here today, that

some might suggest that methamphetamine addiction cannot be effectively treated. Clearly, my life is evidence to the contrary. The

years between 1965 and 1970 found me in and out the juvenile

court systems, 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 than keeping

me locked up.

My road to recovery began with a very simple, act, though. An

uncle, finding me dazed, my body reduced to that of some sort of

holocaust survivor, simply put his arms around me and invited me

in to have something to eat. There was no scolding, no lecture, no

condemnation, just loving concern, served with a bowl of peaches.

Today I applaud groups like CASA, who foster the values found

around the family table and the quality companies that support

their efforts.

It does take a village. An effective drug treatment program, especially for the highly addictive methamphetamine, must be comprehensive. Faith in God, the support of my church, my family,

dedicated school teachers and community organizations like the

YMCA, coupled with a viable, quality psychological counseling and

a State-run system that worked, brought me to a place of transformation and renewal in 1970.

One of the first jobs I took as I rebuilt my life was that of a prep

cook. You have to start somewhere. Still, without a high school diploma, a little consistent work experience and a troubled adolescence, I faced many challenges. People were not eager to hire me.

But it only takes one exception. The first chef that I worked for had

a policy of hiring the worst applicants. His thought was that if you

gave someone a second chance, as someone had given him, the person would rise to that opportunity, work harder than someone with

other choices. 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 the Washington, DC area, before I joined Blair House, who

had limited training, limited educations and limited opportunities

was a challenge. I met those challenges by listening and recognizing that outside influences faced by employees also affected their

performances.

34

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 in hotels in Washington, DC, and in Atlanta became involved in methamphetamine and amphetamines because they were

working two jobs to support their families. I personally paid an employee’s rent and covered their time off for treatment to compensate for the limited resources that were available, rather than

lose an otherwise good employee.

The social fabric of America has 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 mortgaged their lives, lost their homes

and spent their life savings to save a child. I know families who

have seen their children relapse into the frightening hell of drug

addiction, simply because the 30 day maximum for mental health

treatment and the 20 allowable followup counseling sessions have

run out. These are the ones with health care. To my knowledge,

Fairfax County, one of the country’s most affluent communities,

has only one facility available for these kinds of programs.

According to a recent Washington Post article, Americans feel

more and more isolated and have fewer people that they feel they

can confide in in times of difficulty. Robert Putnam has chronicled

these alarming social trends in a monumental work, Bowling

Alone: The Decline and Revival of American Community.

I am concerned about the mixed messages that we seem to be

sending out. Today we have a lock them up and throw away the

key mentality too often. I am especially concerned about this when

it comes to juvenile justice: 14, 15 and 16 year olds are not adults.

I do believe we should have little tolerance for those who manufacturer and distribute dangerous drugs for profit. In this, truly the

love of money is the root of all evil. Those who market their witches 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 had the same opportunity to rebuild and reclaim my life 35 years ago, as I have. I was

fortunate. My arrests and convictions all took place before my 18th

birthday. And because I successfully completed my parole without

incident for 5 years from my release from the California Youth Authority, my juvenile record was expunged, as it should have been.

With the difficulties of my adolescence behind me, I was allowed

to rebuild my life, rise to the top of my craft while providing for

my family and served my country with honor and distinction.

Trustworthiness is not about having lived a perfect life. It is 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 prison. It was a place of solitude

where one could consider their actions, come to repentance and return to society.

35

I am not a recovered addict one slip away from remission. I am

a highly successful professional, a father, a husband married 34

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 disillusioned moral crisis. Addiction is a symptom of a deeper plague. To

effectively treat addiction we must have a comprehensive plan to

address the root causes. Left untreated, those causes will only reappear or resurface in a different form.

I am here by God’s grace to be sure, but I am here because those

around me cared enough to come alongside me and offer help. My

story is one of success. I am one for whom the system worked,

where the unconditional love of family, community, Government resources, family doctor, faith-based organizations and self-determination and good counseling came together to save a life.

Mr. SOUDER. Thank you very much for your testimony.

Darren, you or Aaronette, who is going to give your testimony?

You are Darren, you are next.

STATEMENT OF DARREN NOBLE

Mr. NOBLE. Good afternoon. Thank you for the chance to speak

to you as a father in recovery. Aaronette and I are the proud parents of two children, Casey, who is 6, and Summer, who is 17

months old. Casey is here with us today. I am also the very proud

stepfather of Joey Binkley.

I used meth for 14 years. My wife and I used meth together. We

wanted to get help to stop hurting ourselves and our children. I

tried treatment. I went into four different treatment programs, but

each program was set up for single adults. I couldn’t bring

Aaronette or the children with me. So I couldn’t concentrate on the

treatment itself. I couldn’t stop worrying about my wife still being

in the situation that I had left. I couldn’t 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 couldn’t think about me. I could only worry about my

family. So after many years of using meth, trying to get clean,

using again, I ended up in prison. In 1999, I was arrested for manufacturing meth. I used to manufacture meth by myself out in the

woods.

When I went into prison, I weighed about 120 pounds. I was not

offered treatment in prison or after prison. After serving 3 years

and 10 months, I was released.

Life didn’t get better for us after prison. Aaronette and I continued to use meth. Our addiction got so terrible that in 2005,

Aaronette gave birth to our second daughter, who was born with

meth in her. Child welfare took our baby away. But child welfare,

along with the family court program, placed us into Bridgeway’s

family treatment program. Aaronette went into the women and

children’s program. I went into the men’s program.

I can’t tell you how wonderful it felt 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. At Bridgeway, we did family therapy, couples counseling, we had parenting classes. I learned how

36

to communicate with my wife. I learned how to honor her. You see,

before, our relationship was based on drugs. But now we know how

to talk to each other, love each other, and we also know how to be

parents.

When I was using meth, my daughter Casey looked so scared.

My daughter Summer lived with her grandmother. She was very

attached to her grandmother. But today, our daughter Casey has

a beautiful sparkle in her eye. She is doing well in school. And our

daughter Summer has been returned to our custody, 7 months ago.

She is inseparable 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 worked

together to help our family get clean and stable. Our social circle

is made up of other parents in recovery. We are blessed. I am

working in construction. We attend church. We still go to therapy.

And we are a family with faith and hope.

Thank you.

Mr. SOUDER. Thank you. Aaronette, do you have a statement?

STATEMENT OF AARONETTE NOBLE

Mrs. NOBLE. Good afternoon. Thank you for the honor of speaking with you today. My name is Aaronette Noble. I am here with

my husband, Darren, my son Joey and my daughter Casey. I am

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 7. I first

drank alcohol at the age of 14, and I began using cocaine and

methamphetamine at the ripe age of 17.

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 things. I know I didn’t.

When I was using meth, I felt dead most of 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 or no faith in 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 teeth and 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 single adult programs but I never succeeded in staying clean. The programs were

very short-term. They were only 90 days at most. I was not helped

as a mother who had this 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 meth got worse. I gave birth to my

daughter, Summer. Summer was born addicted to meth. She was

removed from my custody by child welfare. At that point, however,

a miracle happened. My children and I were referred to a comprehensive family treatment program. We entered into Bridgeway

37

Counseling and the Division of Family Services. My husband made

a commitment to do the same.

Bridgeway had just opened a men’s residential treatment center

next to the women’s center. We were the first married couple to be

in treatment at the same time. It helped to know that we were

doing this apart but also together. Our addiction tore our family

apart, so you see, we needed to find our solution as a family. I received services I didn’t even know I needed. I saw a psychiatrist,

who helped me with my depression, and I could sleep better, think

more clearly. It was like someone turned a light on in my head,

and my mind wasn’t constantly racing any more.

At Bridgeway, we started family therapy. I got counseling for

past domestic violence and sexual abuse. I didn’t even think I had

issues in these areas until I finally opened up to my counselors and

was truthful with myself. We took parenting classes, went to meetings and attended church. The Division of Family Services brought

our baby to Bridgeway for Darren and me to see. She is 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 is what she does.

She gives me strength and courage.

After 30 days of doing Bridgeway’s residential program, my family and I transitioned into Bridgeway’s intensive outpatient program. The 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 Bridgeway during the day. We then as a

whole family purchased a used trailer for $500. 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 allow the

Division of Family Services to 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 smile as often as we could.

We also continue to receive the family based treatment services

of 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 like Bridgeway.

But there are also many families in need of family treatment,

and the waiting lists 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 the blue eyes, has been reunited with us now. She has been with us for 7 months. I am sure

those of you who are parents can feel the light of having all your

children next to you brings you. The light is with me today, it is

with me here in Washington, DC, it is with me every moment. I

know that being a parent is not just a right, today it is a privilege.

It is mine and Darren’s privilege to be parents.

No one plans to tear their world apart, and the world of their

children. Today, because of available family treatment, I can plan

every day to put their world back together. This is work, but it is

the best kind of work. It is a struggle, but it is the best kind of

struggle. We continue to go to meetings, we continue to meet with

38

the court, we continue to make sober friends. And we begin, for the

first time, to be sober heroes to our children.

Thank you.

Mr. SOUDER. Thank you. Joey, are you going to share your story

with us now?

STATEMENT OF JOSEPH BINKLEY

Mr. BINKLEY. Hello. My name is Joseph Binkley. I am 18 years

old and am a recent graduate of Ritenour High School in St. Louis,

MO. For most of my life, my mother has been addicted to drugs

and alcohol. In my early years, I had no idea that my mother had

anything wrong with her. And I had no idea about drug addiction

or the symptoms thereof.

It wasn’t until the end of elementary school that I realized that

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 until 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 at Bridgeway. The family treatment program helped rebuild

my family and healed my mother’s issues. Throughout the experiences of my mother’s addiction and recovery, I could not 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 any normal family would have. Surprisingly to most, my at-home issues have not affected me academically. Throughout the years, I have maintained a high grade point

average. At the end of high school, I had around a 3.8 grade point

average, perfect attendance and was involved with multiple groups

and organizations, including Leadership, D.J. for the school radio

station, RCO, Teenage Health Consultants, Mu Alpha Theta, varsity baseball, Ritenour Big Brother/Big Sister, and I was on homecoming court.

I was promoted to a managerial position at my job at

ChuckaBurger, and I have also recently begun working as a driver

for Pizza Hut. I have been accepted to Southeast Missouri State

University with two scholarships, though I am still looking for

more additional funding. I will begin Southeast Missouri State in

the fall. I plan on becoming a physics teacher, so I am majoring in

physics education.

Thank you.

Mr. SOUDER. Thank you for your testimony.

Dr. Rawson, we appreciate your being here today. I just want

you to know I am not going to sing happy birthday to you, but we

thank you for coming on your birthday. Maybe as a concession,

when UCLA comes to Notre Dame this fall to lose, I will do at least

39

a clap in memory of your birthday and that you had come before

the committee on your birthday. [Laughter.]

Thank you very much for joining us, and we are looking forward

to your testimony.

STATEMENT OF RICHARD A. RAWSON, PH.D

Mr. RAWSON. Thank you, Chairman Souder. I want to thank you

for the effort you have put in to address this problem of methamphetamine in the United States. For 20 years in southern California, we have been wrestling with this problem and trying to get

some attention. Until your efforts, it has been somewhat challenging. This committee has been a breath of fresh air in giving us

some assistance and attention to this problem.

My name is Rick Rawson. I am a professor at UCLA. And for the

last 30 years, I have done work in the field of drug abuse. From

1983 until 1998, I ran a non-profit organization called the Matrix

Institute in southern California. We were asked by the health director in San Bernardino County in 1986 to come and open a clinic

because of a methamphetamine epidemic in San Bernardino in

1986. 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 opened in 1986 in the first year saw 150 patients.

This year it will see closer to 1,000 patients. Over that time, we

have now seen between 7,000 or 8,000 methamphetamine users in

that clinic.

In the late 1990’s I went back to work. I had started at UCLA

and I went back to work to UCLA and I have been there now for

10 years, overseeing a portfolio of research. But for 15 years, I sat

in a chair and saw one patient right after another, half of them

being cocaine users and half of them being methamphetamine

users. We started to put together some treatments and developed

a treatment model that has since become known as the Matrix

Model that you have heard of, and we have collected some data on.

Now that I am a so-called methamphetamine expert, I spend

about 100 days a year traveling around the country talking about

methamphetamine and the problem and the treatment. I do hear

some very interesting questions and myths. But of course, the one

that is most interesting is this issue about methamphetamine users

being untreatable. The term I frequently hear is that fewer than

5 percent of methamphetamine users get better.

I think that initial reference came from a Rolling Stone article

in 1997, that is where that figure came from. It was one of our better scientific journals. [Laughter.]

In my written testimony, I give you some data on this comparability between treatment of methamphetamine users and

treatment of other substance abuse disorders. But in short, we

have run three controlled clinical trials and we have analyzed three

large data sets where we have looked at meth users and cocaine

users. We have looked at the data in every way we can possibly

think of to look at it. We have found absolutely no evidence of any

difference between those groups.

40

In fact, we think that the treatment for stimulant users, probably 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 is 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 is what we have tried to program into our treatment materials. SAMHSA has evaluated 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. We can’t see any systematic difference.

Why has the myth occurred? I think probably it is developed because during the 1980’s, when we saw large numbers of cocaine

users in urban centers, and NIDA responded and developed a set

of training materials, and these training materials were disseminated where there were cocaine problems, people became quite

skilled at using these empirically based treatments.

However, in rural areas, where there really wasn’t much of a cocaine problem in the 1980’s and 1990’s, they continued pretty much

to use treatment methods that had been developed for alcoholics in

the 1960’s and 1970’s, and just never gained any exposure to these

new treatment strategies. When the meth users started showing up

in the 1990’s and this century, they didn’t know what to do with

them. They had 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. 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 SAMHSA has developed really

are quite excellent. 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 is also one

of the cities that was impacted early by the meth problem.

The data they are 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 20 years. This epidemic

does not go away on its own. It is not one where it peaks and then

you see a dropoff. We haven’t seen any evidence in Hawaii or in

Portland, OR, of any reduction in use. We have 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 are doing with these

hearings and getting attention to this problem is important, because I think it is going to continue to spread into the east coast

41

and into the urban centers. And I think it is going to persist in

areas where it has been a problem for some time. That is what the

San Diego data tell us.

Second, if you look at 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. In California,

in the last data set that we looked at, almost a third of adolescents

entering treatment were primary meth users. In some places, female admissions were over 50 percent. That is if you looked at alcohol, marijuana and everything, coming into treatment, we were

seeing 50 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 is not a problem there. Our 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 are 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 that paying

some attention to this problem with adolescents is important.

I appreciate the opportunity to speak to you. I am a big fan of

this committee and the work that you have done. I would like to

thank you all for taking this effort on.

Mr. SOUDER. Thank you very much.

Ms. Heaston, it is good to see you. Thank you for coming from

Indiana to be with us today, and we look forward to your testimony.

STATEMENT OF LEAH C. HEASTON

Ms. HEASTON. Mr. Chairman and members of the committee,

thank you for inviting me to participate in this hearing.

For most methamphetamine abusers, 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, DrugFree Noble County, Judge Michael Kramer, CADCA 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, rural areas have been left

recruiting and training from within. This process is very lengthy

and expensive, especially as most rural areas are not experienced

with the cocaine epidemic. So treatment starts to feel like an uphill

battle.

Until rural areas have enough qualified, experienced staff providing these services, the outcomes for treatment will be affected. The

42

next barrier is summarized by Dr. Thomas Freese, as he states,

‘‘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 than it is to incarcerate them. According to the principles of the

Drug Addiction Treatment, A Research-Based Guide, it states that

‘‘conservative estimates indicate that for every dollar spent on

treatment, four to seven dollars are returned in reduced crime,

criminal justice costs, and theft.’’

The Noble County jail has a third of its population incarcerated

for methamphetamine related crimes, and in 10 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 do 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 lack 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, 47 percent of the individuals abusing methamphetamine are women. Research shows that women are less likely than

their male counterparts to access services. Women are also in need

of child care service, which is an additional cost and barrier.

One way to increase the effectiveness of treatment is to have separate programs for men, women and adolescents. In rural areas,

implementing one program is difficult. Three separate programs is

almost impossible.

Due to the effects of methamphetamine on the brain, treatment

needs to be long-term, intensive and comprehensive. It needs to include topics on methamphetamine, but also medical, psychiatric

and mental health issues. Another barrier in rural areas is the difficulty recruiting and retaining psychiatrists. With the use of the

Matrix Model, treatment is effective.

In summary, my recommendations for rural communities are:

first, the continued and increased support of the Substance Abuse

Prevention and Treatment Block grant. In Indiana, this block grant

funds over 70 percent of all our addiction services, and 95 percent

of prevention services.

Second, the continued support of CADCA, which assists communities with linkage to national evidence-based resources and the development of community-based interventions for the prevention

and treatment of alcohol and drug abuse. Assist rural communities

with resources for personnel recruitment, retention and training.

43

Provide resources for child care for those involved with treatment,

and expand the access to treatment.

I would like to thank you for your time, and for your commitment in addressing these concerns.

Mr. SOUDER. Thank you very much.

Dr. Harle.

STATEMENT OF MICHAEL B. HARLE

Mr. HARLE. I am glad that you made me a doctor. I am going

to work really hard to make sure that I live up to that. [Laughter.]

Good afternoon, Chairman Souder, and committee. I have written testimony here, and I don’t want to read it, because I think

that you can 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 have asked questions about or that I have direct experience in.

I will just give you a little bit of my background. I am the president and executive director of Gaudenzia, Inc. We are the largest

freestanding treatment program in the State of Pennsylvania, and

we are soon to be the largest program probably in the State of

Maryland. We are also located in Delaware.

We service an awful lot of people on any given day. We have

been in existence since 1968. We have 91 programs in 51 locations.

About 2,300 people a day are in outpatient and residential programs in the community and about 1,600 of those people are behind the walls in prison.

Additionally, we have 419 children under the age of 12 that are

not addicted but are in treatment with their parents. We have six

programs that are for women and their children and their family

members. So we are pretty serious about doing this.

This month we will open up and additional program in the Park

Heights section of Baltimore. By the way, right across the street

from our facility is where they used to have those lines that Congressman Cummings talked about. I have observed those lines.

Those lines still exist, but they do not exist near our treatment program, because one of the things that addicts don’t like to be around

is jails and treatment programs, while they are actively addicted.

When they are not addicted, that is the place that you will find

them.

I am presently also the president of Therapeutic Communities of

America, which represents over 700 programs in 32 States, including Puerto Rico and the Virgin Islands. I have been witness, many

of our TCA members are located in places like the central valley

of California, where 100 percent of their treatment admissions are

methamphetamine. Our treatment programs have been treating

these people probably since 1968.

So to just let you know that it depends on where you live in the

country on whether or not your admission is for methamphetamine.

I think there was an earlier discussion in regard to the economics

of this. Where it is more available, the treatment admissions go up.

Where it is cheaper, treatment admissions go up. So there are

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, and I am going to give you a little bit of a different perspecVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00047 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
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tive. As a counselor, and I think I heard a little bit of this before,

I didn’t see differences in regards to the outcome for methamphetamine addicts. 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, with some

of my clients, continued for years beyond that. Not as great, but

you had to stay there with them, you had to get in there and be

with them. The longer the addiction was, the longer you are going

to have to spend time in treatment.

What I added to this was an attachment A. Attachment A shows

that in the State of Washington, there was a recent study done

where they say for every addict there is a cost offset of about $296

per person when you treat them. Methamphetamine treatment,

stimulant treatment, is actually more cost effective than other

treatments for other diseases. Not much, it is a difference of $19

per day that you save. So you save money when you provide treatment. And that is what I want to discuss.

The problem is that there are giant holes in our national treatment network. It does not exist in the right amounts in the right

places throughout the country. You heard about the rural areas.

You heard about the lack of family treatment. For some reason, as

a society, we have not invested the kind of money in treatment programs as we have 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 am treating on some days that I do

in the community. We have a real problem here that we need to

address. And it didn’t just happen today. It is not at the doorstep

of this committee. It has been a problem for the last decade or so.

What we have done is we consistently leveled off our treatment and

we have added things to our treatment system, such as managed

care. It is not managed care, it is managed cost. And what it has

done is it has reduced the length of stay of treatment. So our treatment system is more damaged today than it was 10 years ago.

Right now, if you are a crack addict in Philadelphia, sometimes

the decisions on whether or not you are going to get treated are

made on Wall Street. They are not being made where they need to

be made. They are being made based on profit and loss, and shortterm profit and loss, not long-term profit and loss. And that model

does not work for substance abuse treatment. We have implemented it throughout the country. That is a problem, and a particular problem for rural areas.

And for women, and for women with children, this is very difficult to access treatment. When people are ready, keep in mind,

you are going to have to use the criminal justice system. People

don’t wake up 1 day and say, you know what, I would really like

to get treatment for my long-term crack addiction or my long-term

methamphetamine addiction. They are psychotic when you are first

talking to them.

So you are going to 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 Therapeutic Communities, we have been doing it a long time,

45

there is a tremendous cost offset. It is a lot cheaper than any other

way of treating them, and it is also a lot cheaper 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 effects of the addiction. Pennsylvania alone spends $3.4 billion, not treating addiction, on

everything but the treatment itself. And I think that you can see

there, there is a CASA study in 2001 that shows that across the

Nation.

Now, the work force problem, if tomorrow you said we need to

put up a treatment system now, we are going to do it now. It is

going to take 10 years. You can’t do it right away. We are going

to have to use the targeted capacity, we are going to have to follow

these epidemics. But think about it long-term. There is going to be

another epidemic.

Right now in Pennsylvania, I have a 100 percent increase in

treatment admissions for methamphetamine in Erie, Erie, PA,

which is in the northwestern corner. I have a 275 percent increase

in heroin in Philadelphia and the southeast of Pennsylvania. I have

programs in the middle of Pennsylvania, it is moving together.

What happens in Harrisburg, the State capital, when these two

things hit? I have two epidemics, and I don’t have any more treatment programs, and I don’t have any more staff. Matter of fact,

most of my staff are getting to retire. Some of them are the methamphetamine folks that I used to treat in the early 1970’s because

Pennsylvania, the southeast corner, was where the Dupont, Allied

Chemical, all the major precursors to make methamphetamine

was. And we had an epidemic.

What we did is we moved the labs to southern California and to

San Diego and made that now, it is called Crystal City, is what

they call San Diego. What we did is we just moved it. So that is

what we did, we made it illegal to sell those precursors in Delaware County, PA, and we moved it to Mexico and they moved it

right back across the border. Eighty percent of the methamphetamine comes from labs in Mexico, 80 percent. And if you stop it in

Iowa, they are going to produce more of it in Mexico. If you stop

it in Mexico, they are going to produce it in Canada.

I am not casting aspersions on anybody, and if they can’t get it

in Canada, they are going to make it in Maryland, wherever there

is profit in this. We have to reduce the demand. And to reduce the

demand, you are going to need effective law enforcement, effective

treatment and effective prevention. Right now, we don’t have the

treatment system to handle this epidemic. That is what they are

telling you, we don’t have the work force, we don’t have the facilities and we need help.

It is going to require a long-term plan. There is no magic cure.

And by the way, if you are looking for a magic cure for methamphetamine, I would guarantee you that same drug we come up

with will end up getting abused and will change the molecules to

that. Our clients look for magic cures. Do not look for magic cures.

Look for long-term, hard-won solutions, just like these folks have

had to do. They have had to work hard at it. Give them the right

resources to do it.

It takes time, it takes effort. I am sorry for being so passionate

about this. But I talk to people who die, we have many people who

46

succeed. We have a lot of people doing really well. But I also have

the displeasure to speak to families who can’t get their kids into

treatment and they have passed away. 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 my message is what I would like to get across, because I

only have a limited time, so thank you.

Mr. SOUDER. Our last witness is Mr. Fleming—are you Doctor?

Or do you want to become one?

Mr. FLEMING. Well, if you want, yes, I would love it. I get more

money that way, I guess. [Laughter.]

STATEMENT OF PAT FLEMING

Mr. FLEMING. My name is Pat Fleming. I am the director of the

Salt Lake County Division of Substance Abuse Services. I would

like to thank you, Chairman Souder, and Ranking Member

Cummings, for hanging in there all day today. You have asked

some really, really great questions and for your leadership on this

issue.

I am not going to read my whole statement, either, because I

think a lot of it has been repeated. Treatment for methamphetamine does work, just know that, you have proof of it 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 is really what our big issue is.

What I would like to talk a little bit about is to give you a little

bit of an idea of what we do in Salt Lake County and how we talk

to our elected officials to get our local elected officials to pony up

some dollars to help us with this issue. We have been rocked by

methamphetamine. We were already on the ropes in our treatment

system. Our treatment system was already under pressure and

then methamphetamine hit. And we really are hurting right now.

It is an epidemic in Utah, it is an epidemic in Salt Lake County.

Just about everybody that we get in there is using methamphetamine in some way, shape or form. We have to deal with this.

When I have talked to all our national organizations, the National Association of Counties, the National Association of State Alcohol and Drug Directors, National Association of County Behavioral Health Directors, I have been talking about this for 10 years.

And it is so nice to have the national organizations and the Congress looking at this issue, because we definitely need help in this

country with this.

I have 12,000 admissions in my treatment system. We are the

largest treatment system in the inter-mountain west. I have 12,000

admissions a year. I have 48,000 people in Salt Lake County that

need to be treated.

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 in the United States are publicly funded. That is the first

place we have to look. We cannot do that any longer. I know Congress will be dealing with health care reform in the next 3, 4, 5,

47

6 years. You definitely need to include this as part of the health

care system. Substance abuse treatment needs to be treated as part

of a disease. It is a disease, it is a chronic disease, it needs to be

treated like a disease. You have to deal with it that way.

The second thing I think you need to do, and I am going to give

you some very specifics here, because I think it is really important,

I don’t have very much time with you. By the way, I have to catch

a plane at 6, so if there are any questions, I would appreciate those

so I can get out of here.

The block grant. All due respect to Mr. Curie, I think he has

done a wonderful job, I want more money in the block grant. Everybody has said that today here. We need $250 million more in

the block grant to put it to $2 billion. Now, it sounds like a lot of

money, but it is not a lot of money in terms of some of the things

we are spending money on these days.

I think what we need to do is, if you want to earmark some

money in the block grant for emerging drugs, whatever you want

to do, go ahead and do that, that is fine. But the short-term solution is to get us 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.

Then the second thing I would say is, if you can work something

into the health care reform package that starts to provide primary

health care, as to substance abuse treatment, in the very beginning

I think what you will start to see is maybe less demand on the

block grant, less demand on the taxpayer.

Finally, the thing I would like to say to you right now is, methamphetamine has really rocked women in Salt Lake and in Utah.

What we see is, 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 have been doing

this for 19 years, and I am very scared about that trend. Because

what happens is, families fall apart without their mothers. They

really do.

We have started four family treatment programs similar to the

ones the Nobles are talking about. They are very, very effective. I

finance those with Medicaid. If I don’t have Medicaid, I am going

to lose three of those four programs. So when Congress is dealing

with the Medicaid issue, and I know it is real simple to say, optional services, we are going to cut this, we are going to cut that,

there are faces that are connected with that.

So I think it has to be a three-pronged thing. We have to have

health care and think about this as a health care issue, get it into

health care, we have to have money in the short term in the block

grant, $250 million, and we have to have Medicaid there, especially

for women with their dependent children. That is how we pay for

this.

I look at the obituaries every day. And in Salt Lake, it is kind

of interesting, our obituaries all have pictures. They have a picture

of that individual next to the obituary. And I have gotten pretty

good at reading between the lines in obituaries to see who is dying

of overdoses. And I will tell you, it is just staggering when you see

48

how many people pop up in the Salt Lake Tribune every day from

this.

So I will conclude. I am just so tickled that you are 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 putting

money in 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 will put money in. Without the

block grant, we don’t have anything.

So I would just urge you to really pay attention to that, and

thank you very much.

Mr. SOUDER. Thank you.

Do you have any questions directly for Mr. Fleming? He is not

going to make it in rush hour unless he is out of here in the next

5 minutes.

Mr. CUMMINGS. Nothing, thank you.

Mr. SOUDER. I thank you for coming in from Salt Lake. If we

have some additional questions, we will submit them to you in

writing.

Mr. FLEMING. Thank you.

Mr. SOUDER. Let me first thank each of you for coming, for being

with us in this long day. It is, as you can see, a very diverse hearing and very helpful. I appreciate the personal testimonies, which

are always very helpful as we move into a hearing process. Partly,

it is good to hear success stories, because sometimes when you go

through this business, it just seems like you jump from one failure

to another, are we going to get blown up on the border because of

terrorism coming in, we have child abuse here and spouse abuse

here, and all different kinds of crime. Of course, we don’t know how

to pay for health care, and Social Security is a mess, pensions are

a mess. It just seems like we jump from one issue to the next.

So having some encouragement that in fact some of the money

that taxpayers are investing works is very helpful to hear. Each of

your testimonies were somewhat different from each other.

I think where I want to start is with Dr. Rawson. I found it really interesting what Mr. Harle said. So first let me get a factual

thing down left over from the first panel. Let me start with Mr.

Harle. Do you agree, Dr. Rawson, with his characterization that a

lot of this early abuse started over by Philadelphia and Delaware

County and then moved to San Diego, and that is why you saw

some of this in San Diego early? Because that is a historical factoid

that I hadn’t heard.

Mr. RAWSON. I wasn’t aware that it migrated like that. But yes,

in the early 1980’s, Philadelphia and the Philadelphia area was the

leading area of methamphetamine abuse and dependence in the

United States. I didn’t know what had been done. I didn’t know

why it went away there.

But then it moved to San Diego, and that is where we started

to see it, so I wasn’t aware of that.

Mr. HARLE. A couple of facts. Dupont, Allied Chemical, Rohm

and Haas, all the major chemical companies, actually in South Jersey, ARCO, all those companies were right there. The chemists

49

were there, the actual precursors were there. And there were drug

addicts there.

What happened is they hooked up with the chemists and they

started to make it. Also, they first started to hijack it, because they

were making a legal amphetamine. But as time went on, they

started making it out in the community as—they are doing the

same thing now. As we were restricting it and restricting it, what

started to happen is people got creative and started making it on

their own, they started bootlegging it. And they were selling, because we didn’t have the Internet, they were selling handwritten

formulas to each other.

So they were recruiting chemist students out of high school to

make it. It got really, really complicated. The motorcycle gangs, the

Warlocks and the Pagans, took over the distribution of the drug up

and down the east coast. They fanned out with that. So what happened is, there was a series of hearings, those drugs became illegal.

The DEA was involved, and made those drugs illegal in the United

States at all. I don’t know the scientific, 2P2 I think is what they

were called on the street.

And that was then moved to Mexico. 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, addiction didn’t

go away, we just switched chemicals is what we did. We gave this

plague to San Diego.

Mr. SOUDER. One of the reasons I wanted to ask is that, given

the fact that Philadelphia and San Diego are not usually considered rural areas out in the national forests, did the African-American community or other minority communities use meth at that

time, when it first moved to San Diego?

Mr. HARLE. I can tell you what was happening. You had availability. You had heroin in the—matter of fact, you need to know

this, because it is really important. You had $5 per bag heroin in

Philadelphia, in the ghetto or in the projects, you got it inner city.

Inner city, inner city. As you moved farther away from the inner

city, the drug went up in price and it got cut. So it would get cut

in half, that is they would cut the purity in half, and they would

double the price. So if you lived in the suburbs, you paid $10 a bag and you got

half the purity. You got the availability thing. So what happened

is in the inner city, where they would sell it, very similar to today,

it was more powerful and cheaper. Methamphetamine was actually

a suburban drug that was moving in toward the city, and if you

lived outside, it was $10 for what they used to call a 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 it would cost

you $20.

So what would happen is, there was trading going on. The suburban methamphetamine, speed freaks, we used to call them, monster, crank, it had all kinds of names, would trade for heroin, they

would trade it, because it really had to do with who controlled the

drug traffic. Keep in mind, the white motorcycle gangs and the suburban kids controlled, it had more to do with the availability of—

I have a million theories of why one different than the other. Don’t

know why.

50

But I can tell you, the theory that it is different gets thrown

right out the window when you talk about crack cocaine. Because

crack cocaine, although it is not as long-lasting, has the same effects. 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 quality treatment that is not

drug-specific as much, but is addiction treatment. Because what

happens is people will switch from one drug to another anyway. So

you had better look at drug addiction as a holistic kind of view. If

you don’t, you are going to constantly have problems.

Now, you need to train our whole work force who hasn’t seen

methamphetamine in a long time on what the effects are. There is

the Matrix, there are different models that you can use. But they

are really techniques that can be integrated into a treatment program. You really need a treatment model that is adaptable across

the whole country that can be adapted to whatever the new epidemic you have.

I have the same counselors treating heroin right now that I had

treating cocaine that I had treating methamphetamine. The problem is, they are getting old and they are retiring and we don’t have

a new work force, we don’t have enough resources to keep that

alive.

Mr. SOUDER. Dr. Rawson, I wanted to ask you, one of the things,

as we have heard from the Nobles, that is in fact different, at least

in the ‘‘home cooker’’ group, is it tends to be more family. In other

words, historically the models are enablers and users. Whereas

when they are cooking, because you can turn people in, unless their

whole family is either involved or at least you may have the kids,

they may be involuntarily involved, but we have had testimony at

some hearings where even the kids are often recruited to get the

chemicals or participate in the cooking.

Does that require different models of treatment? Obviously today

we heard about family treatment. Could you describe a little bit

how your Matrix Model works and how it might be different in

meth there from other types of drugs, or to deal with enablers and

users?

Mr. RAWSON. Yes. The basic treatments with addiction are, as

has been said, common across all addictions. Meth, really, a couple

of the things that make it impact the family to a greater degree

are the fact that people cook it in their homes, and you are seeing

50 percent of the users are women. Heroin is about three or four

to one, men to women. So you are 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 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 inform them and get them understanding the addiction, so they can provide appropriate support to the addict in his

or her recovery. So it really means the individual person as the target really is changed.

With meth users, you really have to address the whole family,

because in general, the addiction has affected the whole family.

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tion and heroin addiction. But because of these two factors, because

the home literally becomes saturated with the drug and the kids

are often exposed to the drug and you see it all in that environment, and so many women are using that it makes it that much

more important with methamphetamine than with other drugs.

Mrs. NOBLE. I would like to comment on that, if I could.

I tried, I do believe, three to four individual treatment programs

before I went into Bridgeway, the family treatment program. And

those treatments were more on education. And on the family treatment programs, they offer different services, like the domestic

abuse, the sexual abuse, having a psychiatrist, psychologist you

could talk to. Just so many more services were available. And for

the children, parenting classes, family therapy, we were offered

that.

And like I said in my testimony, I didn’t even know I had issues

in that. Addiction, not only to meth, but everything else, it starts

out as an individual problem, but then it becomes a family problem, and then it becomes the community problem. So like I said,

I went to three or four before that, and I knew all the just for todays and keep it simple. But I needed to find out why I kept using,

what issues were with me. Because it is not just as simple as, I

came to believe that a power greater—you have to be able to get

the issues also so that you can intertwine that education in.

Also as a preventive for the future, my family is involved in it.

Therefore, maybe he will be able to make better choices that I

wasn’t able to make, because my mom and dad were alcoholics, and

I wasn’t given the opportunity to learn and know that there were

more choices to handle certain issues in life.

Mr. SOUDER. When you and Darren, Darren, did you have other

abuse problems before meth?

Mr. NOBLE. Yes. I believe I was an addict at birth, it started out

with alcohol, weed, heroin, cocaine, crack, meth.

Mr. SOUDER. But meth is what put you, in the end, into treatment?

Mr. NOBLE. Yes.

Mr. SOUDER. When both of you were abusing different types of

drugs, one of the things we have heard from met addicts at the

hearings that is slightly different that we have heard, but not completely different than other drugs, is that you tend to often become

more isolated because of the impact of paranoia, fear of being discovered if you are home cooking, and you get isolated from most

support groups. In other words, you are not necessarily going to be

involved in church and community. Often you even leave your job.

Did you see that differently in the usage of this drug, or was that

kind of a pattern that was developing anyway?

Mr. NOBLE. The only thing I can add is, outside of my addiction

in general, the cooking the dope, I had been using since I was home

from prison, I haven’t cooked since I went to prison, I thought I

could change my ways. But cooking is a high of its own. I don’t

know if you know that. But that is something that is separately addictive from using it and using my drugs. Cooking drugs, making

dope was a high of its own. That is what dragged me away from

my family, because that is all I was worried about. Forget everything else.

52

But in my addiction of using methamphetamine, the paranoia

wasn’t there the same as when I was cooking. That is how we have

gotten better, through the family therapy.

Mr. CRONKHITE. If I could add something into this, first of all,

Mr. Cummings, to perhaps try to answer one of your questions that

you raised earlier, about why there may appear to be less participation in methamphetamine addiction in the African-American

community, I would be interested to see if there were any statistics

at some point of whether or not there was less methamphetamine

use in the Italian American community. And one of the reasons is,

there is a stronger sense of family, a stronger sense of community

in general.

As the chairman was just stating, methamphetamine use is isolating, is not necessarily, you don’t get together, pass a pipe

around. Because it is so damaging physically, because it destroys

your body so much, you actually end up, this emaciated, out of the

concentration camp look, massive amounts of weight loss. I have

known people who have been heroin addicts for 15 years and been

successful brokers on Wall Street. You don’t necessarily notice that

they are having this kind of a problem.

So part of it, as an adolescent, with extreme acne that came as

a result of this, with this great weight loss, with this psychosis that

came around, it is not a socially active, group participation drug.

So that is why I found for myself, and this was again, 35 years ago,

but the people in the community who surrounded themselves

around my life and helped me through the process, part of that

whole process of course involved long term psychological counseling. It was not something that could happen overnight.

I was fortunate, I guess if we can use that term, fortunate in

that I was arrested and I was entered into the California Youth

Authority. So I had this long-term care, which was provided by the

State as a youth offender. Other people may not have had that.

So I think when we start looking at these kinds of programs

where we 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 have to first

treat the victim, the addict, like he’s been in a car wreck. Then

there is going to be a long-term period of time of rehabilitation, just

like somebody who goes from being on the ER stretcher to walking

with a crutch to getting physical therapy to having long-term care

before they can really run again at full speed. So it is not something that is going to happen overnight.

I was one of those suburban speed freaks in California whose

graduate student friends at UCLA cooked the stuff up in the Hollywood hills and it was distributed by motorcycle gangs in Los Angeles. It is interesting, the paradigm does not seem to have changed

much in that period of time. But again, I wonder whether or not,

how much 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 isolating and further isolating as

we become less connected to one another.

Mrs. NOBLE. I would like to go back to the family issue, of

women, why I believe I used meth is because of the role that the

mother plays. It is a tiring job. But with family therapy, it brought

53

us all together and everybody could distinguish their roles in the

family and the church and the community.

I think the family unit has taken a back seat to a lot of things

today in life. And drugs have gotten into our families to the extent

where families aren’t together any more, a lot of families aren’t.

And I believe that family therapy worked for us because it brought

us together, it gave us an opportunity to address our issues, what

each of us individually and together were going through.

Now we can communicate with each other. Now we can tell each

other our hopes, our dreams, our expectations and work together

as a unit, the way that it should be. Because before we went into

this treatment place, we were lost. Before I went into this treatment place, I knew that jail or death was the only hope for me.

And now, it has opened a lot of doors in my life. I have a life now.

Mr. SOUDER. Mr. Cummings.

Mr. CUMMINGS. I was just thinking about something that the

chairman said at the beginning of this hearing. It is something that

I just want to address to the Noble family. What the chairman said

was that a lot of people look at this thing as a thing of choice, that

is the use of drugs. And one of the things that I have noticed in

my community, the Seventh Congressional District, as I move from

place to place, Dr. Rawson, I have noticed that it seems as if people

are becoming less and less sympathetic and empathetic, because

they feel as if somebody made a choice.

And it is a real tough, it is a tough one. 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 it is hard for me to get excited,

as much as I would love to provide funding for drug treatment, I

don’t have a lot of sympathy, because I go through problems, too.

I have psychological problems, too, I can’t afford a psychiatrist. But

damn it, I get up every day, I work and I do the right things. And

I can’t even put my kid through school, but yet you want me to say,

it is OK 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 what I said to a graduating class of African-American addicts, recovering addicts the other day for a drug court, I said, you

have to understand, the public is saying, OK, I mean, a lot of the

public is saying, you made a choice. And they are getting less and

less tolerant of funding bad choices. And I think that is something,

and I just wonder as you go through, and I am going to talk to the

family in a minute, do you get any of that when you are moving

around to your hundreds of conferences and all that kind of stuff?

Or those are not the kind of everyday people that you talk to?

Mr. RAWSON. No, those are exactly the people I talk to. And yes,

I think that there is a fatigue factor going on with that. However,

if you look at California, in 2000 the California voters in the voter

initiative passed Proposition 36, which put $600 million into the

treatment system, as opposed to into the jail system. If you make

it a choice between treatment, and you document that treatment

works, and particularly if you hook it with the criminal justice system, the drug court movement, in my 30 years of working in this

54

field, is the most encouraging movement I have seen. Because it

uses the leverage of the court system to push people in the door.

As was said earlier by someone, Mr. Curie, I think, people don’t

wake up 1 day and say, gee, I think I want to get sober. That happens in response to something, in response to some pressure. I

think that the California voters, anyway, 6 or 5 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. We are

the champs when it comes to building prisons.

And one of the places I went was Minnesota, where they are

starting to see, 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 is a fatigue. I do think people are tired

of having to deal with the problems in their communities. But

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 recognition on the

public’s part that treating people with addiction disorders is a better use of money than locking them up in prisons. Because prisons

simply make them better criminals.

Mr. CUMMINGS. I agree. I think you are absolutely right. I want

you to understand, I am probably the No. 1 advocate of treatment

in this Congress. But at the same time, I know that there are

Members of this Congress who, if I hear this, I know that there are

other people who hear it. And it is something that we may have

to deal with even more so later on as budget stuff gets tighter and

tighter. Because I think you are right, when you match it up with

prison, building more prisons, it makes a lot of sense.

I have to get back to something, though. Why do you all think

it is that women are more likely, I think it was you, Dr. Rawson,

who said that with heroin, I guess heroin and cocaine, it is three

to one men. With methamphetamine, it is basically pretty much 47

percent, if I remember correctly, women.

Mr. RAWSON. That is right.

Mr. CUMMINGS. Why is that?

Mr. RAWSON. I would point at three factors. You have heard

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 anti-depressant when you first start

taking it.

And finally, Mrs. Noble’s comments about the role of a woman

in today’s society, being a mother, 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. So it is a drug that does have good

functional value for a while, and many of the women we talk 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 16 hour day and take care of all their responsibilities. You take

heroin, you go take a nap.

Mr. CUMMINGS. And nod. Don’t forget the nodding.

Mr. RAWSON. That is right. [Laughter.]

Cocaine is so short-acting that you can’t take it enough, it is so

expensive, you can’t take it to extend a day for 16 hours. But methVerDate 11-MAY-2000 11:42 Jul 16, 2008 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6633 C:\DOCS\43331.TXT KATIE PsN: KATIE
55

amphetamine is the perfect drug. And if you are a woman with

those demands, it really matches up well with the demands on a

woman in today’s society.

Mr. CUMMINGS. Mrs. Noble, I don’t want you to repeat things

that you have already said, but based on what he just said, do you

have anything to add that you have not said already?

Mrs. NOBLE. Yes. I wanted to say, at first, using drugs is a

choice. But once the disease of addiction sets in, it is no longer a

choice. I had so much to say I lost it.

But I was going to say, we are going back to the family treatment. Maybe if my mom had went into family treatment, maybe

if she would have gone into family treatment, then I would have

learned the coping skills, where my son has had an opportunity to

learn more. Now he can teach his children. Maybe it might stop the

cycle of addiction. Because nothing else has.

Mr. CUMMINGS. Tell me something. One of the things, and I am

going to get back to you, Mr. Harle, but one of the things we spend

a lot of money on in this Congress are ads, anti-drug ads. And I

am just wondering, I see you shaking your head already, Mrs.

Noble, but we want to use our dollars effectively and efficiently.

Have you ever looked at an ad and said, you know, they have a

point here?

Mrs. NOBLE. No.

Mr. CUMMINGS. No?

Mrs. NOBLE. No.

Mr. CUMMINGS. So ads just didn’t affect you?

Mrs. NOBLE. No. Too many distractions.

Mr. CUMMINGS. What about you, Mr. Noble?

Mr. NOBLE. To me, as a kid growing up, I don’t think anything

was—I wasn’t scared, I wasn’t intimidated by things. When I went

out to try something, I went out to try it, especially drugs. When

I am wanting to do something, I am not trying to shy away from

the things they are telling me not to, as an addict. But me, I am

a believer that me, I was born an addict. This is what I was destined to be.

But the treatment wasn’t there for me, for me and my family to

acknowledge. And like you were saying earlier with the lady, people who are opposed to treatment, say it is a waste of money, well,

you could take that lady my record and ask me if she wants me

to live next to her, in and out of prison and the shit I have done

in my life, or you could take her who I am now after going through

family treatment, or do you want this man living next to you?

Mr. SOUDER. Joey, let me ask you the same question. You saw

the narcotics in your family. You got a 3.8 average, you are going

to be a physics teacher, go to college. You made it through all this

with all the activities. Did the ads or any of the anti-drug programs, your teachers, what helped change you?

Mr. BINKLEY. Well, I see the ads on TV, and there is so much

else on TV, it is just another thing that is on TV, you don’t really

pay attention to it. You know the D.A.R.E. programs, I was in

Teenage Health Consultants, which dealt a little bit with that. But

it was more my home experiences to kind of let me know that is

not good, that is not what I need to do. Because it just has a negative effect on the whole family.

56

You can even see people outside the family looking in, noticing

that it is not a good thing, and they kind of shunned it. So I made

sure to stay away from it.

Mr. CUMMINGS. Mr. Harle, you wanted to say something. Please.

Mr. HARLE. Yes, I think what you bring up, the stigma, the issue

of stigma, our folks, and I say that in a loving kind of way, are not

the kind of folks, when they are actively addicted to any of the

drugs, that are really encouraging a lot of sympathy from anybody.

Matter of fact, the kinds of stuff that our folks do when they are

addicted would make anyone not want to fund anything. So we are

pretty aware of that.

But what we need to do is educate the public that treatment

works. I think people are frustrated. And most people have this,

one out of four families is faced with this. So a lot of times, when

you are talking to people and saying, I am really frustrated with

this, they are talking about somebody that they know or in their

own family. That is how much this is a part of our culture.

And I think if we can get across to people that this is a

generational disease, and I think it is right here in front of us, it

is a generational disease, and it will grow if we don’t stop somewhere. What you need to know is, we have 8,000 clients, the majority of them, their age of first use was under 11 years old. If you

are talking about people making choices, they are experimenting,

and that is why I think prevention, as you talked about earlier, is

important.

But it is really, the decisions that kids are making are before the

age of 11 years old. And many of the kids that we are talking about

are kids who have addiction in their family. I have 500 of them I

see every day. Half of them are going to become CEOs, and they

are going to be just like the young man right here, they are going

to say, you know what, I have seen this in my family, I am not

going to let it happen to me, I am going to work as hard as I possibly can not to let it happen.

The other 50 percent or 60 percent are going to end up with the

problem themselves for biological or environmental or for whatever

other reasons. This is a generational disease that we have to stop

somewhere. And I agree, you are going to need all the support in

the world to convince the folks in the community, and we are going

to have to get behind you, people in recovery are going to have to

get behind you, treatment providers are going to have to get behind

you. Because I don’t think, though, that the average citizen thinks

that locking these folks any more is going to do anything. I think

we have gotten that across.

Mr. CUMMINGS. I hope that you understand what I was saying.

Mr. HARLE. I got it.

Mr. CUMMINGS. And I know Mr. Noble did. I guess the frustration comes, and I am almost finished, Mr. Chairman, the frustration comes when people feel that people make bad decisions.

Mr. HARLE. Right.

Mr. CUMMINGS. And that they then have to pay for them. I think

that is the problem. But between the two of you, what you said,

I think is was you, Mrs. Noble, that said the No. 1 thing may be

a choice, but then it is not a choice. But what you just said is so

57

powerful. It is starting with our kids. Then that means that we as

adults are doing something wrong.

So in some kind of way, you think about a mother’s and a father’s love. I just heard what you said, Mr. Noble, about you getting high. If you have little kids, the one thing that I think should

almost frighten any parent, should make any parent just go nuts,

is to think that they are cutting off the future possibilities of their

children being successful. Any parent.

Mrs. NOBLE. Can I comment on that?

Mr. CUMMINGS. Yes, please.

Mr. SOUDER. Actually, we have six votes over on the floor. So

this will be your last comment.

Mrs. NOBLE. OK. In the addiction process, somewhere along the

line, right became wrong and wrong became right. And that is

what you teach your children. And that is what I taught my children.

But through the family based treatment programs, you get the

opportunity to turn that around, to teach your kids what I was

doing was not right.

Mr. CUMMINGS. Thank you.

Mrs. NOBLE. And you can bring the morals and everything back

into your family.

Mr. CUMMINGS. Thank you, Mr. Chairman.

Mr. SOUDER. I want to thank each of you for coming, for taking

time out. If there are additional comments that you want to submit, we will continue to try to work for additional treatment funds.

But I want to give you this, you are 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 they have

family experiences. There is no one I have ever met in any prison

or in any treatment program that hasn’t said that they have been

through multiple treatment programs. If you oversell treatment,

you will not convince the elected officials or the voters to do this.

It has started to happen in drug courts, that short-term data that

says there is an 85 percent success rate is not convincing when we

start to get long-term data. This is a hard business.

And as we heard today, there is going to be recidivism with it,

and that you can’t take artificial statistics. And partly overselling

of treatment will result in people, and also there are different types

of drug addicts. If the drug addict is violent, they are going to have

a different opinion about treatment versus locking up, than treatment. And that is quickly shown, too.

But I think that we are moving into a more sophisticated period,

and drug courts are starting to illustrate that. And if we can get

nuanced approaches.

Then the last thing is, sometimes when you have an epidemic

that hits the news, because there is also fatigue in news coverage,

fatigue in what CSI and Law and Order can cover for that year or

two, and when we have a new phenomenon come up, you find more

willingness of the general public, particularly where you see something like meth, where they see labs going up and children getting

damaged and the types of problems.

58

We have an opportunity right now to move the whole treatment

debate as part of the meth debate. And one of my frustrations with

the administration has been a lack of understanding that, because

like you say, these things may not exactly repeat themselves, but

they run. There are nuances to the differences, they are 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. I have sat through, and we have sat

through so many of those hearings, and yet every one, today we

have learned so many different angles with this. It has been tremendously helpful to us and hopefully it will be to anybody who

watched it.

With that, we stand adjourned.

[Whereupon, at 5:18 p.m., the subcommittee was adjourned.]

[NOTE.—At the time of printing no prepared statements were

available.]

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