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Nora D. Volkow, M.D. Director National Institute on Drug Abuse

Drug Abuse Treatment for. Criminal Justice Populations. What Do We Know?. Nora D. Volkow, M.D. Director National Institute on Drug Abuse. Decreased Brain Metabolism in Drug Abuse Patient. High. Control Cocaine Abuser. Low. Drug addiction is a brain disease

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Nora D. Volkow, M.D. Director National Institute on Drug Abuse

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  1. Drug Abuse Treatment for Criminal Justice Populations What Do We Know? Nora D. Volkow, M.D. Director National Institute on Drug Abuse

  2. Decreased Brain Metabolism in Drug Abuse Patient High Control Cocaine Abuser Low Drug addiction is a brain disease that affects behavior Decreased Heart Metabolism inHeart Disease Patient Healthy Heart Diseased Heart Sources: From the laboratories of Drs. N. Volkow and H. Schelbert

  3. Although Treatments For Addiction Are Available, They Are Not Being Widely Used By Those Who Need Them Location TX Received In 2005 An Estimated 23.2 Million Americans Were Dependent On or Abused Any Illicit Drugs or Alcohol But…Only3.9 Million (17%) of These Individuals Had Received Some Type of Treatment In the Past Year 2.1 Self Help Group Outpatient Rehab Inpatient Rehab Outpatient Mental Health Center Hospital Inpatient Private Doctor’s Office Emergency Room Prison or Jail 1.5 1.1 1.0 0.8 0.5 0.4 0.3 0 .5 1.0 1.5 2.0 2.5 Numbers in Millions Source: 2005 NSDUH, National Findings, SAMHSA, OAS, 2006.

  4. Drug use involved in > 50% of violent crimes and 60-80% of child abuse/neglect cases (NIJ, 1999) Corrections officials estimate 70-85% of inmates need drug treatment (GAO, 1991) 68% of jail inmates report regular drug use (BJS, 2005) U.S. Adult Offender Population

  5. 80 70 60 50 40 30 20 10 0 ALL DEPENDENCE ABUSE 24 or younger 25-34 35-44 45-54 55 or older Source: Substance Dependence, Abuse and Treatment of Jail Inmates, 2002, DOJ, BJS, 2005. Substance Dependence Or Abuse Among Jail Inmates by Age

  6. CREST Completers + Aftercare CREST Completers + Aftercare No Treatment No Treatment CREST Dropouts CREST Dropouts CREST Completers CREST Completers Continuity of care is essential for drug abusers re-entering the community Delaware Work Release TC (Crest) + Aftercare Drug-Free an Arrest-Free 3 Years After Release (N=448) 100 * 69 80 Drug-Free Arrest-Free * 55 60 * 35 * 29 40 28 27 * 17 20 5 0 Martin, Butzin, Saum, & Inciardi (1999), The Prison Journal * p < .05 from Comparison

  7. Through Over Three Decades of Scientific Research We Have Learned An Enormous Amount About Drug Abuse and Addiction and Its Treatment in Criminal Justice Populations

  8. Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence 3 0 ml/gm METH Abuser (1 month detox) Normal Control METH Abuser (24 months detox) Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

  9. Evaluation of A Hypothetical Treatment Relapse Rates Are Similar For Drug Dependence & Other Chronic Illnesses 10 HYPERTENSION 9 8 During Pre - - Post 7 6 Symptom Severity Addiction Treatment Does Work 100 5 4 90 3 80 2 1 70 0 60 Pre During During During Post 50 to 70% 50 to 70% 10 ADDICTION 50 % of Patients Who Relapse 40 to 60% 9 Pre - - - - - - - - - - - - Post 40 8 30 to 50% 30 7 6 20 Symptom Severity 5 10 4 0 3 Drug Dependence Type I Diabetes Hypertension Asthma 2 1 0 Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000. Pre During During During Post Source: McLellan, AT, Addiction 97, 249-252, 2002.

  10. In Treatment Urine Test Positive C vs. C+M, C vs. C+M p< .001 C vs. C+M p< .01 Medications are an important part of treatment for many drug abusing offenders Maryland Prison Study: Treatment Linkage and Opiate-Free One Month Post Release N=166 C = Counseling Only; C+T = Counseling & Treatment Referral; C+M = Counseling & Methadone Started in Prison Preliminary Analysis: Tim Kinlock, et al., 2006

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