Michael Dennis, Ph.D. Chestnut Health Systems, Normal, IL Randolph Muck, M.Ed.

1. Why target YouthBuild for screening, brief intervention and treatment - or don’t you have enough to do already? Michael Dennis, Ph.D. Chestnut Health Systems, Normal, IL Randolph Muck, M.Ed. Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT), Rockville, MD Presentation at the YouthBuild Learning Exchange, Chicago, IL, May 27, 2010. This presentation was supported by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA) under contracts 270-07-0191, as well as several individual CSAT, NIAAA, NIDA and private foundation grants. The opinions are those of the authors and do not reflect official positions of the consortium or government. Available on line at www.chestnut.org/LI/Posters or by contacting Michael Dennis, Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, phone 309-451-7801, fax 309-451-7765, e-Mail: mdennis@Chestnut.Org Questions about the GAIN can also be sent to gaininfo@chestnut.org . Questions about SAMHSA and funding should be directed to Mr. Randolph D. Muck, 1 Choke Cherry Drive, Room 5-1097, Rockville, MD 20857, randy.muck@samhsa.hhs.gov .

2. Over 90% of use and problems start between the ages of 12-20 It takes decades before most recover or die Alcohol and Other Drug Abuse, Dependence and Problem Use Peaks at Age 20 NSDUH Age Groups 100 People with drug dependence die an average of 22.5 years sooner than those without a diagnosis 90 80 70 60 Severity Category 50 No Alcohol or Drug Use Light Alcohol Use Only 40 Any Infrequent Drug Use 30 Regular AOD Use 20 Abuse 10 Dependence 0 65+ 12-13 14-15 16-17 18-20 21-29 30-34 35-49 50-64 Source: 2002 NSDUH, Dennis & Scott 2007, Neumark et al., 2000

3. ..as well as family, school and mental health problems Family, Vocational & MH by Substance Severity Adolescents 12-17 Source: NSDUH 2006

4. Substance use severity is related to crime and violence Crime & Violence by Substance Severity Adolescents 12-17 Source: NSDUH 2006

5. <SBIRT Target 37% 48% 52% 36% < Tx Target (9%) (13%) (29%) (13%) Household Population (12-65) vs. Youth (16-23) who have dropped out of school Dependence is associated with disproportionate costs (13 vs. 29%, OR=1.87 for youth drop out) Household Population All Age 12-65+ Transitional Age Youth Age 16-23 Drop outs Source: NSDUH 2006

6. Cost of Substance Abuse Treatment Episode Level of care (mean length of stay) SBIRT least expensive • $750 per night in Detox • $1,115 per night in hospital • $13,000 per week in intensive • care for premature baby • $27,000 per robbery • $67,000 per assault $70,000/year to keep a child in detention $22,000 / year to incarcerate an adult $30,000/ child-year in foster care Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004

7. Investing in Treatment has a Positive Annual Return on Investment (ROI) • Substance abuse treatment has been shown to have a ROI of between $1.28 to $7.26 per dollar invested • Even the long term and more intensive Treatment Drug Courts programs have an average ROI of $2.14 to $2.71 per dollar invested This also means that for every dollar treatment is cut, we lose more money than we saved. Source: Bhati et al., (2008); Ettner et al., (2006)

8. Few Get Treatment: 1 in 17 adolescents, 1 in 22 young adults, 1 in 12 adults Substance Use Disorders are Common,But Treatment Participation Rates Are Low:United States (US) Over 88% of adolescent and young adult treatment and over 50% of adult treatment is publicly funded Much of the private funding is limited to 30 days or less and authorized day by day or week by week Source: OAS, 2006 – 2003, 2004, and 2005 NSDUH

9. People Entering Publicly Funded Treatment Generally Use For Decades It takes 27 years before half reach 1 or more years of abstinence or die 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent still using Years from first use to 1+ years of abstinence 0 5 10 15 20 25 30 Source: Dennis et al., 2005

10. The Younger They Start, The Longer They Use 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent still using Age of First Use* Years from first use to 1+ years of abstinence under 15 60% longer 15-20 21+ 0 5 10 15 20 25 30 * p<.05 Source: Dennis et al., 2005

11. The Sooner They Get The Treatment, The Quicker They Get To Abstinence 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Years to first Treatment Admission* Percent still using 20 or more years Years from first use to 1+ years of abstinence 57% quicker 10 to 19 years 0 to 9 years 0 5 10 15 20 25 30 • p<.05 Source: Dennis et al., 2005

12. Cumulative Recovery Pattern at 30 months 5% Sustained Recovery 37% Sustained 19% Intermittent, Problems currently in recovery 39% Intermittent, currently not in recovery The Majority of Adolescents Cycle in and out of Recovery Source: Dennis et al, forthcoming

13. Recovery* by Level of Care 100% Outpatient (+79%, -1%) 90% Residential(+143%, +17%) 80% Post Corr/Res (+220%, +18%) 70% CC better 60% Percent in Past Month Recovery* 50% OP & Resid Similar 40% 30% 20% 10% 0% Pre-Intake Mon 1-3 Mon 4-6 Mon 7-9 Mon 10-12 * Recovery defined as no past month use, abuse, or dependence symptoms while living in the community. Percentages in parentheses are the treatment outcome (intake to 12 month change) and the stability of the outcomes (3months to 12 month change) Source: CSAT Adolescent Treatment Outcome Data Set (n-9,276)

14. References • Bhati et al. (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to Drug-Involved Offenders.  Washington, DC: Urban Institute. • Capriccioso, R. (2004).  Foster care: No cure for mental illness.  Connect for Kids.  Accessed on 6/3/09 from http://www.connectforkids.org/node/571 • Chandler, R.K., Fletcher, B.W., Volkow, N.D. (2009).  Treating drug abuse and addiction in the criminal justice system: Improving public health and safety.  Journal American Medical Association, 301(2), 183-190 • Dennis, M. L., Scott, C. K. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical Practice , 4(1), 45-55. • Dennis, M. L., Scott, C. K., Funk, R., & Foss, M. A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment, 28, S51-S62. • Ettner, S.L., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., & Hser, Y.I. (2006).  Benefit Cost in the California Treatment Outcome Project: Does Substance Abuse Treatment Pay for Itself?.  Health Services Research, 41(1), 192-213. • French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates of cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469 • Neumark, Y.D., Van Etten, M.L., & Anthony, J.C. (2000). Drug dependence and death: Survival analysis of theBaltimore ECA sample from 1981 to 1995. Substance Use and Misuse, 35, 313-327. • Office of Applied Studies (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings Rockville, MD:  Substance Abuse and Mental Health Services Administration.  http://www.oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm#7.3.1