Understanding the Demand for Illegal Drugs (2010) / Chapter Skim
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4 Treatment
4 Treatment
Pages 65-88
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From page 65... ...
This chapter takes a broad perspective to examine the question of whether and how treatment can affect drug demand. We start by explor 6
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From page 66... ...
We then turn to the potential for reducing demand through expansion of treatment, with particular attention to integration of drug treatment with the criminal justice system. Finally, we consider how the impact of policy changes designed to expand, improve, or better inte grate drug abuse treatment services can be modeled and researched.
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Although many opiate users in follow-up studies have reported trying both self-help and formal treatment at various times, a relatively low percentage (< 10 percent) reported being enrolled in methadone treatment at any given time (Hser et al., 2001)
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Although the time frame is much shorter in this than in other studies, these data are consistent with those of Hser and colleagues (2001, 2007b) in that about 60 percent of drug users followed after an index treatment episode had poor long-term outcomes as evidenced by continued drug use.
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From page 69... ...
, for example, document that multiple treatment episodes are the norm for drug users and suggest that prior treatment exposure may be associated with poor out comes. But other data suggest that long-term prognosis appears to be better for those who re-enter treatment promptly after relapsing (Moos and Moos, 2007; Scott et al., 2003)
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In the United States, there are about 14,000 facilities that offer drug abuse treatment, and they serve more than 1.1 million drug and alcohol users, according to the National Survey of Substance Abuse Treatment Services (Substance Abuse and Mental Health Services Administration, 2008)
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From page 71... ...
Improving voluntary participation may require some new strategies that remove barriers to treatment entry while making treatment itself a more attractive option. For example, there has been some success in promoting treatment entry by using vouchers that are distrib uted to drug users at the locations such as needle exchange sites (Booth et al., 1998; Strathdee et al., 2006)
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From page 72... ...
Integrating Treatment with the Criminal Justice System Although the methods that may be needed to increase voluntary participation are currently speculative, one logical and more certain pathway for enhancing the reach of drug abuse treatment to a large relevant population of drug users would be through coordination with the criminal justice system (Chandler et al., 2009)
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. Drug Courts Drug courts represent a relatively new and innovative variation on pretrial diversion strategies whose goal is to integrate treatment with criminal justice supervision.
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were randomly assigned to receive methadone maintenance treatment initiated either before or shortly after release from incarceration; the control group who was released received drug abuse counseling without medication. The study demonstrated significantly better outcomes on measures of treatment entry, drug use, and criminal activity both 3 months after (kinlock et al., 2008)
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Additional research on the feasibility and effectiveness of sustained-release naltrexone for use in criminal justice populations is warranted. Overall, better coordination of treatment and criminal justice programs could be a very effective component of a demand reduction strategy.
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For example, it may be difficult to identify physical locations for new treatment programs due to the reluctance of neighborhood residents to host drug treatment clinics in their area. This means that innovation may be required for treatment expansion that requires new physical sites.
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reported a 53 percent annual turnover rate of clinic direc tors within 175 nationally representative drug and alcohol treatment programs interviewed in 2001. These issues can be addressed by expansion of training for substance abuse counselors and may also be aided by management training for clinic leaders, many of whom may have risen through the ranks of clinical staff and assumed leadership roles with little expertise or experience in management.
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However, this goal has to be tempered with the findings that relapse to drug use is a consistent and pervasive occurrence following treatment episodes for the majority of those who enter programs, a dynamic similar to that observed for other chronic illnesses, such as diabetes and hypertension (McLellan et al., 2005a)
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This direct approach to understanding treatment effects on demand reduction would predict that the demand reduction benefits of residential or pharmacological treatment for opioid dependence may be more readily apparent than the benefits of psychosocial counseling interventions. Opiate (e.g., heroin)
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, drug abuse treatment is imperfect and does not "work" comprehensively in the way that patients,
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from expansion of psychosocial counseling programs. Despite the caveats, treatment expansion, both within and outside of the criminal justice sys tem, as well as treatment improvement, need to be seriously considered in any policy discussions about demand reduction.
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. The mobile health experience: A blueprint for expanding access to substance abuse treatment.
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Journal of Substance Abuse Treatment, , 291-300. Higgins, S.T., G.J.
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. Over view of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS)
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. What are the correlates of substance abuse treatment counselor salaries?
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Journal of Substance Abuse Treatment, , S63-S72. Scott, C.k., M.L.
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. Short-term alcohol and drug treatment outcomes predict long-term outcome.
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