demand reduction in the 2010 drug control strategy: prevention, intervention, treatment &...

Demand Reduction in the 2010 Drug Control Strategy:

Prevention, Intervention, Treatment &Recovery

A. Thomas McLellan

Chief Scientist & Deputy Director

• Evidence Based Interventions

• Delivered Within Communities

• Investment in Infrastructure

Different policies for levels of Severity

Addiction ~ 25,000,000(Focus on Treatment)

“Harmful Use” – 68,000,000(Focus on Early Intervention)

Little or No Use(Focus on Prevention)

In Treatment ~ 2,300,000

1. National Prevention System

2. Engage Primary Care

3. Close the Addiction Tx Gap

4. Special Care for Offenders

5. Improved Data Systems

Prevention

1. Addiction has an “at-risk” period

2. Risks have common antecedents – Single Interventions can produce multiple effects

3. Combined interventions provideenhanced impact

Schools

Parents

Law Enforcement

Environmental Policies

10 12 15 18 21

Schools

Parents

Law Enforcement

Environmental Policies

10 12 15 18 21

1. Evidence-Based Prevention System Throughout at risk period

2. Help States to Support “Prevention Prepared Communities”

3. Coordinate Federal Purchasing

Intervention

Substance Abuse

Addiction ~ 25,000,000(Focus on Treatment)

“Harmful Use” – 68,000,000(Focus on Early Intervention)

Little or No Use(Focus on Prevention)

In Treatment ~ 2,300,000

1. Detect Emerging Cases of “Addiction”

“Unhealthy” Substance Use Complicates Care for Virtually Every Chronic Illness. So….

2. Anticipate Drug-Drug Side Effects

3. Anticipate Non-Compliance

A Continuing Care Model

PrimaryContinuing Care

Primary Care

Specialty Care

Continuing Care In Addiction

RecoverySupport Services

Primary Care

Specialty Care

ScreenInterveneMonitorRefer

Re-InterveneMonitor/Support

StabilizeMotivate/MedicateTrain Self-MgmntRefer

4. Expand SBIRT Code and Financing

5. Train/Motivate Generalist Physicians

6. Coordinate & Expand Prescription Drug Monitoring Programs

Treatment

~ 12,000 specialty programs in US

• 31% treat less than 200 patients per year

~ 77% government funded

Private insurance <12%

Sources – NSSATS, 2008; D’Aunno, 2004

7. Integrate Addiction Treatment into Federal Healthcare Systems

8. Performance Contracting in State Treatment Systems

9. Consumer Choice Through Vouchers for Recovery Services

Recovery “A voluntarily maintained lifestylecharacterized by sobriety, personalhealth and citizenship”

J. Substance Abuse Trt, 2008

Community Corrections

Pre-Arrest

Pre-Trial

Prosecution

Sentencing

In Jail/Prison

Re-Entry

~5 MillionOffendersIn Community

700,000/yrReleased

10. Drug Treatment Alternatives to Prison

Continued Emphasis on Drug Courts

11. Offender Re-Entry Programs

12. Screening and Brief Treatments of Juvenile Offenders with MH and SA Problems

Data Systems

13. Maintain legacy systems – but…

pilot Community Performance Measures as:

• Early warning of new drugs & problems

• Report Card for policy performance

1. National Prevention System

2. Engage Primary Care

3. Close the Addiction Tx Gap

4. Special Care for Offenders

5. Improved Data Systems