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Demand Reduction in the 2010 Drug Control Strategy:
Prevention, Intervention, Treatment &Recovery
A. Thomas McLellan
Chief Scientist & Deputy Director
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• Evidence Based Interventions
• Delivered Within Communities
• Investment in Infrastructure
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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
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1. National Prevention System
2. Engage Primary Care
3. Close the Addiction Tx Gap
4. Special Care for Offenders
5. Improved Data Systems
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Prevention
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1. Addiction has an “at-risk” period
2. Risks have common antecedents – Single Interventions can produce multiple effects
3. Combined interventions provideenhanced impact
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Schools
Parents
Law Enforcement
Environmental Policies
10 12 15 18 21
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Schools
Parents
Law Enforcement
Environmental Policies
10 12 15 18 21
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1. Evidence-Based Prevention System Throughout at risk period
2. Help States to Support “Prevention Prepared Communities”
3. Coordinate Federal Purchasing
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Intervention
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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
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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
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A Continuing Care Model
PrimaryContinuing Care
Primary Care
Specialty Care
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Continuing Care In Addiction
RecoverySupport Services
Primary Care
Specialty Care
ScreenInterveneMonitorRefer
Re-InterveneMonitor/Support
StabilizeMotivate/MedicateTrain Self-MgmntRefer
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4. Expand SBIRT Code and Financing
5. Train/Motivate Generalist Physicians
6. Coordinate & Expand Prescription Drug Monitoring Programs
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Treatment
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~ 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
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7. Integrate Addiction Treatment into Federal Healthcare Systems
8. Performance Contracting in State Treatment Systems
9. Consumer Choice Through Vouchers for Recovery Services
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Recovery “A voluntarily maintained lifestylecharacterized by sobriety, personalhealth and citizenship”
J. Substance Abuse Trt, 2008
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Community Corrections
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Pre-Arrest
Pre-Trial
Prosecution
Sentencing
In Jail/Prison
Re-Entry
~5 MillionOffendersIn Community
700,000/yrReleased
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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
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Data Systems
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13. Maintain legacy systems – but…
pilot Community Performance Measures as:
• Early warning of new drugs & problems
• Report Card for policy performance
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1. National Prevention System
2. Engage Primary Care
3. Close the Addiction Tx Gap
4. Special Care for Offenders
5. Improved Data Systems
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