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, This presentation was supported by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA) under contracts , 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 or by contacting Michael Dennis, Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, phone , fax , Questions about the GAIN can also be sent to Questions about SAMHSA and funding should be directed to Mr. Randolph D. Muck, 1 Choke Cherry Drive, Room , Rockville, MD 20857,

Alcohol and Other Drug Abuse, Dependence and Problem Use Peaks at Age 20 Source: 2002 NSDUH, Dennis & Scott 2007, Neumark et al., No Alcohol or Drug Use Light Alcohol Use Only Any Infrequent Drug Use Regular AOD Use Abuse Dependence NSDUH Age Groups Severity Category Over 90% of use and problems start between the ages of It takes decades before most recover or die People with drug dependence die an average of 22.5 years sooner than those without a diagnosis

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

Crime & Violence by Substance Severity Source: NSDUH 2006 Adolescents Substance use severity is related to crime and violence

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

Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 Cost of Substance Abuse Treatment Episode $22,000 / year to incarcerate an adult $30,000/ child-year in foster care $70,000/year to keep a child in detention $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 Level of care (mean length of stay) SBIRT least expensive

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 Source: Bhati et al., (2008); Ettner et al., (2006) This also means that for every dollar treatment is cut, we lose more money than we saved.

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

People Entering Publicly Funded Treatment Generally Use For Decades P e r c e n t s t i l l u s i n g Years from first use to 1+ years of abstinence Source: Dennis et al., % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% It takes 27 years before half reach 1 or more years of abstinence or die

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

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

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

Recovery* by Level of Care * 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) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pre-IntakeMon 1-3Mon 4-6Mon 7-9Mon Percent in Past Month Recovery* Outpatient (+79%, -1%) Residential(+143%, +17%) Post Corr/Res (+220%, +18%) OP & Resid Similar CC better

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 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), Dennis, M. L., Scott, C. K. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical Practice, 4(1), 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), 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, Neumark, Y.D., Van Etten, M.L., & Anthony, J.C. (2000). Drug dependence and death: Survival analysis of the Baltimore ECA sample from 1981 to Substance Use and Misuse, 35, 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.