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 provide enhanced impact

Schools Parents Law Enforcement Environmental Policies

Schools Parents Law Enforcement Environmental Policies

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 Primary Continuing Care Primary Care Specialty Care

Continuing Care In Addiction Recovery Support Services Primary Care Specialty Care Screen Intervene Monitor Refer Re-Intervene Monitor/Support Stabilize Motivate/Medicate Train Self-Mgmnt Refer

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 lifestyle characterized by sobriety, personal health and citizenship” J. Substance Abuse Trt, 2008

Community Corrections

Pre-Arrest Pre-Trial Prosecution Sentencing In Jail/Prison Re-Entry ~5 Million Offenders In Community 700,000 /yr Released

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