Nora D. Volkow, M.D. Director National Institute on Drug Abuse Nora D. Volkow, M.D. Director National Institute on Drug Abuse What Do We Know? Drug Abuse Treatment for

Healthy Heart Diseased Heart Decreased Heart Metabolism in Heart Disease Patient Control Cocaine Abuser Decreased Brain Metabolism in Drug Abuse Patient Sources: From the laboratories of Drs. N. Volkow and H. Schelbert High Low Drug addiction is a brain disease that affects behavior Drug addiction is a brain disease that affects behavior

In 2005 An Estimated 23.2 Million Americans Were Dependent On or Abused Any Illicit Drugs or Alcohol But…Only 3.9 Million (17%) of These Individuals Had Received Some Type of Treatment In the Past Year In 2005 An Estimated 23.2 Million Americans Were Dependent On or Abused Any Illicit Drugs or Alcohol But…Only 3.9 Million (17%) of These Individuals Had Received Some Type of Treatment In the Past Year Although Treatments For Addiction Are Available, They Are Not Being Widely Used By Those Who Need Them Although Treatments For Addiction Are Available, They Are Not Being Widely Used By Those Who Need Them Source: 2005 NSDUH, National Findings, SAMHSA, OAS, Self Help Group Outpatient Rehab Inpatient Rehab Outpatient Mental Health Center Hospital Inpatient Private Doctor’s Office Emergency Room Prison or Jail Self Help Group Outpatient Rehab Inpatient Rehab Outpatient Mental Health Center Hospital Inpatient Private Doctor’s Office Emergency Room Prison or Jail Numbers in Millions Location TX Received

U.S. Adult Offender Population Drug use involved in > 50% of violent crimes and 60-80% of child abuse/neglect cases (NIJ, 1999) Corrections officials estimate 70-85% of inmates need drug treatment (GAO, 1991) 68% of jail inmates report regular drug use (BJS, 2005) Drug use involved in > 50% of violent crimes and 60-80% of child abuse/neglect cases (NIJ, 1999) Corrections officials estimate 70-85% of inmates need drug treatment (GAO, 1991) 68% of jail inmates report regular drug use (BJS, 2005)

Substance Dependence Or Abuse Among Jail Inmates by Age Substance Dependence Or Abuse Among Jail Inmates by Age

* p <.05 from Comparison Delaware Work Release TC (Crest) + Aftercare Drug-Free an Arrest-Free 3 Years After Release (N=448) Delaware Work Release TC (Crest) + Aftercare Drug-Free an Arrest-Free 3 Years After Release (N=448) No Treatment CREST Dropouts CREST Completers CREST Completers + Aftercare * * * * * Drug-FreeDrug-FreeArrest-FreeArrest-Free No Treatment CREST Dropouts CREST Completers CREST Completers + Aftercare Martin, Butzin, Saum, & Inciardi (1999), The Prison Journal Continuity of care is essential for drug abusers re-entering the community Continuity of care is essential for drug abusers re-entering the community

Through Over Three Decades of Scientific Research We Have Learned An Enormous Amount About Drug Abuse and Addiction and Its Treatment in Criminal Justice Populations Through Over Three Decades of Scientific Research We Have Learned An Enormous Amount About Drug Abuse and Addiction and Its Treatment in Criminal Justice Populations

Partial Recovery of Brain Dopamine Transporters in Methamphetamine (METH) Abuser After Protracted Abstinence Normal Control METH Abuser (1 month detox) METH Abuser (24 months detox) 0 3 ml/gm Source: Volkow, ND et al., Journal of Neuroscience 21, , 2001.

Relapse Rates Are Similar For Drug Dependence & Other Chronic Illnesses Relapse Rates Are Similar For Drug Dependence & Other Chronic Illnesses Type I Diabetes Type I Diabetes Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, Drug Dependence Drug Dependence Hypertension Asthma 40 to 60% 30 to 50% 50 to 70% % of Patients Who Relapse Addiction Treatment Does Work Addiction Treatment Does Work

C = Counseling Only; C+T = Counseling & Treatment Referral; C+M = Counseling & Methadone Started in Prison Maryland Prison Study: Treatment Linkage and Opiate-Free One Month Post Release Preliminary Analysis: Tim Kinlock, et al., 2006 C vs. C+M, C vs. C+M p<.001 In Treatment C vs. C+M p<.01 Urine Test Positive N=166 Medications are an important part of treatment for many drug abusing offenders Medications are an important part of treatment for many drug abusing offenders