1. Demand Reduction in the 2010 Drug Control Strategy: Prevention, Intervention, Treatment & Recovery A.Thomas McLellan Chief Scientist & Deputy Director

2. Evidence Based Interventions Delivered Within Communities Investment in Infrastructure

3. 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

4. 1. National Prevention System 2. Engage Primary Care 3. Close the Addiction Tx Gap 4. Special Care for Offenders 5. Improved Data Systems

5. Prevention

6. 1.Addiction has an “at-risk” period 2.Risks have common antecedents – Single Interventions can produce multiple effects 3. Combined interventions provide enhanced impact

7. Schools Parents Law Enforcement Environmental Policies 10 12151821

8. Schools Parents Law Enforcement Environmental Policies 10 12151821

9. 1.Evidence-Based Prevention System Throughout at risk period 2.Help States to Support “ Prevention Prepared Communities ” 3. Coordinate Federal Purchasing

10. Intervention

11. 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

12. 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

13. A Continuing Care Model Primary Continuing Care Primary Care Specialty Care

14. 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

15. 4. Expand SBIRT Code and Financing 5. Train/Motivate Generalist Physicians 6. Coordinate & Expand Prescription Drug Monitoring Programs

16. Treatment

17. ~ 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

18. 7.Integrate Addiction Treatment into Federal Healthcare Systems 8. Performance Contracting in State Treatment Systems 9. Consumer Choice Through Vouchers for Recovery Services

19. Recovery “A voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship” J. Substance Abuse Trt, 2008

20. Community Corrections

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

22. 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

23. Data Systems

24. 13. Maintain legacy systems – but… pilot Community Performance Measures as: Early warning of new drugs & problems Report Card for policy performance

25. 1. National Prevention System 2. Engage Primary Care 3. Close the Addiction Tx Gap 4. Special Care for Offenders 5. Improved Data Systems