demand reduction in the 2010 drug control strategy: prevention, intervention, treatment &...
TRANSCRIPT
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 provideenhanced impact
Schools
Parents
Law Enforcement
Environmental Policies
10 12 15 18 21
Schools
Parents
Law Enforcement
Environmental Policies
10 12 15 18 21
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
PrimaryContinuing Care
Primary Care
Specialty Care
Continuing Care In Addiction
RecoverySupport Services
Primary Care
Specialty Care
ScreenInterveneMonitorRefer
Re-InterveneMonitor/Support
StabilizeMotivate/MedicateTrain Self-MgmntRefer
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 lifestylecharacterized by sobriety, personalhealth and citizenship”
J. Substance Abuse Trt, 2008
Community Corrections
Pre-Arrest
Pre-Trial
Prosecution
Sentencing
In Jail/Prison
Re-Entry
~5 MillionOffendersIn Community
700,000/yrReleased
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
