Treatment
Stopping use before it starts is a priority of the Office of National Drug Control Policy, but treating drug users is critical to demand reduction efforts. From extensive work in the field of addiction science, we know that treatment for drug dependency and addiction—including to methamphetamine—can be effective. The programs we support make significant contributions to closing the treatment gap. At present 8.1 million of the 34.8 million past year drug users in the United States meet the clinical definition of abuse or dependency. Of these, 1.4 million received treatment at a specialty treatment facility. Continued success in healing America’s drug users is predicated on the availability of treatment for the remaining 6.6 million.
Treatment for methamphetamine addiction is possible. For example, the Matrix Model is an evidence-based intensive outpatient treatment program created by The Matrix Institute in Los Angeles. It has been tested through research, showing favorable outcomes. It is a manual-based treatment that uses cognitive behavioral therapy, relapse prevention and skill training, all presented in Motivational Interviewing style. Treatment includes educational sessions for client families and other support people. Skill training groups focus on recovery and relapse prevention. The main objective of the program is to provide clients with a behavioral structure and daily skills enabling the eventual development of a clean and sober lifestyle.
Research studies indicate that the Matrix model is very effective in treating various addictions, including methamphetamine. Matrix clients were 38 percent more likely to stay in treatment compared with other treatment modalities and were 27 percent more likely to complete treatment. In some sites of the research clinical trail (total of 8 sites), the Matrix condition was associated with significantly longer periods of abstinence. Treatment completion was about 41 percent.
Programs focused on methamphetamine recovery: The President’s FY 2007 budget request includes $1.67 billion for the Substance Abuse Prevention and Treatment Block grant, of which 20 percent is set-aside for substance abuse primary prevention. These funds are directed to specialty treatment providers, many of whom provide treatment for abuse and dependence of methamphetamine. The President’s budget also includes $371 million in discretionary grants (Programs of Regional and National Significance), including Access to Recovery.
Administered by SAMHSA, the President’s Access to Recovery (ATR) program is now in 14 States and one Native American organization. Over the three year grant cycle, ATR will provide services to an estimated 125,000 people who seek treatment, but are not able to obtain it, in part, because they cannot afford it. To close the treatment gap, ATR also funds essential recovery support services not generally reimbursable through conventional Federal treatment resources, such as comprehensive relapse prevention services, transportation, or child-care. Many providers are unable to offer “wrap-around” services, even though they are less costly than services
required in the initial stages of recovery, are of paramount significance to those in recovery—especially in the treatment of methamphetamine
addiction—and often are pivotal for remaining drug-free. Tennessee’s ATR program is implemented state-wide and is a good example of the how ATR can be used to help methamphetamine users. The principal emphasis of Tennessee’s ATR program is on treatment services and recovery support services in the Appalachians and other rural areas of Tennessee for individuals who abuse or are addicted primarily to methamphetamine.
The President’s FY07 request for ATR is $98.2 million, which includes $24.8 million for an ATR-Methamphetamine initiative, and approximately $3 million for an evaluation program.
The FY 2007 request for PRNS also includes $5.4 million for a grant program targeting methamphetamine addiction in rural areas. This program, first funded in FY 2005, supports 11 grants.
Screening, Brief Intervention, Referral and Treatment (SBIRT) A key component of expanding the Nation’s treatment capacity lies in early detection and engaging health professionals in the identification, counseling, referral, and ongoing medical management of persons with substance use disorders. The Department of Health and Human Services offers grants through the Screening, Brief Intervention, Referral and Treatment (SBIRT) program to States, territories, and tribal organizations to provide effective early identification and intervention in general medical settings. This program is based on research showing that by simply asking questions regarding unhealthy behaviors and conducting brief interventions, patients are more likely to avoid the behavior in the future and seek help if they believe they have problem. The programs are based in clinical settings, a location that has a high propensity to attract higher-risk populations, who through violence, accidents or health-related problems, are seen by medical professionals.
SBIRT expands the continuum of care available for treatment of substance use disorders by matching an individual’s stage of illness to the initial treatment experience and improves linkages among general community-health related services and specialized substance abuse treatment agencies. Universal screening of patients in a general medical setting can significantly reduce drug and alcohol use among non-dependent users, even without accompanying intervention.
SBIRT could help identify a cohort of methamphetamine users that enter hospital or clinical environments seeking treatment for reasons other than for methamphetamine abuse. This cohort would have the opportunity to be shepherded into interventions or treatment programs.
Awards for the program were made in September 2003 to six States and one Tribal Council. In addition to these grants, 12 universities and colleges have received funding to develop a screening and intervention model to be used on campuses. These programs will identify drug problems at an early stage and help reduce drug dependency and addiction in this vulnerable age cohort. The Office of National Drug Control Policy works closely with the Substance Abuse and Mental Health Administration to monitor the success of these programs and to highlight the
benefits of early screening and intervention. As part of the FY07 budget, $31.2 million is requested for this important initiative.
Drug Courts. There are currently in excess of 1,750 drug courts in operation and another 400 in development. Using the coercive power of the courts to alter behavior through a combination of escalating sanctions, mandatory drug sentencing, and rigorous case management to address the individual’s overall needs, drug courts divert non-violent, low-level offenders whose underlying problem is drug use away from prison and into supervised treatment The National Center on Addiction and Substance Abuse (CASA) at Columbia University reviewed and synthesized over 120 evaluations and determined that drug courts provide the most comprehensive and effective control of drug-using offenders criminality and drug usage while under the courts supervision. A National Institute of Justice report demonstrated that, within the first year of release, 43.5 percent of drug offenders are rearrested, whereas only 16.4 percent of drug court graduates are re-arrested. This ratio of re-arrest rates persists in year two following graduation from drug court.
Program focused on methamphetamine recovery: Drug Courts. Drug courts are another highly effective strategy to identify methamphetamine-addicted populations and guide them into treatment. According to the Special Assistant to the Butte County District Attorney, drug courts are one of the only measures that have worked with its methamphetamine-addicted population. Of the 1,800 felony probation cases filed in Butte County Drug Court in California in 2003, more than 60 percent were methamphetamine related. Methamphetamine has so saturated the drug-dependent population that 87 percent of drug court participants in 2005 have been methamphetamine users. The Butte County Drug Court has helped much of this population receive the treatment they need to recover from drug addiction. Of the 500 program graduates in the past nine years, the aggregate recidivism rate is only 14.9 percent. This statistic not only highlights the efficacy of drug courts in providing treatment, but the effectiveness of this approach to preventing relapse in the criminal justice system. A unique component of drug courts is the requirement for constant monitoring, a process that has been found to be particular effect for methamphetamine abusers who benefit from longer treatment with constant oversight.
Vigo County Drug Court in Indiana is an example of a successful program. In operation since 1996, the drug court has a 16 percent recidivism rate. In 2005, 35 percent were admitted into the program because of methamphetamine-related offenses, many of whom were referred to Hamilton House, a community mental health center and managed care provider in the Terre Haut area, for substance abuse treatment. Over 30 percent of the clients seen by Hamilton Center’s addiction services present with methamphetamine use. The Center uses the Matrix model and collaborative family therapy, treatment protocols that address users of methamphetamine. This is but one example of the drug court to treatment model that is helping to identify and heal drug users in America.
There is strong administration support for drug courts. The President’s FY 2007 budget requests a funding level of $69.2 million for drug courts
programs—an increase of $59.3 million over the 2006 enacted level. This increase reflects a commitment to this program.
