nora d. volkow, m.d. director national institute on drug abuse nora d. volkow, m.d. director...
TRANSCRIPT
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?What Do We Know?
Drug Abuse Treatment for Drug Abuse Treatment for
Healthy Heart Diseased Heart
Decreased Heart Metabolism in Heart Disease PatientDecreased 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. SchelbertSources: From the laboratories of Drs. N. Volkow and H. Schelbert
High
Low
Drug addiction is a brain disease that affects behaviorDrug addiction is a brain disease that affects behavior
In 2005 An Estimated 23.2 Million Americans
Were Dependent On or AbusedAny Illicit Drugs or Alcohol
But…Only 3.9 Million (17%) of These Individuals
Had Received Some Type ofTreatment In the Past Year
In 2005 An Estimated 23.2 Million Americans
Were Dependent On or AbusedAny Illicit Drugs or Alcohol
But…Only 3.9 Million (17%) of These Individuals
Had Received Some Type ofTreatment 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, 2006.Source: 2005 NSDUH, National Findings, SAMHSA, OAS, 2006.
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 MillionsNumbers in Millions0 .5 1.0 1.5 2.0 2.50 .5 1.0 1.5 2.0 2.5
2.12.1
1.51.5
1.11.1
1.01.0
0.80.8
0.50.5
0.40.4
0.30.3
Location TX ReceivedLocation 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 estimate70-85% of inmates need drugtreatment (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 estimate70-85% of inmates need drugtreatment (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
ALLALL DEPENDENCEDEPENDENCE ABUSEABUSE0
10
20
30
40
50
60
70
80
24 or younger24 or younger 25-3425-34 35-4435-44 45-5445-54 55 or older55 or older
Source: Substance Dependence, Abuse and Treatment of Jail Inmates, 2002, DOJ, BJS, 2005.Source: Substance Dependence, Abuse and Treatment of Jail Inmates, 2002, DOJ, BJS, 2005.
* p < .05 from Comparison* p < .05 from Comparison
Delaware Work Release TC (Crest) + AftercareDelaware Work Release TC (Crest) + AftercareDrug-Free an Arrest-Free 3 Years After Release (N=448)Drug-Free an Arrest-Free 3 Years After Release (N=448)
Delaware Work Release TC (Crest) + AftercareDelaware Work Release TC (Crest) + AftercareDrug-Free an Arrest-Free 3 Years After Release (N=448)Drug-Free an Arrest-Free 3 Years After Release (N=448)
No No
Treat
men
t
Treat
men
t
CREST
CREST
Dropouts
Dropouts
CREST
CREST
Comple
ters
Comple
ters
CREST
CREST
Comple
ters
+
Comple
ters
+
Afterc
are
Afterc
are
*
*
**
*Drug-FreeDrug-FreeDrug-FreeDrug-Free Arrest-FreeArrest-FreeArrest-FreeArrest-Free
No No
Treat
men
t
Treat
men
t
CREST
CREST
Dropouts
Dropouts
CREST
CREST
Comple
ters
Comple
ters
CREST
CREST
Comple
ters
+
Comple
ters
+
Afterc
are
Afterc
are
Martin, Butzin, Saum, & Inciardi (1999), The Prison JournalMartin, Butzin, Saum, & Inciardi (1999), The Prison Journal
Continuity of care is essential for drug abusers re-entering the communityContinuity of care is essential for drug abusers re-entering the community
5
17
27
3529 28
55
69
0
20
40
60
80
100
Through Over Three Decadesof Scientific Research We HaveLearned An Enormous Amount
About Drug Abuse and Addictionand Its Treatment in
Criminal Justice Populations
Through Over Three Decadesof Scientific Research We HaveLearned An Enormous Amount
About Drug Abuse and Addictionand 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, 9414-9418, 2001.
Relapse Rates Are Similar For Drug Dependence & Other Chronic Illnesses
Relapse Rates Are Similar For Drug Dependence & Other Chronic Illnesses
Type I DiabetesType I
Diabetes
Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.
Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.
00101020203030404050506060707080809090
100100
Drug Dependence
Drug Dependence
HypertensionHypertension AsthmaAsthma
40 t
o 60
%40
to
60%
30 t
o 50
%30
to
50%
50 t
o 70
%50
to
70%
50 t
o 70
%50
to
70%
% o
f P
atie
nts
Wh
o R
elap
se%
of
Pat
ient
s W
ho
Rel
apse
Addiction Treatment Does Work
Addiction Treatment Does Work
0
1
2
3
4
5
6
7
8
9
10
Pre During During During Post
0
1
2
3
4
5
6
7
8
9
10
Pre During During During Post
Sym
ptom
Sev
erit
ySy
mpt
om S
ever
ity
Sym
ptom
Sev
erit
ySy
mpt
om S
ever
ity
Evaluation of A Hypothetical TreatmentEvaluation of A Hypothetical Treatment
HYPERTENSIONHYPERTENSION
ADDICTIONADDICTION
Source: McLellan, AT, Addiction 97, 249-252, 2002.Source: McLellan, AT, Addiction 97, 249-252, 2002.
C = Counseling Only; C+T = Counseling & Treatment Referral; C+M = Counseling & Methadone Started in Prison
9%
60%
49%40%
69%
29%
-10%
0%
10%
20%
30%
40%
50%
60%
70%
80%
C C+T C+M
Maryland Prison Study: Treatment LinkageMaryland Prison Study: Treatment Linkageand Opiate-Free One Month Post Releaseand 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 offendersMedications are an important part of treatment for many drug abusing offenders