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