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Addiction Treatment and the

Challenge of Meth Addiction


Carol Falkowski
Director, Research Communications
Hazelden Foundation
www.hazelden.org
April 2004

Diagnostic Criteria:
Substance Dependence

A maladaptive pattern of substance use leading to


clinically significant impairment or distress
manifested by 3 or more of the following occurring
at anytime within the same 12-month period:
1. tolerance of the substance: need for markedly
increased amounts to achieve intoxication or
the desired effect, or markedly diminished
effect with continued use of the same amount
2. withdrawal: the characteristic withdrawal
syndrome, or substance taken to relieve or
avoid withdrawal symptoms

Substance Dependence (continued)

3. larger amounts of substance taken or over a longe


period than was intended
4. persistent desire or unsuccessful efforts to cut
down or control use

5. great deal of time spent in activities to obtain, us


or recover from the substances effects
6. important social, occupational and recreational
activities given up or reduced because of use

7. continued use despite knowledge of a persistent o


recurrent psychological or physical problems
likely to have been caused or exacerbated by use

Addiction:
A chronic disorder with
behavioral components that
requires lifelong management
and periodic professional
services

Addiction
is NOT just a lot of drug
use.

Effective treatment for


addiction exists.
No single treatment is appropriate
for all individuals.
Treatment need NOT be voluntary
to be effective.
Approach is similar regardless of
primary drug.

Addiction treatment:
Saves money.

Every $1 spent on treatment saves


$12 in future averted social,
medical and criminal justice costs.

Addiction treatment:
-

arrests the progression of the disease


reduces drug and alcohol abuse
improves health
protects the public safety
increases
worker productivity
restores families, communities

Its a FACT:
To be effective treatment
must address:
drug use
medical problems
social problems
coexisting psychological
problems

Its a FACT:
Various addiction treatment
approaches include:
- behavioral therapy,
- medications, and
- combinations of the two.

Its a FACT:

Three components considered


critical to recovery from addiction includ

detoxification,
rehabilitation, and
aftercare.

Its a FACT:
Medical detox is the first stage
and by itself does little to change
long-term drug use.

Its a FACT:
Remaining in treatment for
an adequate period of time
is critical for treatment effectiveness.
Good outcomes are contingent upon
adequate lengths of treatment.

Its a FACT:
Critical components of
12-Step
Facilitation
Model of TREATMENT:

Focus on disease concept


Individual therapy
Group therapy
Link to 12 step philosophy
Family involvement and education
Abstinence
Individualized treatment plan

Its a FACT:
Critical components of effective AFTERCARE:

Change in friends/drug using scene,

Effective support group,

Sober, healthy living environment.

Treatment outcomes for addiction


are similar to the outcomes of other
chronic diseases with behavioral
components.
SOURCE: McLellan, A.T., Lewis, D.C., et al, (2000) Drug dependence, a chronic medical
illness: Implications for treatment, insurance and outcomes evaluation. Journal of the
American Medical Association, 284 (13).

Addicts who fully abstain from drugs/alcohol @ 1 year


40 60%
Diabetics who fully adhere to medication schedule
<60%

Hypertensives who fully adhere to medication regim


<40%
Asthmatics who fully adhere to medication regimen
<40%
SOURCE: McLellan, A.T., Lewis, D.C., et al, (2000) Drug dependence, a chronic medical
illness: Implications for treatment, insurance and outcomes evaluation. Journal of the
American Medical Association, 284 (13).

Diet and behavioral changes that reduce


the risk of recurrence and improve functioning:
Addicts completely abstinent from
drugs/alcohol @ 1 year
40 60%
Diabetics, hypertensives and asthmatics who make
behavioral changes to avoid retreatment within a year:

< 30%

SOURCE: McLellan, A.T., Lewis, D.C., et al, (2000) Drug dependence, a chronic
medical illness: Implications for treatment, insurance and outcomes evaluation.
Journal of the American Medical Association, 284 (13).

Meth addicts:

Often do not get the help they need due to:


- meth rages, volatility, and anger while under the
influence
- lack of available treatment
- immediate incarceration for violent criminal behavior

Meth addicts:

- have high level of physical problems


- often deal or manufacture meth
(criminal lifestyle that extends
beyond
drug abuse or addiction)

Meth addicts:

require adequate treatment exposure to


sort through symptoms stemming from
drug effects (sleep-deprived psychosis,
paranoid delusions) vs. an underlying
psychiatric disorder

Meth addicts:

require structured, extended aftercare:


- halfway house, or
- supported, sober, living
environment

Latest trend in addiction


treatment?
Most folks who need it dont receive it
last

The duration and availability of treatment over the


decade has decreased. 28 Days is a movie title.

10.3 million Americans dependent on


alcohol
or drugs
2.8 million received treatment (27%)
SOURCE: US Department of Health and Human Services, Substance Abuse and
Mental Health Services Administration, 1999 National Household Survey on Drug
Abuse.

Key elements to hold addicted


criminals accountable.
1 - Strong criminal justice sanction
2 - Quality treatment
3 - Structured, supportive living
environment
Most addicts need a harsh consequence in order to get
sober, but without treatment (in addition to the harsh
consequence) they have a poor chance of recovery.

ONE EXAMPLE:
Challenge Incarceration Program
An intensive, rigorous, highly
structured and disciplined program for
carefully selected, non-dangerous drug
and property offenders.

ONE EXAMPLE:
Challenge Incarceration Program
Phase I: a minimum of six-months institution phase
Phase II: a highly supervised community phase under intensive
surveillance which lasts a minimum of six months

Phase III: a supervised community release phase, generally


lasting six months. When offenders successfully complete Phase
III, they are placed on supervised release for the remainder of their
sentence.

www.corr.state.mn.us/facilities
/cip.

REFERENCES:
Principles of Drug Addiction Treatment: A ResearchBased Guide, National Institute on Drug Abuse,
National Institutes of Health, NIH Publication No. 99
4180, October 1999.
McLellan, A.T., Lewis, D.C., et al, (2000) Drug
dependence, a chronic medical illness:
Implications for treatment, insurance and
outcomes evaluation. Journal of the American
Medical Association, 284 (13).
Falkowski, Carol L., (2003) Dangerous Drugs: An
Easy-to-Use Reference for Parents and
Professionals, Hazelden Publishing.
www. Hazelden.org