DRUG ABUSE AND ADDICTIONPsychiatric Definition
Although not all experts agree on a single definition of drug addiction, the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5; 2013) is the most widely used reference for diagnosing and treating mental illness and substance-related disorders. In the DSM-5, the APA classifies all issues relating to substance abuse and dependence into a single category, substance use disorder, which is measured along a spectrum from mild to severe, depending on the number of symptoms.
As is mentioned in Chapter 1 , the DSM-5 lists 11 symptoms related to substance use disorder. Common symptoms include:
- The person has repeatedly failed to live up to major obligations, such as on the job, at school, or in the family, because of drug use
- The person has used the substance in dangerous situations, such as before driving
- The person has had multiple legal problems because of drug use
- The person continues to use drugs in the face of interpersonal problems, such as arguments or fights caused by substance use
The DSM-5 requires that at least two to three of the 11 symptoms be present before an individual is diagnosed with mild substance abuse disorder; the presence of four to five symptoms indicates a moderate disorder, while six or more symptoms are associated with severe substance use disorder.
In Drugs, Brains, and Behavior: The Science of Addiction (July 2014, https://www.drugabuse.gov/sites/default/files/soa_2014.pdf ), the National Institute on Drug Abuse (NIDA) answers the question “What is drug addiction?” the following way: “Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs…. Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful consequences, and are preventable and treatable, but if left untreated, can last a lifetime.”
Beginning in the 1980s advances in neuroscience led to a new understanding of how people become addicted to drugs and why they stay that way. As reflected in the NIDA definition, most psychiatric and medical researchers espouse the disease model of addiction. Addicts, they say, respond to drugs differently than people who are not addicted. Much of the difference is associated with differences in brain functioning and can be linked to genetic factors. According to George R. Uhl et al., in “Molecular Genetics of Addiction and Related Heritable Pheno-types” (Annals of the New York Academy of Sciences, vol. 1141, October 2008), drug addiction is a disease that is linked to the effects of many genes as well as to environmental factors. Approaches to treatment emphasize that addiction must be treated in the same way as other chronic diseases.
In “Evidence-Based Treatments of Addiction” (Philosophical Transactions of the Royal Society, vol. 363, no. 1507, October 12, 2008), Charles P. O'Brien of the University of Pennsylvania points out that modern definitions Page 92 | Top of Articleof addiction (such as the NIDA definition) emphasize “uncontrolled drug use rather than tolerance and physiological dependence as essential features of the disorder.” He adds that “it is generally recognized that addiction has strong hereditary influences and once established, it behaves as a chronic brain disorder with relapses and remissions over the long term.” To help understand this pattern of compulsive behavior and its importance, O'Brien suggests that one only need to think of a friend, relative, or acquaintance who has tried to give up smoking only to relapse at some later time, and probably multiple times, into compulsive smoking behavior while knowing full well the health consequences of his or her actions.
The modern approach to treatment has come to reflect the complexity of the drug abuse–addiction spectrum and combines medical approaches, behavior modification, education, and social support functions that are intended to redress imbalances in the patient's total environment. The components of a comprehensive drug treatment approach are shown in Figure 6.1 . Arrayed in the center are categories of treatment used alone or in combination and, on the periphery, social service functions that may have to be deployed to solve some of the patient's problems that led to drug use or addiction in the first place.
TREATMENT FACILITIESNational Survey of Substance Abuse Treatment Services Data
The Substance Abuse and Mental Health Services Administration (SAMHSA) has been collecting data on substance abuse facilities since 1976. One of its current programs is the National Survey of Substance Abuse Treatment Services (N-SSATS). The N-SSATS numbers represent a snapshot of the treatment units on a particular day and do not indicate how many people are being treated over the course of an entire year.
SAMHSA reports in National Survey of Substance Abuse Treatment Services (N-SSATS): 2014 (March 2016, https://www.samhsa.gov/data/sites/default/files/2014_National_Survey_of_Substance_Abuse_Treatment_Services/2014_National_Survey_of_Substance_Abuse_Treatment_Services/2014_National_Survey_of_Substance_Abuse_Treatment_Services.pdf ) Page 93 | Top of Articlethat as of 2014, the number of treatment facilities that responded to the N-SSATS stood at 14,152. (See Table 6.1 .) More than one-tenth (1,454) of these facilities were in California.
Of the 14,152 facilities offering substance abuse treatment in 2014, 11,618 (82.1%) offered outpatient care. (See Table 6.1 .) Nearly a quarter (3,473, or 24.5%) offered nonhospital residential care, while 762 (5.4%) provided hospital inpatient treatment.
Overall, there were 1,312 facilities certified by SAMHSA to provide opioid addiction treatment in 2014. Of these, 1,184 (90.2%) offered outpatient care. An additional 125 facilities (9.5%) provided hospital inpatient services for people receiving treatment for opioid addiction in 2014, while 112 facilities (8.5%) offered nonhospital residential treatment for opioid addiction.
HOW MANY PEOPLE ARE BEING TREATED?National Survey on Drug Use and Health Data
To collect data from people who seek and receive substance abuse treatment, SAMHSA included questions about treatment in its 2015 National Survey on Drug Use and Health and published its findings in Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (September 2016, https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf ). Figure 6.2 shows the results of a survey asking recipients whether or not they needed treatment for substance use during the past year. SAMHSA defines individuals needing treatment as those who either suffered from substance use disorder or received treatment for substance use disorder at a specialized facility at some point during the past year. As Figure 6.2 shows, 21.7 million individuals aged 12 years and older needed substance abuse treatment in 2015; this figure represented 8.1% of all people in that age group. Among young adults between the ages of 18 and 25 years, more than 5.4 million (15.5%) needed substance abuse treatment in 2015. In addition, 1.3 million (5.1%) adolescents between the ages of 12 and 17 years needed substance abuse treatment that year.
SAMHSA also asked substance abusers whether or not they received treatment in 2015. Of the 21.7 million individuals aged 12 years and older who needed treatment that year, only 3 million (14%) actually received treatment for substance abuse. (See Figure 6.3 .) Among individuals needing treatment for substance abuse, those aged 26 years and older (2.3 million, or 15.5%) were the most likely to receive treatment; by contrast, young people between the ages of 18 and 25 years (563,000, or 10.4%) who needed treatment for substance abuse were the least likely to receive treatment that year.
According to SAMHSA, 20.8 million people aged 12 years and older suffered from substance use disorder in 2015. This figure represented 7.8% of all individuals in that age group. Incidences of substance abuse disorder were typically higher among adults suffering from mental illness. As Figure 6.4 shows, nearly one out of five (8.1 million, or 18.7%) adults aged 18 years and older who struggled with mental illness also struggled with substance use disorder in 2015.
Another source of data for the drug-treatment population comes from SAMHSA's Treatment Episode Data Set (TEDS). This program counts admissions over the period of a year rather than the number of people in treatment on a particular day during the year. When the same person is admitted two or more times during the same year, he or she is counted for each of those admissions, whereas the N-SSATS counts individuals only once. SAMHSA reports in Treatment Episode Data Set (TEDS) 2003–2013: National Admissions to Substance Abuse Treatment Services (December 2015, https://www.samhsa.gov/data/sites/default/files/2003_2013_TEDS_National/2003_2013_Treatment_Episode_Data_Set_National.pdf ) that there were nearly 1.7 million TEDS admissions in 2013.
CHARACTERISTICS OF THOSE ADMITTED
In Treatment Episode Data Set (TEDS) 2003–2013, SAMHSA indicates that males represented most of those who were admitted for drug and/or alcohol treatment, although the percentage of men dropped slightly between 2003 and 2013 (from 69.1% to 66.3%) and that of women increased (from 30.9% to 33.7%). The number of males admitted for treatment in 2013 was more than 1.1 million versus 565,906 female admissions. (See Table 6.2 .) These results and data reflect that a greater proportion of men than women abuse drugs in the United States. According to Table 4.1 in Chapter 4 , 12.5% of males were past-month (current) users in 2015, compared with 7.9% of females.
In 2003, 35- to 39-year-olds accounted for 282,422 of the nearly 1.9 million people receiving substance abuse treatment, the largest number out of any age group; this age demographic was followed by those aged 40 to 44 years (280,378). (See Table 6.2 .) Ten years later, of the nearly 1.7 million people receiving treatment for substance Page 94 | Top of Articleabuse, the two largest groups were those aged 25 to 29 years (273,508) and 20 to 24 years (244,501).
Most of those admitted to substance abuse treatment facilities in 2013 were non-Hispanic white, who accounted for more than 1 million of the nearly 1.7 million people receiving treatment that year. (See Table 6.3 .) They were followed by non-Hispanic African Americans (313,771) and Hispanics (225,753). As Table 6.3 shows, the total number of individuals admitted for substance abuse treatment declined for all three racial groups between 2003 and Page 95 | Top of Article2013. In contrast, the number of Native Americans or Alaskan Natives receiving substance abuse treatment rose from 35,486 to 41,953 during this period.
TYPES OF TREATMENT
The disease model of addiction described at the beginning of this chapter, which views drug addiction as a chronic disease, considers long-term treatment as necessary. O'Brien notes that “as is the case with other chronic diseases, when the treatment is ended, relapse eventually occurs in most cases.”
Detoxification is usually a precursor to rehabilitation because that process cannot begin until the individual's body has been cleared of the drug and a certain physiological equilibrium has been established. Drug rehabilitation refers to processes that assist a drug-addicted person in discontinuing drug use and returning to a drug-free life.
Drug-addicted individuals must usually undergo medical detoxification (detox) in an outpatient facility, a residential center, or a hospital. Medical help, including sedation, is provided to manage the painful physical and psychological symptoms of withdrawal. The detox of many drugs can be achieved with minimal discomfort by replacing the drug of dependence with a less risky drug in the same pharmacological category (e.g., replacing heroin with methadone) and gradually reducing the dose. People addicted to nicotine can accomplish detox on their own by using gradually decreasing doses of nicotine patches. Rehabilitation usually follows detox.
Rehabilitation (rehab) has many forms, but it is always designed to change the behavior of the drug abuser. Changed behavior (achieving independence of drugs or Page 96 | Top of Articlealcohol) requires understanding the circumstances that led to dependence, building the confidence that the individual can succeed, and changing the individual's lifestyle so that he or she avoids occasions that produce drug-using behavior. Individual counseling, interaction with support groups, and formal education are used in combination with close supervision, incentives, and disincentives. Certain individuals require a new socialization that is achieved by living for an extended period in a structured and supportive environment in which new life skills can be acquired. Treatment may involve guiding the individual to seek help from other social agencies to reorder his or her life. (See Figure 6.1 .)
Some individuals may be mentally ill and will then receive, as part of drug rehab, mental health services in outpatient or hospital settings. Most treatment takes place in outpatient settings, with the individual reporting daily, weekly, or less frequently for periodic treatment and assessment.
STATISTICS ON ADMITTED PATIENTSAdmissions by Substance
Data on admissions by the primary substance of abuse provided by TEDS for 2013 are shown in Table 6.4 . In that year alcohol alone or in combination with a secondary substance accounted for the largest number of people receiving treatment (631,578, or 37.5% of all admissions), followed by opiates (471,575, or 28%, mainly heroin), marijuana (281,991, or 16.8%), methamphetamine/amphetamines (138,514, or 8.2%), and cocaine (102,387, or 6.1%).
Note: Based on administrative data reported to Treatment Episode Data Set (TEDS) by all reporting states and jurisdictions (excluding Puerto Rico).
Note: Based on administrative data reported to Treatment Episode Data Set (TEDS) by all reporting states and jurisdictions (excluding Puerto Rico).
The 2013 admissions for alcohol abuse (either alone or in combination with a secondary substance) of 37.5% were down from 41.6% reported by TEDS in 2003, when 776,369 of nearly 1.9 million total admissions for substance abuse treatment were for alcohol abuse. Total alcohol-related admissions declined annually through 2004, when it fell to 729,192 of 1.8 million (40.3%). The total number of alcohol-related admissions then climbed steadily over the next four years, peaking at 854,471 out of 2.1 million (41.4%) in 2008, before falling gradually to the 2013 figure.
A detailed examination of admissions in 2013 is provided in Table 6.4 , which shows the distribution of people at admission by major drug categories: gender, race, and ethnicity.
GENDER. As noted earlier, the total male admissions (66.3%) were higher than the total female admissions (33.7%) in 2013. This trend held in all but two substance categories: sedatives (52.5% females versus 40.5% males; the total does not add to 100% because the “all other” category does not show gender) and tranquilizers (47% females versus 46.5% males). (See Table 6.4 .) The greatest male–female differences were noted in hallucinogens admissions (67.1% males versus 25.1% females), alcohol admissions with a secondary drug (66.7% males versus 25.8% females), alcohol-only admissions (65.2% males versus 26.6% females), marijuana-related admissions (65.1% males versus 24.4% females), and heroin admissions (60.8% males versus 32.1% females).
RACE AND ETHNICITY. In 2013 non-Hispanic whites made up 61.1% of the substance abuse treatment admissions; non-Hispanic African Americans, 18.7%; Hispanics, 8.4%; Native Americans or Alaskan Natives, 2.5%; and Asians or Pacific Islanders, 1%. (See Table 6.4 .) Non-Hispanic whites had the highest admission rates for all drug categories except smoked cocaine and phencyclidine (PCP). Non-Hispanic African Americans had the highest PCP-related admissions (63.8%) and smoked-cocaine admissions (56.5%). Non-Hispanic African Americans were second in admission rates for alcohol only, alcohol with a secondary drug, heroin, other opiates, cocaine other than smoked, marijuana, sedatives, hallucinogens, inhalants, and other. Hispanics were second in admission rates for methamphetamine/amphetamines. It should be noted that the Hispanics category is treated as an ethnicity rather than as a race and includes both white and African American individuals of Hispanic origin.
Note: Based on administrative data reported to Treatment Episode Data Set (TEDS) by all reporting states and jurisdictions.
It is important, however, to consider these rates of substance abuse treatment by race in the context of the overall racial composition of the United States. The 2013 TEDS data indicate that the total U.S. population consisted of 68.8% non-Hispanic whites, 13% Hispanics, and 12.1% non-Hispanic African Americans. (See Table 6.3 .) When substance abuse treatment rates for 2013 are compared with these population statistics, non-Hispanic whites were underrepresented in treatment (61% in treatment versus 68.8% of the U.S. population), the proportion of Hispanics in treatment was comparable to Hispanics in the population (13.4% in treatment versus 13% of the U.S. population), and non-Hispanic African Americans were disproportionately admitted for treatment (18.7% in treatment versus 12.1% of the U.S. population).
In 2013, 61.3% of those admitted to treatment were admitted into ambulatory (nonresidential) treatment facilities; of the remainder, 21.8% went into 24-hour detox (both residential-type and hospital inpatient) and 16.9% went into residential facilities. (See Table 6.5 .)
Among those going into detox, the largest percentages were admitted for tranquilizers (40.8%), heroin (32.7%), and alcohol only (30.7%). (See Table 6.5 .) Those using marijuana had the highest percentage entering ambulatory care (86%).
Table 6.6 shows the source of referral of patients to substance abuse treatment in 2013. More than one-third (36.8%) of all people admitted came to get treatment on their own volition. The largest referral source (sending 33.7% of individuals) was the criminal justice system. Much of the remaining one-third of all referrals came from substance abuse care providers and other health care providers (9.1% and 7.3% of referrals, respectively). Other referrals came from schools, employers, and community agencies.
Regarding the source of referral based on the drug of abuse, most heroin users (58.4%) and other opiate users (50%) sought treatment on their own accord. (See Table 6.6 .) The criminal justice system sent more than half of marijuana users (51.9%) and nearly half of methamphetamine/amphetamine users (46.6%) to treatment.
HOW EFFECTIVE IS TREATMENT?
During the 1960s there was an opioid epidemic in the United States, and the federal government released substantial funds to substance abuse treatment programs. This funding has continued over the decades and is supplemented by state governments and private sources. According to the Office of National Drug Control Policy, in FY 2017 Budget and Performance Summary: Companion to the National Drug Control Strategy (December 2016, https://obamawhitehouse.archives.gov/sites/default/files/ondcp/policy-and-research/fy2017_budget_summary-final.pdf ), the fiscal year 2017 federal budget request for drug abuse treatment and prevention was $15.8 billion, up from $14.7 billion enacted in fiscal year 2016.
With so much money devoted to substance abuse treatment, there has been considerable research conducted on the effectiveness of the programs. The bulk of this research began during the late 1960s and extended into the 1990s.
In the press release “New Research Documents Success of Drug Abuse Treatments” (December 16, 1997, http://drugfree.org/learn/drug-and-alcohol-news/new-research-documents-success-of-drug-abuse-treatments/ ), the National Institutes of Health notes that the first major study of drug-treatment effectiveness was the Drug Abuse Reporting Program (DARP), which studied more than 44,000 clients in 52 treatment centers between 1969 and 1973. Program staff then studied a smaller group of these clients six and 12 years after their treatment. A second important study was the Treatment Outcome Prospective Study (TOPS), which followed 11,000 clients admitted to 41 treatment centers between 1979 and 1981. Both DARP and TOPS found major reductions in both drug abuse and criminal activity after treatment.
SAMHSA's Services Research Outcomes Study (SROS; September 1998, http://archive.samhsa.gov/data/Sros/toc.htm ) confirmed that both drug use and criminal behavior are reduced after drug treatment. The SROS provided the first nationally representative data to answer the question: Does treatment work? This study, although now nearly 20 years old and reporting on even older data, has not been repeated.
In this nationally representative sample, alcohol use decreased by 14% and drug use declined by 21%. Decreases varied from drug to drug, with heroin use decreasing the least.
Results by type of treatment were variable. On average, the best results for decreasing use of all drugs, especially cocaine and marijuana, were achieved with treatment that lasted six months or more. Long-term drug treatment appears to be necessary due to the chronic nature of addiction and its tendency to recur when treatment is stopped.
Notes: Planned medication-assisted opioid therapy is therapy with methadone or buprenorphine is part of client's treatment plan. Information is based on administrative data reported to Treatment Episode Data Set (TEDS) by all reporting states and jurisdictions.
Notes: Detailed criminal justice referral is a supplemental data set item. Individual supplement data set items are reported at each state's option. Information is based on administrative data reported to Treatment Episode Data Set (TEDS) by all reporting states and jurisdictions.
The SROS also showed that treatment for substance abuse can significantly reduce crime. Criminal activities such as breaking and entering, drug sales, prostitution, driving under the influence, and theft/larceny decreased between 23% and 38% after drug treatment.
Although no comprehensive research survey to rival the scope of the SROS has emerged, a number of important studies that evaluate the effectiveness of certain substance abuse treatment and prevention programs have been published since the late 1990s. For example, Ted R. Miller and Delia Hendrie provide in Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis (2008, http://store.samhsa.gov/shin/content/SMA07-4298/SMA07-4298.pdf ) a detailed analysis of existing substance abuse treatment programs (including school-based programs for minors) and of the various social and economic costs that are associated with addiction. The NIDA offers an overview of some recent findings in “DrugFacts: Lessons from Prevention Research” (March 2014, https://www.drugabuse.gov/publications/drugfacts/lessons-prevention-research ). Drawing from a range of scholarly papers, the NIDA outlines 16 key “principles” of effective treatment methods, including the role of “protective factors” (such as family and community support) in sustaining effective substance abuse treatment and the importance of tailoring prevention programs to address the unique needs of particular communities and social groups. The NIDA cites several valuable research studies concerning the efficacy (the ability of an intervention to produce the intended diagnostic or therapeutic effect in optimal circumstances) of certain approaches to drug treatment, among them E. Michael Foster, Allison E. Olchowski, and Carolyn H. Webster-Stratton's “Is Stacking Intervention Components Cost-Effective? An Analysis of the Incredible Years Program” (Journal of the American Academy of Child and Adolescent Psychology, vol. 46, no. 11, November 2007) and J. David Hawkins et al.'s “Results of a Type 2 Translational Research Trial to Prevent Adolescent Drug Use and Delinquency: A Test of Communities That Care” (Archives of Pediatrics and Adolescent Medicine, vol. 163, no. 9, September 2009).
Additionally, the NIDA notes that treatment should be readily available and address issues in a person's life—not just the addiction. According to the NIDA principles, effective treatment should include counseling, behavioral therapies, appropriate medications, and drug use monitoring. Drug-addicted individuals often have other illnesses, such as mental illnesses or infectious diseases that were contracted by needle-sharing or other risky practices, and the NIDA suggests that these illnesses should also be treated. It adds that one single treatment is not appropriate for everyone and that any drug treatment plan should be periodically reevaluated and adjusted, depending on a patient's progress and needs.
In the third edition of Principles of Drug Addiction Treatment: A Research-Based Guide (December 2012, https://www.drugabuse.gov/sites/default/files/podat_1.pdf ), the NIDA breaks down the broader economic benefits of drug treatment programs. Every dollar spent on addiction treatment saves an estimated $12 in costs related to drug-related crime (including the prosecution of these crimes), as well as drug-related health care expenses. From the perspective of health benefits related to addiction treatment, the NIDA notes that the likelihood of relapse among addicts who have received treatment ranges from between 40% and 60%. This range is slightly higher than that of individuals recovering from type 1 diabetes, who suffer relapses at a rate of between 30% to 50%, but lower than the relapse rates for hypertension and asthma, both of which range from 50% to 70%.
Medications can help drug-addicted individuals not only by suppressing drug withdrawal symptoms but also by helping reestablish proper brain function and reducing drug cravings during treatment. Antidrug vaccines, which were under development as of March 2017, may help drug-addicted individuals in the future. In “Anti-drug Vaccines to Treat Substance Abuse” (Immunology and Cell Biology, vol. 87, no. 4, May–June 2009), Berma M. Kinsey, David C. Jackson, and Frank M. Orson review the status of the development of these vaccines for treating addictions. The researchers explain that antidrug vaccines work by triggering the development of antibodies against particular drugs in vaccinated individuals. The antibodies bind to the drug in the bloodstream before it is able to get to the brain. Thus, the vaccinated individual receives no drug effects by taking a drug, such as cocaine or methamphetamine—that is, the pleasure centers of the brain are not stimulated because the drug never reaches the brain. Because the person does not experience any “reward” for taking the drug, the craving sensations for the drug eventually subside.
In reality, however, antidrug vaccines do not work perfectly. For example, if an individual's body does not respond well to the vaccine by developing a substantial amount of antibodies, then only some of the drug is bound in the bloodstream and some enters the brain. To get a desired drug effect, a drug addict will have to increase the doses of a drug. Thus, Kinsey, Jackson, and Orson suggest that counseling and behavior therapy will also be needed for antidrug vaccines to be effective.
Kinsey, Jackson, and Orson surmise that antinicotine vaccines are the ones most likely to be available first to the public because their development is the furthest Page 103 | Top of Articlealong. Nicholas T. Jacob et al. of the Scripps Research Institute reveal in “Investigations of Enantiopure Nicotine Haptens Using an Adjuvanting Carrier in Anti-nicotine Vaccine Development” (Journal of Medicinal Chemistry, vol. 59, no. 6, March 2016) that vaccines containing high numbers of antinicotine antibodies helped delay the physiological effects of nicotine on mice during testing. According to the researchers, mice given the antinicotine vaccine were also revealed to have lower concentrations of nicotine in their brain, the area of the body where the drug has its most powerful addictive effects.
As of March 2017, vaccines were also under development for cocaine, morphine, and methamphetamine addictions. In “Scientists Working to Create a Vaccine for Drug Addiction” ( DrugRehab.com , March 14, 2016), Chris Elkins reports that one promising treatment is TA-CD, a vaccine that helped cocaine addicts refrain from using the drug during clinical trials. In addition, Elkins notes that vaccines under development for methamphetamine and PCP addiction were proven to reduce levels of the drug in the brains of animals undergoing laboratory testing.
Drug courts are programs that use the court's authority to offer certain drug-addicted offenders to have their charges dismissed or their sentences reduced if they participate in drug court substance abuse treatment programs. Drug court programs vary across the nation, but most programs offer a range of treatment options and generally require one year of commitment from the defendant.
Randall T. Brown of the University of Wisconsin School of Medicine and Public Health describes drug courts and reviews their effect in “Systematic Review of the Impact of Adult Drug-Treatment Courts” (Translational Research, vol. 155, no. 6, June 2010). Brown notes that drug courts vary in the number of individuals they serve annually, with the typical range being between 80 and 120. Courts in large urban areas often serve hundreds more. He explains that drug courts use rewards and sanctions to motivate individuals to comply with their treatment. Rewards include praise from the judge, fewer court appearances, and gift cards to local stores. Those who adhere to the rules and remain drug free for a sustained period (48% on average) graduate from treatment and are provided with a ceremony that is attended by family and friends. Sanctions include admonitions from the judge, community service, increased drug screening, and incarceration. Brown's review of the literature on the effect of drug courts “points toward benefit versus traditional adjudication in averting future criminal behavior and in reducing future substance use, at least in the short term.”
The National Drug Court Institute, which is supported by the Office of National Drug Control Policy and the U.S. Department of Justice's Office of Justice Programs, studied its own drug court system, and its findings were reported by West Huddleston and Douglas B. Marlowe in Painting the Current Picture: A National Report on Drug Courts and Other Problem-Solving Court Programs in the United States (July 2011, http://www.ndci.org/sites/default/files/nadcp/PCP%20Report%20FINAL.PDF ). Huddleston and Marlowe indicate that drug courts decrease criminal recidivism (relapse into criminal activity), save money, increase retention in treatment, and provide affordable treatment. The researchers note that between 2005 and 2009 the total number of drug courts in the United States rose from 1,756 to 2,459, an increase of 40%.
WHERE TO GO FOR HELP
Many organizations provide assistance for addicts, their families, and their friends. Most of the self-help groups are based on the Twelve Step program of Alcoholics Anonymous (AA). Whereas AA is a support group for problem drinkers, Al-Anon/Alateen is for friends and families of alcoholics. Families Anonymous provides support for family members and friends who are concerned about a loved one's problems with drugs and/or alcohol. Other organizations include Adult Children of Alcoholics, Cocaine Anonymous, and Narcotics Anonymous. For an addict, many of these organizations can provide immediate help. For families and friends, they can provide knowledge, understanding, and support. For contact information for some of these organizations, see the Important Names and Addresses section at the back of this book.