Rural Crime & Justice Center A University Center of Excellence Minot, North Dakota

Treatment Myths Myth: Drug addiction is a voluntary behavior Fact: Voluntary use becomes compulsive use Fact: Continued use changes the brain Myth: Drug addiction is a character flaw Fact: Addiction is a brain disease Source: Target Meth

Treatment Myths Myth: A person has to want treatment for it to be effective. Fact: People who enter treatment in which they face “high pressure” to confront their addiction do comparatively better, regardless of why they sought treatment. Source: Target Meth

Treatment Myths Myth: Treatment doesn’t work. Fact: Treatment reduces drug use by 40 to 60 percent. Fact: Treatment improves many aspects of peoples lives other than problematic drug use. Source: Target Meth

Treatment Source: NDDHS Commission on Alternatives to Incarceration, June 2006 Studies show no significant differences in treatment outcomes measuring the following: Retention in treatment rates Urinalysis data during treatment Rates of treatment program completion

Treatment Treatment outcomes are similar to that of other chronic diseases with behavioral components: Addicts who fully abstain from drugs/alcohol after 1 year: 40-60% Diabetics who fully adhere to medication regimen: <60% Hypertensives who fully adhere to medication regimen: <40% Asthmatics who fully adhere to medication regimen: <40% Diabetics, hypertensives & asthmatics who make behavioral changes to avoid repeat treatment within a year: <30% Source: Journal of American Medical Association, 2000

Treatment What does treatment do? reduces drug and alcohol use arrests the progression of the disease improves health protects the public safety increases worker productivity restores families, communities Source: NDDHS Commission on Alternatives to Incarceration, June 2006

Treatment Prior to the rise of cocaine use in the 70’s and 80’s, treatment focused on alcohol, opiates and sedative abuse. The epidemic of cocaine/crack focused attention on stimulant abuse. Methamphetamine abuse in the 90’s brought new challenges to treatment. Methamphetamine became popular in rural areas. Source: Methamphetamine Use: Lessons Learned, February 2006

Treatment The longer and more sever the use, the more severe the psychiatric symptoms. Study of over 1,000 MA users in treatment found high levels of: Depression Anxiety Suicide Mood changes Symptoms easily triggered or worsened by new use or stressors. Damaged memory Violent behavior Impaired motor coordination Source: Methamphetamine Use: Lessons Learned, February 2006

Treatment Common difficulties with stimulant users: high rates of relapse extended periods of depression episodes of confusion & paranoia protracted craving Source: Methamphetamine Use: Lessons Learned, February 2006

Treatment What might we expect to see in treatment? Impaired cognitive functions resulting in difficulties with the following: learning new information solving problems maintaining attention filter distracting or conflicting information quickly processing information Sources: American Journal of Psychiatry August 2005 / Biological Psychiatry, February 2005

Treatment Some abilities get worse in early abstinence: Recall Recognition Some deficits improve after a period of 12-weeks of abstinence: The ability to ignore irrelevant information The ability to manipulate information Source: NDDHS Commission on Alternatives to Incarceration, June 2006

Treatment Attention is fundamental to many cognitive functions. Consider impairment in treatment plan. Journaling, even after group, to remind them of what they talked about. Frequent reminders of tasks. Consider abstaining from all stimulants, to include caffeine and tobacco. Sources: NIDA, Cardwell C. Nuckols, Florida Alcohol & Drug Abuse Association

Treatment Research on treating methamphetamine addiction is ongoing. Progress has been made but the development, implementation and evaluation of specialized treatment programs takes time. Some promising approaches: community reinforcement contingency management intervention relapse prevention network therapy Source: Midwest HIDTA

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