The principles listed below are the result of long-term research studies on the origins of drug abuse behaviors and the common elements of effective prevention programs. These principles were developed to help prevention practitioners use the results of prevention research to address drug use among children and adolescents in communities across the country. Parents, educators, and community leaders can use these principles to help guide their thinking, planning, selection, and delivery of drug abuse prevention programs at the community level.

Prevention programs are generally designed for use in a particular setting, such as at home, at school, or within the community, but can be adapted for use in several settings. In addition, programs are also designed with the intended audience in mind: for everyone in the population, for those at greater risk, and for those already involved with drugs or other problem behaviors. Some programs can be geared for more than one audience.

Principle 1 – Prevention programs should enhance protective factors and reverse or reduce risk factors (Hawkins et al. 2002).

* The risk of becoming a drug abuser involves the relationship among the number and type of risk factors (e.g., deviant attitudes and behaviors) and protective factors (e.g., parental support) (Wills et al. 1996).
* The potential impact of specific risk and protective factors changes with age. For example, risk factors within the family have greater impact on a younger child, while association with drug-abusing peers may be a more significant risk factor for an adolescent (Gerstein and Green 1993; Dishion et al. 1999).
* Early intervention with risk factors (e.g., aggressive behavior and poor self-control) often has a greater impact than later intervention by changing a child’s life path (trajectory) away from problems and toward positive behaviors (Ialongo et al. 2001).
* While risk and protective factors can affect people of all groups, these factors can have a different effect depending on a person’s age, gender, ethnicity, culture, and environment (Beauvais et al. 1996; Moon et al. 1999).

Principle 2 – Prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over-the-counter drugs (Johnston et al. 2002).

Principle 3 – Prevention programs should address the type of drug abuse problem in the local community, target modifiable risk factors, and strengthen identified protective factors (Hawkins et al. 2002).

Principle 4 – Prevention programs should be tailored to address risks specific to population or audience characteristics, such as age, gender, and ethnicity, to improve program effectiveness (Oetting et al. 1997).

Principle 5 – Family-based prevention programs should enhance family bonding and relationships and include parenting skills; practice in developing, discussing, and enforcing family policies on substance abuse; and training in drug education and information (Ashery et al. 1998).

Family bonding is the bedrock of the relationship between parents and children. Bonding can be strengthened through skills training on parent supportiveness of children, parent-child communication, and parental involvement (Kosterman et al. 1997).

* Parental monitoring and supervision are critical for drug abuse prevention. These skills can be enhanced with training on rule-setting; techniques for monitoring activities; praise for appropriate behavior; and moderate, consistent discipline that enforces defined family rules (Kosterman et al. 2001).
* Drug education and information for parents or caregivers reinforces what children are learning about the harmful effects of drugs and opens opportunities for family discussions about the abuse of legal and illegal substances (Bauman et al. 2001).
* Brief, family-focused interventions for the general population can positively change specific parenting behavior that can reduce later risks of drug abuse (Spoth et al. 2002b).

Principle 6 – Prevention programs can be designed to intervene as early as preschool to address risk factors for drug abuse, such as aggressive behavior, poor social skills, and academic difficulties (Webster-Stratton 1998; Webster-Stratton et al. 2001).

Principle 7 – Prevention programs for elementary school children should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout. Education should focus on the following skills (Conduct Problems Prevention Research Group 2002; Ialongo et al. 2001):

* self-control;
* emotional awareness;
* communication;
* social problem-solving; and
* academic support, especially in reading.

Principle 8 – Prevention programs for middle or junior high and high school students should increase academic and social competence with the following skills (Botvin et al. 1995; Scheier et al. 1999):

* study habits and academic support;
* communication;
* peer relationships;
* self-efficacy and assertiveness;
* drug resistance skills;
* reinforcement of anti-drug attitudes; and
* strengthening of personal commitments against drug abuse.

Principle 9 – Prevention programs aimed at general populations at key transition points, such as the transition to middle school, can produce beneficial effects even among high-risk families and children. Such interventions do not single out risk populations and, therefore, reduce labeling and promote bonding to school and community (Botvin et al. 1995; Dishion et al. 2002).

Principle 10 – Community prevention programs that combine two or more effective programs, such as family-based and school-based programs, can be more effective than a single program alone (Battistich et al. 1997).

Principle 11 – Community prevention programs reaching populations in multiple settings—for example, schools, clubs, faith-based organizations, and the media—are most effective when they present consistent, community-wide messages in each setting (Chou et al. 1998).

Principle 12 – When communities adapt programs to match their needs, community norms, or differing cultural requirements, they should retain core elements of the original research-based intervention (Spoth et al. 2002b), which include:

* Structure (how the program is organized and constructed);
* Content (the information, skills, and strategies of the program); and
* Delivery (how the program is adapted, implemented, and evaluated).

Principle 13 – Prevention programs should be long-term with repeated interventions (i.e., booster programs) to reinforce the original prevention goals. Research shows that the benefits from middle school prevention programs diminish without followup programs in high school (Scheier et al. 1999).

Principle 14 – Prevention programs should include teacher training on good classroom management practices, such as rewarding appropriate student behavior. Such techniques help to foster students’ positive behavior, achievement, academic motivation, and school bonding (Ialongo et al. 2001).

Principle 15 – Prevention programs are most effective when they employ interactive techniques, such as peer discussion groups and parent role-playing, that allow for active involvement in learning about drug abuse and reinforcing skills (Botvin et al. 1995).

Principle 16 – Research-based prevention programs can be cost-effective. Similar to earlier research, recent research shows that for each dollar invested in prevention, a savings of up to $10 in treatment for alcohol or other substance abuse can be seen (Aos et al. 2001; Hawkins et al. 1999; Pentz 1998; Spoth et al. 2002a).

NIDA’s prevention research program addresses all stages of child development, a mix of audiences and settings, and the delivery of effective services at the community level. The Institute focuses on risks for drug abuse and other problem behaviors that occur throughout a child’s development. Prevention interventions designed and tested to address risks can help children at every step along their developmental path. Working more broadly with families, schools, and communities, scientists have found effective ways to help people gain the skills and approaches to stop problem behaviors before they occur. Research funded by NIDA and other Federal research organizations—such as the National Institute of Mental Health and the Centers for Disease Control and Prevention—shows that early intervention can prevent many adolescent risk behaviors.

References

Aos, S.; Phipps, P.; Barnoski, R.; and Lieb, R. The Comparative Costs and Benefits of Programs to Reduce Crime. Vol. 4 (1-05-1201). Olympia, WA: Washington State Institute for Public Policy, May 2001.

Ashery, R.S.; Robertson, E.B.; and Kumpfer, K.L.; eds. Drug Abuse Prevention Through Family Interventions. NIDA Research Monograph No. 177. Washington, DC: U.S. Government Printing Office, 1998.

Battistich, V.; Solomon, D.; Watson, M.; and Schaps, E. Caring school communities. Educational Psychologist 32(3):137–151, 1997.

Bauman, K.E.; Foshee, V.A.; Ennett, S.T.; Pemberton, M.; Hicks, K.A.; King, T.S.; and Koch, G.G. The influence of a family program on adolescent tobacco and alcohol. American Journal of Public Health 91(4):604–610, 2001.

Beauvais, F.; Chavez, E.; Oetting, E.; Deffenbacher, J.; and Cornell, G. Drug use, violence, and victimization among White American, Mexican American, and American Indian dropouts, students with academic problems, and students in good academic standing. Journal of Counseling Psychology 43:292–299, 1996.

Botvin, G.; Baker, E.; Dusenbury, L.; Botvin, E.; and Diaz, T. Long-term follow-up results of a randomized drug-abuse prevention trial in a white middle class population. Journal of the American Medical Association 273:1106–1112, 1995.

Chou, C.; Montgomery, S.; Pentz, M.; Rohrbach, L.; Johnson, C.; Flay, B.; and Mackinnon, D. Effects of a community-based prevention program in decreasing drug use in high-risk adolescents. American Journal of Public Health 88:944–948, 1998.

Conduct Problems Prevention Research Group. Predictor variables associated with positive Fast Track outcomes at the end of third grade. Journal of Abnormal Child Psychology 30(1):37–52, 2002.

Dishion, T.; McCord, J.; and Poulin, F. When interventions harm: Peer groups and problem behavior. American Psychologist 54:755-764, 1999.

Dishion, T.; Kavanagh, K.; Schneiger, A.K.J.; Nelson, S.; and Kaufman, N. Preventing early adolescent substance use: A family centered strategy for the public middle school. Prevention Science 3(3):191–202, 2002.

Gerstein, D.R.; and Green, L.W., eds.; Preventing Drug Abuse: What Do We Know? Washington, DC: National Academy Press, 1993.

Hawkins, J.D.; Catalano, R.F.; Kosterman, R.; Abbott, R.; and Hill, K.G. Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatric and Adolescent Medicine 153:226–234, 1999.

Hawkins, J.D.; Catalano, R.F.; and Arthur, M. Promoting science-based prevention in communities. Addictive Behaviors 90(5):1–26, 2002.

Ialongo, N.; Poduska, J.; Werthamer, L.; and Kellam, S. The distal impact of two first-grade preventive interventions on conduct problems and disorder in early adolescence. Journal of Emotional and Behavioral Disorders 9:146–160, 2001.

Johnston, L.D.; O’Malley, P.M.; and Bachman, J.G. Monitoring the Future National Survey Results on Drug Use, 1975–2002. Volume 1: Secondary School Students. Bethesda, MD: National Institute on Drug Abuse, 2002.

Kosterman, R.; Hawkins, J.D.; Spoth, R.; Haggerty, K.P.; and Zhu, K. Effects of a preventive parent-training intervention on observed family interactions: Proximal outcomes from Preparing for the Drug Free Years. Journal of Community Psychology 25(4):337–352, 1997.

Kosterman, R.; Hawkins, J.D.; Haggerty, K.P.; Spoth, R.; and Redmond, C. Preparing for the Drug Free Years: Session-specific effects of a universal parent-training intervention with rural families. Journal of Drug Education 31(1):47–68, 2001.

Moon, D.; Hecht, M.; Jackson, K.; and Spellers, R. Ethnic and gender differences and similarities in adolescent drug use and refusals of drug offers. Substance Use and Misuse 34(8):1059–1083, 1999.

Oetting, E.; Edwards, R.; Kelly, K.; and Beauvais, F. Risk and protective factors for drug use among rural American youth. In: Robertson, E.B.; Sloboda, Z.; Boyd, G.M.; Beatty, L.; and Kozel, N.J., eds. Rural Substance Abuse: State of Knowledge and Issues. NIDA Research Monograph No. 168. Washington, DC: U.S. Government Printing Office, pp. 90–130, 1997.

Pentz, M.A.; Costs, benefits, and cost-effectiveness of comprehensive drug abuse prevention. In: Bukoski, W.J.; and Evans, R.I., eds. Cost-Benefit/Cost-Effectiveness Research of Drug Abuse Prevention: Implications for Programming and Policy. NIDA Research Monograph No. 176. Washington, DC: U.S. Government Printing Office, pp. 111–129, 1998.

Scheier, L.; Botvin, G.; Diaz, T.; and Griffin, K. Social skills, competence, and drug refusal efficacy as predictors of adolescent alcohol use. Journal of Drug Education 29(3):251–278, 1999.

Spoth, R.; Guyull, M.; and Day, S. Universal family-focused interventions in alcohol-use disorder prevention: Cost effectiveness and cost-benefit analyses of two interventions. Journal of Studies on Alcohol 63:219–228, 2002a.

Spoth, R.L.; Redmond, D.; Trudeau, L.; and Shin, C. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors 16(2):129–134, 2002b.

Webster-Stratton, C. Preventing conduct problems in Head Start children: Strengthening parenting competencies. Journal of Consulting and Clinical Psychology 66:715–730, 1998.

Webster-Stratton, C.; Reid, J.; and Hammond, M. Preventing conduct problems, promoting social competence: A parent and teacher training partnership in Head Start. Journal of Clinical Child Psychology 30:282–302, 2001.

Wills, T.; McNamara, G.; Vaccaro, D.; and Hirky, A. Escalated substance use: A longitudinal grouping analysis from early to middle adolescence. Journal of Abnormal Psychology 105:166–180, 1996.

* Information for this InfoFacts was taken directly from the publication, Preventing Drug Use among Children and Adolescents, A Research-Based Guide for Parents, Educators, and Community Leaders, Second Edition, National Institute on Drug Abuse, 2003.

Posted August 10, 2009

From:

http://www.drugabuse.gov/infofacts/lessons.html

More than two decades of scientific research have yielded a set of fundamental principles that characterize effective drug abuse treatment. These 13 principles, which are detailed in NIDA’s new research-based guide, Principles of Drug Addiction Treatment: A Research-based Guide, are:

1. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each patient’s problems and needs is critical.
2. Treatment needs to be readily available. Treatment applicants can be lost if treatment is not immediately available or readily accessible.
3. Effective treatment attends to multiple needs of the individual, not just his or her drug use. Treatment must address the individual’s drug use and associated medical, psychological, social, vocational, and legal problems.
4. Treatment needs to be flexible and to provide ongoing assessments of patient needs, which may change during the course of treatment.
5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The time depends on an individual’s needs. For most patients, the threshold of significant improvement is reached at about 3 months in treatment. Additional treatment can produce further progress. Programs should include strategies to prevent patients from leaving treatment prematurely.
6. Individual and/or group counseling and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships.
7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Methadone and levo-alpha-acetylmethadol (LAAM) help persons addicted to opiates stabilize their lives and reduce their drug use. Naltrexone is effective for some opiate addicts and some patients with co-occurring alcohol dependence. Nicotine patches or gum, or an oral medication, such as bupropion, can help persons addicted to nicotine.
8. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because these disorders often occur in the same individual, patients presenting for one condition should be assessed and treated for the other.
9. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification manages the acute physical symptoms of withdrawal. For some individuals it is a precursor to effective drug addiction treatment.
10. Treatment does not need to be voluntary to be effective. Sanctions or enticements in the family, employment setting, or criminal justice system can significantly increase treatment entry, retention, and success.
11. Possible drug use during treatment must be monitored continuously. Monitoring a patient’s drug and alcohol use during treatment, such as through urinalysis, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that treatment can be adjusted.
12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place them or others at risk of infection. Counseling can help patients avoid high-risk behavior and help people who are already infected manage their illness.
13. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Participation in self-help support programs during and following treatment often helps maintain abstinence.

Principles of Drug Addiction Treatment: A Research-based Guide (NCADI publication BKD347) has been mailed to NIDA NOTES subscribers in the U.S. Copies of the booklet can be obtained from the National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847, 1-800-729-6686.

Posted August 7, 2009

From:

http://www.nida.nih.gov/NIDA_Notes/NNVol14N5/tearoff.html

A number of information sources are used to quantify America’s drug problem and to monitor drug abuse trends. Foremost among these sources are the Monitoring the Future survey (MTF) and the National Survey on Drug Use and Health (NSDUH). Since 1975, the MTF survey has measured drug, alcohol, and cigarette use as well as related attitudes among adolescent students nationwide. For the 2007 survey, 48,025 students in 8th, 10th, and 12th grades from 403 public and private schools participated. Funded by the National Institute on Drug Abuse, the MTF survey is conducted by investigators at the University of Michigan.

The NSDUH is an annual survey on the nationwide prevalence and incidence of illicit drug, alcohol, and tobacco use among Americans aged 12 years and older conducted by the Substance Abuse and Mental Health Services Administration. Approximately 67,500 people are included in this survey.

In MTF and NSDUH, there are three primary prevalence periods for which data are reported: lifetime, past year, and past month (also referred to as “current”). It is generally believed that past year and past month are the better indicators of actual use. However, some analyses are done for only one specific prevalence period; therefore, data for both past year and past month are reported here.

Additional sources of information are provided at the end of this fact sheet.
Trends of Abuse

Alcohol
Overall, the prevalence of underage (ages 12–20) past-month alcohol use and binge drinking has been unchanged since 2002. In 2006, about 10.8 million persons (28.3 percent) in this age group reported drinking in the past month. However, there has been a long-term decline in past-year alcohol use among 8th-graders (persons aged 12 to 13 years), from 46.8 percent in 1994 to 31.8 percent in 2007.

In 2006, an estimated 30.5 million people (12.4 percent) aged 12 or older reported driving under the influence of alcohol at least once in the past year. Although this reflects a downward trend from 14.2 percent in 2002, it remains cause for concern.

Tobacco
According to NIDA’s MTF survey, smoking rates are at their lowest point in the history of the survey. In the past year, smoking prevalence among 8th-graders—13- to 14-year olds, the youngest age group surveyed—dropped in all prevalence categories: lifetime, past-month, and daily use. Daily smoking rates dropped to 3 percent in 2007, down from a peak of 10.4 percent in 1996. The NSDUH survey found that between 2002 and 2006, the rate of past-month cigarette use by 12- to17-year olds declined from 13 percent to 10.4 percent. Another encouraging trend is the decrease in cigarette use by young adults aged 18 to 25 years: Use decreased from 40.8 percent in 2002 to 38.4 percent in 2006.

Illicit Drugs
Illicit drug use by the Nation’s adolescents is declining for almost all specific types of drugs. When data for 8th-, 10th-, and 12th-graders are combined, they show that overall, past-month illicit drug use declined by 24 percent between 2001 and 2007, dropping from 19.4 percent to 14.8 percent. The downward trend in illicit drug use has been driven largely by declines in marijuana smoking.

* Past-year marijuana use among 10th-graders dropped from a peak of 34.8 percent in 1997 to 24.6 percent in 2007.
* Among 12th-graders, use declined from a peak of 38.5 percent in 1997 to 31.7 percent in 2007.
* Annual prevalence of marijuana use by 8th-graders is down to 10.3 percent in 2007, from a 1996 peak of 18.3 percent.
* In the 5 years between 2002 and 2006, the level of current marijuana use among persons aged 12 to 17 years declined from 8.2 percent in 2002 to 6.7 percent in 2006.
* The trend was also seen among older groups. From 2002 to 2006, the rate of current use of marijuana among 18- to 25-year olds dropped from 17.3 to 16.3 percent.

Current cocaine use has remained stable between 2002 and 2006 (there were 2.4 million users in 2006 aged 12 or older); however, a positive trend is the decline in use of crack cocaine, particularly among younger age groups. From 2001 to 2007, the percentage of 10th-graders reporting past-month use of crack declined from 0.7 percent to 0.5 percent.

Despite these downward trends, the MTF survey data highlight some problem areas. For example, there has been a drop in perceived harmfulness of hallucinogens. For the third year in a row, there was a drop in perceived harmfulness of MDMA (ecstasy) among 8th-graders. Tenth-graders reported a decrease in perceived harmfulness of LSD and MDMA, and a decrease in disapproval of LSD. This change in attitude is reflected in an increase in past-year use of MDMA by both 10th- and 12th-graders over the past 2 years.

Prescription Drugs
Also of concern is the increase in past-month nonmedical use of prescription drugs among young adults aged 18 to 25, from 5.4 percent in 2002 to 6.4 percent in 2006. The increase is being driven largely by the use of pain relievers such as OxyContin and Vicodin. Furthermore, in 2006, the number of new initiates in the nonmedical use of prescription pain relievers was roughly even with that of marijuana among persons aged 12 or older.

The complete NSDUH survey findings are available at http://oas.samhsa.gov/NSDUHLatest.htm.
The complete MTF survey findings are available at http://www.monitoringthefuture.org.

Posted August 6, 2009

From:

http://www.nida.nih.gov/infofacts/nationtrends.html

Director’s Perspective
Vol. 22, No. 3 (April 2009)

NIDA Director, Dr. Nora D. Volkow

The American Recovery and Reinvestment Act of 2009, signed into law by President Obama on February 17, aims to restore the Nation to economic health. To establish conditions for lasting prosperity, the stimulus package will invest in research to protect and improve the physical and mental health of our citizens. The National Institutes of Health is receiving a one-time stimulus infusion of $10.4 billion to support groundbreaking studies, modernize the research infrastructure, and engage more people in scientific endeavors. All the projects must create and preserve jobs and be completed within 2 years.

To fund programs that will yield the greatest payoff in improved public health, NIDA has set two overarching priorities. Its first is to make progress toward eradication of smoking addiction. Smoking causes an estimated 400,000 premature deaths in the United States annually and costs the economy hundreds of billions of dollars in medical care and lost work. NIDA’s second priority is to elucidate the ways that genes affect brain development and structure. Such knowledge will advance our ability to treat addiction and many other conditions.

NIDA plans to apply stimulus funds to advance several strategic approaches to yield powerful therapeutic interventions. These include (1) conducting safety and efficacy studies of new medications to treat addiction and prevent relapse; (2) accelerating followup studies on anti-addiction vaccines and augmenting immunotherapy development; (3) developing biomarkers—screens for drug exposure and addiction vulnerability—that practitioners can use to target anti-addiction efforts; (4) identifying new targets for treatment by discovering genetic variations that affect behavioral hallmarks of addiction; (5) determining how chronic drug exposure and other environmental factors activate or silence genes; and (6) learning to use genetic profiles to tailor therapy to individual patients.

Stimulus package resources will allow NIDA to support many skilled scientists, including some in small laboratories, whom it would otherwise not have the resources to fund. The new funding will also enable science teachers and students to participate in summer projects in NIDA-funded labs.

NIDA plans to allocate its stimulus funding to applications previously reviewed as well as to new proposals submitted under three grant programs:

• The Research and Research Infrastructure Grand Opportunities (GO) program (www.nida.nih.gov/Recovery/gogrants.html) will fund large-scale research projects to accelerate breakthroughs, support early and applied research on cutting-edge technologies, and develop approaches to improve interactions among multidisciplinary research teams.
• Challenge Grants in Health and Scientific Research (www.nida.nih.gov/Recovery/NIDAChallenge.html) are designed to yield quick advances by filling knowledge gaps, spurring new technologies, and strengthening methodology.
• Core Center Grants (www.nida.nih.gov/Recovery/p30corecenters.html) are for faculty recruitment to enhance research resources through the multidisciplinary biomedical research core centers.

Posted August 4, 2009

By NIDA Director, NORA D. VOLKOW, M.D.

http://www.nida.nih.gov/NIDA_notes/NNvol22N3/DirRepVol22N3.html

AlcoholScreening.org reaches milestone during National Alcohol Awareness Month

BOSTON, MA – “Is my drinking risky?” At AlcoholScreening.org, over one million people have now learned the answer to this question by taking a confidential, free online screening to assess their drinking patterns. Visitors to the free health-screening website receive personalized feedback, finding out if their alcohol consumption is likely to be within safe limits — or if it may be harmful to their health now, or in the future. They also find out whether they drink more or less than other people of their age and gender.

AlcoholScreening.org was developed by Join Together, a project of the Boston University School of Public Health. Based on the AUDIT (Alcohol Use Disorders Identification Test), a standard in screening instruments, this simple, anonymous test takes only a few minutes and provides confidential results. AlcoholScreening.org was launched in April 2001, and the website delivered its millionth health screening on April 7, 2009. The milestone coincides with National Alcohol Awareness Month.

“Thanks for the statistics, I just thought it was ‘normal’. I will try to cut down, I knew I was at risk because of my family tradition, yet I thought I was still on the safe side. I have clear data to re-evaluate my habits,” wrote one user.

AlcoholScreening.org also features answers to frequently asked questions about alcohol and health consequences, and provides links to support resources and a national database of 11,000 local treatment programs. Hundreds of sites link to AlcoholScreening.org and more than fifty organizations use its syndication option to integrate AlcoholScreening.org into their own websites. Syndication also allows these sites to add local resource information.

“Consumers across the country use the Internet to get health information. It makes sense that they should use it to learn whether they may have personal health risks related to their alcohol use,” said David Rosenbloom, Join Together Director. “Research shows that questions about alcohol consumption patterns, coupled with brief feedback about risk levels or referral to assessment or treatment, when appropriate, can lead individuals to reduce risky drinking over sustained periods. Reducing risky drinking patterns can prevent injuries from car crashes and other mishaps, long term illnesses, and problems with family, community members or with law enforcement.”

Take the Test: Visit AlcoholScreening.org

Join Together works to advance effective alcohol and drug policy, prevention and treatment. Major funding is provided by the Robert Wood Johnson Foundation. More information about Join Together is available at: http://www.jointogether.org/aboutus/.

Sponsored by the National Council on Alcoholism and Drug Dependence, Inc., (NCADD) since 1987, Alcohol Awareness Month encourages local communities to focus on alcoholism and alcohol-related issues throughout the month of April. Alcohol Awareness Month began as a way of reaching the American public with information about the disease of alcoholism – that it is a treatable disease, not a moral weakness, and that alcoholics can and do recover.

Posted August 3, 2009

From:
Join Together
580 Harrison Avenue, 3rd Floor
Boston, MA 02118

http://www.jointogether.org/news/yourturn/announcements/2009/one-million-people.html

Once the problem of addiction is recognized, individuals can begin the process of recovery by following a treatment plan. Recovery is the process of overcoming both physical and psychological dependence on a psychoactive drug, with a commitment to sobriety.

What is the difference between treatment and recovery?

Treatment and recovery are interconnected, but not the same. As the NIDA Principles of Drug Addiction indicate, treatment is an important component to the recovery process.

According to the Center for Substance Abuse Treatment (CSAT), “treatment” is defined as in- or outpatient services that focus on initiating and maintaining an individual’s recovery from alcohol or drug abuse and on preventing relapse. Treatment can include detoxification, group or individual counseling, rehabilitation and the use of methadone or other prescription medications. It also can involve drug or alcohol education and self-help groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Quite often, treatment is considered the “light at the end of the tunnel” for those afflicted with substance abuse addiction. Unlike addiction itself, treatment is a positive process, involving a variety of support systems that systematically help lead individuals to successful, fulfilling lives without drugs and/or alcohol.

Individuals who have participated and completed treatment programs are considered to be “in recovery.” Thus, recovery is recognized as “…an ongoing process of improvement–biologically, psychologically, socially and spiritually–while attempting to maintain abstinence from alcohol and other drugs.” (Strawn, Julie, WIN, “Substance Abuse Welfare Reform Policy,” Issue Notes, Vol. 1, No. 1, 1/7/97. p.3) Furthermore, individuals can be forced into treatment, but cannot be forced into recovery. Recovery from alcohol and other drug abuse is a voluntary process, and a strategy to reach recovery should include treatment. Therefore, treatment is not a long-term solution to alcohol and other drug addiction, but a commitment to recovery is. In addition, some people become “clean and sober” solely through continuous participation in 12-step programs, instead of through treatment. They, too, consider themselves “in recovery.”
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What are the steps of recovery?

There are six stages that addicts must undergo for long-term recovery:

Transition – The period of time needed for the addict to realize that safe use of alcohol or other drugs for them is not possible.

Stabilization – The period of time in which the addict experiences physical withdrawal and other medical problems and learns how to separate from the people, places and things that promote drug abuse.

Early recovery – When an individual faces the need to establish a chemical-free lifestyle and builds relationships that support long-term recovery.

Middle recovery – The time for developing a balanced lifestyle where repairing past damage is critical.

Late recovery – The period of time in which the individual identifies and changes mistaken beliefs about oneself, others, and the world that causes or promotes irrational thinking.

Maintenance – The lifelong process of continued growth, development and management of routine life problems.
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Do addicts ever fully recover?

Addicts should realize that their life can never be the way it was before their addiction. This does not mean that a recovering addict cannot live a healthy and fulfilling life. Rather, addicts should be aware that recovery is a process that always will need to be maintained.
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Is abstinence/sobriety the same as recovery?

No. Sobriety or abstinence is simply refraining from the ingestion of alcohol or other drugs. Recovery is the process by which the ingestion of alcohol or other drugs is recognized as problematic and avoided.

Posted July, 31 2009

From:

http://www.dol.gov/asp/programs/drugs/workingpartners/sab/recovery.asp#q1

Researchers in Chicago apply an old medical maxim: “Chronic diseases require chronic cures.”

Supplementing regular recovery checkups with motivational interviewing and active linking to treatment can get relapsing patients back into treatment sooner and help them stay longer, report NIDA-funded researchers. In the 2 years following treatment, patients who received the additional interventions were three times as likely to reenter treatment as others who received assessments only.

Lead investigator Dr. Christy Scott and coinvestigator Dr. Michael Dennis developed the effective intervention, which they call the Recovery Management Checkup (RMC) system, to expedite the recovery of people who had attended treatment and were now living in the community and experiencing substance abuse problems. They say the findings suggest that their approach to treating substance abuse as a chronic condition may help patients shake off the shame of relapse. “By the time patients had participated in checkups for 2 years, many who were initially reluctant to reenter treatment would call a peer to link them with help after a slip,” says Dr. Scott, of Lighthouse Institute in Chicago, a Division of Chestnut Health Systems, Inc.
INTERVENTION MATCHES RELAPSE PATTERNS

In developing the RMC system, the researchers built on previous studies in which they had identified patterns of chronic substance abuse, relapse, and recovery. They found that, during the first 3 years after treatment, people frequently transitioned between recovery, substance abuse, and treatment—a cyclic pattern suggesting that periodic checkups, with intervention when necessary, might help shorten relapse episodes. They also researched approaches used to manage other chronic health conditions and found that monitoring for relapse and reducing the time from relapse to treatment reentry improved long-term outcomes.

To implement the RMC system, Drs. Scott and Dennis hired and trained a cadre of research assistants and linkage managers, many of whom were local recovering individuals. Chestnut staff and clinical colleagues at Haymarket Center, the largest addiction treatment provider in Illinois, interviewed 448 men and women who had met the standard criteria for a substance abuse diagnosis at some time in their lives, had abused alcohol or other drugs in the past 90 days, were not in protective custody, and intended to live in Chicago for the next year. Cocaine, alcohol, opiates, and marijuana were the most commonly abused drugs. Immediately following the interview, patients received a referral to Haymarket Center for treatment—60 percent as residents and 40 percent as outpatients—for 27 days, on average; 11 percent remained in treatment for 90 days or more. Upon leaving treatment, each patient scheduled eight quarterly followup appointments. Before the first checkup, researchers randomly assigned the patients to either the RMC intervention or an assessment-only control group.

At each checkup appointment, patients met with a research assistant. The assistant administered a 45-minute version of the Global Appraisal of Individual Needs assessment and ascertained information about the patient’s living situation and substance involvement. If the patient had not abused any substance during the past 90 days, the assistant encouraged continued abstinence and scheduled the next appointment. Patients who reported slips were merely advised to reenter therapy if they were in the control group, but met with a linkage manager if they were in the intervention group and living in the community.

The linkage manager conducted motivational interviews, usually lasting less than 30 minutes, in which he or she provided feedback on patients’ substance abuse and related problems, discussed ways to work through barriers to treatment reentry, and considered motivations to return to therapy. If a patient was willing to reenter treatment (even with low motivation), the linkage manager scheduled an appointment, telephoned with a reminder, and arranged transportation. The linkage manager provided assistance for 2 weeks, but afterward, responsibility for continuing therapy fell to the patient. Between RMC appointments, the patient received cards and calls from the research office; these served as a reminder of the next visit and carried a message of support from the research team.
CHECKUPS BOOST CHECK-INS

The researchers were able to interview patients at both the beginning and end of a quarter in 87.5 percent of cases. They categorized each patient’s current status as in the community abusing substances, in treatment, in recovery (no substance abuse, problems, or treatment while living in the community), or incarcerated. Between the beginning and end of each quarter, about one-third of the patients, on average, transitioned from one status to another. Most (82 percent) transitioned at least once during the study, with 62 percent moving between points several times (see chart).

Among patients who relapsed, 67 percent of RMC patients reentered treatment within 90 days after the checkup, compared with 51 percent of assessment-only patients. RMC patients returned to treatment sooner (27 versus 45 days) and stayed in treatment longer (7.75 versus 4.68 days), on average, than the control group. Length of treatment predicted transition to recovery at the next quarterly assessment—for every 10.5 days in treatment, a patient was 1.2 times more likely to be abstinent at the next quarterly checkup.

“The checkups help a patient evaluate his or her behavior and recovery-related issues—much as a person with diabetes would report on blood sugar levels and diet and exercise patterns,” says Dr. Thomas Hilton of NIDA’s Division of Epidemiology, Services and Prevention Research. “By employing individuals in recovery as linkage managers, the program also offered an opportunity for the patient to return to treatment or at least receive support from someone who has been there.”

Drs. Scott and Dennis plan to tailor the checkups for specific populations—for example, women involved in the criminal justice system. Treatment providers who want to implement the checkups can contact Dr. Scott (cscott@chestnut.org).

SOURCE

Scott, C.K.; Dennis, M.L.; and Foss, M.A. Utilizing recovery management checkups to shorten the cycle of relapse, treatment reentry, and recovery. Drug and Alcohol Dependence 78(3):325-338, 2005. [Abstract]

Posted July 30, 2009

By Lori Whitten, NIDA NOTES Staff Writer

From:

http://www.nida.nih.gov/NIDA_notes/NNvol20N6/Checkup.html

Many crimes are rooted in alcohol and drug addictions. Yet, too often, nonviolent offenders are simply sent to jail and not treated for the addiction problems that led them there.

When we release individuals with untreated addictions back into communities, they usually return to their friends, their habits, and their crimes.

More than half of those in the criminal justice system who complete treatment programs and participate in aftercare do not commit new crimes. Most prisoners who serve mandatory sentences, but get no treatment, commit new crimes and start using drugs or alcohol soon after release.

Drug courts are designed to help people with addictions who are facing criminal charges get through treatment and recover from their addiction. Their basic premise is to leverage the authority of the criminal-justice system to keep defendants in treatment, recognizing that the recovery process may well include lapses and relapses, but the longer a person stays in treatment, the greater chance he/she has for sustained recovery.

While the participant is enrolled in the drug court, final disposition of the criminal charges is suspended and — depending upon the participant’s ultimate success or failure — may be dismissed or otherwise changed.

It is widely recognized that drug courts result in varying degrees of reduced recidivism and cost savings for the criminal-justice system, and are most effective with high-risk, defendants with a long history of addictions.

In addition, drug courts produce many other societal benefits, including increased coordination and delivery of public health and mental health services, vocational training and job placement which increase the likelihood of sustained recovery.

Posted July, 29, 2009

From:

http://www.jointogether.org/keyissues/incarceration/treatment-vs-incarceration-readmore.html

Vol. 22, No. 2 (December 2008)

Low-risk offenders do equally well with and without regularly scheduled court appearances.

Adjusting the frequency of mandatory drug court monitoring sessions according to offenders’ risk of lapsing into criminal activity, including drug abuse, can enhance program success rates while conserving resources, according to a recent NIDA-supported study. Researchers found that high-risk drug offenders—those with antisocial personality disorder or prior histories of drug abuse treatment—achieved better outcomes when ordered to attend a judicial status hearing every 2 weeks, rather than at the 4- to 6-week intervals that drug courts typically impose. In contrast, lower risk offenders’ treatment success was not compromised when courts required them to appear only if they committed serious or repeated infractions of program rules.

“Our research represents a first step in tailoring adaptive supervision interventions to drug-abusing offenders,” says Dr. Douglas Marlowe of the Treatment Research Institute and the University of Pennsylvania, Philadelphia. Dr. Marlowe, Dr. David Festinger, and colleagues conducted the study as part of a broader effort to improve the efficacy and cost-effectiveness of drug court interventions by identifying which components of the model work best for various groups of drug offenders.
CUSTOM TAILORING COURT SUPERVISION

Drug courts are intensive, community-based programs that substitute judicially supervised treatment and case management for prosecution or incarceration. Defendants who complete the drug court program and remain arrest-free for 6 months after graduation have their charges dropped and their arrest records expunged. The judicial status hearing, during which a judge rewards achievements and punishes infractions with sanctions that progressively increase in severity, is among the costliest components of drug court programs.

Drs. Marlowe and Festinger designed their study to answer two questions: Would high-risk drug offenders benefit from hearings held more frequently than usual, and would low-risk drug offenders still experience treatment gains if their hearings were held less often than the norm? The researchers had reason to predict the answers would be “yes” to both questions because of observations they had made in a previous study. That study’s design and small participant population, however, had not allowed definitive findings on these issues.

Participants in the new study were recruited from a misdemeanor drug court in Wilmington, Delaware. Among the drugs that they reported abusing at the time of their assignment to drug court, cannabis was the most common, followed by alcohol, stimulants or cocaine, opiates, sedatives, and hallucinogens. Each participant was assigned to a clinical case manager who coordinated treatment referrals, submitted monthly reports to the judge, and appeared at the participant’s judicial status hearings.

Ninety-two of the 279 participants were classified as high-risk because they had an antisocial personality disorder or had relapsed after previous treatment for drug abuse. Within the high-risk group, 42 were assigned to report to drug court biweekly, and 50 reported every 4 to 6 weeks. In the low-risk group, 92 were put on the 4- to 6-week schedule, and 95 were told to appear in court only after serious rule infringements—most commonly failure to attend counseling appointments or provide drug-free urine specimens.

Within a year, 75 percent of the high-risk participants who attended hearings every 2 weeks graduated from the program, compared with 56 percent of high-risk participants assigned to follow the standard schedule. The former group also provided more drug-free urine samples and reported less alcohol intoxication (see table), as well as less criminal activity.

Among the low-risk participants, outcomes were similar regardless of how often hearings took place. For example, program graduation rates were 75 percent among the offenders who appeared in drug court every 4 to 6 weeks and 72 percent among those who appeared in court only when a problem arose, averaging less than two hearings during the study year. “Reducing the number of court hearings for these individuals could permit a program to conserve costly resources without sacrificing client outcomes or public safety,” Dr. Marlowe says.

DRUG COURT FREQUENCY CAN AFFECT TREATMENT OUTCOME Participants who were considered high-risk provided more drug-free urine samples when they were required to appear in drug court every 2 weeks (gray-green) rather than according to the standard schedule of every 4 to 6 weeks (gold). In contrast, participants who were at lower risk of relapse did comparably well on the standard schedule (blue) and when court appearances were scheduled only in response to treatment-rule infractions (red).
DRUG COURT FREQUENCY CAN AFFECT TREATMENT OUTCOME – line graph. Week in Drug Court in relation to the percentage of drug-free urine samples. See previous text for additional information. Source: Marlowe, D.B., et al. Matching judicial supervision to clients’ risk status in drug court. Crime and Delinquency 52, 52-76, 2006.
ROOM FOR IMPROVEMENT

“Adjusting the frequency of court hearings to participants’ risk status will make a difference, but there still will be considerable room for improvement in drug court outcomes,” Dr. Marlowe notes. For high-risk participants who continue to have drug or alcohol problems, the program needs further tailoring, he explains. Those who are not compliant with the program—for example, those who fail to attend counseling sessions or to deliver urine specimens—might respond to more frequent judicial supervision or to sanctions such as home curfews. In contrast, increasing the scope of treatment services might be more effective with high-risk participants who are compliant with program rules but fail to achieve abstinence because of the severity of their drug addiction or a related difficulty, such as a co-occurring mental disorder, family problems, unemployment, or homelessness. Dr. Marlowe notes that even low-risk drug offenders need more effective interventions.

“Dr. Marlowe is helping us fill our knowledge gap about drug courts by identifying the elements that make them effective,” says Dr. Redonna K. Chandler, chief of NIDA’s Services Research Branch. “We may eventually be able to match criminal justice supervision and treatment services to the needs of individual offenders, making drug courts both more effective and more costeffective.” Dr. Marlowe says, “We hope that drug court programs eventually become flexible enough to allow participants doing poorly to be switched to a more intensive track and allow those doing well in an intensive program to move to a lower supervision regimen.”

SOURCE

Marlowe, D.B., et al. Adapting judicial supervision to the risk level of drug offenders: Discharge and 6-month outcomes from a prospective matching study. Drug and Alcohol Dependence 88(Suppl. 2):S4-13, 2007. [Abstract]

Drug Courts Add Value

Studies have shown that drug courts significantly increase the time drug abusers stay in treatment. An average of 60 percent of drug court clients complete at least 12 months of treatment, whereas only 10 percent of probationers and parolees typically remain for a year in community-based drug treatment programs, says Dr. Douglas Marlowe of the University of Pennsylvania, summarizing several research reports. A 1998 review of 13 drug court studies found that drug court clients abuse substances less frequently than comparable probationers (10 percent of urine tests were positive, compared with 31 percent). What’s more, drug courts reduce re-arrest rates by 8 to 24 percent, according to five meta-analyses in 2005 and 2006. Although drug courts tend to be more expensive than other programs, the reduction in recidivism decreases later judicial costs and financial loss to crime victims, according to a U.S. Government Accountability Office report published in 2005.* It cited net predicted benefits of $1,000 to $15,000 per participant.

*Adult Drug Court: Evidence Indicates Recidivism Reduction and Mixed Results for Other Outcomes, GAO-05-219, February 2005.

By:  NIDA Notes Staff

Posted July, 28 2009

From:

http://www.nida.nih.gov/NIDA_notes/NNVol22N2/HighRisk.html#insert

By Bob Curley

Addiction treatment is included in the minimum benefits packages in all three major national healthcare reform bills now being considered by Congress, and each also includes equal coverage of addiction-related services as outlined in the 2008 Wellstone parity bill.

Carol McDaid of Capital Decisions, who lobbies on behalf of addiction treatment and prevention organizations,said that of the five “big buckets” that advocates for addiction services need to fill in the healthcare reform debate, at least these two are being treated favorably by lawmakers, while work still needs to be done on three others — prevention, workforce development, and electronic health records.

“We’re thrilled [addiction treatment is] in at this point,” said Victor Capoccia, Ph.D., director of the Closing the Addiction Treatment Gap (CATG) program, which this week issued a white paper stating that covering addiction treatment services under healthcare reform could make a major contribution to cutting health costs.

Compared to the last big health reform battle on Capital Hill — Hillary Clinton’s ill-fated stab at universal coverage in 1993-94 — “we’re in much better shape as a field in terms of advocacy,” said McDaid.

That’s due in part to the fact that the field waged a recent and successful battle for inclusion in and passage of the parity law, so the arguments in favor of addiction treatment coverage are still fresh in policymakers’ minds, noted McDaid.

Also, federal agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy have been far more engaged in collaborating with the field under the Obama administration, and cooperation between the addiction and mental-health communities has matured and coalesced around the Coalition for Whole Health, said McDaid.

For example, SAMHSA recently issued a consensus statement calling for addiction and mental health services to be included in healthcare reform and outlining a series of core principles for reform, while the Coalition for Whole Health has drafted legislative language reflecting the field’s priorities.

CATG, funded by the Open Society Institute, helped organize a July 17 briefing for Washington, D.C., policymakers on the case for addiction treatment in health reform. The hearing, which was attended by more than 230 people, will be followed by a series of regional policy panels during the Congressional summer recess, according to Capoccia. The group also sponsored a survey released in June showing that a solid majority of American support inclusion of addiction treatment in national healthcare reform, and plans a more detailed followup survey later this summer.

Progress on Prevention

Addiction-field advocates have made some progress towards ensuring that alcohol and other drug prevention services are included in the preventive-health provisions of the healthcare reform legislation. The bills will also cover screening and brief intervention for problem drinking as a covered preventive service. “This is enormously important, because research has shown that widespread screening can lead to significant reductions in alcohol related medical expenses,” said David Rosenbloom, president and CEO of the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

However, “There are certainly gaps in how coverage will be included” for prevention services, cautioned Capoccia.

Advocates also are working to ensure that addiction-treatment professionals can share in the workforce-development programs envisioned under the various bills, such as forgiveness for educational loans and increased slots for medical residents. “It could become a real issue if we get parity and have a big increase in patients with no providers to serve them,” pointed out McDaid.

Finally, field leaders are pressing lawmakers to ensure that addiction-treatment providers can tap into assistance to develop and enhance electronic health records to improve coordination and efficiency, while at the same time recognizing the special confidentiality issues inherent in addiction treatment, McDaid said.

Currently, the addiction field “comes out better in the House Tri-Committee bill,” said McDaid, although she stressed that the measures are “good across the board.” None of the bills deal with the specifics of healthcare benefits, which would be spelled out after passage by special committees established under the reform act.

A ‘Secret Weapon’ to Cut Healthcare Costs

Capoccia goes beyond arguing for simple inclusion, arguing that expanding addiction treatment for the estimated 20 million American who need it could be a “secret weapon” for cutting overall healthcare costs in the U.S. “When you treat people, their use of general medical services and associated costs both decrease,” he said. “Even if you only help one-fifth, 25 percent of them, it begins to translate into lost of money on an annual basis — to say nothing of the fact that people with an illness should get treatment, period.”

CASA’s Rosenbloom urged lawmakers to consider raising the federal tax on alcohol as part of health-reform legislation. “It will raise a lot of the money needed to pay for reform and also lower future medical care costs,” he said. “When the price of alcohol goes up, problematic drinking by young people and the small number of very heavy drinkers goes down.” Rosenbloom said research shows that governments currently spend $7 dealing with the consequences of excessive alcohol use for every dollar they collect in alcohol taxes.

McDaid — who would like to convince lawmakers to get the Congressional Budget Office to score addiction treatment services and conduct a cost-benefit analysis of inclusion in health reform — said she’s not surprised that the public and members of Congress are reacting sharply to the cost of healthcare reform now that specifics are emerging. She expects that the debate will stretch out much further than the summer.

“I still believe we will get something done, though I think Congress may be in until Christmas Eve,” she said. “The question is how significant will it be — will it be incremental or a whole-system reform?”

McDaid is less concerned about Congress backtracking on providing coverage for addiction treatment services. “I think many of the victories we have had will be sustained” in whatever reform bill passes, she said.

What Comes After Reform?

For the addiction field, the hard work will hardly be starting if and when the ink dries on a healthcare reform bill. While lawmakers may be willing to finally deny the myth that addiction treatment is too expensive and accept that it saves money in the long run — and Washington’s recent embrace of drug courts suggests they are — the field still faces tremendous challenges in terms of accountability and lack of integration with the mainstream healthcare system.

Capoccia said that there is good outcome data to support certain types of treatment, such as medication-assisted programs and those using motivational enhancement and interviewing techniques. Standards developed by the National Quality Forum have been adopted by some states to guide purchasing decisions.

But many programs still lack credible outcome data, and Capoccia predicted that programs that lack accountability and quality standards will be “winnowed out” within five years of healthcare reform passing. “Accountability is written all over healthcare reform,” he said.

Capoccia added that healthcare reform is likely to force addiction treatment providers to become more sophisticated and comprehensive in the services they offer to the patients they “own” — namely, those with severe or persistent addiction or mental-health problems. “If we own them, we’ll have to provide or link to general medical care, too,” he said.

Currently, however, “Our field is woefully unprepared to make the changes necessary to operate in a healthcare-reform environment,” said Capoccia.

Posted July 27, 2009

By: Bob Curley

From:

http://www.jointogether.org/news/features/2009/positive-prognosis-for.html