Link for Data Table:
Cost Effectiveness of Treatment vs. Law Enforcement
(Treatment Need, 2011) "In 2011, 21.6 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (8.4 percent of persons aged 12 or older). Both the rate and the number declined between 2010 (9.2 percent and 23.2 million) and 2011 and between 2002 (9.7 percent and 22.8 million) and 2011. In 2011, 2.3 million persons (0.9 percent of persons aged 12 or older and 10.8 percent of those who needed treatment) received treatment at a specialty facility, which did not differ from the rates and numbers in 2010 and 2002."Source:Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 84.
(Persons Receiving Treatment, 2011) "Of the 2.3 million persons aged 12 or older who received specialty substance use treatment in 2011, 898,000 received treatment for alcohol use only, 780,000 received treatment for illicit drug use only, and 574,000 received treatment for both alcohol and illicit drug use. These estimates were similar to the estimates for 2010 and 2002."Source:Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 84.
(Cost Effectiveness of Treatment vs. Law Enforcement in Reducing Substance Use) The RAND Corporation found that the additional spending needed to achieve a 1% reduction in the number of cocaine users varies according to the sort of program used, and that treatment is the most cost-effective:
Effect of Control Programs on the Number of Cocaine Users Control Program Cost of a 1% Decrease
in Cocaine Users per year
Ratio of Program Cost
to Treatment Cost
Source-country control $2,062,000,000 13.3 Interdiction 964,000,000 6.2 Domestic enforcement 675,000,000 4.4 Treatment 155,000,000 +1.0Source:Rydell, C.P. & Everingham, S.S., Controlling Cocaine, Prepared for the Office of National Drug Control Policy and the United States Army (Santa Monica, CA: Drug Policy Research Center, RAND Corporation, 1994), p. 36.
(Federal Spending on Treatment) The US Office of National Drug Control Strategy estimated federal spending on substance abuse treatment and treatment research:
$9,261.6 billion requested for FY2014
$8,082.4 billion in 2013 (Annualized Continuing Resolution)
$7,848.3 billion in 2012
$8.953.9 billion in 2011
$8.937.2 billion in 2010
$8.426.9 billion in 2009
$7.422.9 billion in 2008
$7.135.0 billion in 2007
$6.811.9 billion in 2006
$6.761.8 billion in 2005Source:"FY 2013 Budget and Performance Summary: Companion to the National Drug Control Strategy," Office of National Drug Control Policy (Washington, DC: Executive Office of the President: April 2012), p. 17.
"National Drug Control Budget: FY2014 Funding Highlights," Office of National Drug Control Policy (Washington, DC: Executive Office of the President, April 2013), p. 12.
(Unmet Treatment Need Quantified, 2011) "Of the 19.3 million persons aged 12 or older in 2011 who were classified as needing substance use treatment but not receiving treatment at a specialty facility in the past year, 912,000 persons (4.7 percent) reported that they perceived a need for treatment for their illicit drug or alcohol use problem (Figure 7.10). Of these 912,000 persons who felt they needed treatment but did not receive treatment in 2011, 281,000 (30.8 percent) reported that they made an effort to get treatment, and 631,000 (69.2 percent) reported making no effort to get treatment. These estimates were stable between 2010 and 2011."Source:Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 85.
(Treatment Episodes in the US, 2010) [Data Limitations of Treatment Episode Data Set] "These reports provide information on the demographic and substance abuse characteristics of admissions to treatment aged 12 and older for abuse of alcohol and/or drugs in facilities that report to individual State administrative data systems. Data include records for admissions during calendar years 2000 through 2010 that were received and processed through October 10, 2011.
"TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, for example, an individual admitted to treatment twice within a calendar year would be counted as two admissions.
"TEDS does not include all admissions to substance abuse treatment. It includes admissions at facilities that are licensed or certified by the State substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services. "
Total PRIMARY SUBSTANCE Alcohol only
Alcohol with secondary
Total No. 1,955,535 436,187 353,759 114,302 47,146 364,624 272,336 170,255 118,546 46,906 % 100.0 22.3 18.1 5.8 2.4 18.6 13.9 8.7 6.1 2.4Source:Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2000-2010. National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 5.
"Substance Abuse Treatment Admissions by Primary Substance of Abuse, According to Sex, Age Group, Race, and Ethnicity, Year = 2010, UNITED STATES," Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS), accessed April 26, 2013.
(Payment Options by Facility Type) "Facilities were asked to indicate whether they accepted specified types of payment or insurance for substance abuse treatment. They were also asked about use of a sliding fee scale and if they offered treatment at no charge to clients who could not pay.
" The proportions of all facilities reporting acceptance of specific payment options were:
" Cash or self-payment 90 percent
" Private health insurance 64 percent
" Medicaid 57 percent
" State-financed health insurance 39 percent
" Medicare 33 percent
" Federal military insurance 33 percent
" Facilities operated by Federal and tribal governments were least likely to accept cash or self-payment (43 and 46 percent, respectively). Private for-profit and Federal government-operated facilities were less likely to accept Medicare, Medicaid, or State-financed health insurance than were facilities operated by private non-profits and State, local, or tribal governments.
" Acceptance of Access to Recovery vouchers was reported in 26 States or jurisdictions. The proportion of facilities accepting Access to Recovery vouchers ranged from 8 percent in New Jersey to 75 percent in Rhode Island [Table 6.19b].17
" Use of a sliding fee scale was reported by 62 percent of all facilities, ranging from 16 percent of facilities operated by the Federal government to 82 percent of facilities operated by local governments.
" Facilities operated by tribal governments were the most likely to accept IHS/63818 contract care funds (63 percent).
" Treatment at no charge for persons who cannot afford to pay was offered by 50 percent of all facilities, ranging from 21 percent of private for-profit facilities to 82 percent of facilities operated by tribal governments."Source:Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2011. Data on Substance Abuse Treatment Facilities. BHSIS Series S-64, HHS Publication No. (SMA) 12-4730. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 30.
(Effectiveness of Treatment on Employment) "The Drug Treatment Outcomes Research Study (DTORS) was one example of European research with encouraging results regarding employment (Jones et al., 2009). This study investigated drug use, health and psychosocial outcomes in 1 796 English drug users attending a range of different types of treatment service. Follow-up interviews were conducted between 3 and 13 months after baseline (soon after initial treatment entry). Regardless of the type of treatment received or drug use outcomes, employment levels increased from 9 % at baseline to 16 % at follow-up. This was accompanied by a corresponding increase in the amount of legitimate income earned per week. The proportion reporting being unemployed but actively looking for work decreased slightly from 27 % to 24 %, reflecting the increase in employment and a 5 percentage point increase in those reporting being unable to work (because of long-term sickness or disability). The proportion of participants classed as unemployed and not looking for work also fell from 24 % to 11 %. Treatment attendance was also associated with changes in housing status; the proportion staying in stable accommodation increased from 60 % to 77 % at follow-up. It should be noted that the findings of this study were weakened by use of a non-experimental design, failure to separate outcomes according to client type and treatment modality, and insufficient detail on the nature of the employment obtained."Source:European Monitoring Centre for Drugs and Drug Addiction, EMCDDA Insights Series No 13, "Social reintegration and employment: evidence and interventions for drug users in treatment" (Luxembourg: Publications Office of the European Union, 2012), ISBN: 978-92-9168-557-8, doi: 10.2810/72023, p. 67.
(Effectiveness of Treatment on Social Reintegration and Employment) "In a recent secondary analysis of a national US survey of clients conducted in the early 1990s (National Treatment Improvement Evaluation Study), researchers tried to identify which types of treatment modality (methadone-substitute prescribing, methadone-assisted detoxification, outpatient detoxification, short-term residential, long-term residential or criminal justice focused) and treatment characteristics (e.g. length of treatment) were associated with better employment outcomes (Dunlap et al., 2007). Overall, the treatment modality received and the characteristics of that treatment (such as length of stay or number of sessions completed) were not significantly associated with employment outcomes. The strongest predictor of employment was pre-treatment employments. The authors hypothesised that receipt of treatment services per se was less important than the quality of services received, although this was not tested."Source:European Monitoring Centre for Drugs and Drug Addiction, EMCDDA Insights Series No 13, "Social reintegration and employment: evidence and interventions for drug users in treatment" (Luxembourg: Publications Office of the European Union, 2012), ISBN: 978-92-9168-557-8, doi: 10.2810/72023, p. 67.
(Treatment and Crime Rates) "Increases in admissions to substance abuse treatment are associated with reductions in crime rates. Admissions to drug treatment increased 37.4 percent and federal spending on drug treatment increased 14.6 percent from 1995 to 2005. During the same period, violent crime fell 31.5 percent. Maryland experienced decreases in crime when jurisdictions increased the number of people sent to drug treatment."
(Source of Admissions to Treatment for Marijuana) "An admission [to treatment] was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. In 1999, 43 percent of all adolescent admissions were marijuana-involved admissions referred to treatment by the criminal justice system, and 39 percent were marijuana involved but referred by other sources. Between 1999 and 2002, the proportion referred by the criminal justice system increased to 45 percent while the proportion referred by other sources decreased to 37 percent. The proportions started to converge in 2007.
"Adolescent admissions not involving marijuana that were referred by the criminal justice system fell from 8 percent in 1999 to 5 percent in 2009. Admissions not involving marijuana that were referred from other sources were fairly stable, at between 9 and 11 percent of adolescent admissions."Source:Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). 1999 - 2009. National Admissions to Substance Abuse Treatment Services, DASIS Series: S-56, HHS Publication No. (SMA) 11-4646, Rockville, MD; Substance Abuse and Mental Health Services Administration, 2011, p. 29.
(Treatment for Alcohol and Other Drugs, 2009) "The concurrent abuse of alcohol and drugs continues to be a significant problem. Because TEDS collects a maximum of three substances of abuse and not all substances abused, alcohol use among polydrug abusers may be underreported.
"• The proportion of admissions aged 12 and older reporting abuse of both alcohol and drugs declined from 43 percent in 1999 to 37 percent in 2009.
"• The proportion reporting abuse of drugs only increased from 27 percent in 1999 to 38 percent in 2009, while the proportion reporting abuse of alcohol only fell slightly, from 27 percent in 1999 to 23 percent in 2009."Source:Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). 1999 - 2009. National Admissions to Substance Abuse Treatment Services, DASIS Series: S-56, HHS Publication No. (SMA) 11-4646, Rockville, MD; Substance Abuse and Mental Health Services Administration, 2011, p. 7.
(Treatment Completion Rates by Race) "Across racial and ethnic groups, treatment completion rates were generally highest for people receiving treatment that primarily targeted alcohol abuse, followed by treatment for methamphetamines, and were lowest for treatment for heroin (Exhibit 2). Except for opiates and heroin, where the differences were not significant, Asian Americans were more likely than whites to complete treatment for all substances. Conversely, blacks and Hispanics were significantly less likely than whites to complete treatment for all substances except for opiates. Native Americans had significantly lower completion rates than whites for all substances except for cocaine and methamphetamines.
"Blacks and Hispanics were less likely than whites to complete treatment across all settings, and Asian Americans were more likely (Exhibit 3). The alcohol treatment completion rate was generally higher for people discharged from residential settings, followed by intensive outpatient settings. However, Asian Americans and Hispanics were just as likely to complete nonintensive as intensive outpatient alcohol treatment."Source:Brendan Saloner and Benjamin Lê Cook, "Blacks And Hispanics Are Less Likely Than Whites To Complete Addiction Treatment, Largely Due To Socioeconomic Factors," Health Affairs, 32, no.1 (2013):135-145 doi: 10.1377/hlthaff.2011.0983, p. 138.
(Criminal Justice System Referrals) "In 2007, the criminal justice system was the largest single source of referrals to the substance abuse treatment system, comprising 37 percent of all admissions in the Treatment Episode Data Set (TEDS) (approximately 670,500 of the 1.8 million admissions). Moreover, the majority of these referrals were from parole and probation offices (44 percent of criminal justice admissions where detailed criminal justice source information is known)."Source:The TEDS Report, "Substance Abuse Treatment Admissions Referred by the Criminal Justice System," Office of Applied Studies, SAMHSA (Arlington, VA: August 2009), p. 1.
(Dependence Among People Who Try Drugs) "Some 4.3 percent of Americans have been dependent on marijuana, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision(DSM-IV-TR; American Psychiatric Association,2000), at some time in their lives. Marijuana produces dependence less readily than most other illicit drugs. Some 9 percent of those who try marijuana develop dependence compared to, for example, 15 percent of people who try cocaine and 24 percent of those who try heroin. However, because so many people use marijuana,cannabis dependence is twice as prevalent as dependence on any other illicit psychoactive substance (cocaine, 1.8 percent; heroin, 0.7 percent; Anthony and Helzer,1991; Anthony, Warner, and Kessler, 1994)."Source:Budney, Alan J.; Roffman, Roger; Stephens, Robert S.; Walker, Denise, "Marijuana Dependence and Its Treatment," Addiction Science & Clinical Practice, Vol. 4, No. 1 (Rockville, MD: National Institute on Drug Abuse, December 2007), p. 5.
(Characteristics of Those Admitted to Treatment for Alcohol Dependence)
" Admissions for primary abuse of alcohol with secondary abuse of drugs represented 18 percent of TEDS admissions aged 12 and older in 2010 [Table 1.1b].
" The average age at admission for primary alcohol with secondary drug abuse was lower, at 36 years, than for abuse of alcohol alone (40 years) [Table 2.1a].
" Non-Hispanic Whites accounted for 59 percent of admissions for primary alcohol with secondary drug abuse (42 percent males and 17 percent females). Non-Hispanic Blacks made up 23 percent3 of admissions (17 percent males and 5 percent females) [Table 2.3a].
" Almost half (47 percent) of admissions for primary alcohol with secondary drug abuse first became intoxicated by age 14, and 93 percent first became intoxicated before age 21 (the legal drinking age) [Table 2.5]."Source:Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2000-2010. National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 14.
(Characteristics of Admissions to Treatment for Alcohol Dependence)
" Admissions for primary alcohol with secondary drug abuse were less likely to be in treatment for the first time than alcohol-only admissions (35 percent vs. 46 percent) [Table 2.5].
" Among admissions referred to treatment by the criminal justice system, admissions for alcohol with secondary drug abuse were more likely than alcohol-only admissions to have been referred to treatment as a condition of probation/parole (32 percent vs. 19 percent) [Table 2.6].
" Among admissions for alcohol with secondary drug abuse, marijuana and smoked cocaine were the most frequently reported secondary substances (26 percent and 9 percent, respectively) [Table 3.8]."Source:Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2000-2010. National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 14.
(Admissions to Treatment for Marijuana, 2009) According to the federal Treatment Episode Data Set, in 2009 there were 354,159 admissions to treatment with marijuana reported to be the primary substance of abuse, out of a total 1,963,089 admissions for all substances that year. According to the TEDS report:
"• Marijuana was reported as the primary substance of abuse by 18 percent of TEDS admissions aged 12 and older in 2009 [Table 1.1b].
"• The average age at admission for primary marijuana admissions was 24 years, although the peak age at admission for both sexes in all race/ethnicities was 15 to 17 years [Figure 12]. Forty percent of marijuana admissions were under age 20 (vs. 12 percent of all admissions), and primary marijuana abuse accounted for 70 percent of all admissions aged 12 to 14 years and 72 percent of admissions aged 15 to 17 years [Tables 2.1a-b].
"• Non-Hispanic Whites accounted for 48 percent of primary marijuana admissions (34 percent males and 14 percent females), and non-Hispanic Black males accounted for 23 percent [Table 2.3a].
"• Twenty-five percent of marijuana admissions had first used marijuana by age 12 and another 31 percent by age 14 [Table 2.5]."Source:Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). 1999 - 2009. National Admissions to Substance Abuse Treatment Services, DASIS Series: S-56, HHS Publication No. (SMA) 11-4646, Rockville, MD; Substance Abuse and Mental Health Services Administration, 2011, p. 19 and Table 2.6, p. 63.
(Characteristics of Patients Admitted to Opioid Substitution Treatment) "General measures of heroin abuse among treatment admissions aged 12 and older were relatively consistent from 2000 through 2010. Primary heroin abuse accounted for 14 to 16 percent of TEDS admissions in every year from 2000 through 2010. Injection was the preferred route of administration for 60 to 70 percent of primary heroin admissions, inhalation for 25 to 34 percent, and smoking or other route for 4 to 5 percent. The majority of primary heroin admissions were 35 years of age or older (54 to 56 percent from 2000 through 2007 and 45 percent in 2010).
"However, these measures conceal substantial changes in the age, race/ethnicity, and route of administration of some subpopulations among heroin-using admissions.
"Table 3.5 and Figure 21. TEDS data show an increase in heroin admissions among young non-Hispanic White adults. Among non-Hispanic Blacks, however, admissions have declined except among older admissions.
" In 2000, just over 1 in 5 heroin admissions (22 percent) was non-Hispanic White aged 20 to 34. By 2010, more than 2 in 5 primary heroin admissions (42 percent) belonged to this subgroup. The proportion of primary heroin admissions who were non-Hispanic White aged 35 to 44 fell from 15 percent to 9 percent in the same period, while the proportions of non-Hispanic White admissions aged 12 to 19 and older than 45 remained constant, at 2 to 3 percent and 7 to 8 percent, respectively.
" In contrast, the proportion of primary heroin admissions that were non-Hispanic Black aged 20 to 34 fell from 6 percent to 2 percent between 2000 and 2010, while the proportion aged 35 to 44 fell from 10 percent to 6 percent. However, the proportion of non-Hispanic Black admissions aged 45 and older increased from 8 percent in 2000 to 10 percent in 2010. Non-Hispanic Black admissions aged 12 to 19 accounted for less than one-tenth of 1 percent of all primary heroin admissions."Source:Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2000-2010. National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, pp. 30-31.
(Treatment Clients with Co-Occurring Substance Abuse and Mental Disorders) "Facilities were asked to estimate the proportions of clients in treatment for both alcohol and drug abuse, for alcohol abuse only, and for drug abuse only. They were also asked to estimate the proportion of clients with diagnosed co-occurring substance abuse and mental disorders.
" Almost all facilities (92 percent) had clients in treatment for both alcohol and drug abuse on March 31, 2011. Eighty-two percent had clients in treatment for drug abuse only, and 80 percent had clients in treatment for alcohol abuse only.
" Most facilities (88 percent) also had clients in treatment with diagnosed co-occurring substance abuse and mental disorders on March 31, 2011."Source:Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2011. Data on Substance Abuse Treatment Facilities. BHSIS Series S-64, HHS Publication No. (SMA) 12-4730. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 22.
(Harm Reduction Interventions) "Harm-reduction services for problematic drug users usually address the associated harms and risk behaviours, such as injecting, with a holistic approach that focuses on the nature and severity of the behaviours and problems experienced by the individual, rather than on a specific substance. Therefore, in response to the elevated health risks associated with problem drug use, including polydrug use, harm-reduction services are generally provided on a case-by-case basis and often according to professionals’ own work experience. Furthermore, harm-reduction interventions usually operate within a broader local prevention strategy that combines other types of services such as outreach work and opioid substitution treatment, which contribute to the reduction of risks and health problems experienced by problem polydrug users. Evidence of the effectiveness of harm-reduction interventions has been reported in other EMCDDA publications (EMCDDA, 2008a) and will be reviewed in a forthcoming monograph on harm reduction."Source:European Monitoring Centre for Drugs and Drug Addiction, "Polydrug Use: Patterns and Responses" (Lisboa, Portugal: 2009), p. 25.
(Marijuana Treatment Admissions by Referral Source, 2010) "Primary marijuana admissions were less likely than all admissions combined to be self- or individually referred to treatment (16 percent vs. 33 percent)."
Treatment Referral Source for Admissions to Treatment with Marijuana as Primary Substance, 2010 Referral Source Percent of Total Criminal Justice/DUI 53.6% Self or Individual 16.0% Substance Abuse Care Provider 5.7% Other Health Care Provider 4.1% School (Educational) 4.1% Employer/EAP 0.7% Other Community Referral 16.0%Source:Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2000-2010. National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 19 and Table 2.6, p. 63.
(Post-Treatment Success) "Examination of all clients exiting [drug treatment] in 2005-06 revealed that 46% didn’t return to drug treatment nor had a drug related contact with the CJS [criminal justice system] in the following four years. This would suggest the majority of these individuals are managing to sustain their recovery from addiction though it is not possible to confirm this from the analysis presented in this report."Source:"A long-term study of the outcomes of drug users leaving treatment," National Treatment Agency for Substance Misuse (London, United Kingdom: September 2010), p. 9.
(Estimates of Persons Classified with Substance Dependence or Abuse)
" In 2011, an estimated 20.6 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8.0 percent of the population aged 12 or older) (Figure 7.1). Of these, 2.6 million were classified with dependence or abuse of both alcohol and illicit drugs, 3.9 million had dependence or abuse of illicit drugs but not alcohol, and 14.1 million had dependence or abuse of alcohol but not illicit drugs.
" The annual number of persons with substance dependence or abuse remained stable between 2002 and 2010, ranging from 21.6 million to 22.7 million. However, the number in 2011 (20.6 million) was lower than the number in 2010 (22.2 million)."Source:Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 73.
(Cost Effectiveness of Substance Abuse Treatment) "Substance abuse treatment is more cost-effective than prison or other punitive measures. The Washington State Institute for Public Policy (WSIPP) found that drug treatment conducted within the community is extremely beneficial in terms of cost, especially compared to prison. Every dollar spent on drug treatment in the community is estimated to return $18.52 in benefits to society."
(Ancillary Services Provided by Treatment Facilities, 2007) "One or more of the 17 specified ancillary services were provided by 99 percent of all facilities (Table 1). Ancillary services provided by more than half of all facilities included substance abuse education (94 percent); case management services (76 percent); social skills development (66 percent); HIV or AIDS education, counseling, or support (56 percent); mental health services (54 percent); and assistance with obtaining social services (52 percent)."Source:Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (September 10, 2009). The N-SSATS Report: Services Provided by Substance Abuse Treatment Facilities in the United States. Rockville, MD. p. 3.
(Ancillary Services Offered by Treatment Facilities, 2007)
Table 1. Percentage of All Substance Abuse Treatment Facilities Offering Ancillary Services: 2007 Ancillary Service Percent Total 99 Substance Abuse Education 94 Case Management Services 76 Social Skills Development 66 HIV or AIDS Education, Counseling, or Support 56 Mental Health Services 54 Assistance with Obtaining Social Services 52 Health Education other than HIV/AIDS 49 Self-help Groups 47 Mentoring/Peer Support 45 Assistance in Locating Housing for Clients 43 Transportation Assistance to Treatment 36 Domestic Violence - Family or Partner Violence Services 36 Employment Counseling or Training for Clients 34 Early Intervention for HIV 25 Child Care for Clients' Children 8 Acupuncture 4 Residential Beds for Clients' Children 4 Source: 2007 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).Source:Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (September 10, 2009). The N-SSATS Report: Services Provided by Substance Abuse Treatment Facilities in the United States. Rockville, MD. Table 1, p. 3.
(Global Treatment Demand) "Expressed in monetary terms, some US$ 200 billion-250 billion (0.3-0.4 per cent of global GDP) would be needed to cover all costs related to drug treatment worldwide. In reality, the actual amounts spent on treatment for drug abuse are far lower — and less than one in five persons who needs such treatment actually receives it."
(Global Treatment Demand, by Substance, 2010) "It is estimated that 20 per cent of problem drug users in 2010 received treatment for their drug dependence. Opioids (largely heroin) continue to be the dominant drug type accounting for treatment demand in Asia and Europe (particularly in Eastern Europe and South-Eastern Europe, where they account for almost four out of every five drug users in treatment). Opioids also contribute considerably to demand for treatment in Africa, North America and Oceania. Only in South America is demand for treatment for opioid use negligible (accounting for 1 per cent of all demand for treatment for drug dependence in the region).
"Cannabis, the most widely consumed illicit drug world-wide, is considered to be the least harmful of the illicit drugs. Yet it is the dominant drug accounting for treatment demand in Africa, North America and Oceania, a major contributor to treatment demand in South America and the second most important contributor to such treatment in Europe.
"Treatment for cocaine use is largely associated with the Americas, particularly South America, where it accounts for nearly half of all treatment for illicit drug use, whereas in Asia, Eastern Europe, South-Eastern Europe and Oceania, the share of demand for treatment for drug use accounted for by cocaine use is negligible (less than 1 per cent).
"Demand for treatment for the use of ATS (mostly methamphetamine), is most noticeable in Asia where such drugs are the second major contributor to treatment demand, and to a lesser extent in Oceania, Western and Central Europe and North America."
(Women Under-Represented in Treatment Globally) "To be equally represented in treatment, the ratio of males to females in treatment should be similar to the ratio of males to females in problem drug use. Using past-month prevalence as a proxy for problematic use,24 gender-disaggregated data from EMCDDA on past-month prevalence and outpatient clients in treatment suggest that in most countries in Europe females could be underrepresented in treatment for the problematic use of cannabis, cocaine and amphetamines (see figure 5). There are few studies that analyse gender differences in the accessibility of treatment services; however, the ratio of males and females reported in treatment in Europe was 4:1 — higher than the ratio between male and female drug users.25 In many developing countries, there are limited services for the treatment and care of female drug users and the stigma associated with being a female drug user can make accessibility to treatment even more difficult. In Afghanistan, for instance, 10 per cent of all estimated drug users have access to treatment services,26 whereas only 4 per cent of female drug users and their partners have access to treatment services and interventions."
(Poly-Drug Users In Treatment) "While it is generally assumed that polydrug use is a hard-to-treat condition, results from large treatment outcome studies in Europe show significant reductions in multiple drug use among highly problematic users. Nevertheless, managing the care of problem polydrug users requires long-term treatment planning with attention to individual needs and multidisciplinary teams working together with flexible and sometimes innovative treatment options."Source:European Monitoring Centre for Drugs and Drug Addiction, "Polydrug Use: Patterns and Responses" (Lisboa, Portugal: 2009), p. 26.
(Treatment Participation among Prison Inmates) "In 2004, about 642,000 State prisoners were drug dependent or abusing in the year before their admission to prison. An estimated 258,900 of these inmates (or 40%) had taken part in some type of drug abuse program (table 10). These inmates were more than twice as likely to report participation in selfhelp or peer counseling groups and education programs (35%) than to receive drug treatment from a trained professional (15%).
"In Federal prison, a higher percentage of drug dependent or abusing inmates (49%) reported taking part in some type of drug abuse programs. Nearly 1 in 3 took part in drug abuse education classes, and 1 in 5 had participated in self-help or peer counseling groups. Overall, 17% took part in drug treatment programs with a trained professional, and 41% had participated in other drug abuse programs."Source:Mumola, Christopher J., and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," (Washington, DC: Bureau of Justice Statistics, Dept. of Justice, Oct. 2006) NCJ-213530, p. 9.
(Substance Abuse Treatment in Prison) "The percentage of recent drug users in State prison who reported participation in a variety of drug abuse programs rose from 34% in 1997 to 39% in 2004 (table 9). This increase was the result of the growing percentage of recent drug users who reported taking part in self-help groups, peer counseling and drug abuse education programs (up from 28% to 34%). Over the same period, the percentage of recent drug users taking part in drug treatment programs with a trained professional was almost unchanged (15% in 1997, 14% in 2004).
"Participation in drug abuse programs also increased among Federal inmates who had used drugs in the month before their offense, from 39% in 1997 to 45% in 2004. While there was no change in percentage of these inmates who had undergone drug treatment with a trained professional (15% in both years), the percentage taking part in other drug abuse programs rose from 32% in 1997 to 39% in 2004."Source:Mumola, Christopher J., and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," (Washington, DC: Bureau of Justice Statistics, Dept. of Justice, Oct. 2006) NCJ-213530, p. 8.
(Addiction as a Public Health Rather Than Criminal Justice Issue) "The Panel anxiously awaits the time when the disease of addiction is no longer treated as a criminal justice issue, but as a public health problem. Moreover, the Panel embraces the notion of a society that enables any individual with a substance abuse problem, regardless of criminal history, to receive treatment in a safe and respectful environment. The Panel hopes to create a climate in which people who are at risk for, suffering from, or in recovery from alcohol or other drug addiction are valued and treated with dignity."Source:US Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, "Changing the Conversation: Improving Substance Abuse Treatment, The National Treatment Plan Initiative; Panel Reports, Public Hearings, and Participant Acknowledgements," (Washington, DC: SAMHSA, November 2000), p. 41.
(Treatment Admissions by Substance) "Five primary substances of abuse accounted for 96 percent of all substance abuse treatment admissions in 2007: alcohol, opiates (including heroin and prescription painkillers), marijuana, cocaine, and methamphetamine. Criminal justice system referral admissions were more likely than all other referral admissions to report primary alcohol abuse, primary marijuana abuse, and primary methamphetamine abuse and less likely to report primary opiate abuse. The high rate of criminal justice system referral admissions younger than 18 years old may have contributed significantly to the high rate of admissions with marijuana as a primary substance of abuse."Source:The TEDS Report, "Substance Abuse Treatment Admissions Referred by the Criminal Justice System," Office of Applied Studies, SAMHSA (Arlington, VA: August 2009, p. 2.
(Global Heroin Treatment Need and OD Deaths) "More than 60 per cent of drug treatment demand in Asia and Europe relate to opiates that are, especially heroin, the most deadly drugs. Deaths due to overdose are, in any single year, as high as 5,000-8,000 in Europe, and several times this amount in the Russian Federation alone."Source:United Nations Office on Drugs and Crime, "Addiction, Crime and Insurgency: The transnational threat of Afghan opium" (Vienna, Austria: October 2009, p. 7.
(Insurance Coverage) "In contrast to other chronic diseases, funding for addiction treatment disproportionately comes from government sources. More than three quarters—77 percent—of treatment costs are paid by federal, state and local governments, including Medicaid and Medicare.
"Private insurance covers only 10 percent of addiction treatment costs, with out-of-pocket expenditures and other private funding making up the remaining percentage. In contrast, private insurance pays for approximately 37 percent of general medical costs. The passage of federal parity and health care reform legislation should help address this imbalance in the future.
"On an individual level, nearly half of those receiving treatment reported using their own money to pay for their care, and 34.8 percent report using private health insurance."Source:"Defining the Addiction Treatment Gap" Open Society Foundations (New York, NY: Open Society Foundations, November 2010), p. 5.
"In 2003, an estimated $21 billion was spent on drug and alcohol addiction treatment. This represents 1.3 percent of all health care spending for that year."Source:"Defining the Addiction Treatment Gap" Open Society Foundations (New York, NY: Open Society Foundations, November 2010), p. 5.
(Cost Savings for Treatment vs. Law Enforcement) "This study found that the savings of supply-control programs are smaller than the control costs (an estimated 15 cents on the dollar for source-country control, 32 cents on the dollar for interdiction, and 52 cents on the dollar for domestic enforcement). In contrast, the savings of treatment programs are larger than the control costs; we estimate that the costs of crime and lost productivity are reduced by $7.46 for every dollar spend on treatment."Source:Rydell, C.P. & Everingham, S.S., Controlling Cocaine, Prepared for the Office of National Drug Control Policy and the United States Army (Santa Monica, CA: Drug Policy Research Center, RAND Corporation, 1994), p. xvi.
(Treatment Admissions for Marijuana) " A recent issue of The DASIS Report2 examined marijuana treatment admissions between 1992 and 2002 and found that between these years [1992 and 2002] the rate of substance abuse treatment admissions reporting marijuana as their primary substance of abuse3 per 100,000 population increased 162 percent. Similarly, the proportion of marijuana admissions increased from 6 percent of all admissions in 1992 to 15 percent of all admissions reported to the Treatment Episode Data Set (TEDS) in 2002.
"During this time period, the percentage of marijuana treatment admissions that were referred from the criminal justice system increased from 48 percent of all marijuana admissions in 1992 to 58 percent of all marijuana admissions in 2002."Source:"Differences in Marijuana Admissions Based on Source of Referral: 2002," The DASIS Report (Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, June 5, 2005), pp. 1-2.
"Domestic enforcement costs 4 times as much as treatment for a given amount of user reduction, 7 times as much for consumption reduction, and 15 times as much for societal cost reduction."Source:Rydell, C.P. & Everingham, S.S., Controlling Cocaine, Prepared for the Office of National Drug Control Policy and the United States Army (Santa Monica, CA: Drug Policy Research Center, RAND Corporation, 1994), p. xvi.
(Funding Barriers) "Despite the many factors that contribute to the gap, the Panel agrees with many in the field that inadequate funding for substance abuse treatment is a major part of the problem. Over the last decade, spending on substance abuse prevention and treatment has increased, albeit more slowly than overall health spending, to an estimated annual total of $12.6 billion in 1996 (McKusick, Mark, King, Harwood, Buck, Dilonardo, and Genuardi, 1998). Of this amount, public spending is estimated at $7.6 billion (McKusick, et al., 1998). The public spending includes dollars from Medicaid and Medicare, as well as other Federal funds from the Department of Defense, the Department of Veterans Administration, the Department of Justice, and the Substance Abuse Prevention and Treatment (SAPT) Block Grant. The SAPT Block Grant provides Federal support to addiction prevention and treatment services nationally through State and local governments. Private spending includes individual out-of-pocket payment, insurance, and other nonpublic sources, and is estimated at $4.7 billion (McKusick, et al., 1998)."Source:US Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, "Changing the Conversation: Improving Substance Abuse Treatment: The National Treatment Plan Initiative; Panel Reports, Public Hearings, and Participant Acknowledgements" (Washington, DC: SAMHSA, November 2000), p. 12.
(Treatment Programs Offering Special Programs or Services, 2000) "Of the 13,573 treatment facilities that responded to the 2000 N-SSATS [National Survey of Substance Abuse Treatment Services], 60 percent reported that they provided at least one of the special programs or services for women. Almost one third of the facilities (33 percent) provided one program or service, 17 percent of the facilities provided two programs or services, 8 percent of the facilities provided three, and 3 percent provided all four programs or services (data not shown). Of the facilities providing programs or services for women, 63 percent reported providing programs for women only, 56 percent reported services addressing domestic violence, 34 percent provided programs for pregnant or postpartum women, and 16 percent offered on-site child care services."Source:"Facilities Offering Special Programs or Services for Women," The Dasis Report (Washington, DC: Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Oct. 11, 2002), pp. 1-2.
(Public vs. Private Insurance) "One of the main reasons for the higher outlay in public spending is the frequently limited coverage of substance abuse treatment by private insurers. Although 70 percent of drug users are employed and most have private health insurance, 20 percent of public treatment funds were spent on people with private health insurance in 1993, due to limitations on their policy (ONDCP, 1996b). In the view of the Panel, private insurers should serve as the primary source of coverage, with public insurance serving as the safety net."Source:US Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, "Changing the Conversation: Improving Substance Abuse Treatment: The National Treatment Plan Initiative; Panel Reports, Public Hearings, and Participant Acknowledgements" (Washington, DC: SAMHSA, November 2000), p. 12.
(Cost Savings of Treatment vs Enforcement) "An additional cocaine-control dollar generates societal cost savings of 15 cents if used for source-country control, 32 cents if used for interdiction, and 52 cents if used for domestic enforcement. In contrast, the savings from treatment programs are larger than control costs: an additional cocaine-control dollar generates societal cost savings of $7.48 if used for treatment."Source:Rydell, C.P. & Everingham, S.S., "Controlling Cocaine," Prepared for the Office of National Drug Control Policy and the United States Army (Santa Monica, CA: Drug Policy Research Center, RAND Corporation, 1994), p. 42.
(Drug Treatment Admissions and Incarceration Rates) "Increased admissions to drug treatment are associated with reduced incarceration rates. States with a higher drug treatment admission rate than the national average send, on average, 100 fewer people to prison per 100,000 in the population than states that have lower than average drug treatment admissions. Of the 20 states that admit the most people to treatment per 100,000, 19 had incarceration rates below the national average. Of the 20 states that admitted the fewest people to treatment per 100,000, eight had incarceration rates above the national average."
Laws and Policies
(International Drug Conventions) "Many countries believe (erroneously) that the international drug conventions prohibit the use of heroin in medical treatment. Furthermore, the International Narcotics Control Board (INCB) has exerted great pressure on countries to cease prescribing heroin for any medical purpose. Nevertheless, a few countries, including the UK, Belgium, the Netherlands, Iceland, Malta, Canada and Switzerland, continue to use heroin (diamorphine) for general medical purposes, mostly in hospital settings (usually for severe pain relief). Until recently, however, Britain was the only country that allowed doctors to prescribe heroin for the treatment of drug dependence."Source:Stimson, Gerry V., and Nicky Metrebian, Centre for Research on Drugs and Health Behavior, "Prescribing Heroin: What is the Evidence?" (London, England: Rowntree Foundation, 2003), p. 4.
(Drug Offenders Sentenced to Treatment) "In 2006 an estimated 38% of persons sentenced for a felony in state courts were ordered to pay a fine as part of their sentence (table 1.5). Approximately 1 in 4 property offenders was ordered to make restitution and 23% of offenders convicted of drug possession were sentenced to treatment."Source:Sean Rosenmerkel, Matthew Durose and Donald Farole, Jr., "Felony Sentences in State Courts, 2006 –Statistical Tables," Bureau of Justice Statistics (Washington, DC: US Department of Justice, December 2009), p. 2.
(Types of Treatment) "Currently, pharmaceutical treatment for substance abuse addiction in the United States is limited to two basic types: (1) replacement therapy; and (2) aversion therapy.21 Replacement therapy is characterized by substituting or replacing the drug that the person is addicted to with a “safer drug” under the theory that the individual can be weaned off the replacement drug over time.22 The most prominent examples of this are methadone maintenance for heroin addiction and nicotine replacement drugs for smokers.23 Unfortunately, there are no “safer drugs” available for individuals with addictions to cocaine, crack, or methamphetamine.24"
"Aversion therapy, on the other hand, involves the use of drugs that interact negatively with the drug of addiction, such as disulfiram, which is used to treat alcoholism.25 This treatment choice posits that the individual will be deterred from using the drug to which they are addicted because, when combined with aversion drugs, it induces nausea, vomiting, and physical pain.26 The problems associated with these treatment methods, however, are numerous. Both require long-term treatment, which greatly increases the chance that an addict will quit treatment and return to using.27 Replacement therapy simply replaces one drug with another, and, as is the case with methadone, the “safer drug” is itself addictive. ... The unpleasant side effects associated with aversion therapy, however, result in many patients stopping treatment and relapsing.31"Source:Donnelly, Jennifer R, "The Need for Ibogaine in Drug and Alcohol Addiction Treatment," The Journal of Legal Medicine (Schaumburg, IL: American College for Legal Medicine, March 2011), Vol. 32, Issue 1, pp. 96-97.
Sociopolitical and Clinical Research
(Economic Benefits from Treatment) "The cost of proven treatment for inmates, accompanied by appropriate education, job training and health care, would average about $6,500 per year. For each inmate who successfully completes such treatment and becomes a taxpaying, law-abiding citizen, the annual economic benefit to society--in terms of avoided incarceration and health care costs, salary earned, taxes paid and contribution to the economy--is $68,800, a tenfold return on investment in the first year. If a year of such comprehensive treatment turns around only ten percent of those who receive it, it will pay for itself within the next year. Even with the difficult inmate population, success rates are likely to reach at least 15 percent of those who receive such treatment and training."Source:National Center on Addiction and Substance Abuse at Columbia University, Behind Bars: Substance Abuse and America's Prison Population, (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, January 8, 1998), Foreword by Joseph Califano, p. iii.
(Cannabis Substitution) "Eighty five percent of the BPG [Berkeley Patients Group] sample reported that cannabis has much less adverse side effects than their prescription medications. Additionally, the top two reasons listed by participants as reasons for substituting cannabis for one of the substances previously mentioned were less adverse side effects from cannabis (65%) and better symptom management from cannabis (57.4%).
"The substitution of one psychoactive substance for another with the goal of reducing negative outcomes can be included within the framework of harm reduction. Medical cannabis patients have been engaging in substitution by using cannabis as an alternative to alcohol, prescription and illicit drugs."Source:Reiman, Amanda, "Cannabis as a Substitute for Alcohol and Other Drugs," Harm Reduction Journal (London, United Kingdom: December 2009).
(Cannabis Substitution Treatment) "Only orally given THC and, to a lesser extent, nefazodone have shown promise [in treating marijuana dependence]. THC reduced craving and ratings of anxiety, feelings of misery, difficulty sleeping, and chills (Haney et al., 2004). In addition, participants could not distinguish active THC from placebo. These findings were replicated in an outpatient study, which found that a moderate oral dosage of THC (10 mg, three times daily) suppressed many marijuana withdrawal symptoms and that a higher dosage (30 mg, three times daily) almost completely abolished withdrawal symptoms (Budney et al., 2007)."Source:Budney, Alan J.; Roffman, Roger; Stephens, Robert S.; Walker, Denise, "Marijuana Dependence and Its Treatment," Addiction Science & Clinical Practice (Rockville, MD: National Institute on Drug Abuse, December 2007), p. 11.
(Stigmatization of Substance Addiction) "Changing The Conversation initiated the first intensive exploration of the stigmas and attitudes that affect people with alcohol and drug problems. The Panel addressed stigma as a powerful, shame-based mark of disgrace and reproach that impedes treatment and recovery. Prejudicial attitudes and beliefs generate and perpetuate stigma; therefore, people suffering from alcohol and/or drug problems and those in recovery are often ostracized, discriminated against, and deprived of basic human rights. Their families, treatment providers, and even researchers may face comparable stigmas and attitudes. Ironically, stigmatized individuals often endorse the attitudes and practices that stigmatize them. They may internalize this thinking and behavior, which consequently becomes part of their identity and sense of self-worth.
"Public support and public policy are influenced by addiction stigma. Addiction stigma delays acknowledging the disease and inhibits prevention, care, treatment, and research. It diminishes the life opportunities of the stigmatized."Source:US Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, "Changing the Conversation: Improving Substance Abuse Treatment: The National Treatment Plan Initiative; Panel Reports, Public Hearings, and Participant Acknowledgements" (Washington, DC: SAMHSA, November 2000), p. 38.
(Computerized Treatment) "Results: Compared with computer- or therapist-delivered CBT/MI [cognitive behaviour therapy and motivational interviewing], PCT [person-centred therapy] was associated with significantly less reduction in depression and alcohol consumption at 3 months. CAC [(clinician-assisted computerised] therapy was associated with improvement at least equivalent to that achieved by therapist-delivered treatment, with superior results as far as reducing alcohol consumption. Change in depression was significantly predicted by change in alcohol use (in the same direction) and an ability to determine primacy, irrespective of whether this was for drug use or depression. Change in alcohol use was significantly predicted by changes in cannabis use and depression, and change in cannabis use by change in alcohol use. In the regression model, treatment allocation did not independently predict change, but was associated with significant reduction in depression and alcohol use at 3 months.
"Conclusions: Over a 3-month period, CBT/MI was associated with a better treatment response than supportive counselling. CAC therapy was associated with greater reduction in alcohol use than therapist-delivered treatment."Source:Frances J Kay-Lambkin, Amanda L Baker, Brian Kelly and Terry J Lewin, "Clinician-assisted computerised versus therapist-delivered treatment for depressive and addictive disorders: a randomised controlled trial," Med Journal of Australia 2011; 195 (3): 44.
(Reasons for Treatment Completion Disparities) "Using national data, we found that blacks and Hispanics were 3.5–8.1 percentage points less likely than whites to complete treatment for alcohol and drugs, and Native Americans were 4.7 percentage points less likely to complete alcohol treatment. Only Asian Americans fared better than whites for both types of treatment. Completion disparities for blacks and Hispanics were largely explained by differences in socioeconomic status and, in particular, greater unemployment and housing instability. However, the alcohol treatment disparity for Native Americans was not explained by socioeconomic or treatment variables, a finding that warrants further investigation."Source:Brendan Saloner and Benjamin Lê Cook, "Blacks And Hispanics Are Less Likely Than Whites To Complete Addiction Treatment, Largely Due To Socioeconomic Factors," Health Affairs, 32, no.1 (2013):135-145 doi: 10.1377/hlthaff.2011.0983, p. 135.
(Factors Explaining Disparities in Treatment Outcomes) "Our analysis points to factors that may help explain disparities and guide policy. In particular, when we adjusted for both individual need and provider setting, we found that alcohol treatment disparities widened between whites and blacks and between whites and Native Americans. Blacks and Native Americans also were more likely to be treated in residential settings than were whites, suggesting that higher placement rates in residential treatment for these groups may actually help limit disparities and could compensate for other forms of disadvantage.
"Further adjustment for socioeconomic status narrowed the completion gap between whites and blacks and between whites and Hispanics for both alcohol and drug treatment. This change suggests that housing instability and lower employment are important barriers to treatment completion for blacks and Hispanics. Adjusting for socioeconomic status modestly increased the relative Asian American advantage, probably because if Asian Americans had the same educational attainment as whites, they would fare even better in treatment.
"Our findings linking lower socioeconomic status to worse treatment completion are important. Low socioeconomic status is a known risk factor for poor access to and quality of mental health treatment.30 Nonethless, some studies suggest that low socioeconomic status may, paradoxically, promote greater access to substance abuse treatment for minorities.31 Adjusting for socioeconomic status narrowed white-minority disparities for all groups except Native Americans in alcohol treatment. This finding warrants further investigation, since Native Americans in alcohol treatment were more likely than whites to be unemployed and to have less education."Source:Brendan Saloner and Benjamin Lê Cook, "Blacks And Hispanics Are Less Likely Than Whites To Complete Addiction Treatment, Largely Due To Socioeconomic Factors," Health Affairs, 32, no.1 (2013):135-145 doi: 10.1377/hlthaff.2011.0983, pp. 140-142.
(Prescription Injectable Opiates) "Prescribing injectable opiates is one of many options in a range of treatments for opiate-dependent drug users. In showing that it attracts and retains long term resistant opiate-dependent drug users in treatment and that it is associated with significant and sustained reductions in drug use and improvements in health and social status, our findings endorse the view that it is a feasible option."Source:Metrebian, Nicky, Shanahan, William, Wells, Brian, and Stimson, Gerry, "Feasibility of prescribing injectable heroin and methadone to opiate-dependent drug users; associated health gains and harm reductions," The Medical Journal of Australia (Sydney, Australia: June 1998) Volume 168, Issue 12, pp. 596-600.
(Heroin Assisted Treatment vs Methadone Maintenance) "The German model project for heroin-assisted treatment of opioid dependent patients is so far the largest randomised control group study that investigated the effects of heroin treatment. This fact alone lends particular importance to the results in the (meanwhile worldwide) discussion of effects and benefits of heroin treatment. For the group of so-called most severely dependent patients, heroin treatment proves to be superior to the goals of methadone maintenance based on pharmacological maintenance treatment. This result should not be left without consequences. In accordance with the research results from other countries, it has to be investigated to what extent heroin-assisted treatment can be integrated into the regular treatment offers for severely ill i.v. opioid addicts."Source:Naber, Dieter, and Haasen, Christian, Centre for Interdisciplinary Addiction Research of Hamburg University, "The German Model Project for Heroin Assisted Treatment of Opioid Dependent Patients -- A Multi-Centre, Randomised, Controlled Treatment Study: Clinical Study Report of the First Study Phase," January 2006, p. 122.
(Effectiveness of Heroin-Assisted Treatment [HAT] and Overview of Research) "A few key conclusions and discussion points regarding the state and future of HAT (heroin-assisted treatment) can be offered based on the above review of completed or ongoing studies.
"First, although the basic goal of the different HAT studies is similar, each of the studies is distinct in key aspects, thus limiting direct comparisons and meta-analyses.40 Although this might be a desirable goal for science, it should be noted that heroin addiction and its consequences occur in distinct real-life environments (including unique cultural and system factors), and interventions need to be devised, measured, and evaluated within these to have authentic relevance for policy and practice.33,41
"Second, the discussed studies above have demonstrated in several different contexts that the implementation of HAT is feasible, effective, and safe as a therapeutic intervention.21,24,26,30 This should not be seen as a conclusion that could be taken for granted because many observers expected disastrous consequences from the provision of medical heroin prescription.
"Third, even within the contexts of relevant methodological constraints, e.g., the Swiss study relying purely on prospective observational data, and most of the other RCTs comparing HAT outcomes against a control intervention (MMT), which participants have previously either rejected by choice or proven to be ineffective, 32,42 the reviewed HAT studies have demonstrated rather robust and consistently positive therapeutic outcomes on the various indicators chosen for a population of high-risk heroin addicts for whom currently no effective alternative therapies are available. Clearly, this demonstrated effectiveness is at this point limited to short-term outcomes, and long-term examinations ought to follow (albeit Swiss follow-up data present initial positive evidence in this regard).43 It may very well emerge that HAT's main long-term benefit does not materialize through life-long maintenance, but by stabilizing and readying many of its patients for other simpler therapeutic interventions or even abstinence.
"Fourth, also given the current expansion and diversification of alternative oral opioid maintenance therapies (e.g., buprenorphine and morphine) and considering the complex logistics (on both providers and patients_ ends), high costs, and sociopolitical controversy around (especially injection) HAT, the most sensible role of HAT is likely that of an exceptional 'last resort' option for heroin addicts who cannot be effectively attracted into or treated in other available therapeutic interventions.44,45 Granted the above, the primary emerging challenge for science—rather than conducting new and more HAT effectiveness studies—is to provide evidence-based guidelines on how to effectively match existing heroin addict profiles and needs with existing treatment options. This challenge has recently been complicated—in at least some jurisdictions—with the increasing diversification of heroin into poly-opioid (e.g., prescription) use profiles.46
"Finally, after extensive HAT research efforts over the past decade, the principal onus of action has shifted from the scientific to the political arena in the jurisdictions under study.12,18 Despite the overall positive results of completed HAT trials undoubtedly justifying some role of HAT in the addiction treatment landscape, authorities in only two countries, Switzerland and the Netherlands, have decisively acted on this issue.34"Source:Benedikt Fischer, Eugenia Oviedo-Joekes, Peter Blanken, Christian Haasen, Jurgen Rehm, Martin T. Schechter, John Strang, and Wim van den Brink, "Heroin-assisted Treatment (HAT) a Decade Later: A Brief Update on Science and Politics," Journal of Urban Health: Bulletin of the New York Academy of Medicine, (2007) Vol. 84, No. 4, pp. 559-560.
(Decline in Problematic Heroin Use) "Heroin misuse in Switzerland was characterised by a substantial decline in heroin incidence and by heroin users entering substitution treatment after a short time, but with a low cessation rate. There are different explanations for the sharp decline in incidence of problematic heroin use. According to Ditton and Frischer, such a steep decline in incidence of heroin use is caused by the quick slow down of the number of non-using friends who are prepared to become users in friendship chains. Musto's generational theory regards the decline in incidence more as a social learning effect whereby the next generation will not use heroin because they have seen the former generation go from pleasant early experiences to devastating circumstances for addicts, families, and communities later on."Source:Nordt, Carlos, and Rudolf Stohler, "Incidence of Heroin Use in Zurich, Switzerland: A Treatment Case Register Analysis," The Lancet, Vol. 367, June 3, 2006, p. 1833.
(Crime Reduction) "With respect to the group of those treated uninterruptedly during four years, a strong decrease in the incidence and prevalence rates of overall criminal implication for both intense and moderate offenders was found. As to the type of offense, similar diminutions were observed for all types of offenses related to the use or acquisition of drugs. Not surprisingly, the most pronounced drop was found for use/possession of heroin. In accordance with self-reported and clinical data (Blaettler, Dobler-Mikola, Steffen, & Uchtenhagen, 2002; Uchtenhagen et al., 1999), the analysis of police records suggests that program participants also tend strongly to reduce cocaine and cannabis use probably because program participants dramatically reduced their contacts with the drug scene when entering the program (Uchtenhagen et al., 1999) and were thus less exposed to opportunities to buy drugs. Consequently, their need for money is not only reduced with regard to heroin but also to other substances. Accordingly, the drop in acquisitive crime, such as drug selling or property crime, is also remarkable and related to all kinds of thefts like shoplifting, vehicle theft, burglary, etc. Detailed analyses indicated that the drop found is related to a true diminution in criminal activity rather than a more lenient recording practice of police officers towards program participants.
"On average, males had higher overall rates than females in the pretreatment period. However, no marked gender differences were found with regard to in-treatment rates. Taken as a whole, this suggests that the treatment had a somewhat more beneficial effect on men than women. This result is corroborated by self-report data (Killias et al., 2002). With respect to age and cocaine use, no relevant in-treatment differences were observed. As to program dropout, after one year, about a quarter of the patients had left the program, and after four years, about 50% had left. Considering the high-risk profile of the treated addicts, this retention rate is, at least, promising."Source:Ribeaud, Denis, "Long-term Impacts of the Swiss Heroin Prescription Trials on Crime of Treated Heroin Users," Journal of Drug Issues (Talahassee, FL: University of Florida, Winter 2004), p. 187.
(Reasons for Discontinuing Treatment) "Finally, the analysis of the reasons for interrupting treatment revealed that, even in the group of those treated for less than one year, the majority did not actually drop out of the program but rather changed the type of treatment, mostly either methadone maintenance or abstinence treatment. Knowing that methadone maintenance treatment and a fortiori abstinence treatment is able to substantially reduce acquisitive crime, the redirection of heroin maintenance patients toward alternative treatments is probably the main cause for the ongoing reduction or at least stabilization of criminal involvement of most patients after treatment interruption. Thus the principal post-treatment benefit of heroin maintenance seems to be its ability to redirect even briefly treated high-risk patients towards alternative treatments rather than back 'on the street'."Source:Ribeaud, Denis, "Long-term Impacts of the Swiss Heroin Prescription Trials on Crime of Treated Heroin Users," Journal of Drug Issues (Talahassee, FL: University of Florida, Winter 2004), p. 188.