Bridges have been built: Is anyone using them?

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Integrated Substance Abuse Programs

Bridges have been built:

Bridges have been built:

Is anyone using them?

Is anyone using them?

Richard A. Rawson, Ph.D, Professor

Richard A. Rawson, Ph.D, Professor

Supported by:

Supported by:

National Institute on Drug Abuse (NIDA)

National Institute on Drug Abuse (NIDA)

Pacific Southwest Technology Transfer Center (SAMHSA)

Pacific Southwest Technology Transfer Center (SAMHSA)

United Nations Office of Drugs and Crime

(2)

The Problem in 1996

The Problem in 1996

The US Substance Abuse Research and

The US Substance Abuse Research and

Treatment Systems each spend billions of

Treatment Systems each spend billions of

dollars per year on the problem of

dollars per year on the problem of

substance abuse treatment.

substance abuse treatment.

However, the efforts have traditionally

However, the efforts have traditionally

been completely disconnected. Despite

been completely disconnected. Despite

over 30 years of research findings, most

over 30 years of research findings, most

treatment services are based on practices

treatment services are based on practices

developed during the 1950s and 1960s.

(3)

U.S. Agencies Involved with Substance

U.S. Agencies Involved with Substance

Abuse Research and Treatment

Abuse Research and Treatment

Research Agencies

NIH

National Institutes of Health

NIDA

National Institute on Drug Abuse

NIAAA

(4)

U.S. Agencies Involved with Substance

U.S. Agencies Involved with Substance

Abuse Research and Treatment

Abuse Research and Treatment

Service Agencies

SAMHSA

Substance Abuse, Mental Health Services Administration

CSAT

Center for Substance Abuse Treatment

CSAP

(5)

Traditional

Traditional

Culture

Culture

of U.S.

of U.S.

Substance Abuse

Substance Abuse

RESEARCH

RESEARCH

System

System

 UniversityUniversity--based, academic personnelbased, academic personnel

 Minimal community involvementMinimal community involvement

 Treatment viewed condescendinglyTreatment viewed condescendingly

 Publish data in professional journalsPublish data in professional journals

 Little systematic attempt to transfer Little systematic attempt to transfer

knowledge

knowledge 

(6)

Traditional

Traditional

Culture

Culture

of U.S. Substance

of U.S. Substance

Abuse

Abuse

SERVICE

SERVICE

Delivery System

Delivery System

 Recovering/paraprofessional staffRecovering/paraprofessional staff

 Minimal connections with academic traditionMinimal connections with academic tradition

 Personal ideology determines treatment Personal ideology determines treatment choices

choices

 Generally antiGenerally anti--medicationmedication

 Uneven and inadequate treatment fundingUneven and inadequate treatment funding

 Little attention to dataLittle attention to data

(7)

Bridging the Gap

Bridging the Gap

: A Benchmark

: A Benchmark

Institute of Medicine (1998). S. Lamb,

Institute of Medicine (1998). S. Lamb,

M.R.

M.R.

Greenlick

Greenlick

, & D. McCarty, D. (Eds.),

, & D. McCarty, D. (Eds.),

Bridging the gap between practice and

Bridging the gap between practice and

research

research

: Forging partnerships with

: Forging partnerships with

community

community

-

-

based drug and alcohol

based drug and alcohol

treatment

treatment

. Washington, DC: National

. Washington, DC: National

Academy Press.

(8)

THE NATIONAL INSTITIUTE ON

THE NATIONAL INSTITIUTE ON

DRUG ABUSE (NIDA) CLINICAL

DRUG ABUSE (NIDA) CLINICAL

TRIALS NETWORK (CTN)

TRIALS NETWORK (CTN)

www.nida.nih.gov

(9)

NIDA Clinical Trials Network (CTN)

NIDA Clinical Trials Network (CTN)

Mission Mission

The mission of the Clinical Trials Network (CTN) is to improve t

The mission of the Clinical Trials Network (CTN) is to improve the he quality of drug abuse treatment throughout the country using sci

quality of drug abuse treatment throughout the country using science ence as the vehicle.

as the vehicle.

The CTN provides an enterprise in which the National Institute o

The CTN provides an enterprise in which the National Institute on Drug n Drug Abuse, treatment researchers, and community

Abuse, treatment researchers, and community--based service based service providers cooperatively develop, validate, refine, and deliver n providers cooperatively develop, validate, refine, and deliver new ew treatment options to patients in community

treatment options to patients in community--level clinical practice. This level clinical practice. This unique partnership between community treatment providers and

unique partnership between community treatment providers and academic research leaders aims to achieve the following objectiv academic research leaders aims to achieve the following objectives:es:

Conducting studies of behavioral, pharmacological, and integrateConducting studies of behavioral, pharmacological, and integrated d behavioral and pharmacological treatment interventions of therap

behavioral and pharmacological treatment interventions of therapeutic eutic effect in rigorous, multi

effect in rigorous, multi--site clinical trials to determine effectiveness site clinical trials to determine effectiveness across a broad range of community

across a broad range of community--based treatment settings and based treatment settings and diversified patient populations; and

diversified patient populations; and

Ensuring the transfer of research results to physicians, cliniciEnsuring the transfer of research results to physicians, clinicians, ans, providers, and patients.

(10)

The NIDA CTN: What is it?

The NIDA CTN: What is it?

Network OrganizationNetwork Organization

 The CTN framework consists of seventeen The CTN framework consists of seventeen Nodes Nodes

(Regional Research and Training Centers, linked with

(Regional Research and Training Centers, linked with

five to ten or more Community

five to ten or more Community--based Treatment based Treatment

programs), a Clinical Coordinating Center, and a Data

programs), a Clinical Coordinating Center, and a Data

and Statistical Center.

and Statistical Center.

 This allows the CTN to provide a broad and powerful This allows the CTN to provide a broad and powerful

infrastructure for rapid, multi

infrastructure for rapid, multi--site testing of promising site testing of promising science

science--based therapies and the subsequent delivery of based therapies and the subsequent delivery of these treatments to patients in community

these treatments to patients in community--based based treatment settings across the country.

(11)

The Pacific Node of the CTN

The Pacific Node of the CTN

 The Pacific Region Node is a partnership The Pacific Region Node is a partnership

between the Regents of the University of

between the Regents of the University of

California, Los Angeles and several community

California, Los Angeles and several community

treatment programs in the State.

treatment programs in the State. 

 The Pacific Node incorporates researchers and The Pacific Node incorporates researchers and

clinicians from throughout California. Many of

clinicians from throughout California. Many of

the clinical networks have been involved in the

the clinical networks have been involved in the

transfer of research into practice for over a

transfer of research into practice for over a

decade

(12)

NIDA CTN: How does it work?

NIDA CTN: How does it work?

Research concepts are generated at each

Research concepts are generated at each

of the Nodes after discussion between

of the Nodes after discussion between

researchers and clinicians.

researchers and clinicians.

These concepts are proposed to the CTN

These concepts are proposed to the CTN

group and are voted on. Those receiving

group and are voted on. Those receiving

highest vote go to director of NIDA for

highest vote go to director of NIDA for

approval.

(13)

Pacific Region Protocol

Pacific Region Protocol

Involvement

Involvement

PROTOCOL0001

PROTOCOL0001 Buprenorphine/Naloxone Buprenorphine/Naloxone for Opiate for Opiate Detoxification

Detoxification - - INpatientINpatient

PROTOCOL0002 PROTOCOL0002 Buprenorphine/Naloxone Buprenorphine/Naloxone for Opiate for Opiate Detoxification

Detoxification - - OUTpatientOUTpatient

PROTOCOL0004 PROTOCOL0004 Motivational Enhancement Treatment Motivational Enhancement Treatment (MET)

(MET) 

PROTOCOL0006 PROTOCOL0006 Motivational Incentives Motivational Incentives - - Drug Free Drug Free Clinics

Clinics 

PROTOCOL0007 PROTOCOL0007 Motivational Incentives Motivational Incentives - - Methadone Methadone Clinics

Clinics 

PROTOCOL0008 PROTOCOL0008 A Baseline for Investigating Diffusion A Baseline for Investigating Diffusion of Innovation

(14)

Pacific Region Protocol

Pacific Region Protocol

Involvement

Involvement

PROTOCOL0009 PROTOCOL0009 Smoking Cessation Treatment With Smoking Cessation Treatment With Transdermal

Transdermal Nicotine Replacement Therapy In Nicotine Replacement Therapy In Substance Abuse Rehabilitation Programs

Substance Abuse Rehabilitation Programs

PROTOCOL0012 PROTOCOL0012 Characteristics of Screening, Characteristics of Screening,

Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral

Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral

Infection, and Sexually Transmitted Infections in

Infection, and Sexually Transmitted Infections in

Substance Abuse Treatment Programs

Substance Abuse Treatment Programs

PROTOCOL0014 PROTOCOL0014 Brief Strategic Family Therapy (BSFT) Brief Strategic Family Therapy (BSFT) For Adolescent Drug Abusers

(15)

Pacific Region Protocol

Pacific Region Protocol

Involvement

Involvement

PROTOCOL0018 PROTOCOL0018 Reducing HIV/STD Risk Behaviors: A Reducing HIV/STD Risk Behaviors: A Research Study for Men in Drug Abuse Treatment

Research Study for Men in Drug Abuse Treatment

PROTOCOL0019 PROTOCOL0019 Reducing HIV/STD Risk Behaviors: A Reducing HIV/STD Risk Behaviors: A Research Study for Women in Drug Abuse Treatment

Research Study for Women in Drug Abuse Treatment

PROTOCOL0027 PROTOCOL0027 Starting Treatment with Agonist Starting Treatment with Agonist Replacement Therapies

Replacement Therapies – – STARTSTART

PROTOCOL0030 PROTOCOL0030 Prescription Prescription Opioid Opioid Addiction Addiction Treatment Study (POATS)

(16)

CTN: Strengths

CTN: Strengths

 Has provided a true forum for researchers and Has provided a true forum for researchers and

clinicians to interact cooperatively and

clinicians to interact cooperatively and

collaboratively

collaboratively 

 Has generated a significant amount of new Has generated a significant amount of new

published research

published research 

 Research and surrounding publications do Research and surrounding publications do

appear to be promoting some transfer of

appear to be promoting some transfer of

research to practice in CTN

research to practice in CTN--affiliated treatment affiliated treatment organizations

organizations 

(17)

CTN: Limitations (opinion)

CTN: Limitations (opinion)

Extremely expensive

Extremely expensive

Extremely bureaucratic and committee

Extremely bureaucratic and committee

heavy

heavy

Productivity not commensurate with

Productivity not commensurate with

budget

budget

Bi

Bi

-

-

directionality of effort is only moderately

directionality of effort is only moderately

successful (mostly researcher driven)

successful (mostly researcher driven)

Impact on the larger US treatment system

Impact on the larger US treatment system

is unknown

(18)

Running the Trials is not enough

Running the Trials is not enough

Diffusion of Innovations. 4

Diffusion of Innovations. 4

th th

Edition

Edition

Everett M.

Everett M.

Rogers

Rogers

-

-

1995

1995

-

-

New York:

New York:

Free Press

(19)

Research Questions

Research Questions

 NIDANIDA’’s CTN offers an important opportunity s CTN offers an important opportunity to examine if and how inter

to examine if and how inter--organizational organizational relationships promote innovation adoption

relationships promote innovation adoption

 Focus on buprenorphine and voucherFocus on buprenorphine and voucher--based based

motivational incentives

motivational incentives 

 Are CTPs in the CTN protocols significantly Are CTPs in the CTN protocols significantly

more likely to adopt bup and/or vouchers?

more likely to adopt bup and/or vouchers?

 Is Is ““trialabilitytrialability” ” a predictor of adoption?a predictor of adoption?

 Does membership in the CTN confer Does membership in the CTN confer

advantages to CTPs that are not involved in

advantages to CTPs that are not involved in

these protocols?

these protocols?

(20)

Adoption of Buprenorphine

Adoption of Buprenorphine

46.0% 16.0% 11.1% 0% 20% 40% 60%

CTPs in Trial Other CTPs Non-CTN

CTPs that participated in the buprenorphine trials

CTPs that participated in the buprenorphine trials

were significantly more likely to have adopted

were significantly more likely to have adopted

buprenorphine than CTPs not in the trials and non

buprenorphine than CTPs not in the trials and non- -CTN centers

(21)

Logistic Regression Model of

Logistic Regression Model of

Buprenorphine Adoption

Buprenorphine Adoption

 Controlling for other organizational factors:Controlling for other organizational factors:

 CTPs in the buprenorphine protocols were 5.2 times more likely CTPs in the buprenorphine protocols were 5.2 times more likely to use buprenorphine (at the 6

to use buprenorphine (at the 6--month followmonth follow--up) than nonup) than non--CTN CTN programs (p<.01)

programs (p<.01)

 Other significant predictors, net of effects of CTN Other significant predictors, net of effects of CTN exposure:

exposure:

 Center offers detox services (O.R. = 3.59)Center offers detox services (O.R. = 3.59)

 Center has a physician on staff or contract (O.R. = 3.94)Center has a physician on staff or contract (O.R. = 3.94)

(22)

Adoption of Voucher

Adoption of Voucher

-

-

Based

Based

Motivational Incentives

Motivational Incentives

44.4% 32.8% 31.2% 0% 20% 40% 60%

CTPs in Trial Other CTPs Non-CTN

These differences in adoption were not

These differences in adoption were not

statistically significant

statistically significant

(23)

Discussion

Discussion

 The ability to compare CTN vs. nonThe ability to compare CTN vs. non--CTN CTN centers provides a unique opportunity to

centers provides a unique opportunity to

examine a variety of factors that influence

examine a variety of factors that influence

innovative behavior and the adoption of

innovative behavior and the adoption of

evidence

evidence--based practices at the organizational based practices at the organizational level.

level. 

 The longitudinal design of these studies will The longitudinal design of these studies will allow for observation of continued trends in

allow for observation of continued trends in

adoption of these techniques.

adoption of these techniques. 

 Future research is planned to examine the use Future research is planned to examine the use of MET and motivational interviewing in CTN

of MET and motivational interviewing in CTN

and non

(24)

From a clinical trial to technology

From a clinical trial to technology

transfer

transfer

 S. Kellogg, M. Burns, P. Coleman, M. Stitzer, J. S. Kellogg, M. Burns, P. Coleman, M. Stitzer, J.

Wale, M. Jeanne

Wale, M. Jeanne KreekKreek, M.D., M.D.

Something of value: The introduction of Something of value: The introduction of

contingency management interventions into

contingency management interventions into

the New York City Health and Hospital

the New York City Health and Hospital

Addiction Treatment Service.

Addiction Treatment Service.

 Journal of Substance Abuse Treatment, Journal of Substance Abuse Treatment, 2005, 2005, Volume 28,

(25)

The NIDA

The NIDA

Methamphetamine Clinical

Methamphetamine Clinical

Trials Group (MCTG)

Trials Group (MCTG)

(26)

MCTG: The Problem

MCTG: The Problem

 NIDA has a desire to speed up the development of NIDA has a desire to speed up the development of

medications for the treatment of methamphetamine use

medications for the treatment of methamphetamine use

disorders.

disorders.

 Too few research groups available in areas of the US Too few research groups available in areas of the US

with extensive methamphetamine use.

with extensive methamphetamine use.

 As complexity of medication testing and regulatory As complexity of medication testing and regulatory system becomes more complex it is difficult for new

system becomes more complex it is difficult for new

investigators to initiate research

(27)

MCTG: The Solution

MCTG: The Solution

 Establish a training/coordinating center to train, Establish a training/coordinating center to train,

organize and monitor sites.

organize and monitor sites. 

 Establish a set of medication testing sites in Establish a set of medication testing sites in

regions with extensive methamphetamine use

regions with extensive methamphetamine use

and an MD and team that can conduct trials.

and an MD and team that can conduct trials. 

 Decide on a medication(s) and protocol for studyDecide on a medication(s) and protocol for study

(28)

Methamphetamine Clinical Trials Group

Methamphetamine Clinical Trials Group

UCLA is the coordinating center for clinical

UCLA is the coordinating center for clinical

studies

studies

5 Sites participate on a contractual basis

5 Sites participate on a contractual basis

Primary focus

Primary focus

-

-

reduction of

reduction of

methamphetamine use

methamphetamine use

All trials use a behavioral platform for all

All trials use a behavioral platform for all

treated subjects

(29)

San Diego, CA

South Bay Treatment Center Joseph Mawhinney, PI

Division of Treatment Research & Development 19 September 2000 Methamphetamine Clinical Trials Group

(MCTG)

Costa Mesa, CA Friends Research Institute

Michael McCann, PI

Des Moines, IA Powell Chemical Dependency Center

Dennis Weis, PI

Kansas City, MO University of Missouri, Kansas City Services, Inc. Jan Campbell, PI Honolulu, HI

John A. Burns School of

Medicine & Queens Hospital William Haning, PI

Los Angeles, CA

UCLA Coordinating Center Richard Rawson, PI

(30)

MCTG Studies

MCTG Studies

 Behavioral Platform Study (Completed Oct, Behavioral Platform Study (Completed Oct,

2002). (N=60)

2002). (N=60) 

 Ondansetron Study ( Completed Dec 1, 2003. Ondansetron Study ( Completed Dec 1, 2003.

(N=120

(N=120 

 Bupropion Study (Completed June 1, 2005) Bupropion Study (Completed June 1, 2005)

(N=120)

(N=120) 

 Topirimate Study (Underway, projected Topirimate Study (Underway, projected

completion, April 1, 2007 (N=120)

completion, April 1, 2007 (N=120) 

(31)

MCTG: Accomplishments

MCTG: Accomplishments

Transferred state

Transferred state

-

-

of

of

-

-

the

the

-

-

art clinical trials

art clinical trials

methods to clinical sites with no previous

methods to clinical sites with no previous

research experience.

research experience.

Successful conducted 3 studies to date

Successful conducted 3 studies to date

with one (bupropion) showing significant

with one (bupropion) showing significant

promise

promise

Sites now are capable of applying for

Sites now are capable of applying for

independent research funding

(32)

Process Improvement 101

(33)

Why Process Improvement?

Why Process Improvement?

 Customers are served by Customers are served by processesprocesses

 85% of customer related 85% of customer related problems problems are are caused by organizational processes

caused by organizational processes 

 To better serve customers, organizations To better serve customers, organizations

must improve

(34)

NIATx Four Project Aims

NIATx Four Project Aims

Reduce Waiting Times

Reduce Waiting Times

Reduce No

Reduce No

-

-

Shows

Shows

Increase Admissions

Increase Admissions

Increase Continuation Rates

(35)

NIATx Results

NIATx Results

Reduce Waiting Times:

Reduce Waiting Times: 51% reduction51% reduction

(37 agencies reporting)

(37 agencies reporting)

Reduce No

Reduce No--Shows: Shows: 41% reduction41% reduction

(28 agencies reporting)

(28 agencies reporting)

Increase Admissions:

Increase Admissions: 56% increase56% increase

(23 agencies reporting)

(23 agencies reporting)

Increase Continuation:

Increase Continuation: 39% increase39% increase

(39 agencies reporting)

(36)

Five Key Principles

Evidence-based predictors of change 

 Understand & Involve the CustomerUnderstand & Involve the Customer

 Focus on Key Problems Focus on Key Problems

 Select the Right Change AgentSelect the Right Change Agent

 Seek Ideas from Outside the Field and Seek Ideas from Outside the Field and

Organization

Organization 

(37)

Most important of all the Principles

Most important of all the Principles

What is it like to be a customer? Staff

What is it like to be a customer? Staff

are customers, too!

are customers, too!

Walk

Walk

-

-

through, focus groups

through, focus groups

Understand and Involve the

Understand and Involve the

Customer

(38)

Focus on Key

Focus on Key

Problems

Problems

What is keeping the executive director

What is keeping the executive director

awake at night?

awake at night?

What processes have staff and

What processes have staff and

customers identified as barriers to

customers identified as barriers to

excellent service?

(39)

Detour 1

Detour 1

Unclear purpose!

Unclear purpose!

Where are you going?

Where are you going?

(40)

Aim Statement

Aim Statement

 ExampleExample

 Improve 30Improve 30--day continuation rates from 30% to day continuation rates from 30% to

80% in outpatient services. 80% in outpatient services.   NeedNeed   TargetTarget 

(41)

Detour 2

Detour 2

No feedback!

No feedback!

Need a tracking measure.

Need a tracking measure.

(42)

California

California

s Proposition 36:Did it

s Proposition 36:Did it

Work?

(43)

The Problem:

The Problem:

California Prison Population,

California Prison Population,

Drug Offenses, 1980

Drug Offenses, 1980

-

-

2000

2000

Source: California Department of Corrections.

Source: California Department of Corrections.

42,947 33,513 23,853 5,116 1,778 0 10,000 20,000 30,000 40,000 50,000 1980 1985 1990 1995 2000

(44)

Increase in California Prison

Increase in California Prison

Population, Drug Offenses, 1970

Population, Drug Offenses, 1970

-

-

1999

1999

Rate per 100,000 Population

Rate per 100,000 Population

0 10 20 30 40 50 60 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 99 Year

Source: California Department of Corrections.

(45)

Solutions?

(46)

Proposition 36

Proposition 36

Substance Abuse & Crime Prevention Act

Substance Abuse & Crime Prevention Act

(SACPA)

(SACPA)

2000 Ballot Measure: Passed by 61% of 2000 Ballot Measure: Passed by 61% of

California voters in 2000

California voters in 2000

Authorized $600,000,000 in new funds for Authorized $600,000,000 in new funds for

implementation. 2001

implementation. 2001--2006.2006.

Drug offenses: NonDrug offenses: Non--sales, nonsales, non- -manufacturing.

manufacturing.

Restrictions on offenders with histories of Restrictions on offenders with histories of

serious or violent crimes

serious or violent crimes

Results in community supervision and Results in community supervision and

treatment instead of: Incarceration or

treatment instead of: Incarceration or

supervision without treatment

(47)

2000 Proposition 36 Ballot Wording:

2000 Proposition 36 Ballot Wording:

Proposition 36

Proposition 36

. Drugs. Probation and

. Drugs. Probation and

Treatment Program.

Treatment Program.

Requires probation and

Requires probation and

drug treatment, not incarceration, for

drug treatment, not incarceration, for

possession, use, transportation of controlled

possession, use, transportation of controlled

substances and similar parole violations, except

substances and similar parole violations, except

sale or manufacture. Authorizes dismissal of

sale or manufacture. Authorizes dismissal of

charges after completion of treatment.

(48)

Result

Result

6,199,992 /

6,199,992 /

60.8%

60.8%

Yes

Yes

votes

votes

3,991,153 /

3,991,153 /

39.2%

39.2%

No

No

votes

votes

Proposition 36 passed and was enacted as the:

Proposition 36 passed and was enacted as the:

Substance Abuse & Crime Prevention Act

Substance Abuse & Crime Prevention Act

(SACPA)

(49)

Arrest or Parole Violation Treatment Conviction and Court Order of Probation and Treatment; or Parole Referral Treatment Completion Conviction Dismissed (probation) Assess ment No shows No shows Repeated violation and dropouts Ineligible No petition, petition denied Attrition

Pipeline

Pipeline

(50)

Implementation

Implementation

Show Rates

Show Rates

Referred Assessed Placed Show rate (%) Year 1 7/01-6/02 44,043 37,495 30,469 69.2 Year 2 7/02-6/03 50,335 42,972 35,947 71.4 Year 3 7/03-6/04 51,033 42,880 37,103 72.6 Total 145,411 123,347 103,519 71.1

(51)

Client Characteristics

Client Characteristics

Half use methamphetamines

Half use methamphetamines

Half used primary drug more than 10 years

Half used primary drug more than 10 years

Half are in treatment for first time

(52)

Treatment Summary

Treatment Summary

34% of clients who enter treatment complete

34% of clients who enter treatment complete

it

it

Most clients are sent to outpatient treatment

Most clients are sent to outpatient treatment

Heroin users rarely get methadone treatment

Heroin users rarely get methadone treatment

Heroin users are least likely to complete

(53)

50.9 10.9 3.1 53.2 8.5 2.5 35.0 5.7 1.5 0 20 40 60 80 100

New drug arrest New property arrest New violent arrest

P ercen t o f o ffen d ers

Referred but untreated (N = 10,196)

Entered but did not complete treatment (N = 14,597) Completed treatment (N = 5,176)

Re

Re

-

-

offending

offending

New Arrests

New Arrests

One Year After Offense, Year 1 (7/01

(54)

53.9a,b 42.2b 40.8a 0 20 40 60 80 100

Assessed but untreated (N = 178)

Entered but did not complete treatment (N = 425) Completed treatment (N = 149) P ercen t o f o ffen d ers

Any Work in the Past 30 Days

Any Work in the Past 30 Days

a,b Group differences are statistically significant, p = .04. Pre-post differences (not shown) are all statistically significant, p <.0001.

(55)

17.7a,b 27.4b 34.6a 0 20 40 60 80 100

Assessed but untreated (N = 178)

Entered but did not complete treatment (N = 426) Completed treatment (N = 149) P e rcen t of of fe n d ers

Any Drug Use in the Past 30

Any Drug Use in the Past 30

Days

Days

(56)

Outcome Summary:

Outcome Summary:

Effect of SACPA As Policy

Effect of SACPA As Policy

SACPA

SACPA

-

-

era offenders have more drug

era offenders have more drug

arrests in the initial 12 months

arrests in the initial 12 months

Initial re

Initial re

-

-

offending is affected by

offending is affected by

differences in incarceration rates

differences in incarceration rates

Violent re

(57)

What about costs?

(58)

-$3,547 -$1,531 $198 -$221 $1,326 $743 $230 -$59 -$2,861 -$4,000 -$3,000 -$2,000 -$1,000 $0 $1,000 $2,000 Prison Jail Probation Parole Arrest and Conviction Treatment Health Tax Total Doll ars p e r o ffe n der -$3,547 -$1,531 $198 -$221 $1,326 $743 $230 -$59 -$2,861 -$4,000 -$3,000 -$2,000 -$1,000 $0 $1,000 $2,000 Prison Jail Probation Parole Arrest and Conviction Treatment Health Tax Total Doll ars p e r o ffe n der

SUMMARY OF FINDINGS

SUMMARY OF FINDINGS

Notes: Figure provides a summary of cost offsets. The zero-line can be interpreted as cost neutral. Any bar above the line represents a cost increase and any bar below the line represents a cost saving.

(59)

COSTS UNDER SACPA

COSTS UNDER SACPA

Savings primarily from prison, jail reductions.

Cost increases primarily from increased

treatment, new crimes.

Costs are $2,861 per offender lower than what

we would expect in the absence of SACPA.

Benefit-to-cost ratio of about 2.5:1.

For treatment completers, the cost savings

reflect a benefit-to-cost ratio of about 4:1

(60)

KEY COST ANALYSIS

KEY COST ANALYSIS

FINDINGS

FINDINGS

Substantially reduced incarceration

Substantially reduced incarceration

costs.

costs.

Greater cost savings for some offenders

Greater cost savings for some offenders

than for others

than for others

Can be improved

(61)

42,947 33,513 23,853 5,116 1,778 0 10,000 20,000 30,000 40,000 50,000 1980 1985 1990 1995 2000

California Prison Population,

California Prison Population,

Drug Offenses, 1980

Drug Offenses, 1980

-

-

2000

2000

Source: California Department of Corrections.

(62)

33,777 42,947 33,513 23,853 5,116 1,778 0 10,000 20,000 30,000 40,000 50,000 1980 1985 1990 1995 2000 2004

California Prison Population,

California Prison Population,

Drug Offenses, 1980

Drug Offenses, 1980

-

-

2004

2004

Source: California Department of Corrections.

(63)

Conclusion

Conclusion

 70% of referrals have entered treatment70% of referrals have entered treatment

 Methamphetamine is the most common drugMethamphetamine is the most common drug

 Half are in treatment for the first timeHalf are in treatment for the first time

 34% of clients have completed treatment34% of clients have completed treatment

 Initial reInitial re--offending is lowest for completersoffending is lowest for completers

 Employment is highest for completersEmployment is highest for completers

 Abstinence is highest for completers, but overall Abstinence is highest for completers, but overall

drug use outcomes are uneven

(64)

Prop 26 (SACPA): Is it good policy?

Prop 26 (SACPA): Is it good policy?

 Approximately 200,000 individuals will have received Approximately 200,000 individuals will have received treatment over program

treatment over program

 Final report currently in processFinal report currently in process

 Fiscal impact appears quite positiveFiscal impact appears quite positive 

 No group has come out to revoke SACPANo group has come out to revoke SACPA

 Disagreements concern exact provisionsDisagreements concern exact provisions

 Failure to pass revised SACPA provisions could result in Failure to pass revised SACPA provisions could result in funding responsibility being passed on to counties.

(65)

UNODC International Network of

UNODC International Network of

Treatment and Rehabilitation Resource

Treatment and Rehabilitation Resource

Centres

(66)

Recognizing and Addressing the Need to Expand Training

Recognizing and Addressing the Need to Expand Training

and Treatment Capacity to Address Substance Abuse

and Treatment Capacity to Address Substance Abuse

Problems

Problems

There is a need for trained professionals to deliver effective There is a need for trained professionals to deliver effective

rehabilitation and harm reduction interventions for substance

rehabilitation and harm reduction interventions for substance

abuse and dependence around the world

abuse and dependence around the world

The paucity of properly trained professional is a barrier to the The paucity of properly trained professional is a barrier to the development and delivery of effective treatment services,

development and delivery of effective treatment services,

especially regarding underserved and inappropriately served

especially regarding underserved and inappropriately served

populations of drug abusers, including women and children

populations of drug abusers, including women and children

There is a worldwide shortage of qualified training experts and There is a worldwide shortage of qualified training experts and educational settings in which drug abuse treatment training is

educational settings in which drug abuse treatment training is

provided, particularly in developing regions

provided, particularly in developing regions

A goal of this training effort is to train clinicians and educatA goal of this training effort is to train clinicians and educate e academics who will train additional professionals to address

academics who will train additional professionals to address

the problems of drug abuse in an empirically rational method

(67)

Capacity Building Plan

Capacity Building Plan

In short, the goal of the capacity building plan is to increase

In short, the goal of the capacity building plan is to increase

the number of personnel who can disseminate and

the number of personnel who can disseminate and

promote the use of effective, scientifically

promote the use of effective, scientifically--supported and supported and practical drug abuse treatment practices around the

practical drug abuse treatment practices around the

world.

(68)

Treatnet Members

Treatnet Members

RS Ketergantungan Obat The Drug RS Ketergantungan Obat The Drug

Dependence Hospital,

Dependence Hospital, Indonesia Indonesia

Iranian National Prison Organisation /Iranian Iranian National Prison Organisation /Iranian National Centre for Addiction Studies INCAS,

National Centre for Addiction Studies INCAS,

Iran

Iran

National Research and Clinical Centre on National Research and Clinical Centre on Medical and Social Problems of Drug,

Medical and Social Problems of Drug,

Kazakhstan

Kazakhstan

Drug Rehabilitation Unit, Mathari Hospital, Drug Rehabilitation Unit, Mathari Hospital, Kenya

Kenya

Centros de IntegraciCentros de Integracióón Juvenil A.C., n Juvenil A.C., Mexico Mexico

(69)

Treatnet Members

Treatnet Members

Shanghai Drug Abuse Treatment Centre, Shanghai Drug Abuse Treatment Centre, China China

Carisma Centre for Attention and Integral Mental Carisma Centre for Attention and Integral Mental Health,

Health, Colombia Colombia

General Secretariat of Mental Health, General Secretariat of Mental Health, Egypt Egypt

TT Ranganathan Clinical Research Foundation, TT Ranganathan Clinical Research Foundation, India India

Regional Research Centre of Narcology and Regional Research Centre of Narcology and Psychopharmacology affiliated to

Psychopharmacology affiliated to

St. Petersburg Pavlov State Medical University,

St. Petersburg Pavlov State Medical University,

Russia

Russia

Psychosocial Attention Centre for Alcohol and other Psychosocial Attention Centre for Alcohol and other Drugs,

(70)

Treatnet Members

Treatnet Members

Turning Point Alcohol and Drug Centre Inc., Turning Point Alcohol and Drug Centre Inc., Australia

Australia

Centre for Addiction and Mental Health CAMH, Centre for Addiction and Mental Health CAMH,

Canada

Canada

Mudra, Mudra, Germany Germany

AsociaciAsociacióón Proyecto Hombre, n Proyecto Hombre, Spain Spain

Maria Ungdom, Maria Ungdom, Sweden Sweden

Cranstoun Drug Services, Cranstoun Drug Services, United Kingdom United Kingdom

Fayette Companies, Fayette Companies, U.S.A. U.S.A.

Stanley Street Treatment & Resources (SSTAR) Inc., Stanley Street Treatment & Resources (SSTAR) Inc., U.S.A.

(71)

Capacity Building Plan for UNODC Treatnet

Capacity Building Plan for UNODC Treatnet

Program: What are we trying to do?

Program: What are we trying to do?

The purpose of the capacity building component for the

The purpose of the capacity building component for the

UNODC Treatnet Program is to develop a set of training

UNODC Treatnet Program is to develop a set of training

materials and a training plan for trainers from 20 Resource

materials and a training plan for trainers from 20 Resource

Centres

Centres established by UNODC. To accomplish this task, we established by UNODC. To accomplish this task, we will:

will:

1. Conduct a training needs assessment.

1. Conduct a training needs assessment.

2. Determine priority training/skill development topics.

2. Determine priority training/skill development topics.

3. Create a set of training modules to address #2.

3. Create a set of training modules to address #2.

4. Conduct a set of training, supervision and mentoring

4. Conduct a set of training, supervision and mentoring

activities with two trainers from each of the resource

activities with two trainers from each of the resource centrescentres.. 5. Collect information to contribute to the project evaluation.

(72)

Need Assessment: A Brief Summary

Need Assessment: A Brief Summary

The following topics received the most interest

The following topics received the most interest..

Motivational InterviewingMotivational Interviewing

Relapse Prevention (CBT)Relapse Prevention (CBT)

AssessmentAssessment

Program managementProgram management

Outreach strategiesOutreach strategies

YouthYouth

Building Service NetworksBuilding Service Networks

FamilyFamily

CoCo--occurringoccurring

Drugs and the brainDrugs and the brain

Brief interventionsBrief interventions

Outpatient treatmentsOutpatient treatments

Harm minimizationHarm minimization

Basic knowledge of drugsBasic knowledge of drugs

(73)

Summary

Summary

 The issue of research practice integration has The issue of research practice integration has

been a priority in the US for almost a decade.

been a priority in the US for almost a decade. 

 Major initiatives have been established to cross Major initiatives have been established to cross

the research

the research--practice gap. practice gap.

 Clinicians are more aware of research value and Clinicians are more aware of research value and

findings

findings 

 Quality research can be done in clinical service Quality research can be done in clinical service

delivery settings

delivery settings 

 It continues to be a challenging, expensive, time It continues to be a challenging, expensive, time

consuming process

(74)

THANK YOU

THANK YOU

RRAWSON@MEDNET.UCLA.EDU RRAWSON@MEDNET.UCLA.EDU WWW.UCLAISAP.ORG WWW.UCLAISAP.ORG

Figure

Updating...

References

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