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Nebraskas Methamphetamine Treatment Study: Final Report

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Title: Nebraskas Methamphetamine Treatment Study: Final Report


1
Nebraskas Methamphetamine Treatment Study Final
Report
  • November 2, 2006
  • Nicole Kennedy, J.D.
  • University of Nebraska at Omaha
  • 402-554-3794
  • nckennedy_at_mail.unomaha.edu

2
Myth or Fact
  • MA is instantly addictive, Everyone who tries
    MA becomes addicted, or Trying MA, even once,
    produces an insatiable craving for the drug for
    the rest of your life
  • MA triggers an extreme reaction within the brain.
    Whether one becomes addicted by one, two or a
    dozen exposures to MA depends on individual
    vulnerabilities to addiction, the potency of the
    MA, and future use patterns.

3
Myth or Fact
  • There is no effective recovery strategy for MA
    addiction.
  • With proper treatment and recovery plans, MA
    addicts have achieved higher abstinence rates
    than alcoholics and marijuana users. As with any
    other chemical dependency, recovery from MA use
    depends, in part, on societys commitment to
    maintaining recovery support on which addicts can
    rely for the rest of their lives.

4
Myth or Fact
  • Coerced treatment does not work or Forcing
    addicts to go through treatment in the justice
    system is a waste of time and money
  • MA may be the tip of an addicts substance abuse
    problem, but it is particularly vulnerable to
    forced treatment. Until an client has been
    liberated from the lingering cognitive and
    psychological effects of MA use, it may be
    impossible to develop the individualized
    treatment strategies necessary to promote
    long-term recovery. Few addicts muster the
    motivation to quit MA until forced to do so.
    Effective treatment, even if initially forced
    upon an addict, can reduce future drug use and
    criminal behavior.

5
Myth or Fact
  • MA affects your mental health or MA makes
    users psychotic
  • As with individual susceptibilities to the
    physical consequences of MA, people vary in their
    psychological response to MA. However, prolonged
    use of MA consistently manifests psychological
    and emotional symptoms which were not apparent
    prior to use. Treatment providers may not be
    able to accurately assess an addicts true
    mental state until the user has abstained from MA
    for at least 45 to 60 days.

6
Myth or Fact
  • MA is Nebraskas biggest substance abuse
    problem
  • Substance abuse is Nebraskas biggest substance
    abuse problem. Methamphetamine use is merely the
    most prominent indicator of the States need to
    respond more effectively to all forms of chemical
    dependency.

7
Myth or Fact
  • Methamphetamine detoxification requires
    residential treatment in a drug rehab center.
  • Effective MA detoxification can be accomplished
    without residential treatment. Out-patient
    detoxification requires intense supervision,
    frequent drug screens and accountability to be
    successful.

8
Myth or Fact
  • Recovery from MA demands a complete abstinence
    from MA and all other drugs and alcohol.
  • The treatment community generally views the use
    of alternative drugs and alcohol as incomplete
    recovery, even if an client discontinues MA use.
    During the early stages of MA treatment, breaking
    the cycle of MA use may represent a critical step
    forward in addressing a users overall addiction
    problem.

9
Findings in the Methamphetamine Treatment Study
10
Increase in Meth Use
  • In 1992, admissions for methamphetamine abuse
    totaled 5.5 per one hundred thousand persons by
    2003, this rate increased nearly twenty-fold to
    99.1 per one hundred thousand.
  • In 1992 and 1997, Nebraskas methamphetamine
    treatment admission rate was lower than any of
    its neighbors by 2002 and 2003 Nebraskas rate
    was exceeded only by Iowa and Wyoming.
  • As the following figure illustrates, Nebraskas
    admission rate (per hundred thousand population)
    for amphetamine abuse treatment has been
    increasing faster than the United States and most
    of its neighbors.

11
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12
Myth of the Meth-Only Addict
  • Debilitating physical and psychological
    consequences of their methamphetamine use are
    frequently the extreme symptoms which draw the
    attention of social service and justice
    professionals, but these addicts are equally
    dependent on other drugs.
  • Studies show that as addicts receive treatment
    for their primary dependency on
    methamphetamine, many compensate by increasing
    their use of alcohol and marijuana.

13
Meth-Specific Treatment
  • From a clinical treatment perspective,
    methamphetamine use clearly indicates a need for
    a specialized case-plan which accounts for how
    methamphetamine factors into the overall
    constellation of an addicts recovery.
  • From the standpoint of justice and social service
    systems, however, the broad array of chemical
    dependency services required to promote long-term
    abstinence do not support the creation of a
    unique treatment infrastructure particularized
    for methamphetamine.

14
Nebraskas Biggest Substance Abuse Problem
  • Nebraskas biggest SA problem is substance abuse
  • The methamphetamine treatment needs of the
    criminal justice and health and human services
    systems cannot be distinguished from the alcohol,
    cocaine, marijuana, or other drug abuse treatment
    needs of those systems they are one and the
    same.

15
Number of Treatment Providers and Addicts
Number of Nebraska Addicts by Drug (CPACS-Univ.
of NE at Omaha-2006)
No. of Treatment Profs by Lic./Cert.
(CPACS-Univ. of NE at Omaha-2006)
16
Stimulants (Other than MA)
Ratio of Treatment Professionals to Drug
Dependent Nebraskans (CPACS-Univ. of NE at
Omaha-2006)
Narcotics
Methamphetamine
1-Psychiatrist
Alcohol
21-Stimulant Only
3-Psychologist
65-Stimulant Alcohol
34-Narcotic Only
5-LADAC
102-Narcotic and Alcohol
46-Meth Only
140-Meth Alcohol
for every
22-LMHP
1092-Alcohol Only
31 Treatment Professionals
1500 Drug Dependent
Nebraskans
There are fewer than 31 treatment professionals
for every 1500 Nebraskans dependent on drugs or
alcohol.
Units
Each
represents 1 person
17
Prosecutor
18
Maximizing Contact with the Justice Social
Service Systems
  • To maximize the contact that an client has with
    the justice or social service systems, we must
    identify the points where addicts can receive
    help before they exit the system.
  • The following figure demonstrates
  • The point(s) in the system where the client will
    receive the most attention for substance
    abuse/mental health problems
  • The point(s) in the system the client will likely
    pass and
  • The point(s) in the system the pass.

19
From Initial Report to the MA Treatment Study
Committee of the Nebraska Community Corrections
Council Moving Past the Era of Good Intentions
Methamphetamine Treatment Study, State of
Nebraska Contract No. 12969-04. December 2005
20
Types of Needed Services
  • Effective substance abuse treatment requires a
    wide array of services be available.
  • The following figure show which substance abuse
    services correspond to the different phases of
    treatment.
  • We must remember that each individual will
    progress through treatment differently and make
    sure that needed services are available despite
    the phase of treatment the client is in.

21
From Initial Report to the MA Treatment Study
Committee of the Nebraska Community Corrections
Council Moving Past the Era of Good Intentions
Methamphetamine Treatment Study, State of
Nebraska Contract No. 12969-04. December 2005
22
Continuum of Care vs. Implementation
  • Continuum of Care represents the ideal, complete
    system response.
  • Implementation has two slightly different goals
  • Respond to the states immediate methamphetamine
    treatment needs
  • What is needed to meet anticipated needs based on
    current, available data estimates?
  • Respond to the states future methamphetamine
    treatment needs
  • What is needed to prepare the infrastructure
    Nebraska needs to move to an evidence-based
    treatment strategy in future?
  • What is needed to build toward the Continuum of
    Care?

23
Treatment Needs 2006
  • Just over 19,000 arrestees/HHSS cases estimated
    to test positive for meth use
  • This population splits into two groups of
    offenders/HHSS
  • Those who will only receive community-based
    services because of justice processing
  • Approximately 8,000 people in 2006
  • Those who will be convicted and incarcerated
  • Approximately 530 people in 2006

24
Community Based Treatment
  • For the people who will not be sentenced to
    prison, non-residential tx models needed
  • 1st Stage Treatment Community-based,
    out-patient, Matrix model
  • 2nd Stage Tx/Recovery Continued Recovery
    Support Services
  • Long-term relapse prevention and recovery
    services Relapse crisis response, recovery
    support groups, and health, income and general
    support services

25
Treatment for Incarcerated
  • For the people who will be sentenced to prison
  • 1st Stage Treatment Therapeutic Community in
    correctional facility
  • 2nd Stage Treatment Transitional/re-entry
    planning and Continued Recovery Support same as
    non-incarcerated
  • Long-term relapse prevention and recovery same
    as non-incarcerated

26
Implementation Of Services
  • MA Treatment Voucher Funds
  • Drug Court Funds
  • Day and Night Reporting Centers
  • MA Tx Education Program for NE Tx providers
  • Tx Professional Expansion Plan
  • DCS Tx Center

27
Distribution of Recommendations
From Initial Report to the MA Treatment Study
Committee of the Nebraska Community Corrections
Council Moving Past the Era of Good Intentions
Methamphetamine Treatment Study, State of
Nebraska Contract No. 12969-04. December 2005
28
Importance of Recommendations
  • The recommendations fortify the States movement
    toward expanded community-based correction
    strategies and away from incarceration
  • The recommendations mobilize a broad array of
    justice, social work, tx providers and community
    leaders to take responsibility for implementing
    reforms
  • The recommendations balance the eventual creation
    of a continuum of care against the opportunity to
    make rapid, significant gains in MA tx reform in
    2006

29
Keys Findings in Study
  • The is a shortage of treatment providers in
    Nebraska.
  • Nebraska must maximize its treatment capacity by
    providing the most effective methamphetamine
    treatment possible.
  • Methamphetamine addiction is a poly-drug problem.
  • Treatment services must be available at all
    phases of the criminal justice and social service
    systems.
  • Ongoing support services must be provided to
    ensure ongoing success in recovery.
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