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

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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.

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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.

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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.

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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.

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Findings in the Methamphetamine Treatment Study
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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.

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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.

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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.

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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.

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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)
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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
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Prosecutor
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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.

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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
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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.

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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
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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?

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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

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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

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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

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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

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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
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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

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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.