Creating Conditions That Reduce the Likelihood That Teenagers Will Abuse Drugs

Treating people with drug and alcohol addition is very difficult. Preventing many of them from becoming addicted in the first place is a good way to avoid many of the problems caused by drug and alcohol addition.

Iceland knows how to stop teen substance abuse but the rest of the world isn’t listening

In Iceland, teenage smoking, drinking and drug use have been radically cut in the past 20 years.

“We didn’t say to them, you’re coming in for treatment. We said, we’ll teach you anything you want to learn: music, dance, hip hop, art, martial arts.” The idea was that these different classes could provide a variety of alterations in the kids’ brain chemistry, and give them what they needed to cope better with life: some might crave an experience that could help reduce anxiety, others may be after a rush.

At the same time, the recruits got life-skills training, which focused on improving their thoughts about themselves and their lives, and the way they interacted with other people. “The main principle was that drug education doesn’t work because nobody pays attention to it. What is needed are the life skills to act on that information,” Milkman says. Kids were told it was a three-month programme. Some stayed five years.

A few factors emerged as strongly protective: participation in organised activities – especially sport – three or four times a week, total time spent with parents during the week, feeling cared about at school, and not being outdoors in the late evenings.

Elsewhere, cities that have joined Youth in Europe are reporting other benefits. In Bucharest, for example, the rate of teen suicides is dropping alongside use of drink and drugs. In Kaunas, the number of children committing crimes dropped by a third between 2014 and 2015.

The solutions Iceland experimented with can’t be copied directly for elsewhere, cultures are different. But many of the concepts and practices can be adopted elsewhere. The idea of investing in helping teenagers live happy, engaged lives instead of locking up teenagers acting out is something we would all benefit from.

Related: The Causes of Drug Addiction are ComplexThe War on Drugs has been a Huge Failure with Massive Unintended ConsequencesFunding Drug Addiction Treatment Would Cost 1/7 the Cost of the Current Criminal System Focused PolicyAlmost everything we think we know about addiction is wrong

The War on Drugs has been a Huge Failure with Massive Unintended Consequences

This webcast takes a look at our experience with the so-called “war on drugs.” The war on drugs has been a huge failure with massive unintended consequences. Policy needs to take into account results. We have some minor attempts to do this but overall the war on drugs has led to increasing damage as we increase the war without considering the results.

Related: Funding Drug Addiction Treatment Would Cost 1/7 the Cost of the Current Criminal System Focused PolicyReducing Harm Due to Drug Use Should be the Aim, Not WarDrug Treatment Funding Can More Than Pay For Itself With Reduced Crime Costs

Funding Drug Addiction Treatment Would Cost 1/7 the Cost of the Current Criminal System Focused Policy

Treatment: Effective (But Unpopular) Weapon Against Drugs

Paying for treatment of hard-core drug users is a bone in the throat of middle class taxpayers–and small wonder. Drug abusers are not an appealing group, and the programs themselves largely fail to wean their clients off drugs for good. Nonetheless, say RAND researchers, treatment programs are a sound investment of public funds because they effectively cut consumption–and consumption is what drives the drug trade.

RAND corporation aims to provide policy guidance, driven by data and research, to policy makers. They differ from many others in that they pay more attention to what works than to the interest groups often telling politicians what to do. RAND is willing to take stands that others are not and often propose policies that conflict with the accepted positions held to for decades by interest groups.

When data supports a policy RAND will encourage the use of that policy even if it seems odd – like paying for drug treatment for those breaking the law. Without treatment RAND data shows the government will spend 7 times as much money. But politicians have been resisting spending 1/7 as much money because they fear voters can’t understand that doing so is wise. This is from a 1995 report by RAND:

Treatment is seven times more cost-effective in reducing cocaine consumption than the best supply-control program and could cut consumption by a third if it were extended to all heavy users, according to the study. Such a strategy could also substantially reduce the number of users and the costs they inflict on society through crime and lost productivity.

And RAND doesn’t even factor in the costs of wasted lives, pain and suffering that are aided by good addition treatment help. Some propose we aid drug users with treatment programs because human suffering is something we should reduce when we can. RAND proposes we do so based solely on the hard cash benefits government will gain. It is hard to argue with a program that reduces costs by 86% (6/7).

While we may have made a little progress has been made in getting more funding since 1995, if we have it is a tiny portion of what would be a wise investment. The failure to use addiction treatment progress continues to add to the budget deficits our governments face and the suffering of drug abusers in our society.

Related: Drug Treatment Funding Can More Than Pay For Itself With Reduced Crime CostsImproving Addiction Treatment with The University of Wisconsin MadisonWhat Should Society Do About Drug Addicts That Are Not Seeking Treatment?

The Success Rate of AA is Only 5-10%

The treatment of drug addiction continues to be difficult. Even finding data on success rates is hard. And analyzing that data is difficult (the data is not straight forward and leaves open many possible questions or criticisms). This study calls into question the effectiveness of a 12-step recovery method to treat addiction.

With Sobering Science, Doctor Debunks 12-Step Recovery

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don’t seem to know that because it’s not widely publicized. … There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It’s not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we’d say OK. But it’s harmful to the 90 percent who don’t do well. And it’s harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it’s you that’s failed.

The reason that the 5 to 10 percent do well in AA actually doesn’t have to do with the 12 steps themselves, it has to do with the camaraderie. It’s a supportive organization with people who are on the whole kind to you and it gives you a structure. Some people can make a lot of use of that. And to its credit, AA describes itself as a brotherhood, rather than a treatment.

image of the Sober Truth book cover

Dr. Lance Dodes has written a book looking at the data behind the results of AA. The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.

Related: Looking at the Evidence of Treating AlcoholismHow Effective is Drug Addiction Treatment?, NIH studyImproving Addiction Treatment with The University of Wisconsin, MadisonMethods Used to Treat Addiction

Prescription Painkillers Kill More Every Year in USA than Heroin and Cocaine Combined

Overdose deaths from prescription painkillers have skyrocketed in the past decade. Every year, nearly 15,000 people die from overdoses involving these drugs—more than those who die from heroin and cocaine combined.

The abuse of prescription painkillers has risen dramatically in the last 15 years; in 1999 4,000 people were killed by these drugs (less than a third of the current numbers of deaths).

Find more information on prescription drug abuse and treatment options from the United States Center for Disease Control.

Related: Prescription Drug Abuse in the USAPrescription Drug Abuse: Pain Killers Can Lead to AdditionDecline in the Misuse of Prescription Drugs in the USA (reported in 2008, was the data accurate?)Brett Favre Overcomes Painkiller Addiction

Drug Treatment Funding Can More Than Pay For Itself With Reduced Crime Costs

Some interesting details and data from Texas government web site.

Drug users constitute a large and growing proportion of the criminal justice population. Drug users not only commit a substantial amount of crime, but as the frequency of drug use increases, the frequency of crime increases and the severity of crimes committed also increases.

Drug use in the general population appears to have declined over the past decade, yet the number of drug-involved offenders is increasing. The number of convictions for drug violations in Texas has increased from 8,103 in 1980 to 23,126 in 1988, a 185 percent increase in less than ten years.

Estimates of lifetime drug users among the nation’s incarcerated population range from 80 to 87 percent.

The American Correctional Association notes that more than 95 percent of drug and alcohol offenders will be discharged from prison, most without receiving any treatment. Because of the high association between drug abuse and recidivism, it is in the public interest to place offenders in the kinds of treatment programs that have been found effective. A noticeable reduction in drug use and criminality can occur with an alliance between the criminal justice system and drug abuse treatment.

Public expenditures for drug abuse treatment are wise and prudent investments. Treatment works to reduce crime, drug abuse, and recidivism. Sustained reductions in recidivism can be achieved up to six years after treatment. With appropriate drug abuse treatment more than 75 percent of offenders with chronic substance abuse histories can reenter the community and lead socially acceptable life styles.

For every dollar spent for drug treatment, $11.54 is saved in social costs, including law enforcement costs, losses to victims, and government funds for health care.

Research has shown that funds invested in drug treatment reduces future criminal justice costs for treated offenders. Every dollar spent on residential drug treatment in probation saves $2.10 in future criminal justice costs. Every dollar spent on outpatient drug treatment in probation saves $4.28 in future criminal justice costs.

This is an old report, from 1997 but the basic model doesn’t change. A large amount of criminal activity is driven by drug addiction. To reduce crime in society drug addiction needs to be reduced. While success rates of drug addiction treatment centers are far from perfect the results more than pay for the cost – just in reduced crime costs (without even considering the better lives these people lead and the benefits to their children and loved ones).

Related: The Rise and Fall of America’s First Prison for Drug AddictsResults of 4 Year Study of Women in Drug TreatmentAlcohol is a Major Cause of Drug Rehab AdmissionsHow Effective is Drug Addiction Treatment?

Results of 4 Year Study of Women in Drug Treatment

A detailed study of women in treatment for drug addition in England shows a 19 percent fall in the number of adult females under 30 entering heroin programmes over the last five years – 1,000 fewer female addicts than in 2005. The fall is even sharper – 26 percent – for the 18-25 age-group, providing further evidence that the heroin epidemic of previous decades may have peaked.

Although part of the trend was offset by rising numbers of cocaine and crack addicts seeking
treatment over the same period, the numbers of women entering treatment in the under 30 age
group fell by nearly nine per cent in four years.

The study also showed that at the same time the numbers of women problem drug users
successfully leaving treatment having overcome their addiction almost doubled. In addition, the
number of women dropping out of treatment has fallen by well over a third in four years.
The study by the National Treatment Agency for Substance Misuse (NTA) also highlights:

  • While women start using drugs at the same age or slightly older than men, they are more adept at seeking help for themselves and tend to come into treatment earlier
  • Cocaine is the fastest growing treatment need among women drug users, accounting for a 55 per cent increase in new entrants since 2005
  • The number of women entering treatment for crack dependency has increased by 14 percent since 2005
  • Almost two-thirds of women entering treatment are mothers, nearly half of whom have a child living with them. The data indicates that treatment outcomes for mothers are stronger than those who were not parents.

“These findings demonstrate how thousands of women have successfully obtained drug treatment and recovered through it,” said Rosanna O’Connor, NTA director of delivery. “Treatment is the first step on the road to recovery, so it is encouraging that women tend to seek help of their own volition, enter treatment earlier before their drug misuse has become entrenched and frequently achieve better outcomes sooner. Treatment provides the opportunity for individuals to get better, for families to stabilise, and for children to be looked-after at home.”

Related: Research on the Brain and Behavior on AddictionUniversity Research on Improving Addiction TreatmentAlcohol is a Major Cause of Drug Rehab Admissions

Research on the Brain and Behavior on Addiction

New research on the brain and behavior clarifies the mysteries of addiction by Craig Lambert, Harvard Magazine, March 2000.

Early experiences with drugs, whether in the womb or as an adult, have ineradicable effects. Drug users often describe a wish to recapture the bliss of their first high. But this goal proves elusive because once the brain has neuroadapted to drugs, it is physiologically and structurally changed. The director of the National Institute on Drug Abuse and many others argue that voluntary drug consumption alters the brain in ways that lead to involuntary drug consumption. The question of whether drug habits are voluntary or not leads us to ask how people get over their addictions, and raises some of the moral issues surrounding compulsive behavior.

Addiction is not all pharmacology, neurotransmitters, and intrapsychic states; the social settings of drug consumption have powerful effects. They can influence basic brain chemistry–which is one reason Gene Heyman rejects the notion that “addictive behavior is insensitive to persuasion, that there’s an irresistible urge to take the drug.” Heyman agrees that drugs alter the brain, but disputes the idea that they change the brain in ways that make choice impossible–he does not believe, in other words, that neuroadaptation makes drug use involuntary. Exhibit A, he says, is 50 million ex-smokers who have voluntarily ended their intake of nicotine.

One reason people believe drug use is involuntary is that recovery rates for addicts treated at clinics are quite bad. Within one year of treatment, relapse rates of 67 to 90 percent are common for alcohol, opiate, cocaine, and tobacco users. “But most of the people who become addicted to drugs don’t go to clinics,” says Heyman. “Actually, only 30 to 40 percent go to clinics. Yet this clinic population has greatly influenced our vision and concept of addiction.”

It turns out that addicts who don’t go to clinics have much higher recovery rates.

This is an interesting article with interesting data. Remember the different recover rates for those that go to clinics and those who does not mean going to a clinic reduces the odds of success. It seems reasonable to guess most of those that go to clinics are drawn from the subset that failed to quit without going to a clinic. So it could be that fail to quit on their own then will fail only quit on their own 3% of the time and quit in a clinic 10% of the time (these numbers are not based on anything just an example of what you must consider about the above statistics).

Even though cigarette smoking is the direct cause of 400,000 American deaths annually, while alcohol directly causes only 100,000 deaths, “alcoholism is a major reason that people don’t stop smoking,” says Vaillant. “Those who keep on smoking after age 50 tend to be alcoholics.” In hospitals, alcoholics cost six times as much as other patients. Half of all people who show up in emergency rooms with severe multiple fractures are alcoholics. “But the emergency rooms treating multiple fractures ignore blood alcohol levels,” Vaillant says. “The causal link isn’t made.”

“No other drug of addiction impairs one’s aversion to punishment the way alcohol does,” he continues. “Yes, compulsive gambling impairs your aversion to being poor, and heroin use impairs your aversion to being arrested. But alcoholism goes across the board. When drinking, people are much more likely to engage in all kinds of dangerous, life-threatening behavior–wife beating, child abuse, unprotected sex with strangers, smoking, drunk driving. You can be five foot two and willing to take on anyone in the bar.”

Related: Alcohol is a Major Cause of Drug Rehab AdmissionsHow Effective is Drug Addiction Treatment?Methods to Treat AddictionWhy Can’t Drug Addicts Quit on Their Own?

Combination Strategy to Treat Alcohol Dependence

New combination of treatments is effective for alcohol dependence

McLean Hospital researchers, along with colleagues from 11 other study sites nationwide, report that the medication naltrexone and up to 20 sessions of alcohol counseling delivered by a behavioral specialist are equally effective treatments for alcohol dependence when delivered with structured medical management in the Journal of the American Medical Association.

Results from the National Institutes of Health-supported Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study show that patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management, an intervention that consisted of nine brief, structured outpatient sessions provided by a health care professional. Contrary to expectations, the researchers found no effect on drinking of the medication acamprosate and no additive benefit from adding acamprosate to naltrexone.

“This was the largest clinical trial looking at the effectiveness of pharmacologic and behavioral treatments for alcohol dependence ever conducted and the results are promising,” said Roger Weiss, clinical director of the Alcohol and Drug Abuse Treatment Program for McLean Hospital, a Harvard Medical School affiliate. Weiss was also the principal investigator of COMBINE for the McLean study site.

Related: Why Can’t Drug Addicts Quit on Their Own?Methods to Treat Addiction

How Effective is Drug Addiction Treatment?

National Institute on Drug Abuse, NIH on how effective is drug addiction treatment:

According to several studies, drug treatment reduces drug use by 40 to 60 percent and significantly decreases criminal activity during and after treatment. For example, a study of therapeutic community treatment for drug offenders (See Treatment Section) demonstrated that arrests for violent and nonviolent criminal acts were reduced by 40 percent or more. Methadone treatment has been shown to decrease criminal behavior by as much as 50 percent. Research shows that drug addiction treatment reduces the risk of HIV infection and that interventions to prevent HIV are much less costly than treating HIV-related illnesses. Treatment can improve the prospects for employment, with gains of up to 40 percent after treatment.

Although these effectiveness rates hold in general, individual treatment outcomes depend on the extent and nature of the patient’s presenting problems, the appropriateness of the treatment components and related services used to address those problems, and the degree of active engagement of the patient in the treatment process.

Generally, for residential or outpatient treatment, participation for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated. For methadone maintenance, 12 months of treatment is the minimum, and some opiate-addicted individuals will continue to benefit from methadone maintenance treatment over a period of years.

Good outcomes are contingent on adequate lengths of treatment.

Related: Center for Substance Abuse Treatment, HHSDrug Treatment Success Rates in EnglandMethods to Treat Addiction