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Types of Abstinence-Based Drug Treatment

Types of Abstinence-Based Drug Treatment. Chemical Detoxification Drug-Free Outpatient/Inpatient Rehabilitation Self-Help Groups (Alcoholics Anonymous, Narcotics Anonymous, etc.) Residential Therapeutic Communities Court-mandated programming Methadone Maintenance

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Types of Abstinence-Based Drug Treatment

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  1. Types of Abstinence-Based Drug Treatment • Chemical Detoxification • Drug-Free Outpatient/Inpatient Rehabilitation • Self-Help Groups (Alcoholics Anonymous, Narcotics Anonymous, etc.) • Residential Therapeutic Communities • Court-mandated programming • Methadone Maintenance • Begins to challenge abstinence-based perspective

  2. Interventions Harm Reduction/Needle Exchange Therapeutic communities Detox Opiate maintenance Drug Court Vaccines Alcoholics Anonymous/ 12 Steps Mainstream Psychology Medical therapies Lifestyle changes MEDICAL MORAL ADDICTION IS A BIOCHEMICALLY ROOTED DISEASE ADDICTION IS A PROBLEM OF THE “WHOLE PERSON” Program Philosophy

  3. Where are People Going to Treatment?

  4. How People Start Outpatient Treatment

  5. Drug Courts: Social Context • 1989 - Miami-Dade County, Florida • Now over 2,300 drug courts nationwide • Social factors leading to drug court movement: • Prison overcrowding, budget crises • Renewed interest in rehabilitation, research showing link between addiction and crime • More power for judiciary after mandatory minimum guidelines • A bipartisan project: Addressing drug war issues, but still not “soft” on crime • Cost effective

  6. Addiction & Criminality • Estimated costs of drug-related crime to societyin 2012: $107 billion • Total cost of drug war to date: over $1 trillion (Drug Policy Alliance) • In 2011, about half of the federal prison population was there for a drug offence. • 1.5 million arrestees at risk of drug abuse or dependence (Urban Institute). • 53% of people in state prison were estimated to have a drug problem, and only 15% were receiving treatment.

  7. The Drugs-Crime Connection

  8. Drug Court Basics • Drug defendants are “sentenced” to treatment instead of traditional criminal justice response • Deferred prosecution v. post-adjudication models • Eligibility: established history of substance abuse problems, non-violence offences • Three shared characteristics: • Coerced treatment with maximum judicial power • Heavy level of surveillance and long term rehab • Strict reward-punishment system in a therapeutic community setting

  9. How do drug courts work? For a minimum term of one year, participants are: • provided with intensive treatment and other services they require to get and stay clean and sober; • held accountable by the Drug Court judge for meeting their obligations to the court, society, themselves and their families; • regularly and randomly tested for drug use; • required to appear in court frequently so that the judge may review their progress; and • rewarded for doing well or sanctioned when they do not live up to their obligations. Source: National Association of Drug Court Professionals

  10. Perspectives on Drug Court • PROS: • Reduction in drug use/recovery from addiction • Coerced treatment gets better results • Recidivism (decreased re-arrest or reconviction) • Cost savings • Restored lives and reunited families • Productive citizens • “Tough love” approach more compassionate than prison • Addresses roots of crime, for some drug-involved offenders • Provides social supports • CONS: • Net-widening • Increased sentence length or severity • Suspends due process, violates basic rights • Racial disparities – African Americans disadvantaged in selection process and in treatment success • Focuses on individual rather than social solutions for addiction • A medical framework silences social factors like role of racial bias in mass incarceration (depoliticization) 10 1 2 11 3 12 4 13 5 6 14 7 8 15 9

  11. Methadone Maintenance Therapy • Late 1960s – Jerome Jaffe established experimental methadone program • Methadone first applied to a therapeutic program by Dole & Nyswander in the early 1970s • 1972- Nixon supported expansion of methadone programs nationwide • Crime rates fell, sometimes dramatically • Deaths from heroin overdoses decreased • 2/3 of Nixon’s original drug war budget went toward addiction treatment • Funding for treatment abandoned for “tough on crime” approach to drugs in 1980s and 1990s

  12. Dole & Nyswander’s Research • Methadone patients stopped engaging in crime, “anti social” behaviors ceased • Psychogenic theory V disease theory • Their argument: The consequences or symptoms of addiction might be anti-social behaviors, but the cause is a metabolic response to drug craving and withdrawal. • Medical cause requires medical cure • Suboxone – contemporary version • Measure of success in MMT • Not abstinence-based • Meeting markers of social functioning and quality of life • Changes notion of what constitutes treatment • What is the end goal of recovery?

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