<DOC>
[109 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:22285.wais]
S. Hrg. 109-248
METHAMPHETAMINE ABUSE
=======================================================================
HEARING
before a
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
SPECIAL HEARING
APRIL 21, 2005--WASHINGTON, DC
__________
Printed for the use of the Committee on Appropriations
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
U.S. GOVERNMENT PRINTING OFFICE
22-285 WASHINGTON : 2006
_____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512ÿ091800
Fax: (202) 512ÿ092250 Mail: Stop SSOP, Washington, DC 20402ÿ090001
__________
COMMITTEE ON APPROPRIATIONS
THAD COCHRAN, Mississippi, Chairman
TED STEVENS, Alaska ROBERT C. BYRD, West Virginia
ARLEN SPECTER, Pennsylvania DANIEL K. INOUYE, Hawaii
PETE V. DOMENICI, New Mexico PATRICK J. LEAHY, Vermont
CHRISTOPHER S. BOND, Missouri TOM HARKIN, Iowa
MITCH McCONNELL, Kentucky BARBARA A. MIKULSKI, Maryland
CONRAD BURNS, Montana HARRY REID, Nevada
RICHARD C. SHELBY, Alabama HERB KOHL, Wisconsin
JUDD GREGG, New Hampshire PATTY MURRAY, Washington
ROBERT F. BENNETT, Utah BYRON L. DORGAN, North Dakota
LARRY CRAIG, Idaho DIANNE FEINSTEIN, California
KAY BAILEY HUTCHISON, Texas RICHARD J. DURBIN, Illinois
MIKE DeWINE, Ohio TIM JOHNSON, South Dakota
SAM BROWNBACK, Kansas MARY L. LANDRIEU, Louisiana
WAYNE ALLARD, Colorado
J. Keith Kennedy, Staff Director
Terrence E. Sauvain, Minority Staff Director
------
Subcommittee on Departments of Labor, Health and Human Services, and
Education, and Related Agencies
ARLEN SPECTER, Pennsylvania, Chairman
THAD COCHRAN, Mississippi TOM HARKIN, Iowa
JUDD GREGG, New Hampshire DANIEL K. INOUYE, Hawaii
LARRY CRAIG, Idaho HARRY REID, Nevada
KAY BAILEY HUTCHISON, Texas HERB KOHL, Wisconsin
TED STEVENS, Alaska PATTY MURRAY, Washington
MIKE DeWINE, Ohio MARY L. LANDRIEU, Louisiana
RICHARD C. SHELBY, Alabama RICHARD J. DURBIN, Illinois
ROBERT C. BYRD, West Virginia (Ex
officio)
Professional Staff
Bettilou Taylor
Jim Sourwine
Mark Laisch
Sudip Shrikant Parikh
Candice Rogers
Ellen Murray (Minority)
Erik Fatemi (Minority)
Adrienne Hallett (Minority)
Administrative Support
Rachel Jones
C O N T E N T S
----------
Page
Opening statement of Senator Tom Harkin.......................... 1
Opening statement of Senator Harry Reid.......................... 2
Prepared statement........................................... 3
Statement of Charles G. Curie, Administrator, Substance Abuse and
Mental Health Services Administration (SAMHSA), Department of
Health and Human Services...................................... 4
Prepared statement........................................... 6
Statement of Nora D. Volkow, M.D., Director, National Institute
on Drug Abuse, National Institutes of Health, Department of
Health and Human Services...................................... 11
Prepared statement........................................... 13
Statement of Vicki Sickels, Des Moines, Iowa..................... 18
Statement of Richard E. Steinberg, president and chief executive
officer, Westcare Foundation, Inc., and president, Therapeutic
Communities of America......................................... 21
Prepared statement........................................... 23
Additional statements:
Prepared statement of the Community Anti-Drug Coalitions of
America.................................................... 42
Prepared statement of the National Association of State
Alcohol and Drug abuse Directors, Inc...................... 45
Prepared statement of the Heartland Family Service, Inc...... 51
Prepared statement of the Legal Action Center................ 54
Prepared statement of the Therapeutic Communities of America. 58
METHAMPHETAMINE ABUSE
----------
THURSDAY, APRIL 21, 2005
U.S. Senate,
Subcommittee on Labor, Health and Human
Services, Education, and Related Agencies,
Committee on Appropriations,
Washington, DC.
The subcommittee met at 10:33 a.m., in room SD-192, Dirksen
Senate Office Building, Hon. Tom Harkin presiding.
Present: Senators Harkin and Reid.
OPENING STATEMENT OF SENATOR TOM HARKIN
Senator Harkin. The hearing of the Labor, Health and Human
Services Appropriations Subcommittee will now come to order.
Our topic this morning is methamphetamine abuse, but before I
read my opening statement I first just want to again publicly
thank the chairman of this subcommittee, Senator Arlen Specter
of Pennsylvania, for the great working relationship that we
have always had. As he has pointed out, this gavel has changed
back and forth four or five times since we have been on the
subcommittee, and it always has, to use his words, been a
seamless transfer of the gavel.
I think it is a mark of his great leadership that he allows
me to chair a hearing here on methamphetamine or other things
that I ask to chair hearings on. Likewise, when I was chairman
I allowed him to have hearings, as I did for people when I
chaired the Agriculture Committee. I think that is really the
way the Senate ought to operate. These are nonpartisan issues
that we are talking about here, and we are very busy people.
Sometimes I have the interest in a certain area or the time to
do something and then sometimes Senator Specter has the
interest and the time and I do not. So this is a way in which
we I think are better able to collect the kind of information
and data that we need to make informed decisions.
So I wanted to publicly again thank my chairman and my
friend Senator Specter for allowing us to have this hearing.
As I said, our topic this morning is methamphetamine abuse.
I am sad to say this, but my home State has been hit
particularly hard by this epidemic. Iowa ranks fourth among all
States in the percentage of residents who are admitted to
treatment centers because of meth. That is not a statistic that
we are happy about.
Fortunately, Iowa is responding. The State recently passed
the toughest law in the Nation for limiting consumer access to
pseudoephedrine, one of the key ingredients for making meth.
Thanks to grants from SAMHSA, the Iowa Department of Public
Health is pioneering innovative strategies for preventing and
treating meth abuse. Des Moines is one of five sites
participating in NIDA's methamphetamine clinical trials group,
studying the use of medication and group therapy in meth
treatment.
But Iowa is not alone in struggling with meth abuse. There
are 16 States that now have higher treatment admission rates
for meth than for cocaine and heroin. Recently we have heard
disturbing reports that meth is moving to big cities on the
East Coast, where the drug has been linked to the spread of
HIV.
Certainly law enforcement has a critical role to play in
curbing meth abuse. I strongly support efforts to crack down on
the people who are making and selling this drug. But even if we
shut down every home-based lab and threw every dealer into
jail, we would still have a meth problem in this country. It
will not go away until we do a better job of preventing people
from using meth in the first place and giving addicts the
treatment they need to kick the habit for good.
That is where this hearing comes in. SAMHSA and NIDA, two
agencies funded in our bill, are our most important Federal
resources for preventing meth abuse. We have to make sure they
get the appropriation levels they need to address the problem.
Meth is destroying lives, filling our prisons, and taking
mothers away from their children, and we need to stop this
epidemic now.
We are fortunate to have an outstanding panel of witnesses
to discuss this issue with us this morning, and I will
introduce them all shortly after I recognize our distinguished
leader here. But I want to offer a special welcome to Vicki
Sickels from Des Moines, who will give us a firsthand account
of what it is like to struggle with an addiction to meth. So,
Vicki, I want to publicly again thank you for taking time to
come here today and tell your story. You are really what this
hearing is all about.
With that, I will turn to my good friend and our
distinguished leader on our side, Senator Reid from Nevada.
OPENING STATEMENT OF SENATOR HARRY REID
Senator Reid. Senator Harkin, thank you. Thank you very
much.
There is so much ill will and partisanship in this body
that I am obligated to say how fortunate we are to have two
people work as closely together as you and Arlen Specter. I
want everyone in this audience and on this panel to understand
what a rare situation we have here. Senator Harkin is the
ranking member. He is not the Chair of this subcommittee. But
he and Senator Specter have been Chair and ranking member as
the majority goes back and forth in this body and they consider
each other equals. Here, in spite of all the partisanship in
this body, Senator Harkin is conducting this hearing. I think
it speaks so well of you and Senator Specter.
Senator Harkin. Thank you.
Senator Reid. I do appreciate your holding this hearing. I
would ask that my full statement be made part of the record.
Senator Harkin. Without objection.
Senator Reid. I had the opportunity a month or so ago to
meet with representatives from the Drug Enforcement
Administration out of Los Angeles and from a 7 task force they
have in Las Vegas that deals with drug interdiction. The whole
purpose of this meeting was to talk about methamphetamines. The
story was like a dime store novel, how manufacturers in Nevada
have been driven south of the border into Mexico and the
lengths they go to to bring the product to Nevada and
throughout parts of this country. The same containers that are
hidden in these vehicles that they bring the stuff to America
in, they use to take back bundles of cash. They have them
hidden in various places in the vehicles and loaded with money.
We have a tremendous problem in Nevada--28.6 percent of the
male arrestees in the city of Las Vegas have methamphetamines
in their blood when tested, 28.6 percent of the men arrested.
As you know, kids are now using methamphetamine too. About 12.5
percent of high school students in Nevada, claim they have used
methamphetamines. Those are the kids that admit it. Think how
many do not.
Southern Nevada has been designated a high-density drug
traffic area since 2001. This administration is eliminating
that program. Tom, it is just a shame, just a shame.
The true war on drugs takes more than dedicated law
enforcement, though. It takes parents and teachers, counselors
working to teach kids that drugs like methamphetamine are
killers. My staff briefed me about what it does to the brain.
We are fortunate that we have a very good treatment facility in
Nevada and I appreciate very much your allowing Mr. Steinberg
to come and testify. WestCare does a great job.
PREPARED STATEMENT
Methamphetamine is a threat to the health and safety of our
families and communities, and I want to say, Tom, that I am
going to study the testimony of Ms. Sickels, because she is the
courageous one to come here and hold herself up, by some, to
ridicule for having been so weak. But the fact of the matter is
you are very strong or you would not be here, and I admire and
appreciate your coming before the Congress to tell your story,
because by telling your story other people will not have to go
through the hell that you have been through.
Senator Harkin, I hope you will excuse me.
Senator Harkin. Thank you very much, Senator Reid. Thank
you for gracing us with your presence. Your statement will be
made a part of the record in its entirety.
[The statement follows:]
Prepared Statement of Senator Harry Reid
I want to thank Senator Harkin for scheduling this hearing and for
his continued efforts on methamphetamine abuse. I also want to thank
our distinguished guests for sharing their expertise about
methamphetamine abuse and for their recommendations about how we can
improve prevention and treatment efforts.
Many Americans believe the war on drugs is something that is only
taking place in our cities, on our boarders, and in the jungles of
South America. The truth is methamphetamine abuse is everywhere, but
its effects are felt particularly hard in largely rural states like
Nevada and Iowa. It is made in clandestine labs in small town America
or smuggled in from Mexico and Canada. It's readily available, cheap
and is abused by people of all races, economic, and social backgrounds.
According to the Nevada Department of Education, over 12.5 percent
of Nevada's high school students have used methamphetamine. In 2004, 40
percent of individuals admitted into treatment programs funded by the
Nevada Bureau of Alcohol and Drug Abuse had used methamphetamine, and
approximately 5,000 Nevadans received treatment for meth addiction. I
have been told that the estimated number of meth users who have not
received treatment may be eight times that amount--that's 40,000
Nevadans!
To tackle a problem of this size and voracity, we have to approach
it from every angle--law enforcement, prevention and treatment. The
President's budget for fiscal year 2006 cuts the High Intensity Drug
Trafficking Area program (HIDTA) funding by 56 percent. This funding
must not be cut. The HIDTAs work to reduce drug-trafficking and
production in designated areas in the United States by facilitating
cooperation among all levels of drug enforcement, and enhancing the
intelligence sharing among these agencies. I have helped create task
forces throughout the state of Nevada, and I also secured the funding
for the creation of the Nevada HIDTA in 2001. I will fight to see this
program is not eliminated.
I will continue to fight so that law enforcement efforts can
continue to shut down methamphetamine labs and prevent trafficking and
dealing, but it is equally important to focus on prevention and
treatment programs. The true war on drugs takes more than dedicated law
enforcement; it takes parents and teachers and counselors working to
teach kids that drugs like methamphetamine are killers.
We also have to reach those who are already addicted to
methamphetamine. This includes those in the prison system. If we don't
treat people who are in jail for crimes associated with their
addiction, then when they get out they are more likely to commit those
same crimes again. Drug counseling and support prevents recidivism of
drug related crimes.
Addiction is not merely a matter of will. It is a medical problem
that has all the properties of a disease. For that reason, we have to
treat it the same way we treat the spread of a horrible disease--
through both prevention and treatment. To do this well, we need to
understand how people become addicted, what research tells us about
methamphetamine affect on the brain, what someone goes through when
coming off the drug and how to integrate former addicts into society.
I am so pleased that Dick Steinberg from the WestCare Foundation in
Las Vegas is testifying before the Committee today. He is doing a
wonderful job of reaching out to those who are addicted to
methamphetamine. Under his tenure as President and CEO of WestCare, the
company has grown from a small treatment center in Las Vegas, into one
of the largest nonprofit substance abuse treatment organizations in the
United States. I look forward to hearing more about their efforts in
Nevada.
Methamphetamine is a threat to the health and safety of our
families and communities. I look forward to hearing from our witnesses
about how we may best direct resources to address this problem--in
Nevada, in Iowa, and across the Nation.
STATEMENT OF CHARLES G. CURIE, ADMINISTRATOR, SUBSTANCE
ABUSE AND MENTAL HEALTH SERVICES
ADMINISTRATION (SAMHSA), DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Senator Harkin. We will turn now to our witnesses. I will
just go from my left to right. First will be Mr. Charlie Curie,
the Administrator of the Substance Abuse and Mental Health
Services Administration, which we call ``SAMHSA'' for short.
That is the Federal agency responsible for improving the
Nation's substance abuse prevention, addictions treatment,
mental health services.
Mr. Curie has over 25 years of professional experience in
mental health and substance abuse service. Prior to his
confirmation as SAMHSA Administrator, Mr. Curie was the Deputy
Secretary for Mental Health and Substance Abuse Services for
the Department of Public Welfare in Pennsylvania. A graduate of
Huntington College, he holds a master's degree from the
University of Chicago School of Social Service Administration.
Mr. Curie, welcome. As I will say to all of you, your
statements will be made a part of the record in their entirety.
In the interest of time, if you could just sum up perhaps and
make the major points of what you would like to say, I would
sure appreciate it. Thank you, Mr. Curie.
Mr. Curie. Thank you, Mr. Chairman, and I appreciate the
opportunity to present information today and for you to hold
this hearing so that we can look at approaches to stem the tide
of methamphetamine abuse in America. It is also a privilege for
me to be here today with my good friend and colleague Nora
Volkow from NIDA. We work very closely together and I think the
world of her. Also it is a pleasure to be with Dick Steinberg,
who is, as has been indicated, an excellent provider. I have
known him for many years. It was especially a privilege this
morning to meet Vicki Sickels because, as Senator Reid
indicated, I think she is the most important person sitting
here with us this morning as an individual that shows treatment
works and recovery is real.
It is abundantly clear that many of our most pressing
public health, public safety, and human services needs have a
direct link to substance abuse. This obvious link is why this
administration places such a great importance on increasing the
Nation's public health approach to prevention and increasing
the Nation's substance abuse treatment capacity.
Over the past 4 years we have worked hard to align SAMHSA's
resources to create systemic change in our approach to
preventing substance abuse and treating addiction. Our everyday
work at SAMHSA is structured around our vision of a life in the
community for everyone and our mission of building resilience
and facilitating recovery. In partnership with our other
Federal agencies, States, and local communities, consumers,
families, providers, and faith-based organizations, we are
working to ensure that 22 million Americans with a serious
substance abuse problem have the opportunity for recovery, to
live, work, learn and enjoy healthy and productive lives.
Under the leadership of President Bush and with the support
of Secretary Mike Leavitt in Health and Human Services and the
Office of National Drug Control Policy Director John Walters,
we have embarked on a strategy that is working by focusing
attention, energy, and resources as a Nation, and we have made
some real progress.
The most recent data confirms that we are steadily
accomplishing the President's goal to reduce teen drug use
overall by 25 percent in 5 years. Now at the 3-year mark, we
have seen a 17 percent reduction and there are now 600,000
fewer teens using drugs than there were in 2001. This is an
indication that our partnerships and the work of prevention
professionals, schools, parents, teachers, law enforcement,
religious leaders, and local community anti-drug coalitions is
paying off.
We know when we push against the drug problem it recedes.
Fortunately, we know more today about what works in prevention
and treatment than ever before. We also know our work is far
from over. In particular, we continue to be very concerned
about methamphetamine abuse. It is an extremely serious
problem. Its use and in part its popularity can be explained by
the drug's availability, ease of production, low cost, and its
highly addictive nature.
Over the years we have initiated a number of grants,
technical assistance and training activities at SAMHSA to
specifically target the prevention and treatment of
methamphetamine addiction. These are detailed in my written
testimony. These past investments continue to inform our
current strategy and have made significant contributions toward
our current efforts.
In particular, I want to bring your attention to our Access
to Recovery Program and our Strategic Prevention Framework.
Access to Recovery, proposed by President Bush, is a new
consumer-driven approach for obtaining treatment and sustaining
recovery through a State-run voucher program. State interest in
Access to Recovery was overwhelming. 66 States, territories,
and tribal organizations applied for the $100 million in grants
in 2004. We funded 14 States and one tribal organization in
August 2004. I might mention that Tennessee and Wyoming, two of
the States, have a particular focus on methamphetamine.
Because the need for treatment is great, as the
demonstrated methamphetamine rates alone have demonstrated and
as you shared, Senator, earlier, President Bush has proposed
increasing funding for fiscal year 2006 Access to Recovery, for
a total of $150 million. The use of vouchers coupled with State
flexibility offers an unparalleled opportunity to assure
treatment resources are being used to address current treatment
needs. In other words, States that are seeing the increase in
methamphetamine can gear their voucher program to address just
that issue and be able to tailor their approach based on the
needs in their State.
At the same time, we are doing more to prevent drug use
before it begins. To align and focus our prevention resources,
SAMHSA awarded Strategic Prevention Framework grants to 19
States and 2 territories to advance community-based programs
for substance abuse prevention. These grantees are working
systematically to implement a risk and protective factor
approach to prevention in the community level.
Whether we speak about abstinence or rejecting drugs,
including methamphetamines, tobacco and alcohol, or promoting a
healthy diet or a healthy lifestyle, we are really working
toward the same objective. We want to reduce risk factors and
promote protective factors. For the first time we have a real
science-based approach to prevention at the community level.
As a result, we are transitioning our drug-specific
programs to a risk-protective approach. This approach again
provides States and communities with flexibility to target
their dollars in the areas of greatest need.
PREPARED STATEMENT
In conclusion, we have been building systemic change so
that no matter what drug trend emerges in the future, States
and communities will be equipped to address it immediately and
effectively before it reaches a crisis level.
Mr. Chairman, thank you very much for the opportunity to
appear today and I will be pleased to answer any questions you
may have.
[The statement follows:]
Prepared Statement of Hon. Charles G. Curie
Mr. Chairman and Members of the Subcommittee, I am Charles G.
Curie, Administrator of the Substance Abuse and Mental Health Services
Administration (SAMHSA), within the U.S. Department of Health and Human
Services (HHS). I am pleased to present SAMHSA's substance abuse
prevention and treatment response to the growing methamphetamine
crisis. It is abundantly clear that many of our most pressing public
health, public safety, and human services needs have a direct link to
substance use disorders. This obvious link is why the Administration
places such a great importance on increasing the Nation's public health
approach to prevention and to increasing the Nation's substance abuse
treatment capacity.
SAMHSA is working to do just that. Our everyday work at SAMHSA is
structured around our vision of ``a life in the community for
everyone'' and our mission ``to build resilience and facilitate
recovery.'' Our collaborative efforts with our Federal partners, States
and local communities, and faith-based organizations, consumers,
families, and providers are central to achieving both our vision and
mission. Together, we are working to ensure that the 22.2 million
Americans with a serious substance abuse problem have the opportunity
to live, work, learn, and enjoy healthy lifestyles in communities
across the country.
Much of what the future holds for the prevention and treatment of
substance abuse is illustrated on the SAMHSA Matrix, a visual depiction
of SAMHSA's priority programs and the cross-cutting principles that
guide program, policy, and resource allocations of the Agency. Over the
past 4 years, we have worked hard to align SAMHSA's resources to create
systemic change. As we said we would, we have invested our available
resources in the program priority areas outlined in the Matrix to
provide a comprehensive, tactical approach to preventing substance
abuse, promoting mental health, and treating addiction and mental
illness.
Equipping communities with substance abuse treatment capacity is a
clear priority for President Bush, HHS Secretary Leavitt, and Office of
National Drug Control Policy (ONDCP) Director Walters. The
Administration has embarked on a strategy that has two basic elements:
discouraging drug use and reducing addiction; and disrupting the market
for illegal drugs.
The strategy is backed by a $12.4 billion Federal anti-drug budget
in fiscal year 2006. SAMHSA has a lead role to play in the demand
reduction side of the equation. SAMHSA helps stop drug use before it
starts through education and community action, and we heal America's
drug users by getting treatment resources where they are needed.
I am pleased to report that our strategy is working. By focusing
our attention, energy, and resources, we as a nation have made real
progress. The most recent data from the 2004 Monitoring the Future
Survey, funded by the National Institute on Drug Abuse (NIDA), confirms
that we are steadily accomplishing the President's goal to reduce teen
drug use by 25 percent in 5 years. The President set this goal with a
2-year benchmark reduction of 10 percent. Last year we met and exceeded
that goal. Now at the 3-year mark, we have seen a 17 percent reduction
and there are now 600,000 fewer teens using drugs than there were in
2001.
Additionally, the most recent findings from SAMHSA's 2003 National
Survey on Drug Use and Health clearly confirm that more American youth
are getting the message that drugs are illegal, dangerous, and wrong.
For example, 34.9 percent of youth in 2003 perceived that smoking
marijuana once a month was a great risk, as opposed to 32.4 percent of
youth in 2002. This is an indication that our partnerships and the work
of prevention professionals, schools, parents, teachers, law
enforcement, religious leaders, and local community anti-drug
coalitions are paying off.
We know that when we push against the drug problem, it recedes, and
fortunately, today we know more about what works in prevention,
education, and treatment than ever before. We also know our work is far
from over. In particular, we continue to be very concerned about abuse
of prescription drugs and methamphetamine. The use of methamphetamine
continues its assault as an extremely serious and growing problem.
THE GROWTH OF METHAMPHETAMINE USE
Methamphetamine use was initially identified in SAMHSA's Drug Abuse
Warning Network (DAWN). DAWN is a public health surveillance system
that monitors drug-related visits to hospital emergency departments and
drug-related deaths that are investigated and reported by medical
examiners and coroners across the country. In the early to mid 1990's,
DAWN data served as an early warning about the rise of methamphetamine
use.
Almost immediately, this early alert from DAWN was confirmed
through another SAMHSA data reporting and analysis system, the
Treatment Episode Data Set (TEDS). TEDS provides information on the
demographic and substance abuse characteristics of the 1.9 million
annual admissions to facilities that receive State alcohol and/or drug
agency funds (including Federal Block Grant funds) for the provision of
alcohol and/or drug treatment services. As early as 1992, TEDS data had
indicated that methamphetamine treatment admissions were accounting for
about 1 percent of all admissions. Within a decade, methamphetamine
admissions grew at a rapid rate. Our most current 2002 TEDS data
indicates the proportion of admissions for abuse of methamphetamine has
grown fivefold from 1992 to 2002, with an increase from 1 percent to
5.5 percent. Of those admitted in 2002 for the treatment of
methamphetamine use, three-quarters (74 percent) were white and half
(55 percent) of the admissions were male, with an average age at
admission of 31 years.
Traditionally, methamphetamine users have been Caucasian, but use
is now expanding to Hispanic and Asian populations, and Tribal leaders
are reporting increased use of methamphetamines by Native Americans as
well. Recent data from SAMHSA's 2002 and 2003 National Surveys on Drug
Use and Health (NSDUH) indicates that a much younger population has
grown vulnerable to methamphetamine's grip. The NSDUH now reports that
young adults aged 18-25 had the highest rate of methamphetamine use
among the 12 million Americans over the age of 12 who have used this
illicit drug. Fortunately, the rates of past-year methamphetamine use
among youths age 12-17 declined from 2002 to 2003, from 0.9 percent to
0.7 percent.
DAWN and TEDS data documented the proliferation of methamphetamine
use over time, and a geographic pattern of methamphetamine use among
the U.S. population emerged as well. Initially a problem in a few urban
areas in the Southwest, methamphetamine use spread to several major
Western cities and then east from the Pacific States into the Midwest,
and now through the South and Southeast. For the United States as a
whole, the methamphetamine/amphetamine admission rate increased by 420
percent between 1992 and 2002. Once thought of as a metropolitan drug
problem, methamphetamine, or ``meth,'' has now become a major drug
problem in rural America and is the fastest-growing drug threat in the
Nation.
The alarming growth of methamphetamine use and, in part, its
popularity can be explained by the drug's wide availability, ease of
production, low cost, and its highly addictive nature. It is a popular
drug because it is a synthetic drug that is easy to make. It is often
produced in small, makeshift ``laboratories,'' using equipment and
ingredients that are--for the most part--readily available at local
drug, hardware, and farm supply stores. The instructions for making
methamphetamines are easily found on the Internet, and the equipment
needed is as simple as coffee filters, mason jars, and plastic soda or
water bottles. Making it even more inexpensive and easy to produce is
the essential ingredient, ephedrine or psuedoephedrine. As you know,
these substances are commonly found in over-the-counter allergy and
cold medicines. Producing an entire batch of methamphetamine can take
less than four hours from start to finish, making it more readily
available than other illicit drugs.
Complicating the efforts to stop methamphetamine's growth is its
highly addictive nature. Immediately, methamphetamine use produces a
brief but intense ``rush,'' followed by a long-lasting sense of
euphoria that is caused by the release of high levels of the
neurotransmitter dopamine into areas of the brain that regulate
feelings of pleasure. Eventually, methamphetamine leads to addiction by
altering the brain and causing the user to seek out and use more
methamphetamine in a compulsive manner. Chronic use leads to increased
tolerance of the drug and damages the ability of the brain to produce
and release dopamine. As a result, the user must take higher or more
frequent doses in order to experience the pleasurable effects or even
just to maintain feelings of normalcy.
Treatment for methamphetamine use, and substance abuse as a whole,
has become an increasingly interconnected process, and the unmet
treatment need in this country has become a weight that is carried by
many. For example, methamphetamine users and their families, in
addition to drug treatment programs, often rely on emergency rooms, the
primary health care system, the mental health care system, child and
family services, and the criminal justice system, all of which see
parts of the problem. Addressing substance abuse, like methamphetamine
use, often requires collaboration among law enforcement officers,
prosecutors, judges, probation officers, treatment providers,
prevention specialists, child welfare workers, legislators, business
people, educators, retailers, and a number of other individuals,
agencies, and organizations who all have critical roles in the
prevention and treatment process.
SAMHSA'S ROLE IN TREATMENT
To help better serve people with substance use disorders, a true
partnership has emerged between SAMHSA and the National Institutes of
Health (NIH). Our common goal is to more rapidly deliver research-based
practices to the communities that provide services. SAMHSA is
partnering with the pertinent NIH research Institutes--NIDA, the
National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the
National Institute of Mental Health (NIMH)--to advance a ``Science to
Service'' cycle. Working both independently and collaboratively, we are
committed to establishing pathways to rapidly move research findings
into community-based practice and to reducing the gap between the
initial development and widespread implementation of new and effective
treatments and services.
At the same time, we are working to ensure consumers and providers
of mental health and substance abuse services are aware of the latest
interventions and treatments. One important tool being used to
accelerate the ``Science to Service'' agenda is SAMHSA's National
Registry of Effective Programs and Practices (or NREPP). The value of
the registry in the substance abuse prevention area has led SAMHSA to
expand this effort to include substance abuse treatment, mental health
services, and mental health promotion programs. The NIH Institutes are
engaged with SAMHSA in identifying both an array of potential programs
for review by the Registry, as well as a cadre of qualified scientists
to assist in the actual program review process. We are committed to
making the NREPP a leading national resource for contemporary, reliable
information on effective interventions to prevent and/or treat mental
health and addictive disorders.
To specifically address the needs resulting from methamphetamine
abuse, SAMHSA began working in 1999 to evaluate and expand on the
Matrix Model (not related to SAMHSA's Matrix), which was developed in
1986 by the Matrix Institute with support from NIDA as an outpatient
treatment model that was responsive to the needs of stimulant-abusing
patients. SAMHSA's Center for Substance Abuse Treatment compared the
Matrix Model to other cognitive behavioral therapies in the largest
clinical trial network study to date on treatments for methamphetamine
dependence. The result was the development and release of a scientific
intensive outpatient curriculum for the treatment of methamphetamine
addiction that maximizes recovery-based outcomes.
SAMHSA also created and released ``TIP #33: Treatment for Stimulant
Use Disorders.'' Treatment Improvement Protocols (TIPs) are best
practice guidelines for the treatment of substance use disorders and
are part of the Substance Abuse Prevention and Treatment Block Grant
technical assistance program. TIPs draw on the experience and knowledge
of clinicians, researchers, and administrative experts. They are
distributed to a growing number of facilities and individuals across
the country. TIP #33 describes basic knowledge about the nature and
treatment of stimulant use disorders. More specifically, it reviews
what is currently known about treating the medical, psychiatric, and
substance abuse/dependence problems associated with the use of two
high-profile stimulants: cocaine and methamphetamine. SAMHSA has also
published a Quick Guide for Clinicians as well as Knowledge Application
Program (KAP) Keys that are also based on TIP #33.
Education and dissemination of knowledge are key to combating
methamphetamine use. SAMHSA's Addiction Technology Transfer Centers
(ATTCs) are providing training, workshops, and conferences to the field
regarding methamphetamine. The Pacific Southwest ATTC has developed two
digital Training Modules on Methamphetamine. Additionally, SAMHSA has
collaborated with ONDCP, the National Guard Bureau's Counter Drug
Office, NIDA, and the Community Anti-Drug Coalitions of America (CADCA)
on a booklet, video tape, and PowerPoint presentation entitled, ``Meth:
What's Cooking in Your Neighborhood?'' This package of products
provides useful information on what methamphetamine is, what it does,
why it seems appealing, and what the dangers of its use are.
Additionally, SAMHSA has been working in partnership with the Drug
Enforcement Administration to provide funding to support a series of
Governors' Summits on Methamphetamine. These summits provide
communities with opportunities for strategic planning and collaboration
building to combat methamphetamine problems faced in their own
communities. Summits have been held in 15 States, including West
Virginia, which will hold its Summit later this week.
SAMHSA also supports and maintains State substance abuse treatment
systems through the Substance Abuse Prevention and Treatment Block
Grant. Block Grant funds are used by States as appropriate to address
methamphetamine abuse and all other substance abuse treatment needs.
Throughout fiscal year 2004 and 2005, SAMHSA also awarded $10.8 million
in competitive grants for projects related to treatment for individuals
using and/or abusing methamphetamine. Among them were the
Methamphetamine Targeted Capacity Expansion (TCE) Grants. Our TCE grant
program continues to help States identify and address new and emerging
trends in substance abuse treatment needs. In fiscal year 2004, SAMHSA
awarded funds to programs in four targeted areas including treatment
focused on methamphetamine and other emerging drugs. Grants were
awarded to six organizations located in California, Texas, Oregon, and
Washington. In fiscal year 2005, SAMHSA expects to award approximately
$5.3 million for up to 11 new TCE grants focusing on treatment for
methamphetamine addiction.
SAMHSA is working hard through grant mechanisms like the TCE grants
to better provide States with the flexibility to begin meeting
treatment needs as soon as trends emerge. For example, in fiscal year
2004, SAMHSA provided funding to the States of Iowa and Hawaii for
urgent methamphetamine-related treatment needs. Iowa also received
funds to address the issue of drug-endangered children who are at risk
as a result of living in homes where methamphetamine is manufactured.
At the time the Emergency Methamphetamine Treatment Grant was awarded
to Hawaii, SAMHSA's TEDS data was indicating a near doubling of adult
admissions due to methamphetamine use there.
Hawaii and Iowa are just a few examples of States whose citizens
are in need of substance abuse treatment services. As you know, there
is a vast unmet treatment need in America, and too many Americans who
seek help for their substance abuse problem cannot find it. Our
recently released NDSUH for 2003 revealed an estimated 22 million
Americans who were struggling with a serious drug or alcohol problem.
The survey contains another remarkable finding. The overwhelming
majority of people with substance use problems who need treatment--
almost 95 percent--do not recognize their problem. Of those who
recognize their problem, 273,000 reported that they made an effort but
were unable to get treatment.
To help meet that need, SAMHSA will continue to fund services
through the Substance Abuse Prevention and Treatment Block Grant and
through the TCE Grant Program. And, now, within TCE we have Access to
Recovery (ATR). Access to Recovery provides us a third complementary
grant mechanism to expand clinical substance abuse treatment and
recovery support service options.
In his 2003 State of the Union Address, President Bush resolved to
help people with a drug problem who sought treatment but could not find
it. He proposed ATR, a new consumer-driven approach for obtaining
treatment and sustaining recovery through a State-run voucher program.
State interest in Access to Recovery was overwhelming. Sixty-six
States, territories, and Tribal organizations applied for $99 million
in grants in fiscal year 2004. We funded grants to 14 States and one
Tribal organization in August 2004. Because the need for treatment is
great--as methamphetamine abuse rates alone have demonstrated--
President Bush has proposed to increase funding for ATR to $150 million
in fiscal year 2006.
Of the States that are now implementing ATR, Tennessee and Wyoming
have a particular focus on methamphetamine. The State of Tennessee will
use ATR-funded vouchers to expand treatment services and recovery
support services in the Appalachians and other rural areas of Tennessee
for individuals who abuse or are addicted primarily to methamphetamine.
This program also will reach out to community and faith-based
organizations to collaborate in this critical effort at a time when
Tennessee has emerged as having one of the largest clusters of
clandestine methamphetamine laboratories in the country. In these
clandestine laboratories, the production of methamphetamine, which can
be an extremely dangerous process, often leads to fires and explosions.
Tennessee now accounts for three-quarters of such explosions in the
South. Along with Tennessee, the Wyoming ATR program is also addressing
the methamphetamine problem, focusing its efforts on Natrona County.
This county has the second-highest treatment need in the State and is
considered to be at the center of the current methamphetamine epidemic
in Wyoming.
Wyoming and Tennessee are just two examples of ATR's potential.
ATR's use of vouchers, coupled with State flexibility and executive
discretion, offer an unparalleled opportunity to create profound
positive change in substance abuse treatment financing and service
delivery across the Nation. And, although it is reassuring to focus on
treatment initiatives and the progress being made, we can and must do
more to prevent drug use before it begins.
SAMHSA'S ROLE IN PREVENTION
SAMHSA's earlier efforts in preventing methamphetamine abuse were
channeled through its Center for Substance Abuse Prevention's (CSAP)
Methamphetamine and Inhalant Prevention Initiative. This initiative
funded grantees that were battling methamphetamine's growth in
communities across the country. For example, in Oregon, health
officials were reporting an increase in the number of youth who were
seeking treatment for addiction to methamphetamine. In 2002, the
``Oregon Partnership Methamphetamine Awareness Project'' was awarded a
SAMHSA grant that targets 9th and 10th grade students over a 3-year
period to prevent substance abuse among young people in school and
community settings in rural Oregon. CSAP's Methamphetamine and Inhalant
Prevention Initiative was designed to conduct targeted capacity
expansion of methamphetamine and inhalant prevention programs and/or
infrastructure development at both State and community levels.
To more effectively and efficiently align and focus our prevention
resources, SAMHSA launched the Strategic Prevention Framework last
year. SAMHSA awarded Strategic Prevention Framework grants to 19 States
and 2 territories to advance community-based programs for substance
abuse prevention, mental health promotion, and mental illness
prevention. We expect to continue these grants and fund seven new
grants in fiscal year 2006 for a total of $93 million. These grants are
working with our Centers for the Application of Prevention Technology
to systematically implement a risk and protective factor approach to
prevention across the Nation. Whether we speak about abstinence or
rejecting drugs, tobacco, and alcohol; or whether we are promoting
exercise and a healthy diet, preventing violence, or promoting mental
health, we really are all working towards the same objective--reducing
risk factors and promoting protective factors.
The success of the framework rests in large part on the tremendous
work that comes from grass-roots community anti-drug coalitions. That
is why we are so pleased to be working with the ONDCP to administer the
Drug-Free Communities Program. This program supports approximately 775
community coalitions across the country. Consistent with the Strategic
Prevention Framework and the Drug Free Communities grant programs, we
are transitioning our drug-specific programs to a risk and protective
factor approach to prevention. This approach also provides States and
communities with the flexibility to target their dollars in the areas
of greatest need.
In conclusion, if we continue to foster these initiatives and
further our goals of expanding substance abuse treatment capacity and
recovery support services and of implementing the strategic prevention
framework, we will simultaneously better serve people in the criminal
and juvenile justice systems, those with or at risk of HIV/AIDS and
hepatitis, our homeless, our older adults, and our children and
families. We are doing our part at SAMHSA. We have been building
systemic change so that no matter what drug trend emerges in the
future; States and communities will be equipped to address it
immediately and effectively before it reaches a crisis level.
Mr. Chairman and members of the Subcommittee, thank you for the
opportunity to appear today. I will be pleased to answer any questions
you may have.
Senator Harkin. Thank you very much, Mr. Curie, for that
very succinct and straightforward statement. I appreciate it
very much.
STATEMENT OF NORA D. VOLKOW, M.D., DIRECTOR, NATIONAL
INSTITUTE ON DRUG ABUSE, NATIONAL
INSTITUTES OF HEALTH, DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Senator Harkin. Now we will turn to Dr. Nora Volkow, the
Director of the National Institute on Drug Abuse or, as we say,
NIDA. Before assuming this position 2 years ago, Dr. Volkow was
Associate Director for Life Sciences at Brookhaven National
Laboratory. Dr. Volkow received her M.D. in 1981 from the
National University of Mexico in Mexico City and performed her
residency in psychiatry at New York University. Dr. Volkow is
an expert on the effects of drug abuse in the human brain and
was the first person to use imaging to investigate the
neurochemical changes that occur during drug addiction.
Dr. Volkow, welcome. Again, if you could summarize your
statement I would sure appreciate it. Thank you.
Dr. Volkow. Mr. Chairman, thanks very much for giving me
the privilege to be here with my colleagues to discuss how the
knowledge gained from drug abuse research can help address the
problems our Nation is facing from methamphetamine abuse.
Methamphetamine is a very dangerous drug. Not only is it highly
addictive, but it is also very toxic. Methamphetamine is a
long-acting and very potent stimulant drug. It can be snorted,
swallowed, injected, or smoked, and it is frequently taken in
combination with other drugs.
Particularly dangerous is when the drug is injected or
smoked since this leads to very fast and high concentrations of
the drug in brain, increasing both its addictive as well as its
toxic properties. Unfortunately, we have seen a shift from the
use of methamphetamine by the oral route in favor of smoking
and injection.
Methamphetamine predominantly affects the cells in the
brain that produce dopamine, a brain chemical that is important
for reward, motivation, cognition, and movement. Like other
drugs of abuse, it produces a sense of euphoria by increasing
the release of dopamine in brain reward centers. In fact,
methamphetamine is the drug of abuse that produces the largest
increases in dopamine, three times greater than for cocaine,
which accounts for its highly addictive properties.
Methamphetamine addiction progresses rapidly and the
estimated time from initial abuse to chronic use is 1 to 2
years, much faster than it is for cocaine, which is estimated
to be 3 years.
When dopamine is liberated in such high concentrations, it
can damage the dopamine cells themselves. Indeed, several
studies in laboratory animals have corroborated damage of
dopamine cells by methamphetamine. In humans, imaging studies
have shown that methamphetamine abusers show abnormalities in
dopamine cells that are similar, though to a lesser severity,
to those seen in Parkinson's patients.
The loss of dopamine cells that occurs with Parkinson's
disease results in marked impairments in movement and in
disruption in cognitive function. Similarly, the damage of
dopamine cells in methamphetamine abusers also results in motor
as well as cognitive impairment, albeit of a lesser degree.
The good news is that, different from Parkinson's disease,
where the damage cannot be reverted, with protracted
detoxification from methamphetamine there is some degree of
recovery. This further highlights the importance of instituting
treatment in methamphetamine abusers to maximize their chances
of a successful recovery.
There are other toxic effects of methamphetamine. The large
increases in dopamine produced by methamphetamine can trigger
psychoses that in some instances persist months after drug
discontinuation. Also, because methamphetamine affects the
contractions of blood vessels it can result in myocardial
infarcts, it can result in cerebral strokes, it can result in
cerebral hemorrhages in young patients.
In addition to its effects on the brain, methamphetamine
intoxication is inextricably linked to risky sexual behaviors,
thus increasing the risk for transmissions of infectious
diseases, such as HIV. The recent case of a methamphetamine
abuser with a particularly virulent strain of HIV is a sobering
reminder of this connection.
Those who inject the drug risk contracting HIV through the
sharing of contaminated equipment and methamphetamine's
physiological effects may also facilitate the transmission.
Preliminary studies suggest that HIV-positive methamphetamine
abusers who are on antiretroviral therapy are at a greater risk
of progressing to AIDS than non-users.
Methamphetamine addiction can be treated successfully. The
Matrix model initially developed through NIDA-supported
research has been shown to prevent relapse. Other behavioral
treatments are being developed and tested through NIDA's
National Drug Abuse Clinical Trial Network and also show
promise for the treatment of methamphetamine addiction.
NIDA is also investing in the development of new
medications for methamphetamine addiction. For example, a
preliminary study of an anti-epileptic medication, gamma-vinyl/
GABA, shows that half of the treated patients remained drug-
free at least for 6 weeks, even when living in an environment
that allowed them ready and easy access to the drug. NIDA's
methamphetamine clinical trial group is also testing modafinil,
a medication used to treat narcolepsy which has been shown to
be effective in cocaine addiction.
In parallel, NIDA is pursuing the development of an
immunization strategy based on monoclonal antibodies for the
treatment of overdose with methamphetamine.
PREPARED STATEMENT
In summary, NIDA has long recognized the danger of
methamphetamine abuse and has actively supported research on
these and related drugs. This research continues to help us
further elucidate methamphetamine's effects on the brain and
its consequences on behavior. This work is critical both in
developing prevention strategies to control its abuse and on
therapeutic interventions to treat those who need it.
Thank you for allowing me to share this information with
you and I will be happy to answer any questions you may have.
[The statement follows:]
Prepared Statement of Dr. Nora D. Volkow
Mr. Chairman and Members of the Committee: Thank you for inviting
the National Institute on Drug Abuse (NIDA), a component of the
National Institutes of Health (NIH), an agency of the U.S. Department
of Health and Human Services, to participate in this important hearing.
As the world's largest supporter of biomedical research on drug abuse
and addiction, we have learned much about the behavioral and health
effects of methamphetamine (METH). I am pleased to be here today to
present an overview of what the science has taught us about METH, a
stimulant drug that can have devastating medical, psychiatric, and
social consequences. NIDA has been conducting basic research on METH
for more than 20 years; however, as its use has increased, NIDA's
research efforts have also increased. In fact, NIDA funding of METH-
related research increased almost 150 percent from 2000-2004, through
which NIDA has been tracking its use and supporting multifaceted
research aimed at better understanding how the drug affects the brain,
its consequences for the brain and behavior, as well as developing
effective treatments for METH addiction.
According to NIDA's Monitoring the Future Survey, we are seeing
significant decreases in METH use among eighth graders; however, the
use among 10th and 12th graders appears to have stabilized (Figure 1).
Of greater concern are findings from NIDA's Community Epidemiology Work
Group (CEWG), which monitors drug abuse problems in sentinel areas
across the Nation and is alerting us to increases in some CEWG areas
and continued spread into rural communities. Moreover, according to the
Treatment Episode Data Set from the Substance Abuse and Mental Health
Services Administration (SAMHSA), the number of people seeking
treatment for METH/amphetamine abuse has also steadily increased from
1996-2002.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Methamphetamine is a Schedule II stimulant, which means it has a
high potential for abuse and is available only through a prescription.
There are only a few accepted medical indications for its use, such as
the treatment of narcolepsy and attention deficit hyperactivity
disorder. As a powerful stimulant, methamphetamine, even in small
doses, can increase wakefulness and physical activity and decrease
appetite. METH comes in many forms and can be snorted, swallowed,
injected, or smoked, the preferred method of use varying by
geographical region and changing over time. Faster routes of
administration, such as smoking and injecting, have become more common
in recent years, further increasing its addiction potential as well as
the severity of its consequences.
METH acts by affecting many brain structures but predominantly
those that contain dopamine, due to similarities in the chemical
structures of METH and dopamine. METH produces a sense of euphoria by
increasing the release of dopamine. In fact, amphetamines are the most
potent of the stimulant drugs in that they cause the greatest release
of dopamine, more than three times that of cocaine. This extra sense of
pleasure is followed by a ``crash'' that often leads to increased use
of the drug and eventually to difficulty in feeling any pleasure.
Long-term methamphetamine abuse can result in many damaging
consequences, including addiction. We know from research that addiction
is a chronic, relapsing disease, characterized by compulsive drug
seeking and use, which is accompanied by functional and molecular
changes in the brain. In addition to being addicted to methamphetamine,
chronic methamphetamine abusers exhibit symptoms that can include
violent behavior, anxiety, depression, confusion, and insomnia. They
also can display a number of psychotic features, including paranoia,
auditory hallucinations, and delusions.
NIDA-supported research has also shown that METH can cause a
variety of cardiovascular problems, including rapid heart rate,
irregular heartbeat, increased blood pressure, and irreversible,
stroke-producing damage to small blood vessels in the brain.
Hyperthermia (elevated body temperature) and convulsions occur with
METH overdoses and, if not treated immediately, can result in death.
WHAT DOES METHAMPHETAMINE DO TO THE BRAIN?
In animals, methamphetamine has been shown to damage nerve
terminals in the dopamine- and serotonin-containing regions of the
brain. Similarly, studies of methamphetamine abusers have demonstrated
significant alterations in the activity of the dopamine system that are
associated with reduced motor speed and impaired verbal learning
(Figure 2). One small study also correlated changes in a marker of
dopamine function with the duration of METH use and the severity of
psychiatric symptoms. Moreover, recent studies of chronic METH abusers
have revealed severe structural and functional deficits in areas of the
brain associated with emotion, specifically depression and anxiety, as
well as memory.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Although METH can produce long-lasting decreases in dopamine
function, which appear to mimic the loss of dopamine seen in diseases
like Parkinson's disease, autopsy studies show that the motor regions
most affected in Parkinson's disease are not as severely affected in
METH abusers. However, the possibility exists that moderate METH-
induced effects during early life could make an individual more
susceptible to Parkinsonism later in life. In contrast, METH-induced
deficits in cognitive regions can be as severe as those in Parkinson's
disease patients. The observed damage in Parkinson's disease is
permanent due to considerable dopamine cell death. Dopamine cell death
has not been documented in methamphetamine abusers, which could explain
why with extended abstinence, there is some recovery from METH-induced
changes in dopamine function (Figure 3).
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
A recent neuroimaging study of METH abusers showed partial recovery
of brain function in some brain regions following protracted
abstinence, associated with improved performance on motor and verbal
memory tests. However, function in other regions did not display
recovery even after two years of abstinence, indicating that some
methamphetamine-induced changes are very long-lasting. Moreover, the
increase in risk of cerebrovascular accidents from the abuse of
methampehtamine can lead to irreversible damage to the brain.
DEVELOPMENTAL EXPOSURE
In addition to its known effects in adults, NIDA is very concerned
about the effects of METH on the development of children exposed to the
drug prenatally. Unfortunately, our knowledge in this area is limited.
The few human studies that exist have shown increased rates of
premature delivery; placental abruption; fetal growth retardation; and
cardiac and brain abnormalities. For example, a recent NIDA-funded
study showed that prenatal exposure to methamphetamine resulted in
smaller subcortical brain volumes, which were associated with poorer
performance on tests of attention and memory conducted at about 7 years
of age. However, most of these human studies are confounded by
methodological problems, such as small sample size and maternal use of
other drugs. For this reason, NIDA recently launched the first large-
scale study of the developmental consequences of prenatal METH
exposure, which includes seven hospitals in Iowa, Oklahoma, California,
and Hawaii, states where METH use is prevalent. This study will
evaluate developmental outcomes such as cognition, social
relationships, motor skills and medical status.
Our knowledge about the effects of METH use later in development is
also incomplete. Despite the stable low levels of METH use for 10th and
12th graders, we are concerned with any use of METH in this age group.
Because the brain continues to develop well into adolescence and even
early adulthood, exposure to drugs of abuse during this time may have a
significant impact on brain development and later behavior. Additional
research will help us understand the effects of METH use during
childhood and adolescence and whether these effects persist into
adulthood.
METHAMPHETAMINE AND HIV
Drug abuse remains one of the primary vectors for human
immunodeficiency virus (HIV) transmission. The recent case of an HIV-
infected METH abuser in New York City with a particularly virulent
strain of HIV is a sobering reminder of the link between drug abuse and
HIV. Methamphetamine is inextricably linked with HIV, hepatitis C, and
other sexually transmitted diseases. METH use increases the risk of
contracting HIV not only due to the use of contaminated equipment, but
also due to increased risky sexual behaviors as well as physiological
changes that may favor HIV transmission.
Preliminary studies also suggest that METH may affect HIV disease
progression. For example, animal studies suggest that METH use may
result in a more rapid and increased brain HIV viral load. Moreover, in
a study of HIV-positive individuals being treated with highly active
anti-retroviral therapy (HAART), current METH users had higher plasma
viral loads than those who were not currently using METH, suggesting
that HIV-positive METH users on HAART therapy may be at greater risk of
developing acquired immune deficiency syndrome (AIDS). These
differences could be due to poor medication adherence or to
interactions between METH and HIV medications. Similarly, preliminary
studies suggest that interactions between METH and HIV itself may lead
to more severe consequences for METH abusing, HIV-positive patients,
including greater neuronal damage and neuropsychological impairment.
More research is needed to better understand these interactions.
To address these issues, NIDA recently invited applications for
administrative supplements to current grants to support studies on HIV
in METH abusers. While there have been many studies on METH and both
injection and risky sexual behavior, there is very little information
on METH and HIV disease progression or on the prevalence of drug-
resistant virus in METH abusers. Therefore, NIDA is planning to
establish a targeted surveillance initiative to monitor the development
of drug-resistant HIV in METH abusers.
WHAT ELSE IS NIDA DOING?
NIDA continues to support a comprehensive research portfolio on
methamphetamine's mechanism of action, physical and behavioral effects,
risk and protective factors, treatments, and potential predictors of
treatment success. For example, recent studies have identified genetic
variants that may be associated with an individual's response to
various drugs of abuse. One such NIDA-funded study demonstrated that
individuals with a particular variant of the dopamine transporter gene
were less able to feel the effects of amphetamine, suggesting that
people with this genotype may be protected from dependence because of a
lack of reactivity to the drug. Understanding genetic risk and
protective factors may aid in the development of targeted prevention
efforts. At the other end of the spectrum, NIDA-supported research is
also seeking to identify markers to predict which METH-dependent
patients may be more likely to relapse to drug use following treatment.
For example, a recent study noted that decreased brain activation
during a decision-making task correctly predicted which patients would
relapse to METH use. These findings may provide an approach for
assessing susceptibility to relapse early during treatment as well as
lead to new treatment approaches that are targeted towards
rehabilitating these deficits, thereby increasing a patient's chance
for long-term sobriety.
NIDA's efforts over the years to understand the basic science
underlying METH's actions are now paying off in the development of
treatments for METH addiction. In early 2000, NIDA convened a group of
experts to provide guidance on the establishment and research focus of
NIDA's methamphetamine treatment program. In response to one of their
recommendations, NIDA launched a methamphetamine medications
development initiative to use animal models to identify, evaluate, and
recommend potential treatments to reduce or eliminate drug-seeking
behaviors and drug effects, such as reversing neurotoxicity and
cognitive impairment.
To further speed medication development efforts, NIDA has also
established the Methamphetamine Clinical Trials Group (MCTG) to conduct
clinical (human) trials of medications for METH in geographic areas in
which METH abuse is particularly high, including San Diego, Kansas
City, Des Moines, Costa Mesa, San Antonio, Los Angeles, and Honolulu.
For example, modafinil, a medication for the treatment of narcolepsy,
which has shown preliminary efficacy in cocaine treatment and may have
positive effects on executive function and impulsivity, will be tested
in the MCTG for its potential in the treatment of METH addiction. Other
NIDA-supported studies are also developing promising medications. For
example, a preliminary study of an anti-epileptic medication, gamma-
vinyl GABA (GVG), showed that half of the GVG-treated patients remained
drug free for approximately six weeks despite living in their normal
home environment with ready access to drugs. To treat METH overdose,
NIDA is pursuing the development of monoclonal antibodies to METH,
which bind to the drug in the bloodstream thereby preventing its
action.
In addition to pharmacological treatments, NIDA is invested in the
development and testing of behavioral treatments. Studies have now
shown that a treatment program known as the Matrix Model can be used
successfully for the treatment of METH addiction. The Matrix Model was
initially developed in the 1980s for treating cocaine addiction. It
consists of a 16-week program that includes group and individual
therapy and components that address relapse and how to prevent it,
behavioral changes needed to remain off drugs, communication among
family members, establishment of new environments unrelated to drugs,
and other relevant topics. When applied to METH abusers, the Matrix
Model has been shown to result in a high proportion of METH-free urine
samples at program completion and 6-month follow-up.
Another behavioral treatment, Motivational Incentives for Enhancing
Drug Abuse Recovery (MIEDAR), an incentive-based method for cocaine and
METH abstinence, has recently been tested through NIDA's National Drug
Abuse Clinical Trials Network and also shows promise for the treatment
of METH addiction. MIEDAR is currently being developed for
dissemination to community treatment providers through NIDA's
collaborative Blending Initiative with SAMHSA.
Because no single behavioral treatment will be effective for
everyone, research into behavioral approaches for treating METH
addiction is ongoing. In 2005, NIDA solicited additional research
applications on the development, refinement, and testing of behavioral
and combined behavioral and pharmacological (and/or complementary/
alternative) treatments for METH abuse and dependence. We expect that,
as with other types of addiction, combining pharmacotherapies with
behavioral therapies will be the most effective way to treat METH
addiction.
Because of the prevalence of drug abuse among the criminal justice
population, NIDA, in collaboration with NIH's National Institute on
Alcohol Abuse and Alcoholism, SAMHSA, and other federal agencies,
established the Criminal Justice Drug Abuse Treatment Research Studies
(CJ-DATS), a major research initiative, bringing together researchers,
criminal justice professionals, and addiction treatment providers, to
develop new strategies to help drug abusing offenders. As part of our
efforts to combat METH addiction, CJ-DATS is collecting self-report and
biological data on methamphetamine use and investigating the
effectiveness of treatments in criminal justice settings for those who
abuse methamphetamine. Within CJ-DATS we are also supporting two
research protocols testing comprehensive treatment approaches for
juvenile offenders, including those who abuse METH.
CONCLUSION
In closing, I would like to say that as someone who has spent
almost 25 years studying the effects of psychostimulants on the brain,
I am particularly concerned about the methamphetamine problem in this
country both because of its powerful addictive potential and because of
its high toxicity. One of NIDA's most important goals is to translate
what scientists learn from research to help the public better
understand drug abuse and addiction and to develop more effective
strategies for their prevention and treatment. NIDA has long supported
research on methamphetamine, which is now paying off in the development
of effective treatments, and it is critical that these treatments
become more readily available to those who need them.
Thank you for allowing me to share this information with you. I
will be happy to answer any questions you may have.
Senator Harkin. Thank you very much, Dr. Volkow, and I will
have some questions about your charts, maybe flesh that out a
little bit more, when we get into the questions and answers.
STATEMENT OF VICKI SICKELS, DES MOINES, IOWA
Senator Harkin. Now I would like to introduce Ms. Vicki
Sickels. Ms. Sickels was born in Sioux City, Iowa, raised in
Creston, she told me. She received a bachelor's degree in
expressive arts from the University of Iowa in 1982. I am told
she became addicted to meth in 1988, finally gained lasting
recovery a decade later after receiving long-term residential
treatment.
She then became certified as a substance abuse counselor
and obtained her master social worker degree from the
University of Iowa. She is currently employed as the chemical
dependency counselor for a methamphetamine research program at
Iowa Lutheran Hospital in Des Moines and does prevention work
for the AIDS Project of Central Iowa.
Ms. Sickels, again thank you very much for being here.
Again, please proceed as you so desire.
Ms. Sickels. Thank you, Senator Harkin. It is an honor to
be here and I would like to thank other people at the table and
in the room for the work that they do on substance abuse.
I would like to stress the fact that I came from a middle
class family. My father was a civil engineer. My mother was a
stay-at-home mom. There was not substance abuse or physical
abuse of any kind in my household. I had a pony and piano
lessons and I was an honor student and sent to college at the
University of Iowa.
As a teenager and a college student, I experimented and I
was a binge-drinking college student and would try really
anything that came across my plate. But I was able to walk away
from those things and I was able to continue with my life and
graduate from college. It was nothing that really yanked the
rug out from underneath me the way that methamphetamine did.
When I discovered methamphetamine or it was introduced to
me in 1988, I had never heard of it. I did not know what it
was. I thought it was what a person did if they could not find
any cocaine. It was really love at first dose for me. The first
time I did it, I had been drinking and then I woke up just a
couple hours after I went to bed or passed out or whatever that
was, but I woke up and just was driven to get my journal and
write.
I am a writer and I was writing poetry and really prolific
and thought, wow, this is something. It is one of those drugs
that make you feel like you can do anything, you can do several
things at once, you can make it all work for a while. Then at
some point you become so disorganized, really what happens is
you lose your mind and you lose just about everything.
It got to the point where meth was all I was doing after
just a few months of doing it. At that time I left the town
that I was in, where everyone I knew was doing it, and managed
to stay clean for a year or so while I had my child. But unlike
other drugs, where I went away and continued with my life, it
sort of comes up wherever you go. I moved from Red Oak to Iowa
City and it came up again in Iowa City. Then I left there and
went to Creston and there it was again.
So the first time I went to treatment was in 1993 and my
family noticed that I was not taking very good care of my 3
year old son. They could tell that he was being neglected. So
they encouraged me to do something about my addiction or they
were going to do something for me. So I went into treatment in
Des Moines. I went to a 28-day inpatient treatment, and they
suggested that I went to a halfway house, but I had things to
do; I was not going to do that.
So I did the 28 days and then I went to Narcotics Anonymous
meetings and had a sponsor and did everything I was supposed to
do. But after 6 months I could not maintain it and I relapsed.
After that relapse, it took me 5 years to get back into
recovery again. During that 5 years I really became a different
person. I was unable to hold a job. I would get factory jobs
and they would last maybe a month or 2 and then I would be
fired because I could not show up or could not show up on time.
One job, I called and said--you know that bug thing that they
talk about with meth--I treated my whole house and everybody,
all my stuff, and I called them up the next day and said: I
just took care of this yesterday and they are back again today.
They said: You do not need to come back, thank you. So that
happened.
I was evicted from the house I was living in by my folks
because they knew what I was up to. They had me committed at
one time, but I was not ready to quit. My behavior was so
bizarre that they had me committed for an evaluation. At that
time I was sentenced to outpatient treatment. In Union County
at that time outpatient treatment was one session one time a
week with a counselor, and that was not going to do me a bit of
good.
My things were stolen, my things were lost, I was evicted
more than once. At one time my son and his father and I were
living with a woman in a house south of Iowa City and I--I am a
very peaceful person, but I punched this woman and knocked her
down in front of the deputy sheriff and spent a night in jail
for assault.
We spent a lot of time going back and forth from town to
town. Always we would stay clean for a month or 2 and then we
would find the people or the people would find us who had it.
Then in 1998 meth labs exploded in Iowa, and someone was
released from prison and came out with a recipe for
methamphetamine and he taught the people in our little subgroup
how to do it.
So we would supply different ingredients and a place to do
it and we were part of this team of meth makers. That blew up
in our face. Well, the lab did not blow up, but we were caught
doing that.
So at that time I had friends who took me by the hand and
called the treatment center and helped me pack my bags, because
I still was convinced: You know, I have had treatment before; I
can go to meetings and I can quit this. They said: You cannot.
They drove me to treatment and got me there.
Once I was there long enough to realize what I needed this
time, because I never wanted to come back again, I got on the
list for the halfway house. So of course I was an unemployed,
uninsured meth addict, so it was State-funded treatment that I
had, and the long-term residential treatment that I went to was
a halfway house in Des Moines. That was State and Federally
funded.
Then I had the long-term support of my family.
Senator Harkin. How long? How long?
Ms. Sickels. It was 90 days that I was in the halfway house
and then it was about 3 years that I stayed at--I call it my
sister's three-quarters of the way house, because she was a
safe person that I could live with while I went to school and
learned to live again.
There was a year after I got clean where I bagged groceries
at a grocery store and it was all I could do to suit up and
show up and just learn how to put one foot in front of the
other again and live. I can remember that during that year I
would feel really good about where I was and then really low.
There was just highs and lows, until about a year, and then it
sort of evened out.
Then I had a plan and I was in school and it sort of evened
out. So when I see the brain imaging, I think it makes sense.
It was the way I felt.
But it was the long-term residential treatment that really
worked for me.
Senator Harkin. So even after you quit taking meth, you
felt that there were some after effects. I have read about
this. I am going to ask some of our experts about this.
Ms. Sickels. Absolutely, absolutely.
But I am sitting here to tell you that treatment works.
Senator Harkin. How long ago was all this now?
Ms. Sickels. It will be 7 years in July.
Senator Harkin. Since then you went on and got your
master's degree.
Ms. Sickels. Uh-hmm.
Senator Harkin. You are now counseling.
Ms. Sickels. Uh-hmm. Also, I wanted to mention, we talked
about HIV and methamphetamine. Hepatitis C is huge. Hepatitis C
is also epidemic. Injecting drug users think that they are not
going to get it because they do not share needles. But it is a
hardier virus than HIV, so if they are sharing spoons and
cottons and water--I do not know that I mentioned that I was an
injecting drug user. I do not think I did. But I was, and I
ended up with hepatitis C.
Most of the people that I used with have hepatitis C as
well. In my work as a prevention counselor at the AIDS Project,
I counsel a lot of people who are testing positive for
hepatitis C. It is huge.
Senator Harkin. Wow. Well, Ms. Sickels, that is a heck of a
story. My goodness. I just congratulate you.
Ms. Sickels. Thank you.
Senator Harkin. It is a lot of will power.
Ms. Sickels. Thanks. Actually, it was a lot of help. It
took a whole team to get me where I am today.
Senator Harkin. That is what I think we have got to get
into and talk maybe to Mr. Curie and others, about how do you
build up the systems approach to this thing.
Ms. Sickels. Right, because I was so blessed to have a
supportive family. A lot of the people that I work with, they
go home and mom is using meth.
Senator Harkin. I am going to move on to Mr. Steinberg, but
one thing that Sheriff Anderson, who is the sheriff of Polk
County, Des Moines, told me, that the amount of time that they
are spending in treatment is not long enough.
Ms. Sickels. Not at all.
Senator Harkin. They are in and then they are out, and they
just do not have the facilities for them. So I see a lot of
heads nodding. Well, we will get into that too.
Thank you, Ms. Sickels, very much. We will get back, we
will have some more interaction here in a second.
STATEMENT OF RICHARD E. STEINBERG, PRESIDENT AND CHIEF
EXECUTIVE OFFICER, WESTCARE FOUNDATION,
INC., AND PRESIDENT, THERAPEUTIC
COMMUNITIES OF AMERICA
Senator Harkin. Now we turn to Richard Steinberg, President
and CEO of WestCare, a company that provides substance abuse
treatment services in six States. He is also the current
President of Therapeutic Communities of America and an
appointed member of SAMHSA's Center for Substance Abuse
Treatment National Advisory Council.
Mr. Steinberg received his bachelor of arts degree in
psychology from California State University at Long Beach, his
master of science in rehabilitation counseling from the
University of Nevada in Las Vegas.
Mr. Steinberg, welcome.
Mr. Steinberg. Thank you, Mr. Chairman.
Senator Harkin. Please, if you could summarize your
statement I would appreciate it.
Mr. Steinberg. Thank you. I appreciate, Senator, you taking
actually the time to do this hearing today. This is very
important to many of us throughout the Nation and it certainly
affects my agency in the different States that we are
operating.
I also would like to take a moment just to say that I am
pleased and honored to be on a panel with such distinguished
folks. Charlie Curie at SAMHSA has been a great friend and
supporter, not only to our agency at WestCare, but a lot of my
colleagues throughout the United States, and, wearing a double
hat as President of TCA, he has done a tremendous amount with
that group in actually looking at different approaches and not
just getting into old approaches and staying fixed, but working
in the mental health arena and the overlaps that we have with
mental health and substance abuse. He has done a great job for
us.
Nora and everybody out at NIDA has been really tremendous
with our field. One of the things that we used to have in the
early days, we were always frustrated as treatment providers
because there was research being done and we did not understand
where that fit with what we were doing. Everybody at NIDA now
has really worked with us--I call it ``where the rubber meets
the road,'' the research and the issues and how that gets
transferred and implemented in the field. Her staff has just
been dynamite to work with and help us.
Sitting next to Vicki Sickels, this is what it is all about
and why we are in this business. To hear you and hear you talk,
I do not know the rest of us have a lot to say today after
listening to her, because this is really what it is all about.
The issue of meth, methamphetamine, is extremely bad,
obviously. It is throughout the Nation and actually in other
countries it is an emerging issue there as well. It is very
high, very potent, very cheap to make, very cheap to get. It
involves all kinds of different systems. But it is out here,
and it is hard to ignore.
The treatment approaches, the treatment really works. In
this case, you hear a lot of different people come along who
have not spent any time and say, well, maybe it does not work.
Well, it really does work. I think Ms. Sickels is an example of
how that does work.
But we are talking about longer-term needs for treatment.
This is not a quick fix. Rarely does somebody seek out
treatment just because they used it one time and they showed up
the next day with help, or needing the help. But normally
people have really kind of lost everything by the time they
come in for treatment. So longer-term approaches are really
needed.
The therapeutic community model is a long-term system. Dr.
Volkow talks about 24 months that it can still be in the
system, and the brain and where it is at. These systems of care
need to be longer term. You cannot have a quick fix to it. I
just share that as a real concern.
WestCare, our programs are nonprofit, community-based. I
guess I want to make sure that I stress that a little bit, that
these are agencies--and we are not unique throughout the United
States--that come together with community citizens being on
boards of directors and working with State systems, and
basically we are treating the people on the first bounce.
Usually the people who come to us do not even have
insurance. It is an important piece because we rely heavily on
the block grant and the block grant systems and how that is
affecting our delivery of care. This brings in some other
issues, too, that people are really struggling now to where and
how to treat the masses of this.
Las Vegas has a real growing issue of people moving in,
about 7,500 a month. As Senator Reid talked about earlier, we
have a real issue with a lot of drugs coming in. You hear the
comic stuff on TV, you know, what happens in Vegas stays in
Vegas, and that also happens with the drug trade and the drug
issues that are going on.
Some of the stats that we have we think are actually low,
but we have an overcrowding of emergency rooms for mental
health and substance abuse, with meth being kind of the key
issue being brought in right now. Emergency rooms are very
overcrowded. We have come up with a system there where all the
hospitals have worked together to move them on to community-
based systems. So that is an important piece in my mind to work
with, and it is expanding. We have about 8,000 this year coming
in out of Las Vegas alone from emergency rooms for these
systems of care.
It is important to also point out that as we are doing our
programs in all the different States, the meth issue is not
something like we saw in the 80s when we came before Congress
to talk about crack cocaine in the inner cities. This is in
rural America, this is in suburbia America. It is all walks of
life are involved. It is hitting everybody and it is not just a
small issue or a small problem, as we have seen. Not that the
issues were small in the past, but they are in the one area.
My concern is that we really need to address this head on,
this meth problem in the Nation. My concern also is that we do
not take block grants and we earmark them just for one type of
issue only, because there has been some stuff over the past
that I have been concerned with and those of us in the field
where we came back--and we did this in the 80s with crack
cocaine--saying, we will just do all this for crack cocaine or
just do all this for HIV drug users or we will just do this for
moms and babies.
PREPARED STATEMENT
Methamphetamine is across the board and we need to be able
to allow the block grant systems to go into States and allow
the States to determine the best usage of those block grants to
work within their communities, because drug issues change.
Those of us who are in the business of dealing with
methamphetamine are still dealing with heroin today and alcohol
and all the other drugs as well. So it is not just one drug
only, but meth is certainly a serious problem.
I thank you for allowing me to talk.
[The statement follows:]
Prepared Statement of Richard E. Steinberg
Mr. Chairman and Members of the Subcommittee, my name is Dick
Steinberg, and I am President and CEO of the WestCare Foundation. I
also serve as President of Therapeutic Communities of America (TCA), a
membership association representing nonprofit community-based treatment
providers throughout the United States. I will focus my testimony on
the scope of the methamphetamine abuse and addiction problem in Nevada,
on WestCare's therapeutic communities (TC) treatment model, and on how
WestCare and other therapeutic communities are working to address the
problems associated with the growing abuse of methamphetamine. From
this point forward in my testimony, I will refer to methamphetamine
simply as ``meth.''
First, I would like to thank the Subcommittee for the opportunity
to testify. I am privileged to provide testimony alongside Mr. Charles
G. Curie, Administrator of the Substance Abuse and Mental Health
Services Administration (SAMHSA) and alongside Dr. Nora Volkow, the
Director of the National Institute on Drug Abuse (NIDA). Mr. Curie and
Dr. Volkow are strong leaders in their respective but related fields of
substance abuse treatment and drug abuse research. I would also like to
thank Ms. Vicki Sickels for testifying today.
I would also like to take this opportunity to thank Senator Harry
Reid for his outstanding leadership on the issues of substance abuse
treatment and mental health treatment. Senator Reid continues to
provide strong support for the funding of NIDA and SAMHSA. In 2001,
Clark County, Nevada was designated a High-Intensity Drug Trafficking
Area. I appreciate Senator Reid's support for this designation.
Founded in 1973, WestCare provides a spectrum of health and human
services in both residential and outpatient environments. Our services
include substance abuse and addiction treatment, homeless and runaway
shelters, domestic violence treatment and prevention, and behavioral
and mental health programs. These services are available to adults,
children, adolescents, and families; we specialize in helping people
traditionally considered difficult to treat, such as those who are
indigent, have multiple disorders, or are involved with the criminal
justice system.
As mentioned earlier, I am also President of Therapeutic
Communities of America (TCA), a national membership association
representing over 500 non-profit programs dedicated to providing
treatment to substance-abusing disadvantaged Americans with multiple
barriers to recovery. Therapeutic communities (TC) believe that
substance abuse clients have multiple barriers to recovery, in addition
to their drug use. Most clients within a TC have cycled through our
criminal justice and human service systems numerous times before
getting to the TC. Through modified programs based on evidence-based
research, TCs have been able to demonstrate successes even with the
most difficult of populations served. Therapeutic communities, through
federal and State funding, have been able to treat America's most
vulnerable at-risk populations.
In 2004, WestCare provided treatment services to over eighty
thousand (80,000) clients in six states (Arizona, California, Florida,
Georgia, Kentucky, and Nevada) and the U.S. Virgin Islands. WestCare is
seeing large and growing numbers of persons of all ages and backgrounds
who abuse or are addicted to meth. In 2004, WestCare provided drug
treatment services for over twenty-seven thousand (27,075) persons. Of
this amount, over twelve thousand (12,692) were addicted to meth or
cited usage during their assessment. Nearly 50 percent of the clients
we serve for substance abuse treatment report abusing meth.
Our experiences in Nevada show that athletes and students sometimes
begin using meth because of the initial heightened physical and mental
performance the drug produces. Blue collar and service workers may use
the drug to work extra shifts, while young women often begin using meth
to lose weight. Others use meth recreationally to stay energized at
``rave'' parties or other social activities. Meth is generally less
expensive and more accessible than cocaine. Users often have the
misconception that meth, while illegal, is not a harmful drug.
Based on WestCare's experiences in Nevada and elsewhere, we believe
that teenagers are highly susceptible to meth abuse and addiction. Many
of our clients are youth or adults who have previously used Ritalin or
other stimulants to treat Attention Deficit Hyperactivity Disorder
(ADHD). The self-reported meth use trends for youth in Nevada are
disturbing. Six percent (6 percent) of middle school students and
sixteen percent (16 percent) of high school students in Nevada have
reported using meth one or more times in their lives. Middle and high
school students in Nevada report having used meth more than report
having used cocaine. Self-reported meth use among this age group is
approximately equal to self-reported use of heroin, hallucinogens,
depressants or tranquilizers.
WestCare's drug and alcohol treatment program works with
adjudicated youth ages 12 to 18 who have been assessed as having a
substance abuse or addiction disorder. Our internal statistics show 52
percent of the female population and 14 percent of the male population
cite meth as their drug of choice. The high percentage of females
identifying meth as their drug of choice has motivated treatment
counselors to address issues pertaining to meth use by teenage females.
Meth abuse is not limited to teenagers. Our experience is that meth
addiction can be a generational addiction sometimes including multi-
generation use in one household: grandmother, parent, son or daughter
using together. Multi-generational meth abuse and addiction presents
significant challenges to treatment providers.
Our experience is that meth abuse and addiction is often associated
with long-term mental health disorders. Meth use may occasionally cause
blurred vision, dizziness, and loss of coordination. Users may
occasionally experience chemically induced schizophrenia and toxic
psychosis. WestCare's clients have experienced brain toxicity, kidney,
liver and lung failure, and heart disease. Users may occasionally
experience permanent brain damage--even with minimal use.
From our experience, meth is a ``crisis'' drug. The affects of meth
on the human brain can lead to severe short-term disorientation and
violence. In 2003-2004, there were 780 calls to the Reno, Nevada Crisis
Call Centers associated with drug addiction. Of those calls, 242, or
nearly one-third, were associated with meth abuse. If these figures can
be extrapolated state-wide, meth abuse is generating approximately one-
third of all crisis drug abuse treatment calls in the state of Nevada.
WestCare is working to deliver the best available diagnostic
practices for treating meth abuse and addiction. WestCare's experience
is that long-term meth abusers require longer terms of treatment than
abusers of other substances, in part because of the length of time
required for the brain to heal from meth-caused damage. WestCare has
experienced a higher percentage of clients with co-occurring disorders
(mental health and substance abuse problems) among clients reporting
meth abuse. From our perspective, there appear to be significant mental
health consequences to meth abuse, implications that are different from
those associated with abuse of other substances such as cocaine or
heroin.
Westcare's therapeutic community methodology of treatment attempts
to address the entirety of social, psychological, cognitive, and
behavioral factors in combating meth abuse and addiction.
Traditionally, therapeutic communities have been community based, long-
term residential substance abuse treatment providers. In recent years,
TCs have expanded their range of services, providing outpatient,
prevention, education, family therapy, transitional housing, in-prison
treatment, vocational training, medical services, and case management.
During my introduction, I mentioned my role as President of TCA.
TCA has submitted a separate written statement to the Subcommittee to
be included in the Hearing Record. I would encourage Subcommittee
Members and staff to review that testimony. The TCA testimony outlines
the principles on which therapeutic communities operate, and the
testimony discusses specifically how the therapeutic community
treatment model is applicable to treating individuals abusing or
addicted to meth.
Before I close, I would like to comment on the important programs
funded by the federal agencies represented at this hearing. SAMHSA and
CSAT operate the Substance Abuse Prevention and Treatment Block Grant
(SAPT), which is the single largest funding stream for treatment
programs for addicted individuals. SAHMSA and CSAT also operate
Programs of Regional and National Significance. Funding provided
through this block grant and through these discretionary programs has
been effective in developing and improving treatment for special
populations and in targeting emerging national and regional needs.
Without these funds, the treatment community could not begin to
effectively develop the necessary infrastructure to treat meth abusers
and addicts.
NIDA and the National Institute on Alcohol Abuse and Alcoholism
(NIAAA) provide invaluable clinical evidence to drug prevention and
treatment providers, improving efforts to combat the consequences of
drug abuse. Although we have much more to learn about treatment best
practices, research conducted by NIDA and NIAAA has contributed
significantly to improving treatment services.
On behalf of WestCare and my colleagues at TCA, please know that we
are grateful for the strong support this Subcommittee has provided
these two agencies in recent years. Substance abuse treatment can work
to reduce meth abuse and addiction. Interdiction and enforcement are an
important part of the solution, but effective treatment is essential to
the solution.
In conclusion, I commend the Subcommittee for conducting this
hearing, and I appreciate having been provided the opportunity to
testify. I would be pleased to answer any questions.
Senator Harkin. Thank you very much, Mr. Steinberg.
Thank you all for being here. We have a period of time here
in which we can enter into kind of a generalized discussion.
First of all, Ms. Sickels, I want to give you this to read.
I was on an airplane once and I was reading the New York Times
Sunday Magazine and it was a story called ``My Addicted Son''
by David Schiff. It was February 6 of this year. Of course, he
is a novelist and so his writing really grabs you. I do not
know if you have seen this, but I think you would appreciate
it. In fact, I am going to ask that this be made a part of the
record also, because it really lays out what happened to his
kid. It just almost really parallels your story.
[The information follows:]
[From The New York Times, February 6, 2005]
My Addicted Son
(By David Sheff)
A father's story.
One windy day in May 2002, my young children, Jasper and Daisy, who
were 8 and 5, spent the morning cutting, pasting and coloring notes and
welcome banners for their brother's homecoming. They had not seen Nick,
who was arriving from college for the summer, in six months. In the
afternoon, we all drove to the airport to pick him up.
At home in Inverness, north of San Francisco, Nick, who was then
19, lugged his duffel bag and backpack into his old bedroom. He
unpacked and emerged with his arms loaded with gifts. After dinner, he
put the kids to bed, reading to them from ``The Witches,'' by Roald
Dahl. We heard his voice--voices--from the next room: the boy narrator,
all wonder and earnestness; wry and creaky Grandma; and the shrieking,
haggy Grand High Witch. The performance was irresistible, and the
children were riveted. Nick was a playful and affectionate big brother
to Jasper and Daisy--when he wasn't robbing them.
Late that night, I heard the creaking of bending tree branches. I
also heard Nick padding along the hallway, making tea in the kitchen,
quietly strumming his guitar and playing Tom Waits, Bjork and Bollywood
soundtracks. I worried about his insomnia, but pushed away my
suspicions, instead reminding myself how far he had come since the
previous school year, when he dropped out of Berkeley. This time, he
had gone east to college and had made it through his freshman year.
Given what we had been through, this felt miraculous. As far as we
knew, he was coming up on his 150th day without methamphetamine.
In the morning, Nick, in flannel pajama bottoms and a fraying
woolen sweater, shuffled into the kitchen. His skin was rice-papery and
gaunt, and his hair was like a field, with smashed-down sienna patches
and sticking-up yellowed clumps, a disaster left over from when he
tried to bleach it. Lacking the funds for Lady Clairol, his brilliant
idea was to soak his head in a bowl of Clorox.
Nick hovered over the kitchen counter, fussing with the stove-top
espresso maker, filling it with water and coffee and setting it on a
flame, and then sat down to a bowl of cereal with Jasper and Daisy. I
stared hard at him. The giveaway was his body, vibrating like an idling
car. His jaw gyrated and his eyes were darting opals. He made plans
with the kids for after school and gave them hugs. When they were gone,
I said, ``I know you're using again.''
He glared at me: ``What are you talking about? I'm not.'' His eyes
fixed onto the floor.
``Then you won't mind being drug-tested.''
``Whatever.''
When Nick next emerged from his bedroom, head down, his backpack
was slung over his back, and he held his electric guitar by the neck.
He left the house, slamming the door behind him. Late that afternoon,
Jasper and Daisy burst in, dashing from room to room, before finally
stopping and, looking up at me, asking, ``Where's Nick?''
Nick now claims that he was searching for methamphetamine for his
entire life, and when he tried it for the first time, as he says,
``That was that.'' It would have been no easier to see him strung out
on heroin or cocaine, but as every parent of a methamphetamine addict
comes to learn, this drug has a unique, horrific quality. In an
interview, Stephan Jenkins, the singer in the band Third Eye Blind,
said that methamphetamine makes you feel ``bright and shiny.'' It also
makes you paranoid, incoherent and both destructive and pathetically
and relentlessly self-destructive. Then you will do unconscionable
things in order to feel bright and shiny again. Nick had always been a
sensitive, sagacious, joyful and exceptionally bright child, but on
meth he became unrecognizable.
Nick's mother and I were attentive, probably overly attentive--part
of the first wave of parents obsessed with our children in a self-
conscious way. (Before us, people had kids. We parented.) Nick spent
his first years on walks in his stroller and Snugli, playing in
Berkeley parks and baby gyms and visiting zoos and aquariums.
His mother and I divorced when he was 4. No child benefits from the
bitterness and savagery of a divorce like ours. Like fallout from a
dirty bomb, the collateral damage is widespread and enduring. Nick was
hit hard. The effects lingered well after his mother and I settled on a
joint-custody arrangement and, later, after we both remarried.
As a kindergartner, when he wore tights, the other school children
teased him: ``Only girls wear tights.'' Nick responded: ``Uh, uh,
Superman wears tights.'' I was proud of his self-assuredness and
individuality. Nick readily rebelled against conventional habit, mores
and taste. Still, he could be susceptible to peer pressure. During the
brief celebrity of Kris Kross, he wore backward clothes. At 11, he was
hidden inside grungy flannel, shuffling around in Doc Martens. Hennaed
bangs hung Cobain-like over his eyes.
Throughout his youth, I talked to Nick ``early and often'' about
drugs in ways now prescribed by the Partnership for a Drug-Free
America. I watched for one organization's early warning signs of
teenage alcoholism and drug abuse. (No. 15: ``Does your child volunteer
to clean up after adult cocktail parties, but neglect other chores?'')
Indeed, when he was 12, I discovered a vial of marijuana in his
backpack. I met with his teacher, who said: ``It's normal. Most kids
try it.'' Nick said that it was a mistake--he had been influenced by a
couple of thuggish boys at his new school--and he promised that he
would not use it again.
In his early teens, Nick was into the hippest music and then grew
bored with it. By the time his favorite artists, from Guns N' Roses to
Beck to Eminem, had a hit record, Nick had discarded them in favor of
the retro, the obscure, the ultra contemporary or plain bizarre, an
eclectic list that included Coltrane, polka, the soundtrack from ``The
Umbrellas of Cherbourg'' and, for a memorable period, samba, to which
he would cha-cha through the living room. His heroes, including Holden
Caulfield and Atticus Finch, were replaced by an assortment of
misanthropes, addicts, drunks, depressives and suicides, role models
like Burroughs, Bukowski, Cobain, Hemingway and Basquiat. Other
children watched Disney and ``Star Wars,'' but Nick preferred Scorsese,
David Lynch and Godard.
At 14, when he was suspended from high school for a day for buying
pot on campus, Nick and my wife and I met with the freshman dean. ``We
view this as a mistake and an opportunity,'' he explained. Nick was
forced to undergo a day at a drug-and-alcohol program but was given a
second chance. A teacher took Nick under his wing, encouraging his
interest in marine biology. He surfed with him and persuaded him to
join the swimming and water-polo teams. Nick had two productive and, as
far as I know, drug-free years. He showed promise as a student actor,
artist and writer. For a series of columns in the school newspaper, he
won the Ernest Hemingway Writing Award for high-school journalists, and
he published a column in Newsweek.
After his junior year, Nick attended a summer program in French at
the American University of Paris. I now know that he spent most of his
time emulating some of his drunken heroes, though he forgot the writing
and painting part. His souvenir of his Parisian summer was an ulcer.
What child has an ulcer at 16? Back at high school for his senior year,
he was still an honor student, with a nearly perfect grade-point
average. Even as he applied to and was accepted at a long list of
colleges, one senior-class dean told me, half in jest, that Nick set a
school record for tardiness and cutting classes. My wife and I
consulted a therapist, and a school counselor reassured us: ``You're
describing an adolescent. Nick's candor, unusual especially in boys, is
a good sign. Keep talking it out with him, and he'll get through
this.''
His high-school graduation ceremony was held outdoors on the
athletic field. With his hair freshly buzzed, Nick marched forward and
accepted his diploma from the school head, kissing her cheek. He seemed
elated. Maybe everything would be all right after all. Afterward, we
invited his friends over for a barbecue. Later we learned that a boy in
jeans and a sport coat had scored some celebratory sensimilla. Nick and
his friends left our house for a grad-night bash that was held at a
local recreation center, where he tried ecstasy for the first time.
A few weeks later, my wife planned to take the kids to the beach.
The fog had lifted, and I was with them in the driveway, helping to
pack the car. Two county sheriff's patrol cars pulled up. When a pair
of uniformed officers approached, I thought they needed directions, but
they walked past me and headed for Nick. They handcuffed his wrists
behind his back, pushed him into the back seat of one of the squad cars
and drove away. Jasper, then 7, was the only one of us who responded
appropriately. He wailed, inconsolable for an hour. The arrest was a
result of Nick's failure to appear in court after being cited for
marijuana possession, an infraction he ``forgot'' to tell me about.
Still, I bailed him out, confident that the arrest would teach him a
lesson. Any fear or remorse he felt was short-lived, however, blotted
out by a new drug--crystal methamphetamine.
When I was a child, my parents implored me to stay away from drugs.
I dismissed them, because they didn't know what they were talking
about. They were--still are--teetotalers. I, on the other hand, knew
about drugs, including methamphetamine. On a Berkeley evening in the
early 1970's, my college roommate arrived home, yanked the thrift-shop
mirror off the wall and set it upon a coffee table. He unfolded an
origami packet and poured out its contents onto the mirror: a mound of
crystalline powder. From his wallet he produced a single-edge razor,
with which he chipped at the crystals, the steel tapping rhythmically
on the glass. While arranging the powder in four parallel rails, he
explained that Michael the Mechanic, our drug dealer, had been out of
cocaine. In its place, he purchased crystal methamphetamine.
I snorted the lines through a rolled-up dollar bill. The chemical
burned my nasal passages, and my eyes watered. Whether the drug is
sniffed, smoked, swallowed or injected, the body quickly absorbs
methamphetamine. Once it reaches the circulatory system, it's a near-
instant flume ride to the central nervous system. When it reached mine,
I heard cacophonous music like a calliope and felt as if Roman candles
had been lighted inside my skull. Methamphetamine triggers the brain's
neurotransmitters, particularly dopamine, which spray like bullets from
a gangster's tommy gun. The drug destroys the receptors and as a result
may, over time, permanently reduce dopamine levels, sometimes leading
to symptoms normally associated with Parkinson's disease like tremors
and muscle twitches. Meth increases the heart rate and blood pressure
and can cause irreversible damage to blood vessels in the brain, which
can lead to strokes. It can also cause arrhythmia and cardiovascular
collapse, possibly leading to death. But I felt fantastic--supremely
confident, euphoric.
After methamphetamine triggers the release of neurotransmitters, it
blocks their reuptake back into their storage pouches, much as cocaine
and other stimulants do. Unlike cocaine, however, meth also blocks the
enzymes that help to break down invasive drugs, so the released
chemicals float freely until they wear off. Methamphetamine remains
active for 10 to 12 hours, compared with 45 minutes for cocaine. When
the dawn began to seep through the cracked window blinds, I felt bleak,
depleted and agitated. I went to bed and eventually slept for a full
day, blowing off school.
I never touched methamphetamine again, but my roommate returned
again and again to Michael the Mechanic's, and his meth run lasted for
two weeks. Not long afterward, he moved away, and I lost touch with
him. I later learned that after college, his life was defined by his
drug abuse. There were voluntary and court-ordered rehabs, car crashes,
a house that went up in flames when he fell asleep with a burning
cigarette in his mouth, ambulance rides to emergency rooms after
overdoses and accidents and incarcerations, both in hospitals and
jails. He died on the eve of his 40th birthday.
When I told Nick cautionary stories like this and warned him about
crystal, I thought that I might have some credibility. I have heard
drug counselors tell parents of my generation to lie to our children
about our past drug use. Famous athletes show up at school assemblies
or on television and tell kids, ``Man, don't do this stuff, I almost
died,'' and yet there they stand, diamonds, gold, multimillion-dollar
salaries and fame. The words: I barely survived. The message: I
survived, thrived and you can, too. Kids see that their parents turned
out all right in spite of the drugs. So maybe I should have lied, and
maybe I'll try lying to Daisy and Jasper. Nick, however, knew the
truth. I don't know how much it mattered. Part of me feels solely
responsible--if only his mother and I had stayed together; if only she
and I had lived in the same city after the divorce and had a joint-
custody arrangement that was easier on him; if only I had set stricter
limits; if only I had been more consistent. And yet I also sense that
Nick's course was determined by his first puff of pot and sip of wine
and sealed with the first hit of speed the summer before he began
college.
When Nick's therapist said that college would straighten him out, I
wanted to believe him. When change takes place gradually, it's
difficult to comprehend its meaning. At what point is a child no longer
experimenting, no longer a typical teenager, no longer going through a
phase or a rite of passage? I am astounded--no, appalled--by my ability
to deceive myself into believing that everything would turn out all
right in spite of mounting evidence to the contrary.
At the University of California at Berkeley, Nick almost
immediately began dealing to pay for his escalating meth habit. After
three months, he dropped out, claiming that he had to pull himself
together. I encouraged him to check into a drug-rehabilitation
facility, but he refused. (He was over 18, and I could not commit him.)
He disappeared. When he finally called after a week, his voice
trembled. It nonetheless brought a wave of relief--he was alive. I
drove to meet him in a weedy and garbage-strewn alleyway in San Rafael.
My son, the svelte and muscular swimmer, water-polo player and surfer
with an ebullient smile, was bruised, sallow, skin and bone, and his
eyes were vacant black holes. Ill and rambling, he spent the next three
days curled up in bed.
I was bombarded with advice, much of it contradictory. I was
advised to kick him out. I was advised not to let him out of my sight.
One counselor warned, ``Don't come down too hard on him or his drug use
will just go underground.'' One mother recommended a lockup school in
Mexico, where she sent her daughter to live for two years. A police
officer told me that I should send Nick to a boot camp where children,
roused and shackled in the middle of the night, are taken by force.
His mother and I decided that we had to do everything possible to
get Nick into a drug-rehabilitation program, so we researched them,
calling recommended facilities, inquiring about their success rates for
treating meth addicts. These conversations provided my initial glimpse
of what must be the most chaotic, flailing field of health care in
America. I was quoted success rates in a range from 20 to 85 percent.
An admitting nurse at a Northern California hospital insisted: ``The
true number for meth addicts is in the single digits. Anyone who
promises more is lying.'' But what else could we try? I used what was
left of my waning influence--the threat of kicking him out of the house
and withdrawing all of my financial support--to get him to commit
himself into the Ohlhoff Recovery Program in San Francisco. It is a
well-respected program, recommended by many of the experts in the Bay
Area. A friend of a friend told me that the program turned around the
life of her heroin-addicted son.
Nick trembled when I dropped him off. Driving home afterward, I
felt as if I would collapse from more emotion than I could handle.
Incongruously, I felt as if I had betrayed him, though I did take some
small consolation in the fact that I knew where he was; for the first
time in a while, I slept through the night.
For their initial week, patients were forbidden to use the
telephone, but Nick managed to call, begging to come home. When I
refused, he slammed down the receiver. His counselor reported that he
was surly, depressed and belligerent, threatening to run away. But he
made it through the first week, which consisted of morning walks,
lectures, individual and group sessions with counselors, 12-step-
program meetings and meditation and acupuncture. Family groups were
added in the second week. My wife and I, other visiting parents and
spouses or partners, along with our addicts, sat in worn couches and
folding chairs, and a grandmotherly, whiskey-voiced (though sober for
20 years) counselor led us in conversation.
``Tell your parents what it means that they're here with you,
Nick,'' she said.
``Whatever. It's fine.''
By the fourth and final week, he seemed open and apologetic,
claiming to be determined to take responsibility for the mess he'd made
of his life. He said that he knew that he needed more time in
treatment, and so we agreed to his request to move into the
transitional residential program. He did, and then three days later he
bolted. At some point, parents may become inured to a child's self-
destruction, but I never did. I called the police and hospital
emergency rooms. I didn't hear anything for a week. When he finally
called, I told him that he had two choices as far as I was concerned:
another try at rehab or the streets. He maintained that it was
unnecessary--he would stop on his own--but I told him that it wasn't
negotiable. He listlessly agreed to try again.
I called another recommended program, this one at the St. Helena
Hospital Center for Behavioral Health, improbably located in the Napa
Valley wine country. Many families drain every penny, mortgaging their
homes and bankrupting their college funds and retirement accounts,
trying successive drug-rehab programs. My insurance and his mother's
paid most of the costs of these programs. Without this coverage, I'm
not sure what we would have done. By then I was no longer sanguine
about rehabilitation, but in spite of our experience and the
questionable success rates, there seemed to be nothing more effective
for meth addiction.
Patients in the St. Helena program keep journals. In Nick's, he
wrote one day: ``How the hell did I get here? It doesn't seem that long
ago that I was on the water-polo team. I was an editor of the school
newspaper, acting in the spring play, obsessing about which girls I
liked, talking Marx and Dostoevsky with my classmates. The kids in my
class will be starting their junior years of college. This isn't so
much sad as baffling. It all seemed so positive and harmless, until it
wasn't.''
By the time he completed the fourth week, Nick once again seemed
determined to stay away from drugs. He applied to a number of small
liberal-arts schools on the East Coast. His transcripts were still good
enough for him to be accepted at the colleges to which he applied, and
he selected Hampshire, located in a former apple orchard in Western
Massachusetts.
In August, my wife and I flew east with him for freshman
orientation. At the welcoming picnic, Karen and I surveyed the incoming
freshmen for potential drug dealers. We probably would have seen this
on most campuses, but we were not reassured when we noticed a number of
students wearing T-shirts decorated with marijuana leaves, portraits of
Bob Marley smoking a spliff and logos for the Church of LSD.
In spite of his protestations and maybe (though I'm not sure) his
good intentions and in spite of his room in substance-free housing,
Nick didn't stand a chance. He tried for a few weeks. When he stopped
returning my phone calls, I assumed that he had relapsed. I asked a
friend, who was visiting Amherst, to stop by to check on him. He found
Nick holed up in his room. He was obviously high. I later learned that
not only had Nick relapsed, but he had supplemented methamphetamine
with heroin and morphine, because, he explained, at the time meth was
scarce in Western Massachusetts. ``Everyone told me not to try it, you
know?'' Nick later said about heroin. ``They were like, `Whatever you
do, stay away from dope.' I wish I'd got the same warning about meth.
By the time I got around to doing heroin, I really didn't see what the
big deal was.''
I prepared to follow through on my threat and stop paying his
tuition unless he returned to rehab, but I called a health counselor,
who advised patience, saying that often ``relapse is part of
recovery.'' A few days later, Nick called and told me that he would
stop using. He went to 12-step program meetings and, he claimed,
suffered the detox and early meth withdrawal that is characterized by
insuperable depression and acute anxiety--a drawn-out agony. He kept in
close touch and got through the year, doing well in some writing and
history classes, newly in love with a girl who drove him to Narcotics
Anonymous meetings and eager to see Jasper and Daisy. His homecoming
was marked by trepidation, but also promise, which is why it was so
devastating when we discovered the truth.
When Nick left, I sunk into a wretched and sickeningly familiar
malaise, alternating with a debilitating panic. One morning, Jasper
came into the kitchen, holding a satin box, a gift from a friend upon
his return from China, in which he kept his savings of $8. Jasper
looked perplexed. ``I think Nick took my money,'' he said. How do you
explain to an 8-year-old why his beloved big brother steals from him?
After a week, I succumbed to my desperation and went to try to find
him. I drove over the Golden Gate Bridge from Marin County to San
Francisco, to the Haight, where I knew he often hung out. The
neighborhood, in spite of some gentrification, retains its 1960's-era
funkiness. Kids--tattooed, pierced, track-marked, stoned--loiter in
doorways. Of course I didn't find him.
After another few weeks, he called, collect: ``Hey, Pop, it's me.''
I asked if he would meet me. No matter how unrealistic, I retained a
sliver of hope that I could get through to him. That's not quite
accurate. I knew I couldn't, but at least I could put my fingertips on
his cheek.
For our meeting, Nick chose Steps of Rome, a cafe on Columbus
Avenue in North Beach, our neighborhood after his mother and I
divorced. In those days, Nick played in Washington Square Park opposite
the Cathedral of Saints Peter and Paul, down the hill from our Russian
Hill flat. We would eat early dinner at Vanessi's, an Italian
restaurant now gone. The waiters, when they saw Nick, then towheaded,
with a gap between his front teeth, would lift him up and set him on
telephone books stacked on a stool at the counter. Nick was little
enough so that after dinner, when he got sleepy, I could carry him
home, his tiny arms wrapped around my neck.
Since reason and love, the forces I had come to rely on, had
betrayed me, I was in uncharted territory as I sat at a corner table
nervously waiting for him. Steps of Rome was deserted, other than a
couple of waiters folding napkins at the bar. I ordered coffee, racking
my brain for the one thing I could say that I hadn't thought of that
could get through to him. Drug-and-alcohol counselors, most of them
former addicts, tell fathers like me it's not our fault. They preach
``the Three C's'': ``You didn't cause it, you can't control it, and you
can't cure it.'' But who among us doesn't believe that we could have
done something differently that would have helped? ``It hurts so bad to
think I cannot save him, protect him, keep him out of harm's way,
shield him from pain,'' wrote Thomas Lynch, the undertaker, poet and
essayist, about his son, a drug addict and an alcoholic. ``What good
are fathers if not for these things?'' I waited until it was more than
half an hour past our meeting time, recognizing the mounting,
suffocating worry and also the bitterness and anger. I had been waiting
for Nick for years. At night, past his curfew, I waited for the car's
grinding engine when it pulled into the driveway and went silent, the
slamming door, footsteps and the front door opening with a click,
despite his attempt at stealth. Our dog would yelp a halfhearted bark.
When Nick was late, I always assumed catastrophe.
After 45 minutes waiting at Steps of Rome, I decided that he wasn't
coming--what had I expected?--and left the cafe. Still, I walked around
the block, returned again, peered into the cafe and then trudged around
the block again. Another half-hour later, I was ready to go home,
really, maybe, when I saw him. Walking down the street, looking down,
his gangly arms limp at his sides, he looked more than ever like a
ghostly, hollow Egon Schiele self-portrait, debauched and emaciated. I
returned his hug, my arms wrapping around his vaporous spine, and
kissed his cheek. We embraced like that and sat down at a table by the
window. He couldn't look me in the eye. No apologies for being late. He
asked how I was, how were the little kids? He folded and unfolded a
soda straw and rocked anxiously in his chair; his fingers trembled, and
he clenched his jaw and ground his teeth. He pre-empted any questions,
saying: ``I'm doing. Great. I'm doing what I need to be doing, being
responsible for myself for the first time in my life.'' I asked if he
was ready to kick, to return to the living, to which he said, ``Don't
start.'' When I said that Jasper and Daisy missed him, he cut me off.
``I can't deal with that. Don't guilt-trip me.'' Nick drank down his
coffee, held onto his stomach. I watched him rise and leave.
Through Nick's drug addiction, I learned that parents can bear
almost anything. Every time we reach a point where we feel as if we
can't bear any more, we do. Things had descended in a way that I never
could have imagined, and I shocked myself with my ability to
rationalize and tolerate things that were once unthinkable. He's just
experimenting. Going through a stage. It's only marijuana. He gets high
only on weekends. At least he's not using heroin. He would never resort
to needles. At least he's alive.
A fortnight later, Nick wrote an e-mail message to his mother and
asked for help. After they talked, he agreed to meet with a friend of
our family who took him to her home in upstate New York, where he could
detox. He slept for 20 or more hours a day for a week and began to work
with a therapist who specialized in drug addiction. After six or so
weeks, he seemed stronger and somewhat less desolate. His mother helped
him move into an apartment in Brooklyn, and he got a job. When he
finally called, he told me that he would never again use
methamphetamine, though he made no such vows about marijuana and
alcohol. With this news, I braced myself for the next disaster. A new
U.C.L.A. study confirms that I had reason to expect one: recovering
meth addicts who stay off alcohol and marijuana are significantly less
likely to relapse.
Two or so months later, the phone rang at 5 on a Sunday morning.
Every parent of a drug-addicted child recoils at a ringing telephone at
that hour. I was informed that Nick was in a hospital emergency room in
Brooklyn after an overdose. He was in critical condition and on life
support.
After two hours, the doctor called to tell me that his vital signs
had leveled off. Still later, he called to say that Nick was no longer
on the critical list. From his hospital bed, when he was coherent
enough to talk, Nick sounded desperate. He asked to go into another
program, said it was his only chance.
So without reluctance this time, Nick returned to rehab. After six
or so months, he moved to Santa Monica near his mother. He lived in a
sober-living home, attended meetings regularly and began working with a
sponsor. He had several jobs, including one at a drug-and-alcohol
rehabilitation program in Malibu. Last April, after celebrating his
second year sober, he relapsed again, disappearing for two weeks. His
sponsor, who had become a close friend of Nick's, assured me: ``Nick
won't stay out long. He's not having any fun.'' Of course I hoped that
he was right, but I was no less worried than I was other times he had
disappeared--worried that he could overdose or otherwise cause
irreparable damage.
But he didn't. He returned and withdrew on his own, helped by his
sponsor and other friends. He was ashamed--mortified--that he slipped.
He redoubled his efforts. Ten months later, of course, I am relieved
(once again) and hopeful (once again). Nick is working and writing a
children's book and articles and movie reviews for an online magazine.
He is biking and swimming. He seems emphatically committed to his
sobriety, but I have learned to check my optimism.
We recently visited Nick. His eyes were clear, his body strong and
his laugh easy and honest. At night, he read to Jasper and Daisy,
picking up ``The Witches'' where he left off nearly three years before.
Soon thereafter, a letter arrived for Jasper, who is now 11. Nick
wrote: ``I'm looking for a way to say I'm sorry more than with just the
meaninglessness of those two words. I also know that this money can
never replace all that I stole from you in terms of the fear and worry
and craziness that I brought to your young life. The truth is, I don't
know how to say I'm sorry. I love you, but that has never changed. I
care about you, but I always have. I'm proud of you, but none of that
makes it any better. I guess what I can offer you is this: As you're
growing up, whenever you need me--to talk or just whatever--I'll be
able to be there for you now. That is something that I could never
promise you before. I will be here for you. I will live, and build a
life, and be someone that you can depend on. I hope that means more
than this stupid note and these eight dollar bills.''
Senator Harkin. When I heard about your story, I remembered
reading this just a couple months ago. So I will give it to you
read when you leave here.
Mr. Curie, again without sounding too parochial, why has
meth become such a big problem in rural States? I mean, there
was always a little bit of heroin--again, Vicki, you can chime
in--some cocaine, marijuana yes, but nothing like meth, nothing
like meth.
Mr. Curie. I think it is the nature of how meth is created.
It is not reliant on a specific drug trade. The ingredients are
available in general stores in local communities. It can be
produced in makeshift laboratories, actually on a kitchen
stove. What we have been finding, that once it is produced in
that sort of local, almost intimate way, that when people begin
using it there is a network of friends and even family who are
not going to be open about it and it becomes part of the social
mores of a particular area and group.
So it is a tougher illicit drug to address. So the low
cost, the availability and the ease of manufacturing and then
the mores seem to be the primary factors that just almost are
like the perfect storm to make this a difficult drug to
address. And the rural areas have been ripe for that.
I think also the rural areas have had much more of a
challenge around treatment and getting at that issue, because
we have found that many of the approaches in treatment that
were successful with cocaine are initially successful in
helping to address meth. The urban areas had a major focus on
cocaine and rural areas really did not have that problem, so
they are somewhat starting from scratch in addressing this kind
of issue in one sense.
Plus it is always--growing up on a farm in Indiana and
being a director of a center in rural Ohio, I also know
firsthand how difficult it is to get treatment resources
focused on the rural areas.
So I think those, all those combined, contribute to this
issue.
Senator Harkin. I went on the web site yesterday. My staff
told me how to find this. You can actually go on a web site and
find how to make meth.
Mr. Curie. Absolutely.
Senator Harkin. All the ingredients are listed there step
by step how to do it.
Mr. Curie. It is very available. It is right there on the
Internet. You could go right now and you can find several kinds
of recipes. It is just mind boggling how accessible that is,
and then how effective it is in terms of creating this drug.
Then we heard from Ms. Sickels and also from Nora and the
science and then the actual results, just the profound
devastating impact this drug has on the human system, even
compared to other illicit drugs that we know for years have
been dangerous.
Ms. Sickels. Senator Harkin.
Senator Harkin. Yes, Vicki, just chime in.
Ms. Sickels. Can I add a line with this question, because I
would like to speak to this question, too. I think all that he
said is true, but part of it has to do with the way meth acts
on your brain, the way that it lifts you up above where you are
at. So if you are in a dead-end job or an unsatisfying
relationship or even I have people who come in and talk about
they use because they have back pain or they relapse because
they have been sick--it lifts you up above whatever emotional
pain or physical pain or boredom. You kind of do not care.
Then it is a vicious circle, because if you are in kind of
a bad financial situation then you use, you do not really care.
Then you lose your job, then you start to lose everything. As
long as people stay high, they will let their electricity be
shut off and their water be shut off, really living in horrible
conditions, but as long as they have got meth they can kind of
raise themselves above that and focus on their projects and it
kind of does not matter.
Senator Harkin. Amazing. Again, as long as we are on this
line, how do young people, high school students--is it a
progression? Is it like smoking and then drinking alcoholic
beverages and then maybe marijuana? Is it a progression to
meth?
Ms. Sickels. That is kind of the way it worked with other
drugs. I am not sure it is like that with meth.
Senator Harkin. I am going to have everyone chime in on
this.
Mr. Curie. I was going to say, Nora can definitely speak to
that in terms of the science. But I agree with Vicki. What we
are seeing is what you just described as a normal progression
you see with overall drug abuse and addictive behavior. For
example, we know that youth who drink alcohol at the age of 15
or younger are over four times more likely to have an addictive
disorder.
But because of the nature of this particular chemical and
its highly addictive nature--and Nora is the most qualified to
describe that in depth--it poses an overwhelming challenge in
addressing the situation.
Dr. Volkow. I think in general basically what we see is the
progression from alcohol, cigarette smoking, marijuana, to
other drugs. But what you have here is what is more accessible
to kids, so when kids have access to tablets of methamphetamine
actually readily available then that puts them in a very, very
dangerous pathway, because not all of the drugs of abuse are
the same vis a vis their addictiveness, and methamphetamine
scores up on the top because of this direct effect of producing
a massive, massive increase in dopamine.
When dopamine is increased in your brain, what the brain is
telling you is this is salient, this is extremely important for
survival. That is what the nature message of dopamine is. So
all of a sudden your brain is acting and it says: This is
incredibly salient. That is the way that nature ensures for us
to do things that are important for survival. So when you are
hungry and you see food, dopamine gets activated and that
ensures that you will do the behavior to engage in the food--
extremely important.
So you are taking this drug that is telling your brain much
more than any natural reinforcer, this is salient. So what
happens is that these kids, they feel that they can do
anything. But the problem is that then everyday things pale in
comparison. So there is nothing that can compete with the drug.
There is nothing that is going to make you feel as excited and
as engaged as methamphetamine will.
So the kid learns this and then the next time that they see
it of course they are driven to it. So the drug is basically
usurping the normal mechanisms by which nature ensures that we
will repeat that given behavior, except that in this case the
given behavior is take the drug. In others it is that you learn
to get food, that you learn to get a partner, that you learn to
take care of children. Dopamine is what actually motivates all
of these behaviors, and the drug is directly doing this at what
we call a supra, supra physiological level that is 5 to 10
times higher than normally naturally reinforcers.
That is why when a kid gets exposed to it it can be so
dangerous. You have a highly, highly addictive drug.
Mr. Steinberg. I was just going to say that the kids do not
see it as being an addictive problem when they are first
getting into it. They talk about it with each other. They do
not see it as a long-term problem.
Senator Harkin. Yes, they are young and they are strong and
they can get over it.
Mr. Steinberg. They are young and they are strong. They
have that superman mentality and everything is fine and they
are going to be just fine with it. It is just becoming so
acceptable. It is used at rave parties, so all these different
issues. They do not see it as an addictive issue.
I guess that is a concern and a message, a prevention
message on a national basis, that probably ought to be looked
at more. But it is a very serious, serious issue and they are
not seeing it as a serious issue.
I think some of the problems we get into, Senator, is that
a lot of times people think that if you are not injecting,
needle use, it is probably not addicting. I think we have
learned over the years. We used to have that in Vietnam. We
were talking about that earlier. People used to smoke just
heroin in Vietnam and they thought, well, at least they do not
inject it. They did not realize how pure it was and how quickly
they were becoming addicted. It was an issue and a real serious
issue.
These kids now are not maybe seeing it because maybe they
are not injecting it on the first bounce.
Senator Harkin. How do most young people start on meth?
Smoking?
Ms. Sickels. Snorting it, probably, is my guess.
Senator Harkin. Snorting it, like cocaine or something like
that?
Ms. Sickels. Right, snorting it or eating it probably would
be the first, yes.
Here is another thing. I talked just briefly about the
multigenerational kind of thing that is going on, but if
parents have alcohol or even marijuana, I do not know, they
probably kind of keep that separate. But a parent on meth is so
disorganized that that is obvious to a kid. I watched more than
one person that I knew as I was going through it start to use
meth with their teenage kids. It is a learned thing that is
going on in their household.
Mr. Curie. To dovetail on that, what Vicki is talking about
are the serious consequences beyond the addictive nature and
what it does to the body, the social consequences. That is I
think a classic example of what it does to the family.
Also, we probably cannot calculate the cost of this drug.
For example, I was aware ONDCP paid a visit to Vanderbilt
University Hospital in Tennessee and out of the 20 victims in
their burn unit 7 were due to methamphetamine lab accidents.
That is $10,000 a day for a burn client, plus the devastation
to that person.
So when we are really trying to dig into the consequences
of this, we probably do not even have a way of calculating
that, but it is costing us dearly in a lot of ways.
Senator Harkin. Dr. Volkow, back to the question that I
kind of raised with Ms. Sickels. That is, it seems that even
after you quit taking meth there are some residual effects that
last for some time.
Dr. Volkow. Yes, indeed. As a researcher, I was very
interested in this question, because if you look at it from the
perspective of studies and you say, well, which is the drug
that is most toxic to the brain, methamphetamine scores
probably on the top. In animals, a few exposures of two or
three doses can produce destruction actually in some instances
of the dopamine cells, which is of course what causes
Parkinson's.
So I was very interested in knowing to what extent people
abusing methamphetamine are putting themselves at risk of a
devastating disease such as Parkinson's. So I was intrigued by
that, and we did document it. We found that with Parkinson's,
the dopamine cells are dead. Patients with methamphetamine
addiction are intermediate. But the concept, though, is that
because they are intermediate they do not still have the
symptoms classically of Parkinson's. But the question was are
they at greater risk later on in their lives of becoming like
Parkinson's patients? This relates to your question, does the
brain recover?
So we have been following these patients that actually are
able to stay clean. Some when they receive treatment, as we
say, treatment works and some patients do stay clean. To our
surprise and the surprise of the field, we observed there was
recovery. People did not believe it because they had assumed
that the damage would be like Parkinson's disease.
Recovery takes time.
For example, this chart--see figure 3 in my prepared
statement--is a person that has been tested 1 month and you see
that it decreases here, the damage there. But it recovers at 24
months. It takes a long time, 2 years, but you see they recover
in this particular individual.
In animal studies done in non-human primates, in monkeys,
they have shown exactly the same thing, that if you wait long
enough--12, 24 months--you can actually recover some of the
damage, which is very, very good news, and that is the way that
I put it forth.
Senator Harkin. But is there a point where if you have been
a meth abuser for a long time, is there a point where you just
do not recover?
Dr. Volkow. That is an absolutely important question. In
animal studies, yes, to extent to which an animal can recover
is dependent on the dose and the time that that animal has been
exposed to the drug. So it is absolutely correct. There is a
point of no return. If you produce damage that is long enough,
then in animals they do not see the recovery.
So your point is very well taken. It is actually a message
that is very, very relevant to put forward. That is why I say
it highlights the importance of treating such that the person
can have a chance of recovery.
Senator Harkin. Thank you.
I do not have a lot of time left. Can we talk a little
about prevention. I mean, I need to have you just tell me about
your best ideas. Ms. Sickels, what are the best ways to prevent
this? We know about treatment and we know that it is going to
take a longer term than what we have had, so we have to have
longer term treatment modalities to get them through.
But how do we prevent this? Any thoughts on that?
Dr. Volkow. I think that actually you are absolutely
putting your finger on the fact that the main way of dealing
with the issue is prevention. We have made prevention our
number one priority exactly for the reason that is driving your
question.
Now, how do you prevent? We know that prevention works.
Now, we have a perfect example of one of the most important
prevention interventions that we have done in our society,
which was cigarette smoking. We did prevention and it has paid
off in an incredible way. It has increased the life expectancy
of Americans, and the cost to the health care system has gone
dramatically down.
Why were we successful? We were successful because we had a
systematic approach that involved clear identification of
knowledge of the damage, that then affected policy, that then
led to involvement of the educational system and industry, that
actually ultimately generated the changes in behavior.
Now, in terms of drugs, drugs of abuse and addiction starts
in adolescence and, unfortunately, sometimes in children. So
our prevention strategies have to target them because they are
the most, most vulnerable. That requires again--and this was
very clearly stated--involvement of the family, involvement of
the school system and the community. I think that that is why
Charlie's strategy is so efficient. They are saying: We cannot
deal with the problem of drug addiction in isolation. We need
to have a systematic involvement that can ultimately
incorporate the individual in the community.
I think that SAMHSA has taken a lead in this role,
highlighting the importance of a multi-pronged approach in the
strategy of prevention and also in treatment.
Mr. Curie. I appreciate that very much, Nora. We have been
working collaboratively together on our Strategic Prevention
Framework at SAMHSA. NIDA is helping fund the evaluation
process of that program. The systematic approach Nora is
talking about we are trying to embody in the Strategic
Prevention Framework, in which we are awarding State incentive
grants to States. I think we are into 19 States now. Our goal
ultimately is to be in every State. States will then embark
with local communities on a process of, one, identifying all
the prevention dollars that a community gets anyway, and there
is a lot of prevention dollars they receive from SAMHSA, from
HRSA, from CDC, from Justice, from Education; and then
embarking on a process in that community to determine an
assessment of the risk factors that exist in that community
that contribute to their drug use. It could be the
methamphetamine use more specifically in that area.
Once they identify the risk factors, then identify
protective factors. And then we have--and again, we have done
this in conjunction with NIDA and our other Federal partners--
we have developed a National Registry of Effective Prevention
Programs. Invest dollars in those prevention programs that we
know have a track record in reducing substance abuse and those
programs that represent the protective factors to address those
risk factors in that community.
For the first time, our goal is to have a baseline to start
with in a community. We can evaluate the level of the meth use,
for example, in that community, and over time see how our
interventions of working collaboratively with the schools, with
youth development organizations, 4-H, the YMCA's, Scouts,
working also with the faith-based community, are having an
effect. A community can have a strategy in place that is
integrated, where dollars are augmenting each other's efforts,
invested in evidence-based programs, and a community can speak
as a whole as to what they are doing.
Right now, as you know, as we are all too familiar with,
historically we fund prevention programs and all programs, it
seems, through silos. The Strategic Prevention Framework is to
break the silos down at the local level. We think that is, as
Nora just articulated quite well, how we fought tobacco. We
need to do the same with methamphetamine and substances in
general.
I know I mentioned underage drinking earlier. That is
another area and I think there is a connection to that to all
of this as well. These things can be addressed with the
Strategic Prevention Framework approach.
Senator Harkin. I am going to go into that a little bit
more. First I just want to recognize and welcome some students.
[Senator Harkin signing]. I think you are from ISD. My brother
graduated from ISD. I am proud to see you here today. Thank
you.
That is the Iowa School for the Deaf.
I understand about everything you said, Mr. Curie. But
just, I do not know, sometimes you have just got to put some
meat on these bones. And how we get this down to the local
level, how we get it into schools--you know, we have tried a
lot of different things. I do not know how we get to young
people.
You have--your son is now how old?
Ms. Sickels. My son is 14.
Senator Harkin. 14. Okay, what do you tell him?
Ms. Sickels. I tell him that other kids are going to
experiment with drugs and alcohol and he does not have that
luxury, that he has got the gene, and that he needs to wait
until he is legal and drink responsibly and let other people
experiment and tell them how dangerous it is. I do not know.
That is all I can say.
Senator Harkin. Are we doing a good enough job in our
schools in terms of prevention, drug prevention, alcohol
prevention? No?
Ms. Sickels. They have people in, but no, I do not think
so. Here is my thing. The high risk kids are the kids who have
parents who are using. A lot of times, the people that I work
with, most of them dropped out of school in tenth grade. Some
of them started using when they were 12 years old. So I do not
know. You have to target that prevention maybe, as Dr. Volkow
said, earlier, target it earlier or somewhere else besides the
schools.
Dr. Volkow. I like that you say that you want to actually
say have meat on things, and I agree that it could be much
better there. For example, you know who is at great risk? Those
kids with mental diseases, and this could be learning
disability, attention deficit disorder, depression. The school
can be alerted about it and also the pediatricians. So
involving the medical community in early recognition is a very,
very powerful one.
Definitely, we can do much better prevention than what we
are doing, and certainly by training teachers to identify those
kids that are having trouble learning or that are having
trouble to interact with other kids. That whole issue--if you
want to bet, which kid can I predict is at higher risk, just
with the knowledge we have now, you are good at betting at
that, paying attention to these kids, because they are not
doing properly, so they go in to try to get drugs to feel
better and that initiates the whole process.
Mr. Curie. We all need to do more. The schools cannot do it
alone. The schools need to be working in conjunction with the
community and they need to be setting the tone in the
community.
When Nora was talking about the progress we made with
tobacco, take a look at the progress we have made with other
illicit drugs. What is important is that we have a consistent
message and repeat it over and over again, at younger ages,
making it part of the norms that this is unacceptable.
I think Vicki articulated well in terms of the parental
role. We are finding in our surveys that the stronger the
message is from the parent in the home, the less likely the
child is to experiment. So it is also empowering parents,
educating parents, giving them the tools they need. So we also
need to do concerted public education and reach out to parents,
who really are up against it themselves in trying to deal with
this.
So that is why you also hear us, I think, talk about the
multifaceted approach. Yes, we need to have engagement in the
schools and we need to continue to have a reinforced message
and we need to do more, but it has got to be the community as a
whole supporting the schools in that effort, and all those
institutions in the community communicating the same message.
The other thing on prevention is, because of the
accessibility of the ingredients for methamphetamine, we see
States now passing laws to make those ingredients less
accessible.
Senator Harkin. We did in Iowa, yes.
Mr. Curie. I think that is a major prevention aspect of the
meth problem in particular, because if someone can buy sizable
amounts of ingredients from your local store and it is not
being monitored or flagged or it is easily accessible without
there being more of a monitoring, it just makes the drug much
more accessible ultimately overall.
So I think we need to take a look at those States that are
passing laws, take a look at what impact that is making, and
look at potentially other States moving in that direction.
Target stores I believe came out this past week indicating they
are voluntarily trying to implement those things reflected in
State laws nationally, and I think they need to be applauded
for doing that.
So I think getting the message out around what we can do to
not make this as an accessible drug is another very important
part of the prevention effort.
Senator Harkin. Just again for the record, I want to note
that we do not have anyone here from the Education Department.
We have had a Safe and Drug-Free Schools and Community State
grant program. Again, it is for all substances, not just meth.
This year the amount of money that we appropriated for that was
$437 million. The budget that we were sent down zeroed that
out, and I just do not think that we ought to be moving in that
direction.
Speaking of budgets now, since this is the Appropriations
Committee, we have the substance abuse block grant, $1.8
billion, level funded. That is for all substances. We have
Access to Recovery, the voucher program that you talked about.
Access to Recovery is for all substances. Then we had a
Prevent Meth Abuse Program that we had focused on here and we
put money into 12 States. It was $14 million over a couple of
years. That is zeroed out.
Again, I have not added all this up. I do not know whether
what we are looking at next year is less than what we have done
in the past. I do not know. So the totality--so the totality of
the funding that we are putting into SAMHSA is going to be less
next year than it was last year, I think, but I am not certain.
Mr. Curie. Yes, sir. For all three centers--mental health,
substance abuse, prevention, and treatment--there is about a
1.5 percent overall reduction. As you know, it is a tough
budget year, we are trying to prioritize and move ahead.
Under substance abuse treatment, though, we are looking at
an overall increase of 7, right around 7 percent. Part of that
has to do with again Access to Recovery being a major focus.
Where we believe Access to Recovery is critical in addressing
the meth issue is that States, particularly those rural States
we are talking about where it is a problem, they are encouraged
to prioritize what the specific drug problem is in their area.
For example, to point to Tennessee and Wyoming as two
States that did receive Access to Recovery awards, they
prioritized addressing meth as a major issue. So most of the
funding to those States are going toward that problem. We are
encouraging other States to examine it.
Around the prevention approach we are taking in SAMHSA,
again we are looking at the meth problem to be addressed in the
Strategic Prevention Framework because again risk factors are
risk factors, and we need to--what I think in the past we have
failed to do is to really work and empower States and
communities to embark upon identifying what is contributing to
their specific problem. That is what we want to fund.
So in our move to systemic change, we are moving away from
just addressing some individual drugs in a targeted capacity
expansion type of approach. We are trying to learn from what we
have found in that and bring systemic change across the country
and allow States flexibility then to gear their treatment and
prevention efforts around the drugs they see emerging in their
areas. Meth obviously is a major priority for those rural
States.
Senator Harkin. But this committee made a decision--I will
not just say this committee; I think the House too--made a
decision a couple years ago or so to focus money on meth
because it was rising so rapidly and, as you say, easy to make,
accessibility of the stuff, and I think there was kind of a
collective judgment on the part of the committee here that we
should really put money in there directed at meth. So that is
where we are coming from on this. So we see when that directed
money is zeroed out, I think some of us get a little concerned
about it.
But what you are saying basically is that the overall thing
is up and it is up to States to decide how they want to focus
on it?
Mr. Curie. We will work with States in making informed
decisions about what the data is saying and about what they are
experiencing, and we take the information we learn from
specific approaches, such as the grants structured toward meth,
see how we could bring them to systemic change in working with
providers.
Senator Harkin. OK, that's good. That's fair.
Mr. Steinberg. Senator, on this, from a provider in the
field and operating in six States and the trust territory of
Virgin Islands, the money we're concerned about on this is a
big issue, because as you start to see things zero-out and it
gets back out to where we're at and it's reduced--we have an
issue that's in our Nation, and we addressed it in the 1980s,
we still have an epidemic proportion of problems going on.
Prevention monies are cut. Some of our programs we've had
out there have been cut back. This is a terrible situation.
You know, years ago we used to joke about it. There used to
be an oil commercial, you know, ``Change the oil now--pay me
now or pay me later.'' The cost to what's going to happen by
not having the money on the front end for prevention and
treatment, and the research that goes into this, is just going
to be terrible in the nation later on.
The health care costs are already way up on this issue, and
are outside of the norm. The incarceration rates are way up
behind this--law enforcement systems.
We have a real problem going on as a nation behind this and
I think it's really, I understand, kind of, balanced budgets,
but the front end of this major issue on a national basis, to
have it cut in any way and not expanded--it should have been
expanded, let alone zeroed-out or stopped.
We have people just waiting to get in treatment, and if you
don't have treatment on demand--and I just want to address that
for a second. People don't always just want to come to
treatment just because they feel like they ought to get
treatment today. There's certain episodes that come to them and
they find and determine that they want to come to treatment. If
they can't get a bed or a treatment slot somewhere, they don't
necessarily the next day decide they want to go back to
treatment.
It's not like cancer where they want to just keep lining
up. They go back out, they commit robberies, they do other
things to support a habit, or they lie and cheat within their
own family to go and keep their habit going, depending on where
the money's coming from.
We have a real issue with that and it's not going away.
There's been some dips and we've made some progress as a
Nation, but it didn't go away. And I think my concern is that
when you get a little bit of help somewhere and they go, ``Oh,
we're on the right direction now. We can cut the funding,''
that just goes right back out to cause some major problems for
us. And I'm real concerned about not having those funds in
there for all the disciplines on the front end.
We seem to always come up with more money for law
enforcement and interdiction, but, you know, meth's a key
thing. We're just opening up a project in rural Kentucky and I
didn't even really know where I was going with this. I got
invited into the State to work on a program, and a judge there
explained something to me. He says, you know, ``I looked at a
fishing tackle box different than I used to'' because recently
he found out it was a portable meth lab.
You know, so you've got issues going everywhere. And my
concern is that we can't stop the front end--the funding coming
in on this area. If we don't do the prevention and education
and the treatment, we're just shooting ourselves in the foot
and we're going to be coming back in 5 and 10 years with a much
worse problem. And it's a terrible problem now.
Senator Harkin. I appreciate that. Yes, I'm concerned about
getting more of that front end prevention also. And I hope this
committee will look hard at that. I'm sure we will.
I think I can speak for Senator Specter. He's also deeply
concerned about the up-front funding for the prevention
aspects. We've talked about that.
I have to go and I want to close this up.
Ms. Sickels, I hope you don't mind me asking this question,
but I'd just like to know, I mean, do you ever worry about
relapsing? Do you ever worry? Or do you feel you're beyond
that?
I mean, you're now counseling people, you're working with
people. Does it ever come back to you?
Ms. Sickels. Sometimes I make the statement that you
couldn't pay me a million dollars to do that stuff again. But
I'm not so foolish as to think that I couldn't be vulnerable
again and in the wrong place at the wrong time again. And I
know how tricky it is. So I work very hard to keep myself from
becoming emotionally vulnerable and away from the places where
it might be laid out in front of me.
Senator Harkin. Does the fact that you were addicted at one
time, the patients that you're working with, does it, kind of,
help gain trust? Do they respond?
Ms. Sickels. Without a doubt, it absolutely does.
Senator Harkin. I can imagine that.
Ms. Sickels. I know people who have been through treatment
who are also on track. They are in school, becoming counselors.
I think that it makes a difference to people, especially meth
addicts. I do not know that it does to other addicts, but it
makes a difference.
Senator Harkin. Good.
Well, this has been very informative and very instructive,
and I appreciate your all being here today. This is a funding
aspect that this committee will wrestle with. I might also just
add parenthetically also that in some of the research aspects
of finding interventions, I know NIH is doing some research, in
terms of finding things that would intercept a drug, where if
you are a drug addict, where you take something which makes you
react so that when you take the drug you get an adverse
reaction.
Dr. Volkow. That is what we are doing with--we have
vaccines to attack cocaine and to attack nicotine.
Senator Harkin. Yes.
Dr. Volkow. Monoclonal antibodies; we have it now for
methamphetamines, but they only work if you take a huge dose
and you become very sick. We can revert those effects. We do
not have a vaccine for--we do not yet have a vaccine for
methamphetamine. But at least we can actually reverse that
acute intoxication. It is exactly the line of thinking that you
are asking, something that can interfere with the effects of
the drug going into the brain.
Senator Harkin. But that research is ongoing now?
Dr. Volkow. Absolutely, yes.
Senator Harkin. Well, thank you again, Mr. Steinberg, Ms.
Sickels, Dr. Volkow, Mr. Curry. Thank you very much for your
leadership in this area.
ADDITIONAL SUBMITTED STATEMENTS
We have receive additional submitted statements that will
be included in the record at this point.
[The statements follow:]
Prepared Statement of the Community Anti-Drug Coalitions of America
BACKGROUND
Over the last several years, the level of methamphetamine (meth)
use in the United States has risen among adults and declined among
adolescents. According to the 2003 National Survey on Drug Use and
Health, 5.2 percent or 12 million Americans have used meth in their
lifetimes.\1\
---------------------------------------------------------------------------
\1\ Office of Applied Studies, The Substance Abuse and Mental
Health Service Administration's (SAMHSA's) 2003 National Household
Survey on Drug Use and Health.
---------------------------------------------------------------------------
Meth production, use and addiction have adversely impacted many
American communities. Meth can be produced in small, clandestine labs,
whose toxicity harm children and poses significant risks to law
enforcement officials and the environment. Meth can be easily made
using readily available materials, such as ammonia, batteries, starter
fluid and ephedrine pills. Rates of meth use vary greatly from region
to region, with the highest prevalence seen throughout the Pacific,
Southwest and West Central portions of the country. Meth availability
is currently on the rise in the Great Lakes and Southeast regions as
well as in the gay communities in major urban areas across America.\2\
---------------------------------------------------------------------------
\2\ ONDCP Drug Policy Information Clearinghouse. Methamphetamine.
November 2003. Available at http://www.whitehousedrugpolicy.gov/
publications/pdf/ncj197534.pdf
---------------------------------------------------------------------------
Using meth causes the body to release high levels of dopamine, a
neurotransmitter that enhances mood and body movement. Short-term
physical reactions to meth include increased wakefulness, physical
activity, respiration, hyperthermia and decreased appetite. Long-terms
risks include cardiovascular collapse and decreased dopamine levels,
which can lead to Parkinson's disease-like symptoms.\3\
---------------------------------------------------------------------------
\3\ National Institute on Drug Abuse (NIDA). ``NIDA InfoFacts:
Methamphetamine.'' Available at: http://www.nida.nih.gov/Infofax/
methamphetamine.html Revised June, 2004.
---------------------------------------------------------------------------
Preventing meth use among our nation's youth must be a priority in
order to reduce its costs and consequences. There are three major
domains of prevention that are most effective: parents, schools and
communities. Research shows that each domain needs to be reinforced by
the other two for the greatest impact to be achieved. Consequently, it
will never be enough to put the responsibility solely on the parent,
the child, the school or the community. There needs to be a
comprehensive blend of individually and environmentally focused
prevention efforts. Multiple strategies across multiple sectors of a
community are the most effective way to reduce drug use, in general,
and meth use in particular.
There have been a core set of substance abuse prevention programs
across federal agencies that have complemented each other in raising
awareness about meth and its consequences on individuals, families,
communities and the environment. With the exception of the Center for
Substance Abuse Prevention's (CSAP) Strategic Prevention Framework /
State Incentive Grant (SPF/SIG) program and the Office of National Drug
Control Policy's (ONDCP) Drug Free Communities (DFC) Support program,
most of these programs are slated for elimination in the President's
fiscal year 2006 budget request. Specifically, the President's fiscal
year 2006 request proposes the elimination of the State Grants portion
of the Safe and Drug Free Schools and Communities (SDFSC) program
(-$441 million); the CSAP methamphetamine grant program (-$1.9
million); and the Drug Enforcement Administration (DEA) Demand
Reduction program (-$9 million).
significant outcomes from the state grants portion of the sdfsc program
The State Grants portion of the Safe and Drug Free Schools and
Communities (SDFSC) program is the primary source of federal funding
for school based prevention that directly targets all of America's
youth in grades K-12 with drug education, prevention and intervention
programming. The program funds essential and effective services
including: peer resistance and social skills training, student
assistance, parent education and education about emerging drug trends.
This program has contributed to significant reductions in meth use
among school-aged youth in many of the states that have been hardest
hit by the meth epidemic. For example:
California.--Between 1997 and 2002 the California Safe and Drug
Free Schools and Communities program contributed to a decrease of 52.9
percent in past 30 day meth use among 9th graders. In 1997, 3.4 percent
of respondents reported using meth in the past month, while in 2002
only 1.6 percent of respondents had used meth (California Student
Survey, 1997 & 2002).
Hawaii.--Between 1998 and 2002 the Hawaii Safe and Drug Free
Schools and Communities program contributed to a decrease of 37.3
percent in lifetime meth use among 10th graders. In 1998, 6.7 percent
of respondents reported using meth in their lifetime, while in 2002
only 4.2 percent of respondents had used meth (Hawaii Student Alcohol,
Tobacco and Other Drug Use Study, 2002).
Idaho.--Between 1996 and 2004 the Idaho Safe and Drug Free Schools
and Communities program contributed to a decrease of 51.9 percent in
lifetime meth use among 12th graders. In 1996, 10.4 percent of
respondents reported using meth in their lifetime, while in 2004 only
5.0 percent of respondents reported meth use (Idaho Survey, 1996 and
SDFS Survey, 2004).
Iowa.--Between 1999 and 2002 the Iowa Safe and Drug Free Schools
and Communities program contributed to a decrease of 50.0 percent in
past 30 day meth use among 6th, 8th and 11th graders. In 1999, 2.0
percent of respondents reported using meth in the past 30 days, while
in 2002 only 1.0 percent of respondents had used meth (Iowa Youth
Survey, 1999 & 2002).
Kansas.--Kansas' Safe and Drug Free Schools and Communities program
contributed to a decrease of 54.3 percent in past 30 day meth use among
8th graders, down from 2.19 percent in 1997 to 1 percent in 2003
(Kansas Communities that Care Survey, 2003).
Maryland.--Maryland's Safe and Drug Free Schools and Communities
program contributed to a decrease of 47 percent in past 30 day meth use
among 8th graders, down from 1.9 percent in 1998 to 1.0 percent in 2002
(Maryland State Department of Education's Maryland Adolescent Survey,
2003).
Pennsylvania.--Between 2001 and 2003 the Pennsylvania Safe and Drug
Free Schools and Communities Support Program contributed to a decrease
of 31.8 percent in lifetime meth use among 12th graders. In 2001, 4.4
percent of respondents reported using meth in their lifetime, while in
2003 only 3.0 percent of respondents had used meth (Pennsylvania Youth
Survey, 2003).
Washington.--Between 2000 and 2002 the Washington Safe and Drug
Free Schools and Communities Support Program contributed to a decrease
of 17.2 percent in past 30 day meth use among 12th graders. In 2000,
2.9 percent of respondents reported using meth in their lifetime, while
in 2002 only 2.4 percent of respondents reported using meth
(Washington's Healthy Youth Survey, 2000 & 2002)
The Administration's proposal to eliminate the State Grants portion
of the SDFSC program would decimate the nation's school based substance
abuse prevention infrastructure. Rural and frontier communities, where
meth production and use inflict the greatest harm, would be left with
virtually no school based drug prevention programming. The SDFSC
program is the cornerstone of all school based drug prevention and
intervention activities. Without it there would be no staff in our
nation's schools whose responsibility is to provide general drug
education and specialized programming for specific drugs such as meth.
THE DRUG-FREE COMMUNITIES PROGRAM (DFC) REDUCES METH USE
Community anti-drug coalitions are broad based groups consisting of
multiple community sectors that use their collective energy, experience
and influence to address the drug problem in their neighborhoods,
cities and/or counties. These coalitions develop comprehensive,
community-wide strategies for addressing every aspect of their
substance abuse problems, including prevention, intervention,
treatment, aftercare and law enforcement, but with a particular focus
on prevention. The DFC program funds community anti-drug coalitions to
address their locally identified drug problems. DFC grantees are
required to provide a dollar for dollar match of non federal support
for every federal dollar they receive. In addition, the grantees are
required to be data driven and comprehensive in their mix of community
partners and the strategies they implement.
The success of meth prevention efforts hinges upon the extent to
which schools, parents, law enforcement and other community groups work
comprehensively and collaboratively through community-wide efforts to
implement a full array of education, prevention, enforcement and
treatment initiatives. The SDFSC program acts as a portal into our
nation's schools for community partners to access K-12 students and
also provides the school based representation in community anti-drug
coalition efforts.
Project Radical in Reinbeck, Iowa
Project Radical, a DFC grantee, has achieved impressive reductions
in meth use in Reinbeck, Iowa. The successful strategies used by this
coalition to address meth, included an important school based component
funded by the SDFSC program.
The Project Radical Coalition contributed to a decrease in past
thirty day meth use by 12th graders, down from 5 percent in 1999 to 0
percent in 2003, resulting in a 100 percent rate of change (American
Drug and Alcohol Survey, 2003).
Between 2004 and 2005, the Project Radical Coalition contributed to
an increase of 3.2 percent in the number of 11th graders who reported
NEVER using meth in the past thirty days. In 2004, 96.1 percent of
students had not used meth in the last 30 days, while in 2005, 99.2
percent reported that they had not used meth in the past 30 days (The
Culture and Climate Survey, 2005).
To achieve these results, the Project Radical Coalition
collaborated with multiple community partners. In conjunction with
SDFSC coordinators, the coalition developed a state certified mentoring
program and became a certified SAFE (Substance Abuse Free Environment)
community. Funding from the SDFSC program was used to purchase and
implement science-based curricula for the Strengthening Families,
Project Alert and Life Skills Training prevention programs. Through
collaboration with community members, local businesses and law
enforcement officials, Project Radical was able to implement the
MethWatch program in their community. The MethWatch program promotes
cooperation between retailers and law enforcement to curtail the theft
and suspicious sales of products used to manufacture meth. In addition,
the cooperation of multiple community sectors also helped to create the
Get a Grip program, which focuses on youth substance abuse screening,
intervention and treatment referrals.
Phillips County Coalition for Healthy Choices in Malta, Montana
Another example of the significant outcomes that can be achieved
when multiple community sectors, including schools, law enforcement,
parents, the media and service organizations, collaborate to address
meth use is the Phillips County Coalition. This DFC grantee contributed
to reducing the number of 7th and 8th graders in Phillips County,
Montana who reported using meth in the last thirty days at a rate of
37.5 percent, from 3.2 percent in 1999 to 2.0 percent in 2003. This is
a significant reduction when considering that the average thirty day
use of meth in middle schools throughout the state of Montana is 4.6
percent.
To achieve these successes the coalition implemented numerous
strategies aimed at the reduction of methamphetamine use, including
school based activities, public service announcements, local news
coverage, parent education and community-wide training opportunities to
provide the public with accurate information about the effects of meth
production and use.
CONCLUSION
Reducing meth use among youth requires the collaboration of
multiple community sectors, including schools, parents, youth, law
enforcement, the faith community, business leaders and social service
providers. This comprehensive approach is necessary in order to provide
parents, youth and other community members with the information and
skills necessary to understand the multiple risks and harms associated
with meth production and use.
Research from the National Institute on Drug Abuse (NIDA) has
confirmed that as the perception of risk associated with a particular
drug rises, use of that drug declines. Collaborative approaches at the
local and state levels between the SDFSC program, the DFC program, the
SPF/SIG program and DEA's Demand Reduction Program have raised
awareness about the harmfulness of meth and led to the implementation
of comprehensive community wide strategies and programs to address meth
production, sale and use. The combined efforts of these federal
programs have had significant results in reducing meth use among youth
in states and communities across America.
This is NOT the time to eliminate funding for the State Grants
portion of the SDFSC program, CSAP's methamphetamine grant program or
the DEA Demand Reduction Program! These programs are all necessary
components of more comprehensive, community-wide efforts to reduce and
effectively address meth use and its consequences in communities across
America.
______
Prepared Statement of the National Association of State Alcohol and
Drug Abuse Directors, Inc.
Chairman Specter, Ranking Member Harkin, Members of the committee,
my name is Lewis E. Gallant, Ph.D., and I serve as Executive Director
of the National Association of State Alcohol and Drug Abuse Directors
(NASADAD). Thank you for holding this hearing today regarding
methamphetamine and its impact on American families and communities. We
sincerely appreciate the resources this Committee has dedicated to
prevention, education, treatment, research and recovery programs. As
you examine further actions regarding methamphetamine, we offer our
support and commitment and look forward to working with you and others
on this important issue.
People Can and Do Recover from Methamphetamine Addiction.--If there
is but one message to take home from today's hearing, it is this:
people can and do recover from methamphetamine addiction. Indeed,
methamphetamine may present unique challenges for our State systems.
However, studies have shown that clinically appropriate services
(screening, assessment, referral, individualized treatment plans within
the appropriate level of care and for the indicated duration of
treatment, along with aftercare and other supports) provided by
qualified staff help people with methamphetamine addiction enter into
recovery.
Core Recommendations.--There is no doubt that a comprehensive
approach is needed to address the problems associated with
methamphetamine. In addition to prevention, treatment and recovery
support services, other entities that must be part of the answer
include law enforcement, schools, child welfare representatives,
businesses, and others. For this hearing, NASADAD would like to offer
the following core recommendations as you consider action on
methamphetamine:
--Federal Funding for Prevention and Treatment Services
--Coordination with the Single State Authorities (SSAs) for Substance
Abuse
--Public Outreach and Education Regarding Methamphetamine Addiction
--Federal Support for Research
--Information Dissemination for Curriculum, Staff Training, Best
Practices
NASADAD Members and Mission.--NASADAD represents State Substance
Abuse Agency Directors--also known as Single State Authorities (SSAs)
for Substance Abuse. SSAs have the front line responsibility for
managing our nation's publicly funded prevention and treatment service
system--including the Substance Abuse Prevention and Treatment (SAPT)
Block Grant. NASADAD's mission is to promote effective and efficient
State substance abuse service systems.
NASADAD Policy Priorities.--NASADAD's key policy priorities for
2005 are to (1) strengthen State substance abuse systems and the office
of the Single State Authority (SSA), (2) expand access to prevention
and treatment services, (3) implement an outcome and performance
measurement system, (4) ensure clinically appropriate care, and (5)
promote effective policies related to co-occurring populations.
What is Methamphetamine?.--Methamphetamine is an addictive
stimulant that impacts the central nervous system. The drug can be
smoked, injected, inhaled or swallowed. As noted by the Council of
State Governments' (CSG) in Drug Abuse in America--Rural Meth (2004),
``Although the main source in the United States is Mexican drug
trafficking organizations, small, clandestine meth labs have popped up
by the thousands all over the country and account for more than half of
labs seized by enforcement.'' In many cases, methamphetamine is
manufactured using common household chemicals in makeshift laboratories
by extracting pseudoephedrine or ephedrine from cold medicine. Other
ingredients can include anhydrous ammonia, lithium metal strips torn
from batteries, and red phosphorous found in matches. According to
Michigan's Methamphetamine Control Strategy (2002), $80.00 spent at a
pharmacy and hardware store can buy ingredients to make an ounce of
methamphetamine worth $1,000.
Quick History.--Methamphetamine is not a new drug. According to
Methamphetamine in Missouri 2004, a policy brief written by Missouri's
Division of Alcohol and Drug Abuse, ``The amphetamine family of drugs
was first introduced to the medical field in the 1930's as a nasal
decongestant. Amphetamine was used in Japan during World War II to
provide soldiers energy and to prevent sleepiness. Eventually, the drug
was made available to the public, and amphetamine abuse was widespread
in Japan among young people.'' The report then notes that amphetamine
abuse did not become pronounced in the United States until the 1960s.
Methamphetamine Use and Prevalence.--According to the National
Survey on Drug Use and Health (NSDUH), approximately 12.3 million
Americans ages 12 or over tried methamphetamine in 2003. The Drug Abuse
Warning Network (DAWN), which monitors drug use reports in emergency
departments in certain parts of the country, detected a steep rise in
methamphetamine related visits over the past 10 years--with
approximately 15,000 in 1995 compared to 39,000 in 2002.
The Substance Abuse and Mental Health Services Administration
(SAMHSA) reported that in more than three-quarters of Western States,
methamphetamine/amphetamine-related treatment admissions rates are
higher than cocaine- or heroin-related admissions rates (Arkansas,
Arizona, California, Hawaii, Iowa, Montana, North Dakota, Nebraska,
Nevada, Oklahoma, Oregon, South Dakota, Utah, Washington, Wyoming).
Although States report data in different ways, some specific reports
from Single State Authorities show the following:
Iowa's Division of Health Promotion, Prevention and Addictive
Disorders noted that methamphetamine treatment admissions were 4,745 or
10.7 percent of all admissions in fiscal year 2001; 5,297 or 12.3
percent of all admissions in fiscal year 2002; 5,585 or 13.2 percent of
all admissions in fiscal year 2003; and 6,170 or 14.5 percent of all
admissions in fiscal year 2004.
Idaho's Substance Abuse Program reported that methamphetamine
clients in the publicly funded system represented 16 percent of all
admissions in 1997 and 34 percent of all admissions in 2004.
Washington's Division of Alcohol and Substance Abuse reported that
in 1993, there were 579 admissions for individuals with methamphetamine
as their primary drug of abuse--representing 1.5 percent of all
admissions. In 2003, there were 5,994 such admissions--representing 20
percent of all admissions. For youth, 3 percent of all admissions were
methamphetamine users in 1999. In 2003, 9 percent of all admissions for
youth were methamphetamine users. In all, between 1994 and 2000,
Statewide admissions for amphetamine /methamphetamine addiction
increased 600 percent.
Louisiana's Office for Addictive Disorders reported that there were
1,119 total admissions for methamphetamine in State fiscal year 2004.
According to the State's Communities that Care survey, 8 percent of
high school seniors tried methamphetamine at least once in 1998
compared to 9.8 percent in 2001. Between 2000 and 2003, methamphetamine
emergency department mentions almost doubled (from 27 to 53). In Region
VII, Bossier City police seized 1,103 grams of methamphetamine in 2002
with a street value of $110,260.
Hawaii's Alcohol and Drug Abuse Division reported that in State
fiscal year 2001, there were 763 admissions for methamphetamine. By
State fiscal year 2003, there were 1,156 admissions.
Nevada's Bureau of Alcohol and Drug Abuse (BADA) reported the
following admissions for clients using methamphetamine as their primary
substance of abuse: 2,232 in 1999--representing 21 percent of all
admissions; 2,494 in 2000; 2,608 in 2001; 2,792 in 2002; 3,300 in 2003
and 3,550 in 2004--representing 29 percent of all admissions.
The Texas Division of Mental Health and Substance Abuse reported an
increase in the percentage of methamphetamine admissions to State-
funded treatment centers over the last 4 years, 10.5 percent of total
admissions in 2004 compared to 5 percent of total admissions in 2000.
California's Department of Alcohol and Drug Programs reported
72,959 admissions for methamphetamine from July 2003 through June 30,
2004. This compares with 3,853 admissions for amphetamine/
methamphetamine clients in 1986. Total methamphetamine mentions in
emergency rooms increased 43.1 percent from 1998 (2,123) to 2002
(3,038).
Colorado's Alcohol and Drug Abuse Division reported that
methamphetamine treatment admissions doubled between 1999 (1,541
admissions) and 2003 (3,189 clients). Overall, methamphetamine clients
in 2003 represented 23.3 percent of all admissions in the State--
overtaking cocaine users (21.9 percent) for the first time.
Utah's Division of Substance Abuse and Mental Health reported that
58 clients were admitted for methamphetamine addiction in 1991. In
2004, there were 5,484 methamphetamine treatment admissions.
Missouri's Division of Alcohol and Drug Abuse reported that there
were 716 methamphetamine treatment admissions in 1995--and 3,607 in
2003. Approximately 64 percent of these admissions in 2003 reported
their first use at age 21 or younger and 48.5 percent of referrals came
from the criminal justice system.
While the methamphetamine is indeed a problem in the West, DAWN
noted that ``. . . recent data suggest that the problem may be
spreading eastward.''
Studies Show People Can and Do Recover from Methamphetamine
Addiction.--As noted earlier, the number one message to take home from
today's hearing should be that people can and do recover from
methamphetamine addiction. Richard A. Rawson, Ph.D., a noted expert in
methamphetamine from UCLA, remarked:
``Interestingly, a pervasive rumor has surfaced in many geographic
areas with elevated methamphetamine problems. The rumor is that
methamphetamine users are virtually untreatable with negligible
recovery rates. Rates from 5 percent to less that 1 percent have been
quoted in newspaper articles and been reported in conferences on
methamphetamine. The resulting conclusion is that spending money on
treating methamphetamine users is futile and wasteful. When asked about
the source of such numbers, speakers are uncertain about their origin.
In fact, no data exists. The fact that methamphetamine users bring new
clinical challenges into treatment settings appears to have been
translated into spurious statistics'' (Challenges in Responding to the
Spread of Methamphetamine Use in the U.S., 2005).
One study funded by the Center for Substance Abuse Treatment (CSAT)
included an eight-site evaluation of methamphetamine treatment. In
particular, an outpatient approach called the ``Matrix Model,'' which
has been used for over ten years, was examined. This regimen involves a
16 week non-residential, psychosocial approach used for drug
dependence. In 2004, Dr. Rawson and his colleagues found that people
entered into recovery using both the Matrix Model and other approaches.
Specifically, at discharge and follow-up points, between 57 percent and
68 percent reported no methamphetamine use for the previous 30 days.
Outcomes data provided by SSAs also demonstrate that services can
and do help people addicted to methamphetamine. Although States collect
data in different ways, some examples include:
Iowa's Division of Health Promotion, Prevention and Addictive
Disorders points to a 2003 evaluation of a CSAT funded Targeted
Capacity Expansion (TCE) Grant that it received specifically for
methamphetamine treatment. The evaluation found that 71.2 percent of
the study's clients using methamphetamine remained abstinent for 6
months after treatment and 75.4 percent of clients were abstinent one
year after treatment. The report also found that 90.4 percent of
methamphetamine clients had not been arrested 6 months after treatment
and 66.7 percent were working full time one year after treatment. A
one-page overview of research findings in Iowa is attached.
Washington's Division of Alcohol and Substance Abuse points to an
analysis of the federally funded TOPPS 2 grant, where it was found that
there were no statistically significant differences in outcomes between
adult methamphetamine users and those using other substances. In
particular, there were no differences in treatment readmission (18.9
percent for methamphetamine users and 20.5 percent for non
methamphetamine users); no differences in employment (49.2 percent of
methamphetamine users gained employment while 49 percent of non
methamphetamine users gained employment); and methamphetamine users
receiving treatment had fewer hospital admissions compared to others
(6.8 percent of methamphetamine users were admitted to hospitals after
treatment while 10.7 percent of non methamphetamine users were admitted
to hospitals after treatment).
Nevada's Bureau of Alcohol and Drug Abuse (BADA) reported that out
of the 1,664 clients addicted to methamphetamine who completed
treatment in 2004, 92.9 percent (1,546 clients) were drug free at
discharge.
The Texas Division of Mental Health and Substance Abuse examined
data describing 2004 methamphetamine clients. For outpatient
methamphetamine clients completing treatment, 78 percent reported
abstinence 60 days after discharge. For non-methamphetamine outpatient
clients completing treatment, 80 percent reported abstinence 60 days
after discharge. In examining 2004 data for residential methamphetamine
clients completing treatment, 77 percent reported abstinence 60 days
after discharge. For non-methamphetamine clients completing residential
treatment, 78 percent reported abstinence 60 days after discharge.
Finally, the Division examined outcomes for publicly funded
methamphetamine clients over a four year period (2001, 2002, 2003 and
2004). The data found that 88 percent of methamphetamine clients
reported abstinence 60 days after discharge.
Missouri's Division of Alcohol and Drug Abuse reported findings
from a 2000 TOPPS II study comparing methamphetamine clients with those
who did not have a methamphetamine problem. The evaluation found, at 6
months and 12 months after admission, no substantial outcome
differences between methamphetamine users and other drug and alcohol
users. In fact, 80 percent of the methamphetamine users reported that
they were satisfied with treatment while 61 percent of the comparison
group reported satisfaction with treatment.
Colorado's Alcohol and Drug Abuse Division reported that 80 percent
of methamphetamine users were meth-free when discharged from treatment
compared to 70 percent of clients who did not use their drug of choice
when discharged after treatment.
Utah's Division of Substance Abuse and Mental Health reported that
for State fiscal year 2004, 60.4 percent of methamphetamine admissions
were reported to have successfully completed treatment. Of those
methamphetamine users completing treatment, 60.8 percent reported being
abstinent at discharge.
Tennessee's Bureau of Alcohol and Drug Abuse reported a 2002-2003
study that specifically examined stimulant abuse among publicly funded
clients in Tennessee, including abuse of amphetamine/methamphetamine,
found that over 65 percent of clients reported that they were abstinent
six months after admission. In addition, the percentage of those
working full time quadrupled, from 9.6 percent to 45.8 percent; the
proportion of those living with their immediate family increased from
12 percent before treatment to 50.6 percent; and while 66.9 percent of
clients had arrest records two years prior to treatment, only 11.4
percent of clients had been rearrested 6 months after admission.
South Dakota's Division of Alcohol and Drug Abuse reported that
approximately half (45.1 percent) of methamphetamine clients in the
study were abstinent one year after treatment in 2003. During that same
year, methamphetamine clients experienced fewer arrests after treatment
compared to 12 months before admission in the following categories:
driving while intoxicated, disorderly conduct, assault or battery,
theft, possession of drugs, and sale of drugs. Before treatment, nearly
two-thirds of methamphetamine clients had been jailed overnight, but
this rate declined to 10.8 percent for those who remained abstinent one
year post treatment.
SPECIFIC RECOMMENDATIONS
Federal Funding for Prevention and Treatment Services.--NASADAD is
very appreciative of this Committee's history of providing increased
and sustained federal resources for treatment and prevention services.
As we look at services for methamphetamine prevention and treatment,
just as we look at services for all substances causing addiction, there
are a number of programs within SAMHSA that are critical. SAMHSA, under
the leadership of Administrator Charles Curie, is working on a number
of fronts to address this important issue. Below is an overview of
these key programs and funding recommendations for fiscal year 2006
that stem from consensus reached by a number of national organizations
that focus on addiction and recovery.
The Substance Abuse Prevention and Treatment (SAPT) Block Grant is
the foundation of our publicly funded prevention and treatment system.
NASADAD recommends $1,847,000,000 in fiscal year 2006 for an increase
of $71 million, or 4 percent, compared to fiscal year 2005. The SAPT
Block Grant provides assistance to our most vulnerable populations--
including those with methamphetamine addiction--to help them secure the
services they need. In 2001, the SAPT Block Grant provided support to
over 10,500 community-based organizations across the country. In
addition, a 20 percent prevention set-aside within the SAPT Block Grant
supports prevention services. This prevention set-aside helps our youth
steer clear of alcohol and drugs--including methamphetamine.
Federal support is also needed for the Center for Substance Abuse
Treatment (CSAT), which is led by Dr. H. Westley Clark. NASADAD
recommends $472 million for CSAT for fiscal year 2006. This includes
$150 million for the President's Access to Recovery (ATR) drug
treatment voucher program--for an increase of $50 million over fiscal
year 2005. ATR is a competitive grant designed to expand access to
clinical treatment and recovery support services.
CSAT's Targeted Capacity Expansion (TCE) program is another federal
tool that increases access to methamphetamine treatment. As part of the
Methamphetamine Anti-Proliferation Act of 2000, the Director of CSAT
was authorized to award grants directly to State Substance Abuse
Agencies to specifically address the problem of methamphetamine.
NASADAD recommends a strong investment in this specific mechanism.
Work also must be done to support the Center for Substance Abuse
Prevention (CSAP) to ensure a strong and coordinated methamphetamine
prevention strategy. NASADAD is very concerned with the proposed $14.4
million cut to CSAP and recommends that $210 million be appropriated
for CSAP in fiscal year 2006--for an increase of $11 million over
fiscal year 2005.
Within the fiscal year 2006 proposed budget, NASADAD applauds CSAP,
and the work of Director Beverly Watts Davis, for planning to increase
the number of Strategic Prevention Framework State Incentive Grants
(SPF SIGs). In particular, CSAP plans to provide $93.4 million for an
increase of approximately $8 million over fiscal year 2005 in order to
support a total of 32 grants (25 continuations and seven new). NASADAD
recommends any fiscal year 2006 increase for CSAP be dedicated to the
goal of awarding a SPF SIG grant to every State in the country.
Coordination with Single State Authorities (SSAs).--As noted above,
State Substance Abuse Directors, also known as Single State Authorities
(SSAs), manage the publicly funded treatment and prevention system.
Their job is to plan, implement and evaluate a Statewide comprehensive
system of clinically appropriate care. Every day, SSAs must work with a
number of public and private stakeholders given the fact that addiction
impacts everything from education, criminal justice, housing,
employment and a number of other areas. As a result, Federal
initiatives regarding methamphetamine should closely interact and
coordinate with SSAs given their unique role in planning, implementing
and evaluating State addiction systems.
An illustration of the collaborative work done by SSAs is their
interaction with the child welfare system. It is estimated nationally
that substance abuse is a factor in 40 percent to 80 percent of child
welfare caseloads, with approximately two-thirds of parents or primary
care givers involved in the child welfare system requiring substance
abuse treatment. Despite the need for services, existing treatment
capacity can only meet less than one-third of the demand. The funding
recommendations included in this testimony will help support necessary
treatment--and help reunite families.
As we look at methamphetamine in particular, children are indeed
impacted every day. According to policy brief issued by Carnevale
Associates, 3,419 children were endangered by methamphetamine
production in 2003. The Office of National Drug Control Policy (ONDCP)
reports that there were 14,260 methamphetamine lab-related incidents in
fiscal year 2003. Children were present at 1,442 of these incidents
while 1,447 children resided in the labs. With this in mind, NASADAD
encourages close collaboration between law enforcement, social
services, child welfare agencies and SSAs to ensure child safety,
protection and permanency, effective methamphetamine addiction
treatment for family members, and elimination of home-based
methamphetamine labs.
Public Outreach and Education Regarding Methamphetamine
Addiction.--More must be done to educate the public regarding the fact
that people can and do recover from methamphetamine addiction. Forums
such as this hearing will be critical to making progress in addressing
the false perceptions of methamphetamine and addiction treatment. In
addition, support for prevention programs in our schools is a vital
part of this education and outreach.
One important federal program that helps our efforts to prevent
methamphetamine use before it starts is the Department of Education's
(Dept. Ed) Safe and Drug Free Schools and Communities--State Grants
Program. For fiscal year 2006, the Administration proposed to
completely eliminate the SDFSC State Grants program--representing a cut
of $441 million. NASADAD recommends a complete restoration of these
funds so that the program may continue to reach an estimated 37 million
youth annually and share tools that will help youth remain drug free.
Another important tool is SAMHSA's Treatment Improvement Protocols
(TIP) series. For methamphetamine use, SAMHSA's TIP 33, Treatment for
Stimulant Disorders, gives substance use disorder treatment providers
with vital information about the effects of stimulant abuse and
dependence, discusses the relevance of these efforts to treating
stimulant users, describes treatment approaches that are appropriate
and effective, and makes specific recommendations on the practical
application of these treatment strategies.
Federal Support for Research.--Congress should continue its strong
support of research at the National Institute on Drug Abuse (NIDA) so
that we may learn more about the impact methamphetamine and the
potential promise of medication as an adjunct to methamphetamine
treatment. In particular, NASADAD recommends $1,067 million for NIDA
for an increase of $60.4 million over fiscal year 2005.
NIDA-supported research has led to a greater understanding of the
impact of methamphetamine on the brain. In particular, NIDA researchers
have discovered that methamphetamine damages nerve terminals in the
dopamine- and serotonin-containing regions of the brain. NIDA has also
established the Methamphetamine Clinical Trials Group (MCTG) to conduct
clinical trials of medications for methamphetamine in States where the
drug is particularly popular. Finally, NIDA's research served as the
foundation for the Matrix Treatment model, which has been effective in
treating methamphetamine dependence.
NASADAD commends NIDA for joining CSAT to sponsor a series of
meetings to focus on how to translate research into every day practice.
Specifically, discussions are examining the link between SSAs and
NIDA's Clinical Trials Network (CTN). NIDA and CSAT also sponsored a
session at NASADAD's 2004 Annual Meeting in Maine and will sponsor a
session at the 2005 Annual Meeting in Florida. Finally, we are pleased
with the NIDA/SAMHSA Request for Applications (RFA) designed to
strengthen SSAs capacity to support and engage in research that will
foster Statewide adoption of meritorious science-based policies and
practices. These activities will be important tools that will inform
our efforts related to methamphetamine.
Information Dissemination.--Federal support for State-to-State
information sharing regarding curriculum development, staff training
and other best practices is critical--and may help prevent certain
States from experiencing the level of methamphetamine use that some
Western States have seen for years.
A vital tool in addressing methamphetamine prevention, treatment
and recovery is the Addiction Technology Transfer Centers (ATTCs).
ATTCs, funded by SAMHSA, began in 1993 and have grown into a national
network with fourteen regional centers (including Pennsylvania, Iowa,
Texas, Nevada, Illinois) and a national office serving all fifty
states. The mission of the ATTC network is to bridge the gap between
alcohol and drug treatment scientists and substance abuse treatment
practitioners. Simply put, ATTCs help translate the latest science into
actual practice.
ATTCs sponsor conferences and workshops to expose substance abuse
counselors to current research-based practices, offer academic programs
and coursework in addiction, provide technical assistance, conduct
workforce studies, coordinate leadership activities, develop training
curricula and products, and create online courses and classes. The
ATTCs coordinate activities to recruit individuals to enter the
addiction treatment field and to develop strategies to help retain the
current workforce.
Two useful tools already generated by the ATTCs relating to
methamphetamine include Methamphetamine 101--the Etiology and
Physiology of an Epidemic, along with Methamphetamine 102--Introduction
to Evidence-Based Treatments both available at http://www.psattc.org.
NASADAD remains concerned with the Administration's proposal to cut
the ATTC program by approximately $1.6 million (from $8,166,000 to
$6,606,000) compared to fiscal year 2005. NASADAD recommends restoring
this proposed cut to the ATTC program.
Support for Regional and State Summits.--Although methamphetamine
use is more prevalent in the West, studies demonstrate that the drug
has made its way across the country and remains a concern of all
States. Specific challenges remain that are unique to individual States
and regions of the country. For some States that have not yet seen a
spike in methamphetamine admissions, action is being taken now to
ensure coordinated plans are in place to address any potential trends.
For example, Vermont recently held a Methamphetamine Summit and
Educational earlier this year to provide training on methamphetamine
prevention and treatment strategies. This meeting included members of
the law enforcement community; public health agencies; community
coalitions and others. Strong federal support to help convene regional
meetings of SSAs and others would help facilitate information
specifically about methamphetamine--and could allow certain areas of
the country to stop the problem before it starts.
CONCLUSION
NASADAD appreciates the opportunity to provide input on this
important issue. We look forward to working with the Committee, SAMHSA
and others as we move forward.
[From the Iowa Department of Public Health]
Iowa Evaluations Support Basic Message: With Treatment, People Recover
From Methamphetamine Addiction
Background.--Two studies done in Iowa (Iowa Adult Methamphetamine
Treatment Project--Final Report, 2003 and Iowa Outcomes Monitoring
System (IOMS)--Iowa Project, 2004) demonstrate that treatment for
methamphetamine addiction is effective. Key findings are below.
Treatment is effective in stopping methamphetamine use.--The 2003
report found that 71.2 percent of the clients using methamphetamine
remained abstinent 6 months after treatment and 75.4 percent of clients
were abstinent one year after treatment. The 2004 report found that of
those who were interviewed 6 months after their discharge, 65.5 percent
of methamphetamine users were abstinent, 53.3 percent of marijuana
users were abstinent, and 43.9 percent of those admitted for alcohol
abuse were abstinent.
Treatment helps those in recovery from methamphetamine addiction
stay out of jail.--The 2003 report found that 90.4 percent of
methamphetamine clients had not been arrested 6 months after treatment
and 95.7 percent of methamphetamine clients interviewed one year after
treatment had not been arrested during the previous 6 months. The 2004
study found that in the six months after treatment, 86 percent of
methamphetamine users had not been arrested, 90.7 percent of alcohol
users had not been arrested, 79.2 percent of cocaine users were not
arrested, and 86.8 percent of marijuana users were not arrested. These
rates compare to 30.9 percent of clients who had not been arrested in
the 12 months prior to treatment.
Treatment helps people get back to work.--The 2003 report found
that 54.8 percent of the methamphetamine clients were working full time
6 months after treatment while 66.7 percent were working full time one
year after treatment. The 2004 report found that the percentage of
those employed full time increased by 16.7 percent for all clients.
While longer treatment periods improve outcomes, results for
patients treated for approximately 60 days or less are still
impressive.--The 2003 study found that methamphetamine clients
interviewed 6 months after discharge who had longer lengths of
treatment (more than 90 days) were almost one and a third times more
likely to remain abstinent and about one and a half times more likely
to be employed full time. The 2004 study found that the average
methamphetamine patient was treated for 65.9 days. In general, patients
with a range of addiction problems who were treated for longer periods
of time were more likely to be abstinent: 41.8 percent for 31-60 days,
47.6 percent for 61-90 days, 54.4 percent for 91-120 days and 62.4
percent for more than 120 days.
ABOUT THE STUDIES
Iowa Adult Methamphetamine Treatment Project--Final Report, 2003.--
The Iowa Department of Public Health (IDPH) received a three-year grant
(1999-2002) from the Substance Abuse and Mental Health Services
Administration's (SAMHSA) Center Substance Abuse Treatment (CSAT) to
expand and study the treatment of methamphetamine addiction in Polk
County, Iowa. Approximately 76 percent of the 306 clients participated
in the follow-up study.
Iowa Outcomes Monitoring System (IOMS)--Iowa Project, 2004.--The
Iowa Consortium for Substance Abuse Research and Evaluation released a
study regarding 832 randomly selected clients who were admitted to
treatment during 2003. In all, 83 declined to participate. Of those
remaining, 582 were selected for follow-up interviews 6 months after
discharge, of which 362 were completed.
______
Prepared Statement of the Heartland Family Service, Inc.
Chairman Specter, Ranking Member Harkin, and members of the
Subcommittee, Heartland Family Service appreciates the opportunity to
submit this testimony concerning the problem of methamphetamine abuse
as it affects Southwest Iowa.
Heartland Family Service is a non-profit, 501(c)(3), non-sectarian
human services agency that has served Southwest Iowa since 1977. The
agency is committed to low and moderate-income families and offers a
variety of programs to strengthen individuals and families through
education, counseling and support. Service is provided in
Pottawattamie, Harrison, Crawford, Monona, Shelby, Mills, Cass,
Montgomery, Page and Fremont counties, Iowa.
While methamphetamine use is not a new epidemic in Iowa, the
problem continues to grow at an alarming rate. Furthermore, the rate at
which methamphetamine is manufactured in Southwest Iowa is even more
alarming. When added to the already evident problems presented by the
use of other substances such as alcohol, cocaine and marijuana, it
becomes apparent that something must be done. The following statistics,
according to Iowa's Drug Control Strategy for 2002, show substance
abuse trends in Iowa (ODCP, 2001). Statistics for 2002 were obtained
directly from the Iowa Department of Public Health.
ADULT SUBSTANCE ABUSE TREATMENT SCREENINGS/ADMISSIONS BY PRIMARY DRUG OF ABUSE FOR THE STATE OF IOWA
----------------------------------------------------------------------------------------------------------------
1999 2000 2001 2002
(percent) (percent) (percent) (percent)
----------------------------------------------------------------------------------------------------------------
Alcohol..................................................... 65.4 65.9 63.0 60.9
Marijuana................................................... 12.3 8.2 17.6 18.2
Methamphetamine............................................. 9.1 10.6 12.1 13.7
Cocaine/Crack............................................... 6.3 7.8 5.3 4.7
Other/Unknown............................................... 6.9 7.5 2.0 2.5
----------------------------------------------------------------------------------------------------------------
Source: Iowa's Drug Control Strategy 2002.
As the U.S. Department of Justice National Drug Threat Assessment
2002 indicates, methamphetamine production began spreading eastward in
the mid- to late 1990's in order to keep pace with growing demand, and
it has become increasingly available in the eastern United States
(NDIC, 2001). Users have now learned simple production methods to
produce their own supply, and according to the Iowa Department of
Public Health, methamphetamine labs in Iowa have become a serious,
growing concern (IDPH, 2002a).
Also during the 1990's, methamphetamine began to replace cocaine as
the drug of choice for many of Iowa's illicit drug users. Not only is
this drug less expensive and more readily available than cocaine, but
its effects last for eight to twelve hours, as compared to cocaine
which lingers for only one to two hours. Consequently, according to the
Iowa Department of Public Safety, methamphetamine remains the major
drug of choice in Iowa (IDPS, 2001). The following chart illustrates
the trend in Clandestine Laboratory seizures by the Iowa Department of
Public Safety from 1996 through 2001 (Fourth Judicial, 2002).
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Also according to the Fourth Judicial Research Initiative (which
closely examined drug prevalence in nine counties of Southwest Iowa in
comparison to the entire state of Iowa), as of December 31, 2001, an
additional 257 labs had been investigated by local and county agencies
throughout the entire state. The combined total of clandestine
laboratories seized by state, local and county departments, for 2001,
was 768. These seizures doubled in one year (Fourth Judicial, 2002).
Furthermore, the Office of National Drug Control Policy reported that
as of February 2002, there were already 61 clandestine laboratories
seized in Iowa (ONDCP, 2002b). These seizures reflect reported
occurrences throughout the entire state, not just for the metropolitan
areas. In addition, preliminary figures for 2001 reported by the Iowa
Department of Public Health show that of the 42 methamphetamine-related
hazardous substances emergency releases in the state, 18 occurred in
the Southwest Iowa region (IDPH, 2002b).
Researchers for the Fourth Judicial District Research Initiative
also examined data regarding admissions to drug treatment centers
throughout the state and in the local area. By analyzing Substance
Abuse Treatment Data (Admission/Screening Data) regularly collected by
the State of Iowa, it was determined that there were 64,673 screen
assessments and admissions for treatment' (including duplicated screens
and admissions) in the entire state of Iowa during 2001. Of these,
2,817 occurred in the Fourth Judicial District--comprised of nine
southwestern Iowa counties listed in the table below (Fourth Judicial,
2002). While this data addresses only nine of the fifteen counties to
be served by this grant, it demonstrates trends for the entire
Southwest Iowa region.
LOCAL TREATMENT ASSESSMENT AND ADMISSION DATA
------------------------------------------------------------------------
2001 number of
Fourth judicial district county total screens/
admits
------------------------------------------------------------------------
Audobon County.......................................... 93
Cass County............................................. 247
Pottawattamie County.................................... 1,568
Fremont County.......................................... 59
Harrison County......................................... 164
Mills County............................................ 189
Montgomery County....................................... 214
Page County............................................. 340
Shelby County........................................... 163
---------------
Total............................................. 2,817
------------------------------------------------------------------------
Source: Fourth Judicial District Research Initiative Examining Drug
Prevalence in the Recent Arrestee Population.
From this data, it is clear that the southwestern portion of the
State of Iowa has a higher than expected number of treatment
admissions. Specifically, statewide data indicated an overall state
average of 653.2 screen assessments and admissions per county for the
entire year; however, the number evidenced in the Fourth Judicial
District was 2.4 times greater (Fourth Judicial, 2002).
In this same research initiative, the counties of the Fourth
Judicial District were examined in relation to the overall state to
determine how Southwest Iowa's drug crime trends compare to the overall
state. Illustrated in the following chart are the results of these
analyses utilizing drug offense rates per 100,000 people (Fourth
Judicial, 2002). (As all counties may not have regularly reported to
the State of Iowa Incident Based Reporting System from where this data
was originally derived, calculations were not possible for the Fourth
Judicial District for 1999.)
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Indicated by these statistics, drug crime trends in Southwest Iowa
readily outnumber official drug rates when compared to the state.
Methamphetamine, otherwise known as ``crank,'' poses such a huge
threat because of its availability and the severe physiological effects
associated with its use. The violence and environmental damage
associated with the production, distribution, and use of the drug
render it the third greatest drug threat. (NDIC, 2001.) This drug is a
highly addictive central nervous system stimulant. Physiological
effects include increased heart rate, elevated blood pressure, elevated
body temperature, increased respiratory rate, and pupillary dilation,
as reported by the U.S. Department of Health and Human Services (CSAT,
1999). Addiction, psychotic behavior, and brain damage (similar to that
caused by Alzheimer's disease, stroke, and epilepsy) are additional
effects of methamphetamine use. Its extreme psychological and physical
addiction, as well as its depletion of necessary chemicals in the
brain, pushes the user into paranoia, physical degeneration and
violence. The degenerative effects may be long lasting or even
permanent. (ONDCP, 2002a.)
This synthetic drug can be a powerful stimulant. It jump-starts the
central nervous system and causes increased activity and alertness in
the user. It can give the user an illusion of great control and mastery
over life. For many, the pleasure and power are so great they find
themselves using despite the negative consequences to their body, mind
and spirit.
Drug treatment providers are continually seeking more effective
ways to treat methamphetamine use and addiction. According to the U.S.
Department of Health and Human Services, research has not yet
demonstrated the optimal duration, frequency, and format of treatment
for stimulant addiction (CSAT, 1999).
A Needs Assessment in a fifteen targeted county area identified the
lack of substance abuse treatment facilities as a concern. Currently,
there are only fifteen residential beds to serve the entire Southwest
Iowa area. There are no halfway house services, specializing in
programming for methamphetamine users.
TOTAL DRUG OFFENSES BY COUNTY
------------------------------------------------------------------------
County 1998 1999 2000
------------------------------------------------------------------------
Audobon.......................... 3 2 1
Cass............................. 79 59 44
Fremont.......................... 5 9 13
Harrison......................... 58 59 71
Mills............................ 8 43 79
Montgomery....................... 82 80 74
Page............................. 48 28 21
Pottawattamie.................... 971 869 1174
Shelby........................... 11 1 ...........
------------------------------------------------------------------------
Source.--Fourth Judicial District Research Initiative Examining Drug
Prevalence in the Recent Arrestee Population.
A PROMISING APPROACH TO THE CRISIS: THE HALFWAY HOUSE INITIATIVE
As one important initiative to address the methamphetamine
epidemic, Heartland Family Service has proposed a Southwest Iowa
Methamphetamine Treatment Program, also known as the Halfway House
initiative, to assist healthcare agencies and the courts by providing
services to women and children in methamphetamine abuse cases.
Heartland is seeking funds to implement this initiative in fiscal year
2006.
This project will be a collaborative effort between Heartland
Family Services, the Iowa Department of Human Services, the courts, and
other social service agencies. It is a clinically managed low-intensity
residential service for substance abuse patients, using Heartland
Family Service's established residential treatment and counseling
facilities.
The Halfway House program offers women an interim residential
treatment service, and at the same time allows them to continue
parenting their children. Treatment is directed toward applying
recovery skills, preventing relapse, promoting personal responsibility
and reintegrating the patient into work, education and family life.
Services include individual, group and family therapy.
This level of care is a missing piece in the substance abuse
treatment continuum of care in Southwest Iowa. Patients who complete
residential programming ordinarily go directly home and receive
outpatient treatment. To prevent relapse, many of these patients would
benefit from a monitored interim treatment setting. Each patient has
clinical oversight by a professional counselor who assesses the
psychosocial history of a substance abuser to determine the most
appropriate treatment plan.
Heartland Family Service sincerely appreciates the opportunity to
present its views about the severity of the methamphetamine abuse
problem.
______
Prepared Statement of the Legal Action Center
The Legal Action Center respectfully requests that this statement
be entered into the official record for the Senate Appropriations
Subcommittee on Labor, Health, and Human Services and Education and
Related Agencies hearing on methamphetamine abuse, held on April 21,
2005. We appreciate the opportunity to submit testimony on this
critical issue and its connection to fiscal year 2006 funding for
alcohol and drug addiction prevention, treatment, education, and
research programs. The Legal Action Center is a non-profit law and
policy organization that works to reduce alcohol and drug addiction and
abuse and the harm it causes to millions of individuals and their
families and friends by providing legal assistance to people in
recovery or still suffering from addiction and programs that serve them
to fight discrimination and violations of privacy, and conducting
public policy advocacy and research to expand prevention, treatment and
research and to promote other sound policies.
METHAMPHETAMINE ABUSE AND ADDICTION
According to the 2003 Substance Abuse and Mental Health Services
Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH)
the incidence of methamphetamine use rose between 1992 and 1998 but
since then there have been no statistically significant changes.
However the NSDUH also indicates that approximately 12 million
Americans have tried methamphetamine, with the majority of past-year
users between 18 and 34 years of age. Additionally, women make up 47
percent of all treatment admissions for methamphetamine, which is a
much greater percentage than admissions associated with most other
drugs. According to the National Institute on Drug Abuse (NIDA),
methamphetamine abuse and production continue at high levels in Hawaii,
west coast areas, and some southwestern areas of the United States and
unfortunately is continuing to spread eastward to urban, suburban, and
rural areas at a pace unrivaled by any other drug in recent times.
Just as addiction to alcohol and other drugs is treatable,
addiction to methamphetamine is treatable as well. Despite contrary
media accounts and common misconceptions, methamphetamine is not a
``new'' drug and individuals who are addicted to methamphetamine have
been successfully treated for years. Research from SAMHSA's Center for
Substance Abuse Treatment indicates the following results:
--Methamphetamine use decreased 69 percent after treatment.
--Employment of methamphetamine users increased 60 percent after
treatment.
--Housing status increased about 24 percent.
--Arrests decreased about 38 percent.
--The number of clients reporting good or excellent health increased
about 30 percent after treatment.
Results from the 2003 Iowa Adult Methamphetamine Treatment Project
also found the following:
--71.2 percent of the clients using ``meth'' remained abstinent 6
months after treatment and 75.4 percent of clients were
abstinent one year after treatment.
--90.4 percent of the clients had not been arrested 6 months after
treatment and 95.7 percent of those interviewed one year after
treatment had not been arrested during the previous 6 months.
--54.8 percent of the clients were working full time 6 months after
treatment while 66.7 percent were working full time one year
after treatment.
Recent efforts by SAMHSA have increased access to treatment for
methamphetamine addiction and, if properly funded, will continue to do
so. These efforts include:
--Providing Substance Abuse Prevention and Treatment Block Grant
(SAPTBG) funds, which a number of Western states are using to
address methamphetamine addiction.
--Awarding $14 million over 3 years to fight methamphetamine-inhalant
abuse in 10 ten states, including Ohio, Iowa, Pennsylvania, New
Mexico, Texas, Hawaii, and Nevada; in addition, in fiscal year
2004, the Center for Substance Abuse Treatment (CSAT) awarded
$2.9 million in funds to 6 grantees to support programs focused
on methamphetamine. Three earmarked awards totaling $1 million
have been made to Iowa and Hawaii for methamphetamine-specific
programs.
--Implementing the Strategic Prevention Framework (SPF) through the
Center for Substance Abuse Prevention (CSAP) for States to
identify geographic, demographic, and specific substance abuse
areas of greatest need.
--Allowing States to focus on methamphetamine addiction through the
Access to Recovery (ATR) Program. Tennessee and Wyoming have
both focused their ATR funds on methamphetamine abuse and
addiction. Tennessee has a special focus on persons abusing or
addicted to methamphetamine in rural or Appalachia areas,
reaching out to community and faith-based organizations.
Wyoming is focusing on Natrona County, the county with the
second highest treatment need in the state and the ``epicenter
of the current methamphetamine epidemic.''
Continued federal funding for these initiatives will help ensure
that individuals who are addicted are able to access treatment for
their illness. Additionally, it will aid the Administration's steady
progress toward reaching its goal of lowering the rate of drug use by
25 percent among youth and adults over five years.
CLOSING THE TREATMENT AND PREVENTION SERVICES GAP
According to the Substance Abuse and Mental Health Services
Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH),
in 2003 approximately 22.2 million people age 12 or over needed
treatment for an alcohol or illicit drug problem. However the 2003
NSDUH also estimated that only 1.9 million of these individuals in need
of treatment actually received specialty treatment, leaving 20.3
million persons with either an alcohol or illicit drug problem needing
but not receiving treatment. Additionally, youth around the nation are
widely exposed to drug and alcohol use and may not receive access to
comprehensive prevention services. Although we are encouraged by
findings in the 2004 Monitoring the Future study that youth illicit
drug use is gradually declining, we must continue to invest in the best
treatment and prevention options and provide services that are
evidence-based, ensuring that our wealth of science becomes
incorporated into everyday practice.
FIELD RECOMMENDATIONS FOR SUBSTANCE ABUSE PREVENTION, TREATMENT,
EDUCATION AND RESEARCH FUNDING FOR FISCAL YEAR 2006
Our organization, in partnership with other advocates, urges
Congress to adopt the following funding levels in fiscal year 2006 for
alcohol and drug treatment, prevention, education, and research
programs in the Substance Abuse and Mental Health Services
Administration (SAMHSA), the Department of Education, and the National
Institutes of Health. These investments will provide desperately needed
services in communities across the country:
--$1.847 billion for the Substance Abuse Prevention and Treatment
Block Grant, the foundation of the publicly supported
prevention and treatment system in this country.
--$472 million for the Center for Substance Abuse Treatment (CSAT),
including $150 million for the Access to Recovery drug
treatment voucher program.
--$210 million for the Center for Substance Abuse Prevention (CSAP).
--$441 million to continue full funding for the Safe and Drug Free
Schools and Communities State Grants program.
--$464 million for research at the National Institute on Alcohol
Abuse and Alcoholism (NIAAA) and $1.0671 billion for research
at the National Institute on Drug Abuse (NIDA).
federal funding is essential to the prevention and treatment of
SUBSTANCE ABUSE AND ADDICTION
Programs that serve people with alcohol and drug addiction depend
nearly exclusively on public funds. According to SAMHSA's National
Expenditure Report released in March, public funding provides the vast
majority of substance abuse expenditures, increasing from 62 percent in
1991 to 76 percent in 2001. Private insurance represented only 13
percent of addiction treatment expenditures in 2001, while it covered
36 percent of all health care expenditures. Between 1991 and 2001
private insurance payments for addiction treatment declined by an
average of 1.1 percent annually. Without strong federal commitment to
closing the treatment gap, educating young people about the importance
of refraining from using illicit drugs and alcohol, and making further
advances on the science of addiction, substance abuse will continue to
be one of the nation's top health problems, causing more deaths,
illnesses, and disabilities than most other preventable health
conditions.
Although the alcohol and drug addiction treatment system relies
heavily on public funds, an extremely small percentage of health care
spending is used for treatment. In 2001, of the $1.4 trillion spent on
health care, an estimated $18 billion was devoted to treatment of
alcohol and drug addiction. This amount constituted just 1.3 percent of
all health care spending and a fraction of the economic and social
costs of substance abuse: in 1998, the total economic costs of alcohol
abuse were estimated to be $185 billion and the total economic costs of
drug abuse were $143 billion, a total of $328 billion. These costs
include medical consequences, lost earnings linked to premature death,
lost productivity, motor vehicle crashes, crime, and other social
consequences. Funding for addiction treatment is not even keeping pace
with inflation. Expenditures on drug and alcohol treatment grew 1.7
percentage points less than the growth rate of all health care.
IMPORTANCE OF FUNDING THE FULL CONTINUUM OF PREVENTION, TREATMENT, AND
RESEARCH
The Legal Action Center urges Congress to help improve access to,
and the effectiveness of, services by increasing support for the
following programs:
--$1.847 billion for the Substance Abuse Prevention and Treatment
Block Grant.--The Substance Abuse Prevention and Treatment
(SAPT) Block Grant is the cornerstone of the nation's
prevention and treatment system, providing approximately half
of all public funding for treatment services, including
methamphetamine treatment. In 2002, the SAPT Block Grant served
1.9 million people; over 10,500 community-based organizations
receive Block Grant funding from the states. The Block Grant
also provides crucial support for the states' prevention
programs, designating 20 percent of the total funding for this
purpose. To help meet the pressing need for treatment and
prevention services and to provide resources to improve their
effectiveness, we urge Congress in fiscal year 2006 to fund the
SAPT Block Grant at $1.847 billion, a $71 million increase.
--$472 million for the Center for Substance Abuse Treatment (CSAT),
including $150 million for the Access to Recovery drug
treatment voucher program.--Sustaining and increasing funding
for CSAT programming is essential to close the treatment gap.
Funding for the Best Practices portfolio within CSAT, which
supports effective treatment through the adoption of evidence-
based practice, is critical in order to ensure that what is
learned about addiction through scientific research is
effectively shared with the treatment provider community. CSAT
supports this technology transfer through its Addiction
Technology Transfer Centers (ATTCs), which are located
regionally throughout the nation and provide training and
technical assistance to providers. In addition, funding for
CSAT's Targeted Capacity Expansion programs that address
specific and emerging drug epidemics, including methamphetamine
and/or underserved populations, such as youth, pregnant and
parenting women, and communities of color must be strengthened.
These CSAT funds enable states and regions dealing with
emerging needs, such as methamphetamine addiction or veterans
returning home in need of essential treatment services, to
appropriately address these needs. Ensuring that these programs
continue to receive support is critical, since many of these
programs locally do not receive traditional Block Grant
funding.
We support the innovative approaches that SAMHSA has developed to
expand the continuum of services offered and the range and
capacity of providers. For example, the Screening, Brief
Intervention, and Referral to Treatment (SBIRT) program helps
to link primary care and emergency services providers with
treatment programs in order to target individuals, particularly
youth, whose abuse of alcohol and drugs is incipient. The new
Access to Recovery (ATR) program holds the promise of expanding
treatment capacity, providing aftercare and recovery support
services that are critical to the effectiveness of treatment,
and promoting the measurement of outcomes that help to improve
program effectiveness. We support the President's request to
increase funding for the ATR program at CSAT by $50 million,
funding the program at $150 million. Additional funding for the
Access to Recovery program would allow seven additional grants
to be funded. Like all new programs that are a departure from
previous approaches, it will take time for states to fully
implement the ATR program, and we urge patience in these first
two or three years of implementation.
--$210 million for the Center for Substance Abuse Prevention
(CSAP).--Addiction is a disease that begins in adolescence;
research by the National Institute on Drug Abuse (NIDA) has
shown that if we can stop use and abuse before age 25, we will
significantly reduce the prevalence of addiction. Prevention
efforts are effective in deterring young people from using
illicit drugs and alcohol. We strongly support CSAP's Strategic
Prevention Framework to promote the use of performance
measurement by providers, expand collaboration across community
agencies, and support implementation of effective prevention
programs at the State and community levels. CSAP's Strategic
Prevention Framework will help communities to promote youth
development, reduce risk-taking behaviors, build assets and
resilience, and prevent problem behaviors across the life span.
--$441 million to continue full funding for the Safe and Drug Free
Schools and Communities State Grants program.--The federal Safe
and Drug Free Schools and Communities Act Program is the
backbone of school-based prevention efforts in the United
States, and it is having a significant impact in many states.
We strongly urge the Subcommittee to support this program and
to maintain current funding for the State Grants. The SDFSC
program has had a significant impact on helping to achieve the
17 percent overall decline in youth drug use over the past
three years, documented by the 2004 Monitoring the Future
survey. According to recent data, upwards of 37 million youth
are served annually by programs funded through SDFSC. Cutting
the SDFSC program will leave millions of American children
without any drug education.
--$464 million for research at the National Institute on Alcohol
Abuse and Alcoholism (NIAAA) and $1.0671 billion at the
National Institute on Drug Abuse (NIDA).--Research into the
causes, costs, treatment, and prevention of alcoholism and drug
addiction plays an important role in improving the quality of
services. Both agencies are taking steps to promote the
transfer of new research to practice, including collaboration
with SAMHSA, state agencies and providers.
Over the past several years, NIDA has made extraordinary
scientific advances in understanding the nature of addiction,
such as those made through the use of imaging technologies like
positron emission tomography (PET scans), and through the
development of new treatment technologies and medications, such
as buprenorphine used to treat opiate addiction. Research on
addiction as a brain disease has been useful in the development
and testing of new science-based therapies. In regards to
methamphetamine NIDA has launched a number of initiatives to
support a comprehensive research portfolio on the drug and its
effects. NIDA's efforts to understand the science behind meth
and its effects has lead to the launching of a methamphetamine
medications development initiative as well as the establishment
of the Methamphetamine Clinical Trials Group (MCTG) both of
which will further the development of medications that are
effective for treatment.
NIAAA also has conducted breakthrough research that has improved
clinical practice, with much of this research focusing on the
genetics, neurobiology, and environmental factors that underlie
alcohol addiction. NIAAA also has sought to use new information
about alcohol use to promote education and an effective public
health response to this problem.
CONCLUSION
Methamphetamine abuse can be prevented and treatment for
methamphetamine addiction does work. Increased federal support is
essential to preventing alcohol and drug abuse and treating addiction.
We appreciate the Subcommittee's focus on the critical issue of
methamphetamine abuse. Thank you for your leadership.
______
Prepared Statement of the Therapeutic Communities of America
Therapeutic Communities of America respectfully requests that this
written statement become part of the official record for the
appropriations hearing before the Senate Appropriations Subcommittee on
Labor, Health and Human Services, and Education on April 21, 2005 on
Methamphetamine Abuse. TCA commends the Chairman and the Committee for
their continued leadership to hold a hearing on this important issue.
METHAMPHETAMINE AND THERAPEUTIC COMMUNITIES
Therapeutic Communities of America (TCA) founded in 1975 as a non-
profit membership association, represents over 500 community-based
programs across the country dedicated to serving those with substance
abuse and co-occurring problems. Members of TCA are predominately
publicly funded through numerous federal, State, and local programs
across multiple agency jurisdictions.
The ``2002 National Survey on Drug Abuse and Health'' Report stated
that only 18.2 percent of all Americans over the age of 12 needing
treatment actually received it. The use of Methamphetamine is becoming
an epidemic in some areas of the United States and we need to help
communities put in place evidence-based treatment services to fight
this growing problem.
Therapeutic communities have been successful in helping many
addicted individuals, often thought to be beyond recovery, secure a way
out of self-destructive behavior. There is a myth that methamphetamine
cannot be treated with success. Methamphetamine can and is being
treated. Historically, TCs have been extremely effective at adapting
their programs to provide effective care as drug use trends change.
While TCA strongly commends Congress' focus on methamphetamine abuse,
we believe that such efforts could be strengthened with a greater
emphasis on treatment. It is critical that methamphetamine legislation
include provisions providing for treatment funds. These funds are
especially crucial because of the nature of the methamphetamine
epidemic--the drug is mostly present in rural communities, where
evidenced-based treatment services tend to be scarce or limited.
All legislation on methamphetamine needs to include the call for
research, treatment demonstration grants, and overall funding and
support for treatment as part of the solution to end the grip of
methamphetamine. While we are confident that existing modified
treatment methods can have great success when applied to
methamphetamine, further research on treatment for this drug can only
improve success rates.
Much of the limited research on methamphetamines comes from the
application of cocaine research. TCs in their experience of treating
special populations: adolescents, criminal justice clients, gang
involved, elderly, co-occurring clients with severe mental illness,
veterans, and women and infants have learned that both timing and
approaches need to be modified to work with these individuals within
the therapeutic community. TCs are welcoming methamphetamine users into
their centers, but currently most TCs are urban-based and not in rural
communities.
The therapeutic community (TC) methodology of treatment addresses
the entirety of social, psychological, cognitive, and behavioral
factors in combating alcohol and drug abuse. Traditionally, therapeutic
communities have been community based long-term residential substance
abuse treatment programs. In recent years, TCA members have expanded
their range of services, providing such services as assessment,
detoxification, residential care, in-prison programs, case management,
outpatient, transitional housing, family therapy, pharmacologic
therapies, education, vocational and employment services, primary
medical services, psychological services, and continuing care. Most
clients within a TC have cycled through our criminal justice and human
service systems numerous times before getting to TCs, yet through
modified programs based on evidence-based research we have able to
demonstrate successes even with the most difficult of populations
served. Many of these clients are mandated to treatment. The success
rates of TCs with clients that are both mandated and not mandated
demonstrate that substance abuse treatment does not have to be
voluntary to be effective. Therapeutic communities support clients to
develop individual change and positive growth and support the addicted
individual with his/her spiritual, behavioral, psychological, social,
vocational, and medical well-being. TCs have long been successful in
effectively coordinating with other community organizations as part of
their comprehensive approach to service.
TCA suggests six treatment principles as guidelines for addiction
public policy and funding: \1\
---------------------------------------------------------------------------
\1\ These principles are based in part on Principles of Drug
Addiction Treatment--A Research-Based Guide, National Institute on Drug
Abuse, National Institutes of Health, NIH Publication No. 004180.
---------------------------------------------------------------------------
--No single treatment is appropriate for all individuals.
--Effective treatment attends to multiple needs of the individual,
not just his or her drug use.
--Remaining in treatment for an adequate period of time is critical
for treatment effectiveness.
--Substance abuse treatment does not need to be voluntary to be
effective.
--Recovery from substance abuse can be a long process and frequently
requires multiple episodes of treatment.
--Treatment of addiction is as successful as treatment of other
chronic diseases such as diabetes, hypertension and asthma.
In our experience, TCA recommends that public policy secure four
additional public policy principles:
--Substance abuse treatment programs should be constructed on
evidence based methodologies that are outcome based and meet
performance measures.
--A skilled service provider with specific training in addiction
should do assessment and referral of an individual for
addiction treatment.
--Substance abuse treatment is cost-effective in reducing drug abuse
and its associated health, economic and social costs.
--Substance abuse treatment programs and their staffs should meet
recognized certification, accreditation and/or licensing
standards.
FEDERAL AGENCY ACTIVITIES
The Substance Abuse and Mental Health Services Administration
(SAMHSA), an agency of the U.S. Department of Health and Human Services
(HHS), was established by an act of Congress in 1992 under Public Law
102-321. Through grant, educational, and communication efforts, SAMHSA
seeks to fulfill its mission to ``focus attention, programs, and
funding on improving the lives of people with or at risk for mental and
substance abuse disorders.'' SAMHSA organizes it efforts around a
matrix that includes much of what therapeutic communities support as
necessary to achieve successful service delivery and positive outcomes
for addiction recovery.
The Substance Abuse Prevention and Treatment Block Grant (SAPT) is
the single largest funding stream for treatment programs for providing
addicted individuals with treatment. TCA commends Congress for
increasing SAMHSA funding over the years. The CSAT Programs of Regional
and National Significance is SAMHSA's discretionary grant program.
These funds have been effective in developing and improving treatment
for special populations and in targeting emerging national and regional
needs. TCA commends SAMHSA for offering incentives and flexibility to
the States to improve service systems and secure positive outcomes.
Providers that are TCA members have worked successfully with the States
in designing programs at the state and local levels and will continue
to actively work with States to provide quality services.
The National Institute on Drug Abuse (NIDA), National Institute of
Health provides invaluable clinical evidence to drug prevention and
treatment communities, improving efforts to combat the consequences of
drug abuse. Research conducted by NIDA has improved addiction services
and allowed federal funds to be used to support effective treatment.
NIDA was established in 1974, and became part of the National
Institutes of Health, Department of Health and Human Services in 1992.
NIDA seeks through its mission ``to lead the Nation in bringing the
power of science to bear on drug abuse and addiction''. TCA appreciates
Congress' actions in doubling the NIH budget over the last several
years.
Therapeutic communities have been successful in translating science
to services, which has allowed us to modify our programs to improve
outcomes. The SAMHSA Treatment Improvement Protocol 33: Treatment for
Stimulant Use Disorders is an example of materials that have been
developed to assist providers on the approaches and application of
treatment to the methamphetamine user. The use of contingency
management, engagement strategies, counseling, medical services,
relapse prevention, family therapy, housing, and vocational services
are listed as part of the approach to treating methamphetamine users.
TCA recommends the following policy recommendations.
THE EXPANSION OF EVIDENCE-BASED TREATMENT ESPECIALLY TO RURAL AREAS
Although rural areas may have some treatment available, the need
for comprehensive services is important in treating the methamphetamine
user. One barrier to expanding treatment is the need for a substance
abuse workforce. There is an inadequate supply of workers trained in
substance abuse treatment, including those specializing in the
therapeutic community philosophy of treatment. The substance abuse
treatment community experiences both high turnover and a low rate of
newly trained workers entering the field. Retention problems lead to
overworked staff and difficulty in training. Low pay, a high stress
work environment and burdensome regulations restricting time spent on
direct patient care plague the substance abuse field. TCA believes the
substance abuse treatment community would benefit from an array of
incentive programs to recruit and retain counselors and other staff
trained specifically in alcohol and drug abuse. In rural areas--the
very same places most affected by the spread of methamphetamine--this
problem is especially acute. Public health programs that provide
incentives for other health professions to settle in rural areas need
to include substance abuse counselors. Career ladders should be
supported for individuals in recovery who want to become certified and
qualified counselors.
CONSTRUCTIVE COORDINATION WITH THE CRIMINAL JUSTICE SYSTEM
The collaboration between the criminal justice system and TCs has
been shown to be effective in cutting recidivism through substance
abuse recovery. NIDA research has helped identify components necessary
for positive treatment outcomes. Although the criminal justice system
and the treatment system have different societal responsibilities, both
can work effectively to coordinate their missions and respect their
expertise. Harry Wexler Ph.D., Senior Principal Investigator, National
Development and Research Institutes, Inc stated at a TCA meeting that
research findings and clinical observations have demonstrated the
successful adaptation of the TC model to treating the addicted offender
with these necessary indicators:
A treatment approach based on a clear and consistent treatment
philosophy.
The establishment of an atmosphere of empathy and physical safety.
The recruitment and retention of qualified and committed treatment
staff.
The specification of clear and unambiguous rules of conduct.
The employment of the ex-offenders and ex-addicts as role models,
staff and volunteers.
The use of peer role models and peer pressure.
The maintenance of the treatment program's integrity, autonomy,
flexibility, and openness.
The isolation of residential program from the rest of the prison
population to diminish the highly negative influence of untreated
inmates.
The literature shows that 9 to 12 months is the minimum duration
needed to produce reductions in recidivism.
The establishment of continuity of care from treatment to community
aftercare including empathy and physical safety.
This NIDA funded research is important, as it shows the need for
continuing care for the offender when he returns to his community, the
importance of mentoring and self-help, and the importance of long-term
treatment for offenders. Improving the Department of Justice
Residential Substance Abuse Treatment for State Prisoners Grant Program
(RSAT) and requiring aftercare will strengthen the program and make it
achieve better and more successful outcomes. The California Amity
Program NIDA study showed that for a 3-year return to custody rate that
re-entering offenders with no treatment had a 75 percent return rate,
but with in-prison treatment and aftercare the return rate dropped to
27 percent.\2\ The President's budget increased funds to the RSAT
program in the fiscal year 2006 request but does not require aftercare.
It is the SAMHSA Block Grant that continues to be the safety net for
aftercare treatment.
---------------------------------------------------------------------------
\2\ Institute of Behavioral Research, Texas Christian University,
Research Summary from Prison Journal, 1999, Wexler, Melnick, Lowe, &
Peters.
---------------------------------------------------------------------------
ELIMINATION OF THE MEDICAID INSTITUTIONS OF MENTAL DISEASE (IMD)
EXCLUSION
Until the IMD exclusion for community residential addiction
treatment is eliminated, many communities will be dependent on CSAT
funding to serve special populations and to target emerging issues
within their communities. SAMHSA has done an excellent job developing
and expanding services to special populations and should have the
continued capacity to help communities' meet specific targeted needs
and to provide cost-effective and appropriate care. These efforts
should be sustained by our health care system for low-income Americans
the same as it is for any other chronic illness. Because of the
Institutions for Mental Disease (IMD) Medicaid exclusion, community
residential addiction treatment is not covered by Medicaid for programs
over 16 beds. The IMD Medicaid exclusion is a significant barrier to
many who seek appropriate and effective substance abuse treatment,
including pregnant women. Those with substance use disorders must have
the full range of treatment options available to them. The exclusion
limits the ability of Medicaid eligible Americans to receive cost-
effective and appropriate care, or any care at all, for their
addiction. With the Methamphetamine epidemic we need to secure access
for Medicaid eligible drug-abusing Americans for appropriate substance
abuse treatment. This includes eliminating the IMD Exclusion for
substance abuse community residential treatment. It is our belief that
the IMD exclusion was not intended by Congress to include community-
based therapeutic communities or substance abuse residential treatment
as it has been interpreted by the State Medicaid Guidelines within the
Department of Health and Human Services. As part of the review of
options to treat the Methamphetamine user, all Medicaid eligible
Americans should have access to appropriate substance abuse treatment.
SUBSTANCE ABUSE AND CO-OCCURRING PREVENTION AND TREATMENT FOR OUR
RETURNING TROOPS
In addressing the Methamphetamine problem in our communities we
should also recognize the potential for drug use by all sectors of the
population, including our returning veterans who may have PTSD or
depression. With our military returning from Iraq, TCA hopes to assist
veterans with addiction and co-occurring disease by preparing and
identifying the appropriate early interventions, actions and services
needed by veterans to make their re-entry successful. TCA supports
public policy that gives veterans access to systems that would provide
them and their families with substance abuse assessment and treatment.
TCA firmly believes that returning veterans should not be lost between
agencies or--worst yet--be left untreated because they fall through the
cracks. SAMHSA and NIDA have great potential to contribute leadership
and work with the Veterans Administration as communities prepare
support services, particularly to our returning reservists and our
National Guardsmen. SAMHSA and NIDA efforts to find common outcomes for
the criminal justice system and substance abuse treatment system have
demonstrated their ability to work with other departments like the
Department of Justice to build bridges that foster positive societal
outcomes. Promoting public policy and funding that supports client
based treatment for veterans and their families based on evidence-based
research will be an emerging and significant need in the coming years.
This at-risk population needs both prevention and treatment programs
readily available in their communities so that throughout the United
States and especially in methamphetamine hubs that we constructively
prevent, treat, and safeguard our veterans at re-entry.
PUBLIC EDUCATION FOR EARLIER INTERVENTION FOR TREATMENT
People recover from drug abuse and are productive citizens and
family members. Often a family is in uproar and they do not recognize
that the uproar may be a family member on drugs. Public education and
community prevention efforts that help families and employers recognize
the need for treatment and identifies where to get help should be part
of any public policy treatment approach. Often one does not see a
problem until they see a solution. That comes with having appropriate
treatment available. Your leadership opens the door for families to see
a solution.
TCA recommends appropriations as listed on the attached chart.
Thank you.
ATTACHMENT 1
----------------------------------------------------------------------------------------------------------------
Fiscal year
---------------------------------------------------------------
2004 final 2005 final
Includes Includes 2006
across the across the administration 2006 TCA
board cut board cut (0.8 request request
(0.59 percent) percent)
----------------------------------------------------------------------------------------------------------------
HHS--SAMHSA Center for Substance Abuse
Treatment--CSAT
SAPT Block Grant................................ $1.779b $1.776b (- $1.776b $1.847b
(+25.2m) 3.5m) (+0.0m) (+71.0m)
Programs of Regional and National Significance-- 419.2m (+102m) 422.4m (+3.1m) 447.1m 472.1m
PRNS (Targeted Capacity Grants & Access to (+24.7m) (+49.7m)
Recovery)......................................
HHS--SAMHSA--Center for Substance Abuse
Prevention--CSAP
Programs of Regional and National Significance- 198.5m (+1.4m) 199m (+0.2m) 184.3m (- 210m (+11.0m)
PRNS........................................... $14.4m)
HHS--National Institute on Health--NIH
National Institute on Drug Abuse--NIDA.......... 991.5m 1.007b 1.010b (+4.0m) 1.067b
(+29.8m) (+15.2m) (+60.4m)
National Institute on Alcohol Abuse and 428.9m 438.5m (+9.6m) 440.0m (+2.0m) 464.8m
Alcoholism--NIAAA.............................. (+12.8m) (+26.3m)
Dept. of Ed.
SDFSC--State grants............................. 437m 441m (-$441m) 441m (level)
----------------------------------------------------------------------------------------------------------------
CONCLUSION OF HEARING
Senator Harkin. Thank you all very much for being here.
That concludes our hearing.
[Whereupon, at 11:46 a.m., Thursday, April 21, the hearing
was concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]
-