First, we should look at the overall statistics of drug users, both recoverers and relapsers. This is data from the Substance Abuse & Mental Healtlh Admin. This shows the majority of illicit drug users are white males, age 18-39, and half have a high school diploma or more. Not to different from overall population, except it emphasizes males and a younger crowd. We should keep this in mind when making recommendations. This is a group we absolute must focus on treatment being the most effective, though we should not discount the minority. If there is a weakness in treatmenht for this population, we should be very concerned. And, the statistics show there IS!
Who makes it? Comparisonof those who do and those who do not recover Sonya Dave, PhD Scaife Family Foundation Fellow IRETA
Outline1. Importance of question2. Addicted population demographics3. Recoverers vs. Relapsers: a. Demographics b. Treatments used c. Attitudes d. Cognitive predictors4. Summary
Importance of understanding features of those who relapseAssist in allocating funds: – Some programs focus on a demographic – Give money to what works – Change what does not workAdjust therapy: – Certain aspects of therapy work – Instilling certain attitudes can be beneficial – Extra emphasis for those predicted to relapse
Majority of illicit drug users are white males 18-39 years; half finished 12thWhite (Non- 10 – 11Hispanic) Years 1-9 Years Other Hispanic 12 Years College/Graduate Black School 18-29 Years Female Less then 18 years 30-39 Years Male 40 + Years
Population least likely to abstain post treatmentTreatment is least effective for reducing drug use in: – Men – Younger population – Crack users – Less educated population – Population not residing with spouse – Repeat relapsersFocus on improving abstinence for these groups.
Population least likely to improve employment post treatmentTreatment associated with decreased employment in: – Underrepresented minorities – Elder – Less educatedFocus on employment opportunities for these groupsWhy decrease? – Treatment starts upon employment problems – Stigma in employment
Treatment that works has long time periods and quality relationTreatments associated with relapse prevention: – Longer time period – Motivated patients stay in treatment – Quality therapist-client relations needed – Presence of case manager – Factors can compensateTreatment pays off: – DATOS study: costs of treatment vs. change in cost of criminalization – 3X cost to criminalize vs. treat
Attitudes associated with abstinenceAlcoholics belief that: – I have a problem with alcohol – Alcohol does not lead to positive effects – I am confident of my ability to reduce my drinking – I cannot control my urge to drinkFostering these ideas in therapy client may aid with recoveryCannot “control urge to drink” – AA Philosophy? – Contradictory to “confident of reducing drinking”?
Cognitive predictors of abstinence: DRCS and Gambling TestDrug Related Cognitions Scale: – Measures the attitudes described previously, e.g. – Acceptance of problem and negative effects – Confidence in ability to reduce drinking – Lack of control of urge to drinkIowa Gambling Test: – Think: who wants to be a millionaire? – Cognitive card-game test – Shows people who abstain can put off immediate rewards for chance of larger rewardsUse of these tests: – Test patients before therapy start – Use to personalize therapy – Do NOT condemn patient to destiny
Summary1. Relapse most common for young males2. Employment outcomes are poor for hispanic, black, less educated3. Attitudes associated with abstinence: No denial, confidence in quitting, lack of control, recognition of negative effects4. Good outcomes need: Quality relation, Long stays, Case Manger5. DRCS and Iowa Gambling test are predictors of outcome and can be useful in personalizing therapy
AcknowledgementsIRETA & Scaife Family Foundation for providing an useful, enjoyable and educational internshipAll speakers and sites for their time and providing excellent talks and visitsMy group of 8 other Scaife fellows