Hello everyone and welcome back. In our past sections we have been discussing different aspects of treatment. In this section we continue that discussion by looking at a wide variety of other models of addictions treatment.

As you can see in slide two there is a wide variety of other models that focus on addictions treatment, however, the focus is not on the individual in this aspect but on the society in general. And in essence it overlaps with some prevention models that we have out there. So let's look at some of these models.

Let's start by looking at harm reduction in slide three. Harm reduction as you can see comes from public health models. The focus is not on stopping the use of drugs, but instead it focuses on reducing the harm an individual has when they are using drugs. So messages coming out of harm reduction models would be do not share needles with other individuals, make sure you are drinking lots of fluids, or have others who are not using drugs make use you are staying safe. So in essence the message is totally different than focusing on the individualized treatment.

The model does not try to make the person stop using. Instead what it tries to do is create situation where the user does not harm themselves or some other individual that is out there. When harm reduction modes are done well, basically there is a reduction of harm to the user and also the other implications involved that occur with others are reduced. However, again, as we talked about earlier it does not stop the use of the compound.

Now what are some examples of harm reduction models? The classic example is shown in slide five. Needle exchange programs are classic examples, or having Heroin clinics for individuals who can't kick heroin. This is common in European countries. Teaching individuals how to clean their works or promoting safe sex. You can also do other things such as testing for different drugs in Rave bars to make sure you are actually getting the drug you are wanting. Designated driving programs are also examples of harm reduction models. And even bartender training to reduce the number of individuals who are going to be drinking and driving.

What are some advantages of harm reduction models? Basically, what you can do by using such models is to increase or create a level of trust between the user and the individuals who are trying to help the user, that is, the staff and the counselors. Once you get that rapport established you can begin to use other techniques such as motivational interviewing, etc to help the client to move toward some kind of treatment.

So what are some disadvantages, well as we can see in slide seven, it does not stop the using behavior. Consequently the client can continue using and even get worse than the way they were before. Harm reduction models are also counter-intuitive to a wide variety of prevention messages which encourages people not to use in the first place. It is also opposite of other techniques which supply reduction that is commonly used in law enforcement.

So in general when we talk about harm reduction models, the focus again it is not stopping the use, the focus again is helping the person stay safe when they are using. What is another large scale treatment approach? The next example is shown in slide eight, these include law enforcement models. Here the focus is on two major groups: supply reduction techniques, and Drug Court. So let's discuss supply reduction techniques in slide nine first.

Basically as we can see here, the supply reduction model is the War on Drugs. It is designed to limit the supply. The results are that when you have a tighter supply fewer people are using the compounds. In addition to that and probably more importantly, fewer people try the compounds because they are not accessible in the community and consequently they do not begin to use them in the first place.

The advantages of supply reduction basically mean that the users have a harder time finding the particular compounds. As a consequence, several things begin to happen. As we can see in slide ten the first result that begins to happen is users begin to travel to the areas where the drugs are more available. An example is moving from populated places where you have large scale of enforcement to areas of lower scale enforcement, that is, rural communities. Another alternative to reducing the supply is basically that many individuals when they can not get their compounds anymore begin to seek treatment. It is also a very controversial aspect but it makes it harder for the individuals to find substances out there and especially for newer individuals.

Law enforcement and supply reduction approaches have reduced the supply somewhat however, as we can see in slide eleven there are still a lot of compounds that are entering the United States. And, it is big business. There is a lot of criminal activity and is very similar to the criminal activity one saw in prohibition of alcohol. There is also a lot of criminal violence. This seems to be more prevalent now than it has been in the past. Another major consequence of supply reduction techniques many users do not go into treatment but instead go into prison. As a consequence of that our prisons are overflowing and overcrowded primarily with individuals who have been using compounds or are addicted to some kind of compound. Another major disadvantage to supply reduction techniques is that when demand becomes very tight the users switch the drugs. So for example, when cocaine became much more difficult to get individuals switched over to methamphetamine, and since has contributed to the Meth crisis we have today.

Overall, as we see in slide twelve, supply reduction models have mixed results. There are lots of drug busts and there are lots of people in prison and there are lots of reductions of compounds that would be available if no real strategy was in place to reduce the supply. However, despite all of these advantages there are still lots of compounds available. As a consequence people still can get them for the most part.

Another aspect of enforcement techniques related to treatment is what we call Drug Court. As we can see in slide thirteen, Drug Court is designed to basically get people into treatment and get individuals who are now in the criminal justice system into some kind of treatment program to keep them off the compound. Basically what the idea is to keep the users out of prison and to reduce the recidivism rates of individuals when they come out of prison. Basically this model works with probation and parole officers, judges, attorneys, treatment providers, and many other agencies. What may not be included are other drug related activities. Classic example is that if you are busted for burglary you go to jail for burglary. If you are dealing drugs then all bets are off. However, if you are caught using or something to that extent then Drug Court might be an alternative for some kind of treatment.

Basically what Drug Court does is encourages a relationship between the officers, and the offenders, and the probation/parole people. What the focus is on is to get the individual into treatment and to keep them in treatment instead of incarcerating them in some kind of prison. It also allows for a wide variety of other interventions to take place and these interventions can come from job services, from public health, from mental health, and even from places that would not normally be found in the treatment community. Despite the advantages of Drug Court there are other issues that need to be considered.

As we can see in slide sixteen, Drug Court is not for everyone. Consequently, you need to have some kind of solid screening that goes along with that. Furthermore, some individuals continue to use despite going into the Drug Court system. And as a result of that those individuals are incarcerated. It is also very controversial to traditional treatment providers who contend that many individuals do not perform well if they are forced into treatment.

However, the results are very clear, Drug Court works, and it works very well. It has gotten a lot of people to treatment that would normally not have been there. As we can see in slide seventeen, it has reduced offender population in prisons. However, despite its use we still have lots of people who are incarcerated and it also provides a great big stick to get users into treatment. That is, if you do not go into treatment and get off the compounds, you go to jail. Which would you prefer? And as most individuals do, they try to get off the compounds. So in general, Drug Court does have a positive aspect in the treatment community and although it does not focus primarily on treating the client it does provide incentives to get the client into treatment and to keep them in treatment until they can begin to make good decisions.

What are some other types of models? Well, as we can see in slide eighteen, the next major model is Economic Models. Economic Models are basically the classic examples of a negative correlation. Basically, what economic models say is this, as the price of a compound increases, the use rate decreases and, as price rates decrease, use increases. It is the classic curve we see in economics. Here is a classic example, New York City several years ago raised taxes on cigarettes, so in essence it costs about five dollars for a pack of cigarettes. There were several consequences of that rate increase. The first thing that happened is that use rates dramatically decreased. And the same kind of intervention has also occurred with the same results in other states as well.

The results of prices have also influenced the price of other drugs. For example, as we see in slide nineteen with Heroin, as the price increases or decreases the rates of Heroin use goes up and down. The same thing happens for alcohol. Initially when taxes increase on alcohol the use rates decrease, however, they gradually increase and plateau up to the level that they were before. Consequently, legislators in their drive to increasing taxes and getting more revenue into the system often target drugs, alcohol, and nicotine to get more taxes. The problem with this approach however, is that a lot of times when people stop using then their reductions in revenue actually decrease and that can cause problems as well. The cost of a compound will also influence use rates as well.

As we can see in slide twenty, with cocaine, if an individual wants to buy powdered cocaine you need a lot of money to purchase that, in essence, about twenty-five thousand dollars. On the other hand, if you can make the cost go down for the user then you will get more people using the drug. So, consequently, the dealers and suppliers begin to make a new product with cocaine and that was crack cocaine. With crack cocaine everyone can afford it even youth. Consequently use rates for crack cocaine significantly increased. It doesn't hurt the marketer either that crack cocaine is highly addictive resulting in very rapid increases in euphoria as well as rapid increases related to withdrawal.

The problem with cost and any other economic model as we see in slide twenty-one is that if the cost becomes too high the individual begins to change the drugs and this occurred with the cocaine use. Specifically, individuals started switching from cocaine to methamphetamine because methamphetamine was much cheaper to use and provided almost the same or even a better high. Another alternative is that users will find alternative sources. For example, with cigarettes and alcohol often times as the price increased individuals would go to the Indian Reservations where the price was actually lower.

So in general, as we see in slide twenty-two, drugs from an economic standpoint are like any other product. If it is cheap, everybody uses it. But as the prices increase individuals begin to try alternatives. And, if it is too high, they will begin to switch to cheaper compounds. Or, as an alternative, they may quit using. So in essence what happens is that when you look at these kinds of models from an economic standpoint, economics can drive use, it can drive treatment and individuals into treatment, however, it is not going to stop treatment in the sense of working with a client on some kind of one to one basis or even in a group, it is a much more broader aspect.

The last major models I would like to talk about are shown on slide twenty-three and these are sociological models. Sociological models like the other models we have talked about previously are more community based. Basically what you try to do is influence the culture related to the compounds. What you do is change the housing environment, change the community; you try to provide alternatives, etc. So in many aspects it has a crossover with prevention. Sociological models are really more preventative than so called treatment but they fall over in the fact that what they do is have two major concepts that are very, very important.

The first of those is shown in slide twenty-four, and that is the concept of deterrence. In general deterrence has two major types, general deterrence and specific deterrence. General deterrence models try to prevent individuals from using in the first place. Consequently the techniques include things like fear tactics, law enforcement, economic models, and on and on and on. The focus here though is that the consequences must outweigh the positive aspects of the use. Specific deterrence’s rely on a related concept. Basically it tries to prevent people from using after their initial use. So often when an individual is caught they may be placed on probation and parole with the idea that they would not use because if they were caught they would go back to prison. The consequences, of course, are that it is designed to prevent people from using again.

A related sociological, psychological concept is shown on slide twenty-five and that relates to the immediate versus delayed consequences of some particular behavior. It is well known throughout the psychological community that small immediate consequences have more power over large delayed consequences. The classic example of smoking a cigarette, which is a small immediate consequence of feeling good, is significantly more powerful than the large delayed consequence of heart disease, lung disease, or even death. So basically the idea here is what you want to do is increase the small immediate consequences to be very negative and not worrying about the longer term delayed consequence.

So in general when you look at all these other typical models of substance abuse treatment you find that they are a mixed bag and there are lots of them as we can see in slide twenty-six. Most of them are macro in nature although some of them are micro but basically what you are doing is using all the techniques in essence to prevent or reduce the use. So in general when you talk about treatment there is a wide variety of different approaches. It does not matter whether the individual is using a group model or a sociological model or whatever it may be. The whole idea is try to reduce the individuals use rates and/or even prevent the use occurring in the first place, especially with youth.

In our next section we will continue on with this discussion by beginning to talk about prevention. So until then we hope you have yourself a great day and we look forward to talking with you then.

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