Teenagers and young adults are targeted in a 5-year plan outlined in the Obama administration's National Drug Control Strategy to reduce illegal drug use by 15% and 10%, respectively.
Released last month by the Office of National Drug Control Policy (ONDCP), the strategy also sets goals for reducing by 15% drug-induced deaths and drug-related morbidity, and reducing by 10% the prevalence of drugged driving among all Americans.
The focus on prevention would include screening and early intervention, treatment and recovery, and law enforcement, which would address the trafficking and production of illicit drugs and the related cycle of crime, delinquency, and imprisonment.
Dr. Robert L. DuPont, a psychiatrist who was the first director of the National Institute on Drug Abuse, said the strategy “improves the links between treatment and the criminal justice system. It is more focused on the primary goal of reducing the demand for drugs than were previous administrations' strategies. Teaming law enforcement with treatment makes both work better.”
President Obama had called for a policy that was rooted in “common sense, sound science, and practical evidence” and that was guided by “sound principles of public health and public safety.” As such, it will incorporate educating young people, who are most at risk for substance abuse; allocation of substantial funding for research and treatment, including recovery; and a comprehensive crime strategy. Communities and community-based faith and civic organizations in particular will be better equipped to implement prevention and support/mentoring initiatives.
The plan also advocates situating addiction screening, intervention, treatment, and recovery more solidly within mainstream health care settings by educating providers about screening and brief intervention techniques, and expanding access to and reimbursement for those services. According to the plan, a trial of pay-for-performance contracting might be launched in some states. Such incentives are already in place in a few states where contracted programs are rewarded for delivering prompt and effective service to addicted patients.
Access to recovery programs—often run by faith- and community-based groups that provide vouchers for things such as treatment or recovery support services, transitional housing, or child care—will receive a boost under the program. Dr. Mark S. Gold, who chairs the department of psychiatry at the University of Florida, Gainesville, said the most important component of the drug control strategy is parity and access to treatment.
“We know that physician addicts have 5-year outcomes proven by drug testing and return to work of greater than 80%. We would like to treat every addict like we treat physician addicts,” Dr. Gold said. In the past, he added, “reimbursement, access to treatment, facilities and infrastructure, turnover of addiction staff, and trained addiction medicine and psychiatry professionals have been limiting” the success of addiction treatment programs.
Teenagers and young adults receive special attention under the strategy, because advances in prevention science show that this population is vulnerable to substance use, the document explains. Research on the adolescent brain has identified an “at-risk period” before the age of 21 years, during which people are more likely to develop substance abuse disorders.
Other findings have shown that effective, evidence-based interventions for young people can protect against long- or short-term damage from substance abuse; risk factors for substance abuse in youth can predict other problems such as bullying, school failure, and depression; prevention programs for young people in a range of settings, such as the home, school, and other communities, have a greater impact than those limited to a single setting; and that substance use is influenced by adults.
From a public safety perspective, the policy outlines an approach to reducing drugged driving through law enforcement and education of the public about the health and safety threat posed by drugged driving. R. Gil Kerlikowske, director of the ONDCP, noted in a preface to the strategy document that drugged driving is now more common than alcohol-impaired driving.
Dr. DuPont, who is also the founding president of the Rockville, Md.–based Institute for Behavior and Health, said this was “extremely important. … Reducing drugged driving is a major way to improve highway safety and save lives. It's also an important way to reduce the demand for illegal drugs in this country. I hope the reduction of 10% in drug use among age 18–25 can be achieved, as it will help us improve public health [and] safety and reduce [the number of] chronic abusers.”
With prescription drug abuse at record levels, the strategy outlines ways to curb such abuse while facilitating the legitimate use of medications. This includes expanding prescription drug monitoring programs, recommending disposal methods to remove unused medications from the home, and working with physicians to achieve consensus standards on opiate painkiller prescribing. Doctor shopping, pill mills, and illegal Internet pharmacies will be targeted by law enforcement, as will methamphetamine manufacturers and marijuana growers.
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