[House Hearing, 109 Congress]
[From the U.S. Government Publishing Office]
METHAMPHETAMINE TREATMENT: AVAILABILITY AND EFFECTIVENESS OF PROGRAMS
TO TREAT VICTIMS OF THE METHAMPHETAMINE EPIDEMIC
=======================================================================
HEARING
before the
SUBCOMMITTEE ON CRIMINAL JUSTICE,
DRUG POLICY, AND HUMAN RESOURCES
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
JUNE 28, 2006
__________
Serial No. 109-223
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
http://www.house.gov/reform
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COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
CHRISTOPHER SHAYS, Connecticut HENRY A. WAXMAN, California
DAN BURTON, Indiana TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
GIL GUTKNECHT, Minnesota CAROLYN B. MALONEY, New York
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
STEVEN C. LaTOURETTE, Ohio DENNIS J. KUCINICH, Ohio
TODD RUSSELL PLATTS, Pennsylvania DANNY K. DAVIS, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
JOHN J. DUNCAN, Jr., Tennessee DIANE E. WATSON, California
CANDICE S. MILLER, Michigan STEPHEN F. LYNCH, Massachusetts
MICHAEL R. TURNER, Ohio CHRIS VAN HOLLEN, Maryland
DARRELL E. ISSA, California LINDA T. SANCHEZ, California
JON C. PORTER, Nevada C.A. DUTCH RUPPERSBERGER, Maryland
KENNY MARCHANT, Texas BRIAN HIGGINS, New York
LYNN A. WESTMORELAND, Georgia ELEANOR HOLMES NORTON, District of
PATRICK T. McHENRY, North Carolina Columbia
CHARLES W. DENT, Pennsylvania ------
VIRGINIA FOXX, North Carolina BERNARD SANDERS, Vermont
JEAN SCHMIDT, Ohio (Independent)
BRIAN P. BILBRAY, California
David Marin, Staff Director
Lawrence Halloran, Deputy Staff Director
Teresa Austin, Chief Clerk
Phil Barnett, Minority Chief of Staff/Chief Counsel
Subcommittee on Criminal Justice, Drug Policy, and Human Resources
MARK E. SOUDER, Indiana, Chairman
PATRICK T. McHenry, North Carolina ELIJAH E. CUMMINGS, Maryland
DAN BURTON, Indiana BERNARD SANDERS, Vermont
JOHN L. MICA, Florida DANNY K. DAVIS, Illinois
GIL GUTKNECHT, Minnesota DIANE E. WATSON, California
STEVEN C. LaTOURETTE, Ohio LINDA T. SANCHEZ, California
CHRIS CANNON, Utah C.A. DUTCH RUPPERSBERGER, Maryland
CANDICE S. MILLER, Michigan MAJOR R. OWENS, New York
VIRGINIA FOXX, North Carolina ELEANOR HOLMES NORTON, District of
JEAN SCHMIDT, Ohio Columbia
Ex Officio
TOM DAVIS, Virginia HENRY A. WAXMAN, California
J. Marc Wheat, Staff Director
Malia Holst, Clerk
C O N T E N T S
----------
Page
Hearing held on June 28, 2006.................................... 1
Statement of:
Cronkhite, Russell, recovered meth addict; Darren and
Aaronette Noble, recovered meth addicts, accompanied by
Joseph Binkley; Richard A. Rawson, Ph.D, associated
director, Integrated Substance Abuse Programs, UCLA; Leah
C. Heaston, MSW, LCSW, ACSW, SAP, Noble County director,
Otis R. Bowen Center for Human Services, Inc.; Michael B.
Harle, MHS, Gaudenzia, Inc.; and Pat Fleming, director,
Salt Lake County Substance Abuse Services.................. 31
Binkley, Joseph.......................................... 38
Cronkhite, Russell....................................... 31
Fleming, Pat............................................. 46
Harle, Michael B......................................... 43
Heaston, Leah C.......................................... 41
Noble, Aaronette......................................... 36
Noble, Darren............................................ 35
Rawson, Richard A., Ph.D................................. 39
Madras, Bertha, Deputy Director, Office of Demand Reduction,
Office of National Drug Control Policy; Nora D. Volkow,
M.D., Director, National Institute on Drug Abuse, National
Institutes of Health, U.S. Department of Health and Human
Services; and Charles G. Curie, M.A., A.C.S.W.,
Administrator, Substance Abuse and Mental Health Services
Administration, U.S. Department of Health and Human
Services, accompanied by H. Westley Clark, M.D., J.D.,
M.P.H., CAS, FASAM, Director, Center for Substance Abuse
Treatment.................................................. 7
Curie, Charles G......................................... 11
Madras, Bertha........................................... 7
Volkow, Nora D., M.D..................................... 9
METHAMPHETAMINE TREATMENT: AVAILABILITY AND EFFECTIVENESS OF PROGRAMS
TO TREAT VICTIMS OF THE METHAMPHETAMINE EPIDEMIC
----------
WEDNESDAY, JUNE 28, 2006
House of Representatives,
Subcommittee on Criminal Justice, Drug Policy, and
Human Resources,
Committee on Government Reform,
Washington, DC.
The committee met, pursuant to notice, at 2 p.m., in room
2154, Rayburn House Office Building, Hon. Mark E. Souder
(chairman of the committee) presiding.
Present: Representatives Souder, McHenry, Cummings, and
Foxx.
Staff present: J. Marc Wheat, staff director and chief
counsel; Michelle Gress, counsel; Malia Holst, clerk; Tony
Haywood, minority counsel; and Jean Gosa, minority assistant
clerk.
Mr. Souder. The subcommittee will come to order.
Good afternoon, and thank you all for being here. Today's
hearing will examine methamphetamine treatment programs, their
availability, effectiveness for addressing the needs of met
victims and their communities.
I am very concerned about this issue. I feel there is
currently a treatment vacuum when it comes to meth. Despite the
fact that the meth epidemic has swept across the country, and
especially devastated our Nation's western States and rural
areas, I am worried that effective treatment for meth addiction
is not available where the people need it the most, because the
communities most affected are the least equipped in their
treatment capabilities to handle the special needs presented by
meth users.
An oft-repeated assertion is that meth addiction cannot be
treated. That is incorrect. It can be treated. We will hear
from successful treatment recipients. But the availability of
effective programs across the Nation is difficult to measure.
Moreover, without strong leadership from the White House Office
of National Drug Control Policy and aggressively tackling this
scourge of meth, Federal measures to address the treatment
vacuum will languish, despite the tremendous toll this drug is
having on our Nation.
The meth epidemic has touched every State in the country,
draining resources, causing serious environmental damage and
destroying lives. SAMHSA's Drug Abuse Warning Network [DAWN],
showed that in the early to mid-1990's, methamphetamine use was
on the rise. The treatment episode data confirmed this:
treatment admissions for meth use grew through the 1990's,
increasing fivefold between 1992 and 2002.
The most recent treatment episode data show that 15 States
have higher rates of admission for amphetamine use, largely
meth, than for heroin or cocaine. In just those 15 States,
there were over 102,000 admissions for amphetamine treatment,
versus 73,000 combined admissions for heroin and cocaine.
Nationwide, there were more than 151,000 admissions for
amphetamine treatment.
To say that meth is highly addictive is an understatement,
and it presents unique clinical challenges for treatment. Meth
produces a short, intense rush, followed by a long-lasting
sense of euphoria. Addiction to meth is caused by the way the
drug alters the brain and leaves the users to compulsively seek
more meth. Chronic use of the drug also leads to increased
tolerance, prompting the user to take higher or more frequent
doses of the drug to get the same effect.
Moreover, meth users may also develop severe psychotic and
paranoid behavior. Meth users who do seek treatment often
relapse and continue chronic meth use. There are currently no
medications that demonstrate effectiveness in treating meth
addiction. But intense behavioral interventions have proven
effective. The largest controlled study of meth treatment
conducted by the Center for Substance Abuse Treatment
demonstrated positive post-treatment outcomes for 60 percent of
the treatment sample, which reported no meth use and which had
urine samples that tested negative for meth.
Nonetheless, traditional treatment programs for alcohol and
marijuana are inadequate for dealing with the unique clinical
challenges presented by this drug. Such treatment programs,
sometimes the only treatment option available in communities
hardest hit by the meth epidemic, result in very poor post-
treatment outcomes for meth users. This represents our greatest
challenge: how do we ensure that our Federal treatment efforts
are addressing the meth epidemic in measurable ways in the
areas hardest hit by the scourge, in many cases very rural
areas?
I look forward to hearing from our witnesses today about
the current state of meth treatment options: how prevalent, how
effective, and by what measure. In the areas where we are
falling short, I hope our witnesses are prepared to offer some
solutions.
We have, by the way, had meth treatment witnesses at at
least six field hearings with scattered reports of both
effectiveness, the mix and availability in those areas. Oregon,
Arkansas, Minnesota immediately come to mind where we have had
meth treatment witnesses at our hearings.
I am particularly interested in the discussion with our
administration witnesses who will present the information on
Federal efforts for developing, supporting and measuring meth
treatment systems and programs. The administration witnesses
comprising our first panel are Dr. Bertha Madras, the Director
for Demand Reduction at the White House Office of National Drug
Control Policy; Dr. Nora Volkow, Director of the National
Institute on Drug Abuse [NIDA], National Institutes of Health;
and Charles Curie, Administrator of the Substance Abuse and
Mental Health Services Administration [SAMHSA], and I am most
pleased to say a fellow Hoosier, one of two Hoosiers testifying
today.
Dr. Clark, are you with Mr. Curie? I wanted to make sure I
introduced you as well. I didn't see you on my list.
Witnesses on our second panel will present on-the-ground
perspectives of treatment, both from the treatment provider
side and the recovered meth user side. This includes a second
Hoosier witness, Leah Heaston, director for Noble County in
Indiana of the Otis R. Bowen Center for Human Services; Richard
Rawson, associate director of integrated substance abuse
programs at UCLA; Russell Cronkhite, a recovered meth addict;
Darren and Aaronette Noble, also recovered addicts, and their
son Joey Binkley; Mr. Michael Harle, president and CEO of
Gaudenzia, Inc., and Mr. Pat Fleming, director of Salt Lake
County Substance Abuse Services.
We welcome all of you.
I also want to say for the record that Malia Holst has been
our subcommittee's clerk, and today is her last hearing. She
has been our clerk since April 5, 2004, and has cheerfully
endured the countless schedule and witness changes during the
time for hearings here in Washington and throughout the United
States.
She is exchanging her time here on the subcommittee for
much better things. She is getting married later this summer,
and then she and her husband will be attending Dallas
Theological Seminary. I want to salute her diligent work and
consistent Christian witness in the time we have had with her
on the subcommittee. She has been a tremendous asset.
Now I would like to yield to Mr. Cummings.
Mr. Cummings. Thank you very much, and I too extend my best
wishes to Malia. I want to thank her for her service to our
committee and to this great country of ours.
Mr. Chairman, I want to thank you for calling this hearing.
But I want to start off by saying that I am concerned about the
title of the hearing. The chairman and I get along very, very
well. We are very good friends and we do just about 99 percent
of the things we do in a bipartisan manner.
But when we say the availability and effectiveness of
programs to treat victims of the meth epidemic, I have never
heard that word used with regard to the people from my district
who suffer from cocaine addiction, heroin addiction, crack
cocaine addiction. They are all victims. I think we have to be
very careful with the use of words. Because there is no one in
this Congress who will fight harder to make sure that those who
have been victimized by any drug are properly treated.
The second thing I want to say before I forget, I want to
thank you, Mr. Curie, for your service. I understand you will
be leaving your position. You have indeed been a breath of
fresh air. Wherever your journey may take you, I feel that we
have been so blessed as a Nation to have you at the helm of
your agency. I just wanted to take this moment to salute you
and thank you.
Mr. Chairman, again, I want to thank you for this hearing.
The National Institute on Drug Abuse [NIDA], defines drug
addiction generally as a chronic relapsing disease,
characterized by compulsive drug-seeking and drug use, and by
neurochemical and molecular changes in the brain. Numerous
studies demonstrate the efficacy of drug treatment in reducing
drug use and related problems and behaviors, including criminal
activity, unemployment, poor health and engagement in risky
sexual or drug consumption behaviors that may result in
infection with HIV, hepatitis and other dangerous communicable
diseases.
Unfortunately, limited public funding for drug treatment
puts the benefits of treatment out of reach for many
individuals who need and seek treatment but cannot afford to
pay the cost out of pocket. Of the 22 million Americans with
substance use disorders in 2003, approximately 3 million people
received treatment, leaving an estimated 19 million Americans
without treatment services.
Closing the so-called treatment gap should be a leading
priority of our national drug control strategy. And nowhere,
absolutely nowhere, is the need for expanded access to
treatment more clear or more compelling than in the context of
what has been described as a national meth epidemic.
Methamphetamine is a very potent and highly addictive
stimulant drug. It has very limited medical use, and as a
Schedule II controlled substance, it can be obtained legally
only by prescription. Meth can be snorted, swallowed, injected
or smoked, and it is frequently taken in combination with other
drugs.
In contrast to cocaine, which is quickly removed and almost
completely metabolized in the body, methamphetamine has a much
longer duration of action and a larger percentage of the drug
remains unchanged in the body. This results in prolonged
stimulant effects.
Some meth users experience psychoses that persist months
after the drug has been stopped. Also because methamphetamine
affects the contraction of blood vessels, it can result in
heart attacks and strokes in relatively young patients. Meth
use is also linked to risky sexual behaviors, increasing the
risk for transmission of infectious diseases, including HIV.
Like other intravenous drug users, those who inject the drug
risk contracting HIV when they share contaminated equipment,
and methamphetamine's psychological effects may also increase
the likelihood of HIV transmission and accelerate its
progression.
According to the 2004 National Survey on Drug Use and
Health, nearly 12 million Americans have used methamphetamine
at least once. NIDA has characterized the abuse of
methamphetamine as an extremely serious and growing problem.
Once concentrated in a few western States, meth use has
expanded geographically and it is moving to more diverse
populations. The fact that meth can be manufactured from
chemical derived from retail products has contributed to the
spread of small, clandestine labs. And these labs contribute to
a set of additional problems, including costly environmental
damage and child endangerment and neglect.
The resulting burden on State and local law enforcement and
social services agencies has been enormous. According to NIDA,
methamphetamine addiction can be treated successfully using
currently available behavior treatments. NIDA is currently
investing in the development of new medications for
methamphetamine addiction.
NIDA also is pursuing the development of an immunization
strategy for the treatment of methamphetamine overdose. In
general, studies show that clinically appropriate treatment,
provided by qualified and trained staff, is effective in
stopping methamphetamine use and that outcomes from meth users
are comparable to outcomes for cocaine and heroin users.
It is vitally important that we expand funding for programs
that support effective treatment services for meth addiction.
These programs include the Substance Abuse Prevention and
Treatment block grant, the foundation of our public treatment
funding infrastructure, and programs of regional and national
significance, such as targeted capacity expansion.
It is important to note that States have achieved
commendable results in block grant funds. According to the
National Association of State Alcohol and Drug Abuse Directors,
in Colorado 80 percent of methamphetamine users were abstinent
at discharge in fiscal year 2003. In Iowa, a 2003 study found
that 71.2 percent of methamphetamine users were abstinent 6
months after treatment. And in Tennessee, over 65 percent of
methamphetamine users were abstinent 6 months after treatment.
Mr. Chairman, we must also provide adequate funding to
support the vital research efforts of NIDA, which has devoted
an increasing amount of funding to meth research.
Unfortunately, as I have noted previously, the administration
has chosen to devote a declining percentage of drug control
funding to demand reduction programs over the past 6 years. I
hope that today's hearing will increase the recognition of the
importance of treatment in addressing addiction and related
problems and in turn, to a reversal of the trend toward de-
emphasizing domestic prevention and treatment relative to
supply reduction efforts abroad.
I anxiously look forward to the testimony of our witnesses,
and with that, Mr. Chairman, I yield back.
Mr. Souder. I thank the gentleman.
Mr. McHenry, the vice chairman of the subcommittee.
Mr. McHenry. Thank you, Mr. Chairman.
Thank you, Mr. Chairman and ranking member, for putting
together this important hearing. I am so glad we have a
distinguished panel before us today.
In my part of the country, in western North Carolina, we
have been severely affected by methamphetamine use. And now,
now that State law and Federal law is curbing the availability
of it, we are still dealing with the ongoing repercussions of
how to treat people that have been addicted to it. It is such a
harmful, destructive and nasty drug that we as a society and as
Government policymakers, we have to make sure that we have the
right policies in place, and make sure that our treatment
dollars are going in the right direction, and that there are
treatment dollars available to effect change.
So it is important that as a committee we actually look at
the availability of and effectiveness of these treatment
programs. Current treatment initiatives in western North
Carolina have shown strong results. Actually, in a recent study
from 2002 to 2005, in my region alone, meth admissions to
treatment programs have doubled, just in 3 short years. It
seems, now that is being experienced around this country,
largely in rural areas.
So it is important that we look at the best way to treat
these meth addicts. One example in my district is through the
Matrix Model. From what I understand, it is the only evidence-
based program for attacking meth addiction. And it has been
effective. I don't think it has been largely understood in the
community, but I look forward to hearing your testimony today
about what we should be doing here in Washington and in our
communities to make sure that the treatment programs are
available.
I appreciate your taking the time to be here to make your
voices heard here in Washington, DC, with this important
committee which we serve on. Thank you again, Mr. Chairman, for
holding this hearing, and for your ongoing fight to make sure
that we have effective drug control and elimination, as well as
treatment programs throughout this country.
Thank you, Mr. Chairman.
Mr. Souder. Thank you. I want to clarify briefly Mr.
Cummings' point, because I think he raised a very fair point.
There is a certain amount of sensitivity that we treat
methamphetamine differently right now because it is
predominantly white users and different than urban areas. I
think it is very important.
In the title here, I would refer to the crack epidemic that
hit Fort Wayne as an epidemic with victims. At the same time,
this isn't like a hurricane where individuals just get hit.
They also choose to participate. So you are simultaneously a
victim and somebody who made a personal decision to do this.
I absolutely believe that any distinctions that we would
have that would be artificially different, we shouldn't refer
to one group as being overwhelmed by a tide and another group
bringing it upon themselves. In my hometown, there is very
little meth in my hometown of Fort Wayne. It is around us, but
it is crack, it is heroin, and it is marijuana and occasionally
oxycontin. And we need to make sure that we treat everybody,
regardless of their racial background, regardless of their
income, the same way, whether it is in treatment or what.
We argue that in fact the administration has been less
responsive to rural areas in the meth thing, and we focused on
that here. But this committee will continue long term to make
sure that we focus on all the different narcotics.
Mr. Cummings. Will the chairman yield?
Mr. Souder. Yes.
Mr. Cummings. Mr. Chairman, I just want to take a moment to
thank you for saying what you just said. That means a lot to me
personally, and I am sure it means a lot to anybody who is
listening to this hearing. Thank you.
Mr. Souder. We have seen our urban areas ravaged, and we
need to work together on how to rebuild this, and suburban
families destroyed and rural areas. All these things need to be
a focus of this committee.
I ask unanimous consent that all Members have 5 legislative
days to submit written statements and questions for the hearing
record, and that any answers to written questions provided by
the witnesses also be included in the record. Without
objection, it is so ordered.
I also ask unanimous consent that all exhibits, documents
and other materials referred to by Members and the witnesses
may be included in the hearing record, and that all Members be
permitted to revise and extend their remarks. Without
objection, so ordered.
Our first panel is composed of the Honorable Bertha Madras,
Deputy Director for Demand Reduction of ONDCP; the Honorable
Dr. Nora Volkow, Director of the National Institute for Drug
Abuse, National Institutes of Health; and the Honorable Charles
Curie, Administrator of the Substance and Mental Health
Services Administration, Department of Health and Human
Services. Mr. Curie will also be joined by Dr. Westley Clark,
Director of the Center for Substance Abuse Treatment at SAMHSA.
Would each of you stand and raise your right hands, and I
will swear you in?
[Witnesses sworn.]
Mr. Souder. Let the record show that each of the witnesses
responded in the affirmative.
Thank you for being with us today, again. I think this
might be your first time, Ms. Madras. We met in my office, but
welcome to our committee, and Dr. Volkow and Mr. Curie have
been here many times. We very much appreciate your leadership
in this issue, as well as Dr. Clark has been here numerous
times.
Ms. Madras.
STATEMENTS OF BERTHA MADRAS, DEPUTY DIRECTOR, OFFICE OF DEMAND
REDUCTION, OFFICE OF NATIONAL DRUG CONTROL POLICY; NORA D.
VOLKOW, M.D., DIRECTOR, NATIONAL INSTITUTE ON DRUG ABUSE,
NATIONAL INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES; AND CHARLES G. CURIE, M.A., A.C.S.W.,
ADMINISTRATOR, SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
ADMINISTRATION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES,
ACCOMPANIED BY H. WESTLEY CLARK, M.D., J.D., M.P.H., CAS,
FASAM, DIRECTOR, CENTER FOR SUBSTANCE ABUSE TREATMENT
STATEMENT OF BERTHA MADRAS
Ms. Madras. Chairman Souder, Ranking Member Cummings and
distinguished members of the subcommittee, thank you for the
opportunity to appear before you today to discuss the Federal
response to treatment needs of populations affected by
methamphetamine.
As a chemical, meth is a serious, unique national problem.
It is one of the few drugs that can be synthesized with little
expertise or equipment. Its production can result in
significant personal and environmental contamination.
As a drug, meth is one of our greatest public health
challenges. It is highly addictive, it can promote brain
damage, its heavy medical and psychological toll on individuals
can impact their children, families, communities and the
criminal justice system at a national level.
With cooperative efforts of the administration and
Congress, there is a historic 19 percent reduction in teenage
drug use over the past 4 years. Of specific reference to
methamphetamine, there is at least a 30 percent reduction in
the number of meth lab incidents, in meth-positive workplace
tests, in lifetime meth use among youths over the past 2 years.
There is also a significant increase in 12th graders who
disapprove of using amphetamines.
The administration's recently released Synthetic Drug
Control Strategy outlines key meth treatment initiatives. A 15
percent reduction in meth use, a 15 percent reduction in
prescription drug use and a 25 percent reduction in domestic
meth labs over the next 3 years are the stated goals.
What are the meth treatment programs that are available? In
general, 25 percent of the Federal budget is targeted to
treatment. Four major programs can impact meth abuse and
addiction treatment. The first is the Substance Abuse
Prevention and Treatment block grants. The 2007 budget requests
$1.7 billion for the block grant. The funds are for treatment
providers, many of whom provide treatment for abuse and
dependence on meth. States that elect to prioritize meth
treatment can target the money for this population.
A second initiative are programs of regional and national
significance. The 2007 budget requests $375 million for
effective screening and treatment programs, which include
Access to Recovery and Screening, Brief Intervention and
Referral to Treatment. These discretionary grants provide
flexibility and services for regional and rural needs.
Access to Recovery, the 2007 budget requests $98 million.
There is a 25 percent setaside specifically for ATR meth
initiative, and $5.4 million targets programs in rural areas.
ATR funds essential recovery support services, not generally
reimbursable through conventional Federal treatment resources.
For example, meth addicts require intensive relapse prevention
training, which is covered by ATR.
The third program is Screening, Brief Intervention and
Referral to Treatment. The 2007 budget requests $31.2 million.
This program provides grants for effective early detection and
intervention in general medical settings. It is positioned to
identify meth users that enter hospital or clinical
environments, seeking treatment for reasons other than for meth
abuse.
The fourth program are drug courts. The 2007 budget request
$69 million for drug court programs, a $59 million increase
over the 2006 enacted level. Drug courts effectively divert
non-violent, low-level offenders away from prison into
supervised treatment and reduce re-arrest rates by over 50
percent.
Of the 2005 adult drug court planning initiatives, the
National Drug Court Institute estimated that 92 percent were
rural. Of these, a significant proportion of offenses that they
will treat are meth-related. This cohort can be steered into
treatment by the drug courts.
In conclusion, I would like to state that substance abuse
treatment works, and so effectively stated by Ranking Member
Cummings, treatment and recovery for meth addiction are
feasible and possible. Treatment programs are flexible and
adaptable to meth. The Screening, Brief Intervention and
Referral to Treatment and Drug Courts identify and help meth
abusers or addicts who do not come forward for treatment, but
come forward for other reasons, medical and/or legal, and then
they are steered into treatment. And the Access to Recovery and
block grants provide the treatment.
The President's drug control policy is characterized by
vigilance, flexibility, adaptability and innovative strategies
to address emerging drug threats. Our ultimate objective is to
eradicate meth use and provide meth users the opportunity for a
renaissance in their lives.
Thank you, and I welcome questions from the subcommittee.
Mr. Souder. Thank you.
Dr. Volkow.
STATEMENT OF NORA D. VOLKOW, M.D.
Dr. Volkow. Good afternoon. It is a privilege for me to be
here, and to be given the opportunity to present how science
can help us combat the problem of drug addiction.
As Director of the National Institute of Drug Abuse, that
funds 85 percent of all of the research related to drugs, we
have long recognized the problem of methamphetamine. We
recognize it not just because it is a very potent stimulant
drug, but because of the data showing that it is one of the
most toxic of illicit drugs.
So as the Director of this Institute, I see it as our
responsibility to develop the science and the knowledge that
will allow us to combat this problem.
What do we know about methamphetamine? We have learned
significantly over the past 5 years, actually past 20 years. As
Mr. Cummings was mentioning, we recognize it as one of the most
potent of the stimulant drugs, probably it is the most potent.
We know that methamphetamine can be taken by smoke, snort,
injection. And what we have seen is that over the past years,
we have seen a shift from the use of methamphetamine through
the routes of administration that are not just the most toxic,
but also the most addictive, that is smoking and injection. And
this in turn may account in part for the increase in the
numbers of medical emergencies, as well as treatment-seeking
addiction from the use of methamphetamine.
We know that methamphetamine, like other drugs of abuse,
predominantly affects dopamine cells, increasing the
concentration of this chemical in the brain, this chemical that
is crucial in allowing us to perceive pleasure, regulate and
motivate our behavior. This chemical is also crucial in
allowing us to think properly.
It is believed that the effects of drugs of abuse, all of
them, to increase dopamine is the reason why they can produce
addiction. Of all the drugs of abuse that we know,
methamphetamine is the one that is most potent in increasing
dopamine in the brain. Indeed, it is at least three times more
effective than cocaine in increasing dopamine in the brain. And
it is believed that this may be one of the reasons about why it
is also so addictive.
Indeed, from human studies, we know that people that get
exposed to methamphetamine may become addicted even faster than
when they take cocaine. In the case of methamphetamine,
addiction has been reported to occur 1 to 2 years after
initiation of use, in contrast to an average of 3 years for the
case of cocaine.
The large increases in dopamine induced by methamphetamine
are not only linked to its highly addictive potential, but also
its toxic properties. These large increases in dopamine damage
the dopamine cells themselves, and the consequences of course
relate to the function of dopamine. These individuals are less
able to experience pleasure from natural reinforcers. But they
also affect their ability to exert cognitive control and the
ability to think clearly.
However, one of the good news in this is that some of these
changes appear to be reverted with protracted detoxification.
This is extraordinarily important, because it further
highlights the importance of initiating treatment and of
initiating treatment at early stages, so that we can maximize
the recovery of that individual.
As mentioned by Mr. Cummings, there are many other toxic
effects of methamphetamine. Methamphetamine does not just go
into your brain, it does damage to the blood vessels, so you
can just end up with a stroke and be paralyzed. But it also
affects other organs. One of the ones that has attracted a lot
of attention is seeing young individuals with myocardial
infection because of the toxic effects of methamphetamine to
the myocardium.
Because of these adverse effects, as was mentioned, many
people believe that methamphetamine cannot be treated, or that
it is extremely difficult to treat. And yet, we know, as has
been mentioned before, that it can be treated. And in fact, the
comparisons with cocaine show similar rates of success.
There are several programs, behavioral interventions, that
have been shown to be effective in the treatment of
methamphetamine addiction. You are going to be hearing
specifically from Dr. Rawson on the Matrix Model, which has
been very successful. There are other interventions,
motivational incentive interventions, prevention of relapse,
that have also shown very positive results.
However, one of the things that we need to recognize in
order to be successful in the treatment of methamphetamine, as
is the case for all other drugs of abuse, is that addiction is
a chronic disease, which means that treatment is not going to
be a one shot and you are going to be cured. It will require
repeated treatments, and relapse does not necessarily mean
failure of treatment. It needs that treatment needs to be
reinstituted. But it highlights the importance of continued
interventions.
At NIDA, as I say, we feel an obligation to develop also
not just better behavioral interventions, but also medications
that can help those afflicted with addiction. In the case of
methamphetamine, we have some very promising compounds, both
from the results in the laboratory animals, but also from pilot
studies in humans. This includes, for example, anti-epileptic
medications, such as GVG or topiramate, which has been actually
showing very promising results in clinical studies on
methamphetamine abusers.
Certain anti-depressant medications, such as Welbutrin,
which is currently also used for the treatment of nicotine
addiction, also has shown positive signals in methamphetamine
treatment. And finally, we are also evaluating the use of
medications that can improve alertness and cognitive
performance, such as modafinil.
As mentioned by Mr. Cummings, we are also developing
immunization strategies, such as monoclonal antibodies, that
can be used for those that are suffering from overdose, and
thus can be acutely saved. But we are also investigating the
feasibility of developing a vaccine for methamphetamine that
can prevent relapse, using similar strategies as those used for
the vaccine for cocaine and for nicotine, which also are
showing some very promising results.
NIDA indeed has long recognized the danger of
methamphetamine abuse and has actively supported research on
these and related drugs. This research continues to help us
elucidate the effects of these drugs in the brain, which is
very important, because of course this leads us to new targets
for medication and treatment. At the same time, we can never,
never under-emphasize the importance of this knowledge to
develop better prevention strategies.
Thank you for allowing me to share this information with
you, and I will be happy to answer any questions you may have.
Mr. Souder. Thank you very much.
The last statement of this panel is from Mr. Charles Curie.
I also want to commend you for your years of service in
Pennsylvania and then at the national level for the last 5
years. I look forward to working with you as you move on to
other endeavors. I am sure you will continue to stay involved
in this field, but we thank you very much for your leadership.
STATEMENT OF CHARLES G. CURIE
Mr. Curie. Thank you, Mr. Chairman, for those kind words,
and also Ranking Member Cummings, for your words earlier. They
mean quite a bit. The partnership that we have had has been
invaluable. I appreciate this opportunity to testify one last
time in my current capacity to this very important
subcommittee.
Mr. Chairman and Ranking Member Cummings, Mr. McHenry, I am
Charles Curie, the Administrator of the Substance Abuse and
Mental Health Services Administration [SAMHSA], within the U.S.
Department of Health and Human Services. I am pleased to say
accompanying me today is Dr. Westley Clark, the Director for
our Center for Substance Abuse Treatment, the able Director,
very able Director, within SAMHSA.
And I am pleased to be able to present, with my colleagues
Dr. Madras and my long-term colleague and friend, Dr. Nora
Volkow, SAMHSA's role in addressing the methamphetamine
addiction crisis that this country faces. First, I also would
ask that my written testimony be placed in the record, which is
much more detailed than my oral testimony. What I would like to
focus on in my oral testimony is our role to more effectively
address this issue.
To efficiently align and focus our prevention resources,
and I would like to begin with prevention, SAMHSA launched the
Strategic Prevention Framework in 2004. The Framework advances
community efforts to prevent drug use, using a risk and
protective factor approach. Whether we speak about abstinence
or rejecting drugs, including meth, tobacco, alcohol, or
promoting exercise and a healthy diet, we are really working
toward the same objective: reducing risk factors that exist in
a community and exist in an individual's life and promoting
protective factors.
By the end of this fiscal year, nearly 40 States will be
implementing this new approach. I am pleased to say that there
are many States that have taken SPF and have definitely aligned
it in addressing the methamphetamine issue. Indiana is one
State that I would point out. In presenting the award to
Governor Daniels in Indianapolis, on the Strategic Prevention
Framework, he made it a point to say that this was going to be
a central element in addressing the meth issue in Indiana.
Again, we shaped Strategic Prevention Framework so that it will
address the local needs and work in partnership to address
those priority needs that are identified locally and by States.
The success of the Framework rests in large part on the
tremendous work that comes from grass roots community anti-drug
coalitions. The anti-drug coalition effort is very much tied
to, and we view it as part and parcel of Strategic Prevention
Framework. That is why we will continue to work with ONDCP to
administer the Drug-Free Communities Program, and this program
currently supports approximately 765 community coalitions
across the country.
In terms of treatment, SAMHSA supports treatment, and you
heard Dr. Madras highlight several of those efforts. Again,
primarily our substance abuse prevention and treatment block
grant is a major vehicle, and is foundational, as has been
mentioned here before. Appropriated at nearly $1.8 billion, the
block grant provides 40 percent of all State funding for public
substance abuse services.
We also support treatment through competitive grants.
Public and non-private entities apply directly to SAMHSA for
targeted treatment funds. Since the subcommittee is well
acquainted with both the block grant and our discretionary
grant portfolio, let me discuss one program in particular. 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 Access to Recovery [ATR], a new
consumer-driven approach for attaining and 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,
and competed for $99 million in grants in fiscal year 2004. We
funded grants to 14 States and one tribal organization in
August 2004. I am pleased to say that again, there were States
who identified methamphetamine as their No. 1 growing problem,
Tennessee and Wyoming, and they targeted their Access to
Recovery funds to address that issue.
Because the need for treatment is great, as methamphetamine
treatment need alone has demonstrated, President Bush proposed
$100 million for a new cycle of Access to Recovery grants in
the 2007 request. Of that, $25 million will be focused
exclusively on methamphetamine. ATR's use of vouchers, coupled
with the State flexibility and executive discretion to target
emerging drug trends such as meth, is creating profound
positive change in substance abuse treatment financing and
service delivery across the Nation. In short, the ATR
initiative has helped all of us operationalize recovery in both
public policy and public financing.
I am also pleased to point out that while in fiscal year
2006 we had $19 million in our budget targeted exclusively
toward methamphetamine in terms of treatment and prevention, in
our proposed 2007 budget that number is $34 million, in terms
of increased emphasis and effort toward methamphetamine.
To help ensure the latest science-based services are being
provided to people with substance abuse disorders, a true
partnership has emerged between SAMHSA and the National
Institute on Drug Abuse [NIDA]. The result of this
collaboration was the result of a development of a treatment
strategy for methamphetamine addiction. The Matrix Model, which
Congressman McHenry mentioned earlier, and you will be hearing
more about from Dr. Rawson, and other cognitive behavioral
approaches, are available in a set of two DVDs produced by our
Pacific Southwest Addiction Technology Transfer Center. Dr.
Clark has them. They are on sale in the lobby after the
hearing. [Laughter.]
And our treatment improvement protocol [TIP] No. 33, the
treatment for stimulant use disorders, again, giving direction
on methamphetamine.
Our national network of Addiction Technology Transfer
Centers also are critical in our efforts to provide training,
workshops and conferences to the field regarding
methamphetamine. I want to stress that these entities are
available to States, to treatment providers in their region, to
have the resources and technical assistance necessary in order
to gain the expertise and the knowledge around address
methamphetamine.
Recently, SAMHSA financed two conferences on
methamphetamine for States. SAMHSA paid for States to bring 15
people each, including State and local officials and providers,
to hear experts in the field of methamphetamine treatment and
research, and a well-received and much-needed opportunity to
learn and share information about methamphetamine.
In conclusion, we are striving to do our part at SAMHSA to
make methamphetamine and continue to make it the priority it
needs to be, especially in areas of this country where, as you
say, Mr. Chairman, the intensity of the consequences of
methamphetamine are overwhelming. We have been building
systemic change also, so that no matter what drug trend emerges
in the future, because we don't know what is going to emerge as
we go along, and we need to be agile, we need to be flexible,
we need to be ready, that States and communities will be
equipped to address it immediately and effectively. Our goal is
always to try to reach it before it hits a crisis level.
Mr. Chairman, Mr. Cummings, Mr. McHenry, Ms. Foxx, as has
been mentioned before, I would like to ask, if I have a few
additional moments, to discuss this being my last appearance in
this capacity before you. As you know, I have submitted my
resignation to the President and will be leaving my current
post in SAMHSA on August 5th. I want to express my appreciation
to the dedication of all of you. Mr. Chairman, Mr. Cummings, we
have been in many hearings together, field hearings. And I have
definitely appreciated your ongoing leadership and unwavering
support for those people who have addictive disease in their
life and who are looking to attain and sustain recovery in the
pathways you give.
This committee has stood strong in terms of assuring that
addiction is addressed in this country. At times when the
public interest in addiction has faded and comes in waves, you
have been unwavering. You have kept it at the top of the list
of priorities. In my 10 years as Administrator of SAMHSA, I
have also found this subcommittee to be both supportive of what
we are doing and at the same time appreciate your keeping our
feet to the fire, appreciate you in terms of bringing, based on
the data, what we need to be addressing. I think that is true
partnership, and I think it has been invaluable to us, as one
would expect from Congress.
So it has been an honor working for you and with you. And
it has been the highest privilege for me to be in this
position. Your subcommittee has been one of the very, very
great highlights of my tenure here. Thank you very much.
Mr. Souder. Thank you very much for your comments. That is
the best praise we have gotten from the executive branch and--
it is because you are leaving, I guess. [Laughter.]
Nevertheless, it is appreciated.
Let me ask a technical question first, and maybe Dr. Volkow
or Dr. Clark and Ms. Madras, Mr. Curie, if any of you have any
further comments on this. Are there medical differences
between, in methamphetamine, it is really unusual, because we
have two simultaneous tracks going on in the United States, the
mom and pop labs where people are home cooking with their own
chemicals, and the crystal meth that is the bulk of the users.
The chaos it has caused and the political problem is greatest
in the areas where it is doing environmental damage, they are
blowing up families, they are tying up drug task forces all day
long while they wait for somebody to come in. And the political
pressure is on those individuals, and those individuals tend to
be more predominantly rural.
The crystal meth moves, some into some cities, particularly
if it moves into cities like Minneapolis-St. Paul, Omaha,
Portland, but we haven't seen massive intrusion into cities.
But does the crystal meth behave on the brain differently than
the home-cooked, and are the chemicals substantially different?
Or does the same treatment process basically work for everybody
who uses some form of methamphetamine?
Dr. Volkow. One of the things, methamphetamine is a racemic
mixture. A racemic mixture is when the compounds have a mirror
image one to the other. The ``d'' version of it is the most
potent. The methamphetamine that you get from home cooking, it
has mostly d-methamphetamine, but there is a little bit of the
l-methamphetamine, very small amounts, 5, 6 percent. Whereas
the methamphetamine that is coming from abroad is 100 percent
pure.
Does this make a difference? I don't think it does.
Actually, we are funding imaging studies to document the
differences between these two compounds and we really don't see
a difference.
So based on the pharmacology itself, it is unlikely to have
much of a difference. Your concern, of course, has to do more
with impurities that may come in the manufacturing of the
methamphetamine. That is where my concern would come in terms
of treating these patients, or what I would expect would happen
to them.
Mr. Souder. Do you expect, and if anybody else has any
comment, you can pick it up in the followup here, do you
expect, the States took the lead and started to control
pseudoephedrine, which has been the fundamental ingredient in
the home cooking. That partly pushed people over to crystal
meth, as we have seen in Oklahoma, started to see in Oregon,
some degree pushing people to the Internet.
We have heard rumors, one I believe was in the hearing in
North Carolina, that people have looked for, obviously, and the
question is, are they finding substitute ingredients, things
other than pseudoephedrine that they can mix in and emulate
methamphetamine? Do you believe that is possible, or do you
believe that by controlling the pseudoephedrine we in fact will
shut down the home cooking?
Dr. Volkow. There is no doubt that control of the
pseudoephedrine has had a dramatic impact on the number of
small laboratories. Unfortunately, that has been taken over by
the importation of methamphetamine from abroad, including
Mexico. Could there be other sources for producing
methamphetamine? To my knowledge, right now, I do not know of
any.
But I am not a chemist, and chemists can be incredibly
creative. So I do not know. My colleague, Dr. Madras, who is
very much a chemist, may be able to shed some light on that.
Ms. Madras. With regard to the precursors, ephedrine well
could serve as a precursor. So could another compound called
phenethylamine. I do think, I certainly agree with my
colleague, Dr. Volkow, that creativity is one of the major
problems we face in the chemical world. Because the creativity,
for example, with regard to cocaine, is what created crack
cocaine versus cocaine hydrochloride. And there was an enormous
difference. The basic molecule cocaine was the same. But crack
cocaine enabled cocaine to be smoked. And that enabled a rapid
bolus of cocaine to enter the brain. Whereas cocaine
hydrochloride, which is just a different salt form, was not
smokeable, because if you heated it up, the entire molecule
fell apart.
So creative chemistry is what we always have to worry
about. And I don't mean creative in a very positive sense.
Mr. Souder. Dr. Clark, did you have a comment?
Dr. Clark. Not only must we deal with the issue of the
precursors, you also have to deal with the issues of
unscrupulous dealers, if you will. We recently had an episode
of phentenyl added to heroin, dealers may choose to add
unrelated substances to products and use that to advance their
economic interests.
So what Dr. Volkow and Dr. Madras said is of critical
importance, and we also need to look at some recent behavior in
terms of what drug gangs have done. The importation issue is a
major issue, but also unscrupulous behavior is also an evolving
issue.
Mr. Souder. Mr. Cummings.
Mr. Cummings. When I talk to young women who are crack
addicts, they tell me that the addiction is very quick. And one
of you mentioned, I think it may have been you, Mr. Curie, how
fast it is, how long it takes for one type of drug, for you to
become addicted, and then how slow it may be for others. I was
just wondering, when you compare crack cocaine to
methamphetamine, is that a rapid addiction situation? Because I
hear that a lot, young women who say they tried crack cocaine
and thought it would just be a one-time thing, next thing you
know, they are on it. Particularly from women. I am just
curious.
Dr. Volkow. I had mentioned that, and indeed, there was a
story that specifically compared the course from occasional use
to compulsive use between cocaine abusers and methamphetamine
abusers. That story did not distinguish between those subjects
that were taking cocaine, as cocaine, whether it is
hydrochloride snorted or injected, versus those that took it
smoked. Effectively, as I mentioned, the routes of
administration that are the most dangerous are the smoked and
the injected. The smoked is the crack cocaine. But injected
cocaine is also highly addictive.
And what you are saying is absolutely correct, and the
transition from snorting to smoking is what is actually
associated with the fast development into the addictive
process. So to address the question correctly, one would have
to compare the transition from smoking occasionally. But once
you start to smoke occasionally cocaine, you become very fast
regular. And that I do not have knowledge of any data. I was
actually trying to find out if there was. So I do not know of a
study that specifically has addressed that.
Mr. Cummings. Mr. Curie, let me ask you this. You had
talked about, you said you were talking about risk factors in
communities, and you said you had worked closely, it was
important to have a close relationship with the anti-drug
coalitions with regard to methamphetamine. This is what we are
talking about, of course.
What is it that they do that helps so much with regard to
methamphetamine, and is that any different than other drugs? In
other words, what they do? Because we have been very strong
proponents of the anti-drug coalitions. We have been fighting
pretty big time. And I just wanted to know how that affects it.
Mr. Curie. I think methamphetamine is the classic example
of why a community anti-drug coalition is so essential. Because
the coalition gives an opportunity to form leadership and focus
on the particular substance abuse, drug issues that are
existing in that particular community. Strategic Prevention
Framework, the reason that it fits so well with the anti-drug
coalitions, is what we expect communities to do is to first
assess all the resources that community already has going
toward drug prevention efforts, then embark upon the process of
assessing what are the risk factors in that community, is it a
transient community, is it a community that doesn't have a
sense of neighborhood, of connectedness. All those things add
to risk factors that could promote substance abuse. There is a
list of many others.
Once they have embarked upon a process of assessing their
risk factors that exist, as well as protective factors that can
be existing in that community, they can then make collective
decisions. And again, the ideal coalition not only brings
together concerned parents and school systems, but city
government, brings together a range of non-profit
organizations, brings together Boys and Girls Club and all
those entities that work together.
They can make informed decisions. And we have a list of a
registry of effective programs. Communities that Care has a
list of evidence-based programs for prevention, and they can
actually begin to make decisions to invest their prevention
dollars into addressing those risk factors. If methamphetamine
is really the emerging problem in a community or is a problem
and it is overwhelming the resources, they can really put an
emphasis on that locally, and we have again technical
assistance and resources to help them do that.
But the coalitions really give leadership and life and
voice and focus to combating and give that consistent voice to
combating the drug problem in the community.
Mr. Cummings. You also gave some stats on Access to
Recovery. I think you said something like 66 States and
jurisdictions requested funding, 14 of them got it. I just like
the block grant situation so much better. When you tell me that
66 entities applied and 14 got it, that doesn't, I mean, that
means we have quite a few folks, 52, to be exact, out there
saying, what about us? And then I think you mentioned too Iowa
and another State that was geared toward methamphetamine,
Tennessee, I think you said.
Mr. Curie. Right.
Mr. Cummings. So would you consider that kind of
competition to get 14 out of 66, when people are having all
these problems, if you had to have a choice, would you rather
see that in block grant or see that in that competitive grant?
Mr. Curie. That is a great question. I think that first of
all----
Mr. Cummings. Since you are leaving, I guess it is safe for
you to answer that. [Laughter.]
Mr. Curie. I can say anything I want.
Mr. Cummings. I wouldn't have asked you that if you weren't
leaving.
Mr. Curie. I support the President's proposed budget. And I
do.
I think the question you are asking is, where can we get
the most value for our dollar in terms of addressing this
issue.
Mr. Cummings. That is right.
Mr. Curie. If you go back to the original Access to
Recovery proposal, the first time the President proposed it, it
was for $200 million. So I think clearly we would say, we would
agree, $100 million wasn't enough, $100 million is what was
appropriated. If we would have had $200 million we probably
could be in up to 30 States during that first cycle, which
could have made a more tremendous difference.
As we moved ahead, we proposed $200 million the second
year, got $100 million. It has been staying at pretty much $100
million. So clearly, I think the administration would be in
agreement that you need to more, especially in that interest.
You are exactly right, 66 States and territories were clamoring
for it, and we were only able to make those awards.
I think we would have been hopeful by now with the original
Access to Recovery plan that we would have perhaps up to $300
million to $400 million if you recall, I think our goal was to
add significant amounts of additional dollars to the treatment
budget, if you go back to the first year, the first term.
Mr. Cummings. Right.
Mr. Curie. I think that we could make a tremendous impact
in an Access to Recovery approach, because a State would get an
award of somewhere around $7 million to $8 million per year. If
we put that same amount of money into the block grant, that
gets dispersed, if we put like $100 million in the block grant,
that gets dispersed over 50 States and the territories, so it
makes less of an impact in States.
So if we want to target particular problems and a State
wants to make a case, that we want to use Access to Recovery
dollars to battle methamphetamine, because in Indiana, for
example, or as they did in Tennessee and Wyoming, meth is
undercutting so many things in the lives of our people, we need
to address it, they could make much of an impact with the $7.5
million grant than if they end up getting an extra half a
million in their block grant.
So I think those are the types of issues that have to be
under consideration in assessing.
Mr. Cummings. Thank you, Mr. Chairman.
Mr. Souder. Mr. McHenry.
Mr. McHenry. Thank you, Mr. Chairman.
A couple of things are happening in my State. First of all,
we passed an effective meth bill in North Carolina at about the
same time we passed Federal legislation here. And that has had
an enormous effect on eliminating the small lapse in these
rural communities in western North Carolina.
Now, we certainly have a problem still because Tennessee
doesn't have as strict of a law about pseudoephedrine as does
North Carolina. So you have some traveling over the mountain
across the lines. You also have those coming from South
Carolina and Tennessee over into my district to buy Sudafed
because of some of the restrictions and having it behind the
counter. They are able to go to a half dozen CVS stores and buy
three boxes of Sudafed.
I talked to a police officer this weekend who deals with
this, and he said that they treat Sudafed now like you would
treat cocaine or marijuana. They hide it in their automobiles.
It is a drug in and of itself and an enormous commodity for
them to trade in.
But having said all that, the issue that we are dealing
with, because we have cut down on these labs so much, it is not
the expense of the labs now, and the dealing with the property
damage and the chemicals you have left. The expenses have
migrated over to these meth addicts, who the law enforcement
continually has to deal with. Because you can throw them in
jail, and once they get back on the street, they are back on
it.
So that leads to the opening question for this hearing,
which is treatment. So my question to the whole panel is, what
type of partnerships do we need with law enforcement and with
treatment facilities? Because it seems like there is a
disconnect. Law enforcement wants to stem the demand. But I
would like to hear your feedback on what we can do to stimulate
that partnership.
Ms. Madras. With pleasure. I think that drug courts offer a
very ideal solution to some of the issues that you have raised.
Drug courts offer a choice of treatment or prison for low level
criminal offenders and certainly, this can be applied to
methamphetamine addicts as well.
What they do is partner the legal system with the treatment
community and treatment providers. They have been extremely
effective, and the interesting thing is that the re-arrest rate
for people who have gone through the drug courts is much lower,
considerably lower. A comparison figure is 54 to 60 percent re-
arrest rate for those who have not been treated compared with
16 percent for those who have.
Mr. McHenry. My State courts in North Carolina, we have a
drug court. I have visited a drug court, and it is an amazing
result that they have had in the community where this exists.
The difficulty is actually getting what is pilot project in
essence in North Carolina State courts and spreading that.
The other issue is that all law enforcement now in my State
wants Federal charges. And the Federal courts have not been as
equipped as that drug court is. So beyond that, what else can
you say? I would say that to all the panelists.
Ms. Madras. In terms of the extending drug courts, the
President's proposal is to increase the budget by more than $50
million for drug courts because of proven efficacy----
Mr. McHenry. Beyond drug courts.
Ms. Madras. Beyond drug courts, I think the second issue is
that screening people through medical systems is a very
effective way of identifying people who have methamphetamine
addictions and yet do not show up in any other venue. They do
not appear for treatment, they do not appear in the criminal
justice system.
Mr. McHenry. My time is limited. Dr. Volkow, would you
address that?
Dr. Volkow. I am glad you are asking that question, because
I think that we have an extraordinary opportunity through the
criminal justice system to touch a very, very large range of
drug-addicted people, including those on methamphetamine. The
problem is that it is almost ubiquitous by its absence. So from
day one when I took over, I started to recognize that there are
very few prisons and jail systems in this country that
institute treatment for drug addiction.
Well, we have two different cultures, and you are picking
them up. One of them is to protect and punish, and the other
one is to treat and to rehabilitate. So the challenge is to
bring it together. So we have a large initiative at NIDA, which
we call NIDA Goes to Jail. It has a multi-pronged approach,
which one of them is to start educating the judges about the
problems of drug addiction, the effects as a disease, but very
important, about the treatment and the treatment outcomes from
the different perspectives.
The other approach to it is how do you bring these
treatments inside of this system that has been rejecting them.
And it is not automatic. So we created a network of prison
systems that combines the criminal justice system with the
academicians to develop these treatments and apply them into
the prison system, and very important, to follow these
individuals once they leave the criminal systems. Because what
research is showing is if you do not do the followup, then a
lot of these benefits are lost.
This is of course the only close partnership with the
SAMHSA and the criminal justice system. But it is an
extraordinary opportunity that if we don't use, not only is it
going to be increasingly costing our Nation, but we are
actually missing the opportunity of helping those that are
afflicted, that unfortunately end up with criminal behavior and
in prison.
Mr. Curie. I might just quickly mention, I endorse
everything that was just said. I think if you look at Cook
County in Illinois, there is a clear belief there, I recommend
the committee take a look at what is occurring there, if you
haven't already. There is a philosophy emerging that every
court needs to be a drug court. Eighty to 90 percent of the
individuals in the criminal justice system, and this is why
NIDA's project is so critical, have a drug and/or alcohol
problem. Over 50 percent of the individuals who are arrested
are under the influence at the time of arrest.
And what we find is, and drug courts have demonstrated
this, but what we find is that if people are engaged in
treatment when they are in prison, then you have literally a
captive audience, so you can force treatment there. And the
continuity, which Nora stressed, is so critical for attaining
recovery. Recidivism goes down.
So I think again there is a lot we can do in growing drug
courts, but I think the point you are making is we also need to
do some urgent things now in the current justice system. I want
to commend what I am finding in the justice system to be a real
enlightenment in terms of more and more understanding, more and
more reaching out for help and support. We have had Governors'
summits on methamphetamine in which we had law enforcement, the
judicial system, the community-based system of care, faith-
based community together. And those summits, I can give you a
list of all the States where they have been held, and again,
that heightens the awareness as well.
So I think it is an ongoing process. I think it is bringing
the models of what is working and making it more the norm in
our prison and court system.
Mr. McHenry. Thank you.
Mr. Souder. Judge Kramer from Noble County, IN told me over
the weekend that he was just going to convert to a drug court.
It is not like the Federal Government has to all the time fund
it. It is nice to have the extra Federal funding, but this is
something that can be done, and the process is implemented if
the people are committed.
I wanted to ask a couple of other medically related
questions. In looking at treatment for meth, does the reason
the individual has chosen to take meth make a difference if the
solutions are largely behavioral? For example, in some areas we
have learned that meth usage is often driven for weight loss,
particularly among women, it seems to be more prevalent there.
In other areas, it may be truck drivers who are trying to stay
awake. Others may be people working on a factory assembly line,
trying to increase their piece work. Others may be just looking
for a high of some sort.
Does why you got involved in meth impact the treatment
process?
Dr. Volkow. Definitely. You are very perceptive here,
because in general a lot of the community has always waited for
the magic bullet that would cure the disease. They have been
terribly disappointed.
Well, it is not surprising, because if you do not address
the issue that led a person to take the drug, that as you
pointed out, in many instances is not just to get high, you are
very unlikely to succeed in getting that person rehabilitated
properly. Particularly cogent, for example, is those situations
where a person may be driven to taking drugs as an attempt to
auto-medicate an unrecognized psychiatric disorder.
In the case of stimulants, for example, that may occur if
you are depressed, or for example, also if you have a problem
with attention deficit disorder. Why? Because when you take
these drugs, you will temporarily feel better and perform
better. However, with repeated administration, the problem gets
compounded, because your mental disorder is not treated and can
deteriorate. But you start to become addicted.
So it is extraordinarily important. That is one of the
things that research has shown about treatment, that it is a
multi-pronged approach. Clearly, SAMHSA has followed that. You
cannot just address this person is taking methamphetamine. You
have to evaluate the uniqueness of the effects of
methamphetamine in that person in each context and what drove
them there.
So what you are saying is extraordinarily important vis-a-
vis our ability to have a successful therapeutic intervention.
Dr. Clark. That is one of the first things we do in a
clinical situation, having treated methamphetamine addicts and
others, you need to make sure you identify what the underlying
issue is. One of the reasons we have a work release program at
SAMHSA is because indeed, if the employer's environment, and we
work with the DOT on workplace drug testing, which has proven
to be very effective, if the employer's environment encourages
the mis-use, in this case, of stimulants, then the person is
being rewarded for mis-using stimulants.
I had a patient who said, ``My job was to do emergency work
when things fell. And I had to sometimes stay up for 72 hours.
Nobody asked me how I could stay up for 72 hours.'' He was
doing cocaine, in this case. But the fact of the matter is, the
job provided incentives for the mis-use of a stimulant. And you
are correct, truck drivers have that. If I get rewarded for
long hours behind the wheel, then I am going to look for ways
to do long hours behind the wheel. So the employers have to
play a role in it. The vectors of value in a community have to
be tied to recovery in order for recovery to have meaning.
Ms. Madras. I would like to add, in terms of the causes, in
the surveys that were done, not recently, but a while ago, more
than 60 percent of the people who used methamphetamine took it
initially because it was available. And that is a very
important factor.
The second issue that I think is important with regard to
treatment outcomes is that the age of onset and the amount of
use can have an enormous influence on whether or not treatment
is successful, so that the earlier a child or an adolescent or
a young adult is identified with regard to methamphetamine, a
far higher probability that they will be successfully treated.
And that is why I think that being able to identify people who
don't show up with the methamphetamine problem, but show up
sporadically in emergency rooms and trauma centers, or even in
college screening, such as what our administration is planning
with regard to the SBIRT Program, is going to have an enormous
influence on catching people before they progress to addiction.
Mr. Souder. One of the things that became apparent in major
league baseball as we did the hearings in this room is that
steroids, while a serious problem, amphetamines are more
common. In fact, some baseball teams actually had the pills
available in the locker rooms, not necessarily authorized by
the team itself, but certainly hadn't shut it down through
their training, and called them different names. We have been
trying to address this question.
Could you describe a little bit of the medical differences
between amphetamines and methamphetamine and some of the range?
Historically this has been called crank, it has had different
names in its lifetime. Right now, everybody refers to it as
methamphetamine. In the opening testimony we talked about the
category of methamphetamine and a little bit of the medical
differences that we are dealing with.
Dr. Volkow. All of these drugs are considered stimulants,
because they activate the sympathetic system, which is one that
allows you do the fight-flight response. Within the stimulants,
there are two categories, one represented by cocaine, and the
other represented by amphetamine and methamphetamine. What is
fascinating is in each one of these categories, you have a
medication that is used extensively in treatment on children
with attention deficit disorder.
So what are the differences and the similarities?
Amphetamine has been abused and continues to be a significant
abuse problem in several countries of the world, such as Japan.
So there is an epidemic of amphetamine abuse. It can be very
addictive, and it also can be very toxic. And just like
methamphetamine, it can produce psychosis.
Now, how does amphetamine compare with methamphetamine, and
why is it that we can still use amphetamine properly to treat
children with attention deficit disorder? Well, to start with,
when we treat, we use a route of administration that is much
less addictive. We use oral administration and we regulate and
titrate the doses. You never will administer an amphetamine for
any other route than oral.
Having said that, as I said, when you inject amphetamine,
the same amphetamine that you give to children to treat
attention deficit disorder, you can crush and inject. It can
produce a very intense high, and it definitely is associated
with addiction.
Now, if you compare amphetamine and methamphetamine in
terms, for example, they are quite similar pharmacologically.
Methamphetamine is more potent than amphetamine itself, in its
ability to increase dopamine as well, and its ability to
increase noradrenaline, which is the other property that is
associated with enhanced alertness that they were referring to.
You need to stay awake for many hours, what are our kids doing
in college? They are taking an amphetamine to study for their
exams without having to read, and they are going to perform
better. Why? Because it has neuradrenergic effects.
Will methamphetamine do the same thing? Yes, it will. But
it will be doing it for a longer period of time. So it is an
issue of potency between methamphetamine and amphetamine. Both
of them are highly dangerous. When abused inappropriately,
amphetamine can be highly dangerous.
Cocaine, on the other hand, is less potent than the
amphetamines. But because it is very unique, it goes in and out
of the brain very rapidly, it can lead to a repeated
administration that can be incredibly dangerous. Also, cocaine,
different from amphetamine and methamphetamine, has local
anaesthetic effects. And that is particularly problematic vis-
a-vis toxicity, because it can lead much more easily to
seizures. This is one of the reasons associated with medical
emergencies with cocaine.
So while they are similar, there are unique
characteristics. And on top of them in terms of potency lies
methamphetamine. And as Dr. Madras stated, one of the things
that makes it also so incredibly problematic is that it is very
easy to synthesize. That is where the move about
pseudoephedrine becomes so very important, because as Dr.
Madras said, and we have known that for many, many years,
availability is one of the most important variables driving
drug experimentation, which is of course the first step toward
the path of addiction.
Mr. Souder. One other question here that often have heard,
well, let me ask two questions. One is that methamphetamine,
more than we hear in other drugs, the users tend to be paranoic
and behave differently as law enforcement approaches, more
likely to be violent.
As you were describing this with the different potentially
co-occurring dependencies and masking other things, is it the
drug that is causing the paranoia, or to some degree they were
already paranoic, and it got exaggerated? In other words, a
person who is more paranoic may be attracted to use this drug
if they had a co-occurring dependency, such as ADD or other
types of things.
Dr. Volkow. You know, it is a fascinating question, but
there is clear-cut evidence that amphetamines can produce
psychosis. You can actually do it, they have done it in the
past where they were doing experiments of giving some of these
pharmacological agents to normal individuals. This was
reported, high doses of amphetamine, not just methamphetamine,
can produce psychosis. So to the question, if you are paranoid,
are you more likely to take this stimulant drug, in fact, you
are not. Because it can make you really, really sick.
So when you have someone, for example, that has a
vulnerability for psychosis and they take one of these drugs,
they get very, very sick. So it becomes subversive. So the drug
itself, what do we know about why that drug can produce
psychosis and why is it so much more frequent than with
cocaine? Because it can increase dopamine so much more than
cocaine. That is one of the elements.
The other element that is unique to amphetamine that does
not happen with cocaine is that the target, that is, where the
drug binds, which is a protein that is involved in recycling
dopamine, so dopamine is liberated, but it is immediately
removed. Cocaine and amphetamine and methamphetamine block it.
But methamphetamine and amphetamine, cocaine does not do that,
bring this protein inside the cell, decreasing its
availability. And that appears to be long lasting.
So what you have is, the protein is no longer there, even
though the drug may not be there, and there is no recycling
process, so dopamine stays longer. And that is really one of
the reasons why it is also so much more frequent to see
psychosis with methamphetamine than with cocaine.
Mr. Souder. Ms. Madras, did you have a comment?
Ms. Madras. Just to add to Dr. Volkow's excellent comments,
in schizophrenia, which is the ultimate form of psychosis, a
blockade of dopamine targets is what produces therapeutic
benefit. So schizophrenia is characterized by psychosis with,
in many cases, paranoia. The underlying theory is that
schizophrenia is a disease where there is too much dopamine not
necessarily being produced, but there is too much dopamine
activity in the brain. And amphetamines parallel that effect by
producing excess dopamine.
So there is a very clear parallel between the two. In fact,
emergency room physicians, if someone comes in with psychosis
and they want to diagnose a person as being schizophrenic, they
have to wait and make sure that they have not taken
amphetamines in order to make the diagnosis.
Mr. Souder. My last question is a direct followup on this,
Mr. Curie has made his whole career on co-occurring
dependencies. And this is the first hearing in all the hearings
we have on meth, I think we have had 10 now, or more, in this
subcommittee, where the subject of the co-occurring dependency
may have led to somebody using. In other words, it isn't just
that they want to get a faster piece rate or stay awake or get
high, that some individuals may have actually kind of self-
prescribed this, because it masks their other symptoms, it may
have actually made it worse.
Is there a study to this effect? Is this common? Is it in
certain areas of the country more? What are we looking at here?
Because in fact, if it makes disease more severe, this is a
potential, another type of the problem that we are tackling.
Mr. Curie. I will make just a couple of general remarks and
let the scientists go into more detail with that. I think first
of all, stressing the fact that an addictive disease is its own
disease, as well as mental illnesses, and there is a range of
mental illnesses. And I think the key is the term co-occurring.
Sometimes they do co-occur, and we have the data to demonstrate
that. Many times when they do co-occur, what we have found in
our systems is that we have failed those individuals, because
we are either treating one or the other disorder instead of
both, in a particular sort of way or acknowledging it. And many
times, the disorders get worse if you are not treating both.
So again, we know more today than ever before about that. I
think in general, you do have situations where people may have
an underlying bipolar disorder, schizophrenia that has been
undiagnosed. And the use of drugs or substances has been a form
of self-medication. You see that. And they may be treated for
addiction. If that goes undiagnosed, it is likely that they are
going to be going back with the medications.
I think you just heard excellent explanations too that many
people do not have an underlying mental illness, but because of
the impact of the substances, psychosis did occur. So all those
things need to be sorted out, but the key is I think us having
an understanding in primary health care settings, in mental
health settings and substance abuse settings, that we need to
do an assessment around the co-occurring issue, and make sure
any door is the right door to assure people are receiving the
appropriate treatment at the appropriate level, depending on
the nature of the co-occurring disorder.
Mr. Souder. In any additional comment on that, could you
also address if the drug can actually cause another psychosis,
for example, will that last, even if they give up the drug? And
then we have crossed the other direction? In other words, you
had co-occurring, but then could actually the drug create a co-
occurring instance?
Dr. Volkow. The question that you are asking is one that
has been challenging the whole research community. For some
there are some clearer answers than for others. It is clear
evidence that certain drugs can induce an anxiety disorder,
given an individual that otherwise would not develop it. The
same thing with a conduct disorder.
With respect to schizophrenia, this has been very
controversial. There is evidence, this has been for many years,
particularly from the European literature, showing that early
exposure to cannabis can indeed increase the risk of
schizophrenia. There is an elegant study that showed that it
could actually trigger it in those individuals that have the
genetic risk, that may or may not have gotten it if they had
not smoked.
So the consensus right now is that by itself, the drug has
not been shown to produce a schizophrenia or a psychosis that
is irreversible. That doesn't mean it doesn't happen. The
overall consensus is that it is likely to produce it in those
that may have the vulnerability, because of your genes.
But again, what genes confer, what we know is the gene is
not going to be a death sentence that you are going to get
schizophrenia. What a gene gives you is a vulnerability that
when, combined with the environmental factors, can determine
whether you will develop the schizophrenia or not.
One of the most important environmental factors
contributing on whether you will develop the mental illness or
not is the exposure to drugs. Dr. Madras made a comment that is
extremely salient, which is the notion that early exposure to
drugs in an vulnerable individual is particularly problematic.
So if you have the vulnerability and get exposed, that
increases your risk of developing depression, of developing
anxiety, of developing psychosis.
Ms. Madras. I think some of our best evidence in linking
the use of drugs with ultimate consequences is with regard to
alcohol. In a study that began in the 1940's and persists to
this day, of a cohort of Harvard graduates, as compared with
other workers in the Boston area, it was found that people who
initiated alcohol use during their youth and adolescence and
subsequently had a much higher incidence of depression
consequently, than people who did not. That was true whether or
not you graduated college or whether or not you did not go to
college.
So there are clear links. But some of the others with
regard to amphetamine and methamphetamine, as Dr. Volkow said,
they are more controversial. There is no question that acutely,
drugs can induce a psychosis. But whether or not it is
reversible I think remains to be determined.
Mr. Souder. Mr. Cummings.
Mr. Cummings. Dr. Volkow, you earlier invoked the term
``magic bullet.'' This Sunday's New York Times Magazine ran an
article entitled ``An Anti-Addiction Pill.'' The article
discusses Prometa, a drug treatment protocol for cocaine,
alcohol and meth addiction, that is being marketed aggressively
by a Los Angeles-based health care services management company
called Hythiam. Some addiction medicine physicians who have
administered this drug protocol have reported encouraging
results in reducing anxiety and drug craving. But some
scientists have expressed concerns about the aggressive
marketing of the protocol without clinical investigation.
Can you comment on that for a moment?
Dr. Volkow. Yes, certainly, I will be happy to comment on
it. In the field of drug addiction, it has been very, very
difficult to change the culture to accept drug addiction as a
disease. As you know, we are treated differently. The
insurance, private insurance, do not cover for the treatment.
Why? Because they say drug addiction treatment does not work.
So it has become extraordinarily important for us to
provide objective evidence of the effectiveness of treatment
interventions. And it is harmful to the field to promote a
treatment without that evidence, because it serves to
propagate, if the treatment, when the studies are done
properly, does not show effectiveness, it serves to propagate
the sense that treatment does not work.
So to my knowledge, and I have looked into the literature,
there is no randomized study that has proven the efficacy of
Prometa. There was a study that was recently reported last week
in the committee on Problems of Drug Dependence meeting, where
they showed positive results. However, that is an open trial,
and where the placebo effect is likely to confound the results
of that study.
So as of now, there is not yet evidence of a randomized
study that can attest for the efficacy of the treatment.
Do I support the utilization of treatments that are not
evidence-based? No, I do not.
Mr. Cummings. What are the possibilities or probabilities
of a pharmaceutical treatment for meth addiction analogous,
say, to methadone? What is the situation there?
Dr. Volkow. I am very confident, and I am not one of those
people that just sort of says, to make a good feeling, that we
will have----
Mr. Cummings. I kind of got that impression. [Laughter.]
Dr. Volkow. That we have some very promising compounds, if
only we could accelerate it faster into the clinics, that we
will be seeing a shift in the way of the treatments that we can
offer to people that are addicted to methamphetamine.
For many years, we were very much married to the concept of
emulating the success with methadone, and now with
buprenorphine for heroin. And as of now, that type of strategy,
which is to provide a medication that actually accesses the
same targets as the drug that is being abused, but with
different properties, which has been so successful in heroin,
as of yet have not yielded success for the treatment of
methamphetamine overall.
That doesn't mean it doesn't work. But what we are doing in
the meantime, rather than just concentrating on that approach,
we are in parallel checking other types of strategies that for
example address, can we interfere with the memories that are
formed when you become addicted to the drug, such that you do
not desire the drug when you are exposed to it. The notion of
the vaccine that will actually change and interfere with the
ability of the drug to get into your brain as a mechanism of
protecting you against relapsing, medications that can
interfere with the responses of our body when we are stressed,
which is one of the factors that lead people to relapse. Why?
Because stress activates the same circuits that are activated
by drugs. So it primes them, wanting you to want the drug.
So that is the other medication strategies that we are
looking for, while at the same time still keeping an eye on the
possibility that perhaps a molecule may work. But as of now, I
cannot tell you of any success in that particular type of
strategy.
Mr. Cummings. One of the things that I wonder about, and we
have touched on it a bit here, is what causes one population to
use a certain drug and another--these are all people that are
trying to get high. And so I look and I see, and one thing may
be access, in other words, if it is there and available. But it
seems as if, and I am just wondering, is it something unique
about methamphetamine, its nature, that draws people to it from
the beginning, as opposed to cocaine? In other words, in the
urban areas, I don't hear too much about methamphetamine in
Baltimore. I am not saying it is not on its way or not nearby.
But on the other hand, you go into the rural areas, and
there it is. A lot of very, very good people come up with great
backgrounds, the next thing you know, they are addicted. But it
is almost like you can put a wall between one drug and another.
I am just wondering, is there any particular person that is
prone to use methamphetamine as opposed to cocaine or crack
cocaine?
Dr. Volkow. The reason why I jumped at your question is
that you touched on something I have been obsessing now for
several years. Because I think it is very important, to me, an
opportunity to understand what may be protecting a certain
population, specifically in the case of methamphetamine. What
has been intriguing me is why there are such low rates in the
African-American community.
Now, you could say, and these are the responses that I got
from people in the field, that it is perhaps of the market and
the accessibility, that the urban territories are
predominantly, they have strong markets to deal with cocaine.
And so there is a pressure and an availability. Or there may be
a culture that makes it negative, not acceptable.
Yet at the same time, I cannot forget what we know from
other sources of drug addiction. For example, smoking is also
much less prevalent in the African-American population. And the
question for many years, people said, well, it has to do with
the way that kids are brought up in their families. But
recently, for example, we have known that African-Americans
have a gene that encodes for the protein that destroys
nicotine, that does not do it very properly. And as a result of
that, they cannot metabolize nicotine properly. And as a result
of that, when they smoke, nicotine concentrations are much
higher and become aversive.
So this is a protection that helps decrease the number of
people that become addicted, that will smoke cigarettes, but
also the amount of cigarettes that they smoke. So I have always
been very intrigued about that possibility. There is no data,
so this is purely speculative. That yes, while environmental
factors are extraordinarily important in addressing the
question why one may favor one, not the other, there may be
other biological factors, such as how do you excrete or
metabolize the drug. And we know for example, that in African-
Americans, kids treated with amphetamines for attention deficit
disorder require much lower doses. Why? Because they excrete is
less.
So it is plausible that it is a combination of factors,
environmental and biological, that can determine the
differences as we are seeing right now, specifically with the
methamphetamine, that we are seeing very low rates of abuse.
Mr. Souder. I need to do a followup with that, because that
came up at one of our other hearings, where you made a similar
reference. And in our field hearings, the home cookers clearly
are in rural areas, partly because it can't be smelled as
easily. That is why they are in the national forests and
elsewhere, they can find the ingredients.
But neither crystal meth nor the home-cooked meth has been
very prevalent in the big cities. But in our hearing in
Minneapolis, and you need to look at Minneapolis, because in
Hennepin County, we have testimony from the drug court and I
think it was the head of the State drug treatment, that in one
neighborhood in Minneapolis, an African-American distribution
organization switched to crystal meth, and all of a sudden, 60
percent of the people hitting the emergency room and in the
drug court were African-American.
It isn't clear whether that sustained itself, whether it
was a brief spurt because a distribution group changed. But
that is the only hearing we have had in the country where we
saw it hit an urban area and the distribution change all of a
sudden in the whole city, one neighborhood took over the drug
addiction problem in the whole city of Minneapolis.
Now, the question is, is this going to repeat itself? There
has been a little bit in New Orleans, a little bit in Detroit.
My understanding is Omaha and Portland have started to see it
in the minority community, too. But there should be starting to
get enough of a sample to be able to test the theory. Because
we have our first urban exposures.
Even in my home district, Fort Wayne has no meth. Elkhart
has crack. South Bend is still cocaine and heroin. Even in
Kosciusko County, where the whole area around the city of
Warsaw-Winona Lake, which maybe had 20,000 people, there is no
meth in the town, in the bigger city. It isn't a question of
minority-majority populations. To some degree there seems to be
an urban-rural phenomenon to this, even on crystal meth.
But this is the big challenge, because in anticipating
where this drug is going to move, if there is indeed a
biological difference, then that makes a big difference where
the drug is going to move. If there is not a biological
difference but just a distribution difference, then we have a
different strategy toward trying to work it.
Mr. Cummings. That is what I was trying to get to.
Dr. Clark.
Dr. Clark. I think it is a combination of all the factors,
that is, what Dr. Madras and Dr. Volkow were stressing, that
indeed you are dealing with multi-factorial issues. The data
shows that African-American people who present for people, only
0.1 percent are users. But that still is 0.1 percent, it is not
zero. I think that is the key issue.
So what Mr. Souder pointed out, the chairman pointed out,
is in fact an issue. There is an access issue. The northeast
does not have a major methamphetamine problem. So you go to
Maine, it does not have a major methamphetamine problem. The
African-American population in Maine is still really quite low.
So there is access, there are drug gangs, there are
importation routes, there are manufacturing routes, there are a
host of issues associated with this. Communities of color,
African-American communities should not assume that this is not
going to be a problem because it hasn't been a problem. The
fact is, if the African-American community has been spared the
problem, it should recognize that the problem can come. And as
other communities, Asian communities, Hispanic and Latino
community. The American Indian and Alaska Native communities,
very high prevalence rate compared to other ethnic groups,
other than Native Hawaiians and Pacific Islanders, 2.2 percent,
which is the largest among Native Hawaiians and other Pacific
Islanders.
So what we are dealing with here is a combination of
access, biology in terms of genetics, preference, gang
activity, importation, routes, etc.
Mr. Cummings. Mr. Chairman, I know we have to get to our
other panelists, and I am going to be very brief. But let me
say this, that in my district, and I have literally seen this
many times, where 100, 150 people, you can be riding down the
street, and all of a sudden you see people coming from
everywhere. And then if you hang around long enough, you see
them lined up, straight in a row. And sometimes it is on a main
thoroughfare.
And if you watch long enough, what will happen is a drug
dealer, along with his comrades, will come and give them
samples. And everybody stands there, and it is almost like
somebody says at 1 o'clock at North and Monroe, this is going
to happen, and they are there on time, they are disciplined,
they stand straight in a line. It is well organized, they have
lookouts everywhere. And I am talking about in broad daylight.
Now, what am I getting to? Drug salespeople are very
sophisticated. They are some of the most brilliant people
probably out there. They can actually operate an enterprise
under the nose of the DEA, the FBI, the local police, the State
police. And they do it very effectively. And what are they
trying to get? Money.
So it says to me that if they can come up with, and by the
way, what they do, the reason why they are giving out these
samples, of course, is to say my product is better than your
product. So come back tomorrow and you can buy it, today it is
free.
So it seems to me, that somewhere in this country, somebody
would say, you know, over there in Indiana, they have this
stuff called meth, it is working, and it is making people high.
And guess what? It stays in your system a long time. So maybe
you can get a bigger bang for your buck. I mean, it is just
logical. These people are out to make money.
So I wonder what it is that would keep that person from
coming over and at least, if they can do this in the inner
city, under the eyes of the police, it seems like they would be
doing it, we would be seeing even more Minneapolis-type
incidents, like the chairman talked about, all over the
country. And that is a concern, because it does tell us what we
have to deal with.
I just can't believe, the reason why all of it, what Dr.
Volkow was saying, and you, Mr. Curie, it makes a lot of sense.
But I have to tell you, a lot of people don't think it is going
to get to the cities. I do. I do. Just because of the profit.
Ms. Madras. Just to add on to this, if one gives animals
access to methamphetamine, or amphetamine, or any of the
emerging drugs, they will self-administer it as robustly as
humans, if not more so. In fact, some of them will kill
themselves with unlimited access. So this is a biological
property of our human brains as well as our colleagues in the
mammalian kingdom.
Mr. Cummings. Last but not least, drug courts. Do drug
courts have more effect--I think you were talking about this,
Mr. Curie--do we find that drug courts are more effective with
regard to methamphetamine, or is it about the same as with
other drugs?
Mr. Curie. I know that Dr. Madras discussed that. I think
in terms of, I mean absolutely in terms of the impact overall
with substance abuse we see drug courts being very effective,
and we have seen them be effective with methamphetamine in
terms of getting people in treatment. We know treatment works.
I don't know if we have the actual data in terms of separating
the meth--I guess the Matrix study would have that, yes.
Mr. Clark. In the SAMHSA research project, one project that
works as well as the Matrix Model was drug courts.
Mr. Cummings. OK.
Ms. Madras. And in the Vigo County drug court system in
Indiana, the recidivism rate was only 16 percent for meth
users, which means very, very high efficacy.
Mr. Cummings. The reason why I asked that is you all talked
about how long it stays in the system. I think somebody used
the term ``intense relapse.'' And I was just wondering whether,
when you have intense relapse, when you have a cocaine addict
in drug court, as compared to a methamphetamine user, if the
relapse is less intense for the cocaine user, more intense for,
of course, the methamphetamine user. I just wondered how drug
court affects that.
Ms. Madras. One of the things the drug courts have that a
voluntary admission into treatment does not is both the
coercive aspect as well as the treatment aspect. So there are
adverse consequences to failing. And what is so interesting in
a number of areas in our society, such as the medical
community, the Department of Defense community, is that when
you impose adverse consequences on relapse, you get a much
higher treatment rate.
For example, physicians who are treated because of
impairment, their relapse rate is much lower, because the
consequence is the loss of their medical license. And in the
Department of Defense, mandatory drug testing leads to 1 to 2
percent positives, compared to the rest of society. So the drug
courts have a certain measure of coercion with adverse
consequences that has an added benefit, compared with voluntary
treatment.
Mr. Cummings. I often say, and I will close with this, Mr.
Chairman, that people do things for one of two reasons or a
combination of both: to gain pleasure or avoid pain. And it
goes to what you just said.
Mr. Souder. I thank you. We have had different people
testify at our meth hearings on drug courts. One of the things
is, the sample size is really relatively small yet in the
United States. By the time you separate out mandatory entrance,
in Arkansas it was mandatory going into the drug court, in
other States it is voluntary to go into the drug court. Also
the number of drugs you are dealing with, also a critical
question is, did you catch them early or catch them late.
Even in some of our counties, the drug court judge tends to
get them earlier in meth than some of the other judges. We have
one judge in one of my counties who has, the person is coming
up for the third offense of cooking meth, and they haven't been
prosecuted yet on the first one. That makes the measurement
difficult, very difficult.
But as we get more experience, the drug courts, the
emergency rooms are the great mines for information to try to
do this. We appreciate the service of all of you. Thank you for
being patient with our questions today. Thank you for making it
in a form that we can understand. It was very informative to
each of us. We thank you for that.
If the second panel could come forward and remain standing
so that I can give you each the oath. Our second panel is
Russell Cronkhite, recovered meth addict; Darren and Aaronette
Noble, recovered meth addicts, with their son, Joey Binkley;
Dr. Richard A. Rawson, associate director of the Integrated
Substance Abuse Programs at UCLA; Leah Heaston, Noble County
director of the Otis R. Bowen Center for Human Services in
Indiana; Mr. Michael Harle, president and CEO of Gaudenzia,
Inc.; and Pat Fleming, director of the Salt Lake County
Substance Abuse Services.
If you will each remaining standing so we can give you the
oath.
[Witnesses sworn.]
Mr. Souder. Let the record show that each of the witnesses
have responded in the affirmative. We thank you for coming
today and we will start with Mr. Cronkhite.
STATEMENTS OF RUSSELL CRONKHITE, RECOVERED METH ADDICT; DARREN
AND AARONETTE NOBLE, RECOVERED METH ADDICTS, ACCOMPANIED BY
JOSEPH BINKLEY; RICHARD A. RAWSON, PH.D, ASSOCIATED DIRECTOR,
INTEGRATED SUBSTANCE ABUSE PROGRAMS, UCLA; LEAH C. HEASTON,
MSW, LCSW, ACSW, SAP, NOBLE COUNTY DIRECTOR, OTIS R. BOWEN
CENTER FOR HUMAN SERVICES, INC.; MICHAEL B. HARLE, MHS,
GAUDENZIA, INC.; AND PAT FLEMING, DIRECTOR, SALT LAKE COUNTY
SUBSTANCE ABUSE SERVICES
STATEMENT OF RUSSELL CRONKHITE
Mr. Cronkhite. Thank you, Mr. Chairman.
Actually, I am very encouraged at some of the things I have
heard today, especially for the progress in the drug courts.
For nearly 12 years, I had the honor to serve our Nation as
the executive chef of Blair House, the President's guest house.
In my tour of duty, I served Presidents Ronald Reagan, George
H.W. Bush and Bill Clinton, as well as nearly every world
leader of this era.
Today I am the author of two successful cookbooks. My work
has appeared in several top food magazines. I continue to
contribute food-related articles to publications like the
Washington Post. Rather than write the latest celebrity chef
trend cookbook, I have chosen to write cookbooks that encourage
quality family time, promote a sense of community and foster
traditional American family values, like A Return to Sunday
Dinner and A Return to Family Picnics. I continue today with my
career as a public speaker and working with faith-based
organizations, community organizations for the purpose of
encouraging families and family values and a sense of
community.
My family value message is not a marketing plan. In August,
my wife and I will celebrate our 34th anniversary. She works
for the Fairfax County school system here. We are the parents
of three grown, adult children.
But the one subject I have not spoken about publicly and
something that I generally do not talk about at all is that I
was addicted to methamphetamine, or speed, crystal meth, during
my adolescent years. Indeed, you will be hard pressed to find
anyone that I worked with in Washington, DC, or worked with in
the hospitality industry over the last 30 years who would even
believe that such a past struggle was even possible.
I find no pleasure in telling or even recalling this self-
imposed hell that is so far removed from my life, but the
epidemic sweeping our country has compelled me to come forward
and tell my story. It is a story of restoration and redemption.
I come here today as a private citizen with no connection to
any party, political organization or advocacy group.
My spiral into the drug culture began in 1965 and soon my
life became a shattered mess that reflected the chaos of the
turbulent times. By 1967, just after my 14th birthday, while
looking for a better thrill, I fell into the frightening world
of methamphetamine into a desperate addiction that continued
over the next 3 years.
Methamphetamine is different than other drugs. Using
methamphetamine is not about escapism. Staying up for days and
weeks on end without sleep is no escape from reality. Meth
addiction is self-destructive. It is a slow suicide and is also
a visible call for help. I knew full well the risks and down
side of methamphetamine use. We used to say ``speed kills,
speed thrills.'' It was a catch phrase. My spiral into this
hell of meth addiction was severe. Self-mutilation, chaos,
psychotic episodes and frightening and violent hallucinations
and dementia. I came very close to pulling the trigger to end
the madness that my life had become. I know those who did, and
I know those who died by the needle.
We were not the children of unfortunate circumstances. The
Los Angeles community where I grew up was similar to the local
communities surrounding Washington, DC, like Arlington and
Falls Church. We were middle class and upper middle class
families. My parents' friends were real estate brokers,
doctors, contractors, school teachers, dentists, business
owners, executives and engineers for companies like Douglass,
Northrop and Hughes.
I am not one who believes that drug addiction is a disease,
per se. It is an illness, yes. It is not something that you can
catch, like a communicable disease, like measles or chicken
pox. There is a certain self-inflicted part to this disease, to
this illness. I do understand the idea and the desire to sort
of let people off the hook in counseling and provide an
emotional, short-term, feel-better fix. But those who have such
a low self-image that they are willing to engage in this kind
of deadly behavior do not need to have additional guilt dumped
on them.
But the loss of personal responsibility, while attractive
in the short term, can also take away the impetus for change.
If we are simply creatures of our genetic makeup, predisposed
to some disposition or some unfair twist of fate, we are sadly
condemned and unable to rise above our very circumstances.
Equally, I am concerned, as has been expressed here today,
that some might suggest that methamphetamine addiction cannot
be effectively treated. Clearly, my life is evidence to the
contrary. The years between 1965 and 1970 found me in and out
the juvenile court systems, and eventually the California Youth
Authority. I owe a lot to some very dedicated counselors and to
a parole officer who was more concerned about seeing me
delivered than keeping me locked up.
My road to recovery began with a very simple, act, though.
An uncle, finding me dazed, my body reduced to that of some
sort of holocaust survivor, simply put his arms around me and
invited me in to have something to eat. There was no scolding,
no lecture, no condemnation, just loving concern, served with a
bowl of peaches. Today I applaud groups like CASA, who foster
the values found around the family table and the quality
companies that support their efforts.
It does take a village. An effective drug treatment
program, especially for the highly addictive methamphetamine,
must be comprehensive. Faith in God, the support of my church,
my family, dedicated school teachers and community
organizations like the YMCA, coupled with a viable, quality
psychological counseling and a State-run system that worked,
brought me to a place of transformation and renewal in 1970.
One of the first jobs I took as I rebuilt my life was that
of a prep cook. You have to start somewhere. Still, without a
high school diploma, a little consistent work experience and a
troubled adolescence, I faced many challenges. People were not
eager to hire me. But it only takes one exception. The first
chef that I worked for had a policy of hiring the worst
applicants. His thought was that if you gave someone a second
chance, as someone had given him, the person would rise to that
opportunity, work harder than someone with other choices. His
views carried over throughout my career.
Being an executive chef, like any business manager, is part
babysitter, part marriage counselor, part drug counselor, part
cop, part coach and part psychologist. Working with lower
income employees here in the Washington, DC area, before I
joined Blair House, who had limited training, limited
educations and limited opportunities was a challenge. I met
those challenges by listening and recognizing that outside
influences faced by employees also affected their performances.
When I was in the hospitality industry, I found that many
of my employees were affected by the social plagues like
domestic violence and substance abuse. Many of the employees
that I had working for me in hotels in Washington, DC, and in
Atlanta became involved in methamphetamine and amphetamines
because they were working two jobs to support their families. I
personally paid an employee's rent and covered their time off
for treatment to compensate for the limited resources that were
available, rather than lose an otherwise good employee.
The social fabric of America has changed. Too often
teachers are no longer part of the communities where they work.
Most cannot afford to be. The lack of affordable health care
means a family whose children struggle with addictive behavior
often have few outlets for professional treatment.
I know families who have mortgaged their lives, lost their
homes and spent their life savings to save a child. I know
families who have seen their children relapse into the
frightening hell of drug addiction, simply because the 30 day
maximum for mental health treatment and the 20 allowable
followup counseling sessions have run out. These are the ones
with health care. To my knowledge, Fairfax County, one of the
country's most affluent communities, has only one facility
available for these kinds of programs.
According to a recent Washington Post article, Americans
feel more and more isolated and have fewer people that they
feel they can confide in in times of difficulty. Robert Putnam
has chronicled these alarming social trends in a monumental
work, Bowling Alone: The Decline and Revival of American
Community.
I am concerned about the mixed messages that we seem to be
sending out. Today we have a lock them up and throw away the
key mentality too often. I am especially concerned about this
when it comes to juvenile justice: 14, 15 and 16 year olds are
not adults.
I do believe we should have little tolerance for those who
manufacturer and distribute dangerous drugs for profit. In
this, truly the love of money is the root of all evil. Those
who market their witches brew of toxic chemicals for the sake
of profit are a pariah on society and should be dealt with
accordingly.
But those who support a habit must be treated as a victim
and a perpetrator. I truly wonder sometimes with a focus on
interdiction rather than on treatment if I would have had the
same opportunity to rebuild and reclaim my life 35 years ago,
as I have. I was fortunate. My arrests and convictions all took
place before my 18th birthday. And because I successfully
completed my parole without incident for 5 years from my
release from the California Youth Authority, my juvenile record
was expunged, as it should have been.
With the difficulties of my adolescence behind me, I was
allowed to rebuild my life, rise to the top of my craft while
providing for my family and served my country with honor and
distinction. Trustworthiness is not about having lived a
perfect life. It is about honesty and integrity. I believe to
be fully redeemed we must be fully restored. William Penn
believed that, and when he and his followers laid plans for
Philadelphia, the first American city, they built a
penitentiary rather than a prison. It was a place of solitude
where one could consider their actions, come to repentance and
return to society.
I am not a recovered addict one slip away from remission. I
am a highly successful professional, a father, a husband
married 34 years, a church member, a member of my community who
long ago, almost another life ago, struggled with addiction,
because I struggled with self-doubt, self-hatred, self-
destruction and a disillusioned moral crisis. Addiction is a
symptom of a deeper plague. To effectively treat addiction we
must have a comprehensive plan to address the root causes. Left
untreated, those causes will only reappear or resurface in a
different form.
I am here by God's grace to be sure, but I am here because
those around me cared enough to come alongside me and offer
help. My story is one of success. I am one for whom the system
worked, where the unconditional love of family, community,
Government resources, family doctor, faith-based organizations
and self-determination and good counseling came together to
save a life.
Mr. Souder. Thank you very much for your testimony.
Darren, you or Aaronette, who is going to give your
testimony? You are Darren, you are next.
STATEMENT OF DARREN NOBLE
Mr. Noble. Good afternoon. Thank you for the chance to
speak to you as a father in recovery. Aaronette and I are the
proud parents of two children, Casey, who is 6, and Summer, who
is 17 months old. Casey is here with us today. I am also the
very proud stepfather of Joey Binkley.
I used meth for 14 years. My wife and I used meth together.
We wanted to get help to stop hurting ourselves and our
children. I tried treatment. I went into four different
treatment programs, but each program was set up for single
adults. I couldn't bring Aaronette or the children with me. So
I couldn't concentrate on the treatment itself. I couldn't stop
worrying about my wife still being in the situation that I had
left. I couldn't stop worrying about my children, what was
happening to my children.
For treatment to work, you need time and space to think
about you. But I couldn't think about me. I could only worry
about my family. So after many years of using meth, trying to
get clean, using again, I ended up in prison. In 1999, I was
arrested for manufacturing meth. I used to manufacture meth by
myself out in the woods.
When I went into prison, I weighed about 120 pounds. I was
not offered treatment in prison or after prison. After serving
3 years and 10 months, I was released.
Life didn't get better for us after prison. Aaronette and I
continued to use meth. Our addiction got so terrible that in
2005, Aaronette gave birth to our second daughter, who was born
with meth in her. Child welfare took our baby away. But child
welfare, along with the family court program, placed us into
Bridgeway's family treatment program. Aaronette went into the
women and children's program. I went into the men's program.
I can't tell you how wonderful it felt to do treatment as a
family. In the family treatment program, I knew that my wife
and children were safe and healing. I could focus on my own
treatment. But I could also heal with my family. At Bridgeway,
we did family therapy, couples counseling, we had parenting
classes. I learned how to communicate with my wife. I learned
how to honor her. You see, before, our relationship was based
on drugs. But now we know how to talk to each other, love each
other, and we also know how to be parents.
When I was using meth, my daughter Casey looked so scared.
My daughter Summer lived with her grandmother. She was very
attached to her grandmother. But today, our daughter Casey has
a beautiful sparkle in her eye. She is doing well in school.
And our daughter Summer has been returned to our custody, 7
months ago. She is inseparable from us. We are a family.
We have a support system made up of wonderful people from
our family court and our family treatment program. They all
worked together to help our family get clean and stable. Our
social circle is made up of other parents in recovery. We are
blessed. I am working in construction. We attend church. We
still go to therapy. And we are a family with faith and hope.
Thank you.
Mr. Souder. Thank you. Aaronette, do you have a statement?
STATEMENT OF AARONETTE NOBLE
Mrs. Noble. Good afternoon. Thank you for the honor of
speaking with you today. My name is Aaronette Noble. I am here
with my husband, Darren, my son Joey and my daughter Casey. I
am a wife, a mother and a recovering addict. I grew up in an
alcoholic home. I smoked marijuana for the first time at the
age of 7. I first drank alcohol at the age of 14, and I began
using cocaine and methamphetamine at the ripe age of 17.
No one plans to have the disease of addiction take over
their lives, and no one plans to end up in prison for
methamphetamine abuse. No one plans to give birth to a tiny
baby born with drugs in their system. No one plans to have
their children tell them that they don't want to have anything
to do with their mother. No one plans for these things. I know
I didn't.
When I was using meth, I felt dead most of the time. All I
did was breathe in and breathe out. I had no motivation. The
world was a very dark place. I had no hope or no faith in
anything or anyone. Every day I would wonder why I just didn't
die. I was so angry at God, the world, and mostly at myself. My
teeth and my hair were falling out, and other people had
custody of my children. My husband and I were homeless and
sleeping in our car.
Did I believe that family treatment could help me with all
that was wrong in our lives? How could it? I had tried single
adult programs but I never succeeded in staying clean. The
programs were very short-term. They were only 90 days at most.
I was not helped as a mother who had this shame and guilt
because of my addiction. My children were not provided
services. We could not heal together as a family.
After years of prison and inappropriate single adult
treatment programs, my addiction to meth got worse. I gave
birth to my daughter, Summer. Summer was born addicted to meth.
She was removed from my custody by child welfare. At that
point, however, a miracle happened. My children and I were
referred to a comprehensive family treatment program. We
entered into Bridgeway Counseling and the Division of Family
Services. My husband made a commitment to do the same.
Bridgeway had just opened a men's residential treatment
center next to the women's center. We were the first married
couple to be in treatment at the same time. It helped to know
that we were doing this apart but also together. Our addiction
tore our family apart, so you see, we needed to find our
solution as a family. I received services I didn't even know I
needed. I saw a psychiatrist, who helped me with my depression,
and I could sleep better, think more clearly. It was like
someone turned a light on in my head, and my mind wasn't
constantly racing any more.
At Bridgeway, we started family therapy. I got counseling
for past domestic violence and sexual abuse. I didn't even
think I had issues in these areas until I finally opened up to
my counselors and was truthful with myself. We took parenting
classes, went to meetings and attended church. The Division of
Family Services brought our baby to Bridgeway for Darren and me
to see. She is a beautiful little girl with big blue eyes that
can see right through you. I want her to only see good things
in me today, and that is what she does. She gives me strength
and courage.
After 30 days of doing Bridgeway's residential program, my
family and I transitioned into Bridgeway's intensive outpatient
program. The beginning of our sobriety was not easy, but maybe
it shouldn't be. Maybe we needed to work and struggle. We
entered into a shelter. I came to Bridgeway during the day. We
then as a whole family purchased a used trailer for $500. I
have to tell you, we love that trailer. It is our first sober
home as a family.
My husband and I voluntarily joined a Family Safety Drug
Court in order to have more structure and more support and
allow the Division of Family Services to be an even bigger part
of our lives. We had nothing left to hide. We only wanted our
family back together. We only wanted to stay sober, we only
wanted to make our children smile as often as we could.
We also continue to receive the family based treatment
services of family counseling, therapy and parenting classes at
Bridgeway. Our family is not an exception. There are hundreds
of parents like us who are clean, sober and stabilized because
of family treatment programs like Bridgeway.
But there are also many families in need of family
treatment, and the waiting lists are long. There are only two
family treatment programs in the whole State of Missouri, so
many families get lost to the disease of addiction.
My beautiful little Summer, with the blue eyes, has been
reunited with us now. She has been with us for 7 months. I am
sure those of you who are parents can feel the light of having
all your children next to you brings you. The light is with me
today, it is with me here in Washington, DC, it is with me
every moment. I know that being a parent is not just a right,
today it is a privilege. It is mine and Darren's privilege to
be parents.
No one plans to tear their world apart, and the world of
their children. Today, because of available family treatment, I
can plan every day to put their world back together. This is
work, but it is the best kind of work. It is a struggle, but it
is the best kind of struggle. We continue to go to meetings, we
continue to meet with the court, we continue to make sober
friends. And we begin, for the first time, to be sober heroes
to our children.
Thank you.
Mr. Souder. Thank you. Joey, are you going to share your
story with us now?
STATEMENT OF JOSEPH BINKLEY
Mr. Binkley. Hello. My name is Joseph Binkley. I am 18
years old and am a recent graduate of Ritenour High School in
St. Louis, MO. For most of my life, my mother has been addicted
to drugs and alcohol. In my early years, I had no idea that my
mother had anything wrong with her. And I had no idea about
drug addiction or the symptoms thereof.
It wasn't until the end of elementary school that I
realized that something was very wrong. My mother was acting
very strange, and she had to be placed into treatment multiple
times for drug abuse. I was not able to be with her during
those times in treatment.
A short time afterwards, she went into prison. From that
moment until about a year ago, I completely stopped talking to
my mother. I did not want anything to do with her. I felt
betrayed.
I lived with my father during my mother's incarceration.
After getting out of prison, my mother was still using drugs.
It wasn't until I learned that my youngest sister, Summer,
was about to be put up for adoption that I felt I had to do
something about this issue. I joined my family in the family
treatment program at Bridgeway. The family treatment program
helped rebuild my family and healed my mother's issues.
Throughout the experiences of my mother's addiction and
recovery, I could not leave my family, because that would not
have helped me or my family. I felt that I may not have done as
well without their support.
We now can have birthday parties, graduation parties, and
events such as those, just as any normal family would have.
Surprisingly to most, my at-home issues have not affected me
academically. Throughout the years, I have maintained a high
grade point average. At the end of high school, I had around a
3.8 grade point average, perfect attendance and was involved
with multiple groups and organizations, including Leadership,
D.J. for the school radio station, RCO, Teenage Health
Consultants, Mu Alpha Theta, varsity baseball, Ritenour Big
Brother/Big Sister, and I was on homecoming court.
I was promoted to a managerial position at my job at
ChuckaBurger, and I have also recently begun working as a
driver for Pizza Hut. I have been accepted to Southeast
Missouri State University with two scholarships, though I am
still looking for more additional funding. I will begin
Southeast Missouri State in the fall. I plan on becoming a
physics teacher, so I am majoring in physics education.
Thank you.
Mr. Souder. Thank you for your testimony.
Dr. Rawson, we appreciate your being here today. I just
want you to know I am not going to sing happy birthday to you,
but we thank you for coming on your birthday. Maybe as a
concession, when UCLA comes to Notre Dame this fall to lose, I
will do at least a clap in memory of your birthday and that you
had come before the committee on your birthday. [Laughter.]
Thank you very much for joining us, and we are looking
forward to your testimony.
STATEMENT OF RICHARD A. RAWSON, PH.D
Mr. Rawson. Thank you, Chairman Souder. I want to thank you
for the effort you have put in to address this problem of
methamphetamine in the United States. For 20 years in southern
California, we have been wrestling with this problem and trying
to get some attention. Until your efforts, it has been somewhat
challenging. This committee has been a breath of fresh air in
giving us some assistance and attention to this problem.
My name is Rick Rawson. I am a professor at UCLA. And for
the last 30 years, I have done work in the field of drug abuse.
From 1983 until 1998, I ran a non-profit organization called
the Matrix Institute in southern California. We were asked by
the health director in San Bernardino County in 1986 to come
and open a clinic because of a methamphetamine epidemic in San
Bernardino in 1986. We had several other clinics at the time
that were seeing hundreds of cocaine users, since that was the
peak of the cocaine epidemic. But in San Bernardino County,
methamphetamine was already a severe health problem.
The clinic we opened in 1986 in the first year saw 150
patients. This year it will see closer to 1,000 patients. Over
that time, we have now seen between 7,000 or 8,000
methamphetamine users in that clinic.
In the late 1990's I went back to work. I had started at
UCLA and I went back to work to UCLA and I have been there now
for 10 years, overseeing a portfolio of research. But for 15
years, I sat in a chair and saw one patient right after
another, half of them being cocaine users and half of them
being methamphetamine users. We started to put together some
treatments and developed a treatment model that has since
become known as the Matrix Model that you have heard of, and we
have collected some data on.
Now that I am a so-called methamphetamine expert, I spend
about 100 days a year traveling around the country talking
about methamphetamine and the problem and the treatment. I do
hear some very interesting questions and myths. But of course,
the one that is most interesting is this issue about
methamphetamine users being untreatable. The term I frequently
hear is that fewer than 5 percent of methamphetamine users get
better.
I think that initial reference came from a Rolling Stone
article in 1997, that is where that figure came from. It was
one of our better scientific journals. [Laughter.]
In my written testimony, I give you some data on this
comparability between treatment of methamphetamine users and
treatment of other substance abuse disorders. But in short, we
have run three controlled clinical trials and we have analyzed
three large data sets where we have looked at meth users and
cocaine users. We have looked at the data in every way we can
possibly think of to look at it. We have found absolutely no
evidence of any difference between those groups.
In fact, we think that the treatment for stimulant users,
probably the outcome is better than it is for heroin addiction,
except that heroin addiction, we have medications like
methadone and buprenorphine, which we don't have for
stimulants. But there is no evidence that I can find or that
any of my colleagues have been able to find that meth users are
any less responsive to treatment than any other patient
populations.
Now, there are some slightly different issues that often
need to be discussed in treatment, and that is what we have
tried to program into our treatment materials. SAMHSA has
evaluated these in a large-scale trial. But in general, across
the board, our treatment outcome data for cocaine users, meth
users, alcohol users, are all very comparable. We can't see any
systematic difference.
Why has the myth occurred? I think probably it is developed
because during the 1980's, when we saw large numbers of cocaine
users in urban centers, and NIDA responded and developed a set
of training materials, and these training materials were
disseminated where there were cocaine problems, people became
quite skilled at using these empirically based treatments.
However, in rural areas, where there really wasn't much of
a cocaine problem in the 1980's and 1990's, they continued
pretty much to use treatment methods that had been developed
for alcoholics in the 1960's and 1970's, and just never gained
any exposure to these new treatment strategies. When the meth
users started showing up in the 1990's and this century, they
didn't know what to do with them. They had never seen patients
like this before. In the urban centers, they had, and they had
adopted these treatments that have been useful.
So I think the issue is not so much that one addiction is
any more difficult than the other, but that one group of
treatment providers in geographic areas had never seen anything
like this. So they were really struck with the difference
between their meth users and their alcoholics, which had been
their standard patient population.
I do think that the materials that SAMHSA has developed
really are quite excellent. The dissemination of those
materials and the training that goes on is going to be critical
to getting the communities affected by methamphetamine
providing effective treatment. I think that is a big need.
There are a couple of things I would like to mention, a
couple of points that I think have not been mentioned. Three
months ago, we had data presented from San Diego County. San
Diego is also one of the cities that was impacted early by the
meth problem.
The data they are presenting from San Diego--the
epidemiologic data--suggests that right now the rates of meth
use and admissions to treatment and emergency room visits are
higher today than they have been any time in the last 20 years.
This epidemic does not go away on its own. It is not one where
it peaks and then you see a dropoff. We haven't seen any
evidence in Hawaii or in Portland, OR, of any reduction in use.
We have seen a reduction in labs, with the precursor controls,
but not in use and not in the extent of the problem. I think
that what you are doing with these hearings and getting
attention to this problem is important, because I think it is
going to continue to spread into the east coast and into the
urban centers. And I think it is going to persist in areas
where it has been a problem for some time. That is what the San
Diego data tell us.
Second, if you look at the Federal data on drug trends, and
you look at adolescents, the Monitoring the Future data, you
would think that there is no problem of meth use among
adolescents. The California treatment data would suggest
otherwise. In California, in the last data set that we looked
at, almost a third of adolescents entering treatment were
primary meth users. In some places, female admissions were over
50 percent. That is if you looked at alcohol, marijuana and
everything, coming into treatment, we were seeing 50 percent of
the girls coming in for methamphetamine dependence.
I think that we have to watch out that we don't let the
same thing happen with the adolescent drug trends that we did
with the adult drug trends, where we look at these surveys and
say, well, I guess there is not a problem there. Our treatment
data in California would suggest very differently, that
adolescents are using methamphetamine, they are becoming
dependent on methamphetamine.
And that should be a priority, because as you heard Dr.
Volkow say, it affects adolescents' brains more profoundly. We
are not sure about the recovery from meth for adolescents,
although the story was very hopeful. It is a concern for us. So
I do think that paying some attention to this problem with
adolescents is important.
I appreciate the opportunity to speak to you. I am a big
fan of this committee and the work that you have done. I would
like to thank you all for taking this effort on.
Mr. Souder. Thank you very much.
Ms. Heaston, it is good to see you. Thank you for coming
from Indiana to be with us today, and we look forward to your
testimony.
STATEMENT OF LEAH C. HEASTON
Ms. Heaston. Mr. Chairman and members of the committee,
thank you for inviting me to participate in this hearing.
For most methamphetamine abusers, treatment options in
rural areas may be few and far between. For the Bowen Center,
even with the ongoing support of our local coordinating
council, Drug-Free Noble County, Judge Michael Kramer, CADCA
and the Indiana Division of Mental Health and Addiction, we are
still having difficulties with the full implementation of the
Matrix Model, due to the following barriers.
The first barrier to the availability of methamphetamine
treatment in rural areas is the absence of qualified and
experienced staff. Staff recruitment and retention of
individuals is very difficult. Even with constant recruitment,
openings are continuous. As a result of the absence of
qualified staff, rural areas have been left recruiting and
training from within. This process is very lengthy and
expensive, especially as most rural areas are not experienced
with the cocaine epidemic. So treatment starts to feel like an
uphill battle.
Until rural areas have enough qualified, experienced staff
providing these services, the outcomes for treatment will be
affected. The next barrier is summarized by Dr. Thomas Freese,
as he states, ``Training alone is insufficient if the funding
necessary to deliver these treatment recommendations is not
available.'' Treatment is not cheap. But it is less expensive
to treat methamphetamine abusers than it is to incarcerate
them. According to the principles of the Drug Addiction
Treatment, A Research-Based Guide, it states that
``conservative estimates indicate that for every dollar spent
on treatment, four to seven dollars are returned in reduced
crime, criminal justice costs, and theft.''
The Noble County jail has a third of its population
incarcerated for methamphetamine related crimes, and in 10
months spent one tenth of their medical budget on oral and
dental damage from the use of methamphetamine. For most
methamphetamine abusers, the cost of treatment is very high.
Many have lost everything due to their use and do not have the
money for food and shelter, let alone treatment. Those
individuals with managed care may not be covered due to legal
difficulties. And even if they are covered, the limitations of
managed care make effective treatment extremely difficult.
Effective treatment should also include family therapy and
case management, which is an additional cost. The lack of
funding for these services is yet another barrier.
Another barrier is transportation. Transit systems do not
exist in rural communities, and even if they do exist, the cost
is prohibitive. Many individuals lack a driver's license,
vehicle and even the money for gasoline. Women present another
interesting challenge, as they are typically the primary
caregiver and run the risk for pregnancy. They also have higher
rates of mental health concerns, poverty and lack the skills
necessary for employment.
In Indiana, 47 percent of the individuals abusing
methamphetamine are women. Research shows that women are less
likely than their male counterparts to access services. Women
are also in need of child care service, which is an additional
cost and barrier.
One way to increase the effectiveness of treatment is to
have separate programs for men, women and adolescents. In rural
areas, implementing one program is difficult. Three separate
programs is almost impossible.
Due to the effects of methamphetamine on the brain,
treatment needs to be long-term, intensive and comprehensive.
It needs to include topics on methamphetamine, but also
medical, psychiatric and mental health issues. Another barrier
in rural areas is the difficulty recruiting and retaining
psychiatrists. With the use of the Matrix Model, treatment is
effective.
In summary, my recommendations for rural communities are:
first, the continued and increased support of the Substance
Abuse Prevention and Treatment Block grant. In Indiana, this
block grant funds over 70 percent of all our addiction
services, and 95 percent of prevention services.
Second, the continued support of CADCA, which assists
communities with linkage to national evidence-based resources
and the development of community-based interventions for the
prevention and treatment of alcohol and drug abuse. Assist
rural communities with resources for personnel recruitment,
retention and training. Provide resources for child care for
those involved with treatment, and expand the access to
treatment.
I would like to thank you for your time, and for your
commitment in addressing these concerns.
Mr. Souder. Thank you very much.
Dr. Harle.
STATEMENT OF MICHAEL B. HARLE
Mr. Harle. I am glad that you made me a doctor. I am going
to work really hard to make sure that I live up to that.
[Laughter.]
Good afternoon, Chairman Souder, and committee. I have
written testimony here, and I don't want to read it, because I
think that you can read it yourself. So I would like to comment
on what I do have in my testimony and try to make those points
that either you have asked questions about or that I have
direct experience in.
I will just give you a little bit of my background. I am
the president and executive director of Gaudenzia, Inc. We are
the largest freestanding treatment program in the State of
Pennsylvania, and we are soon to be the largest program
probably in the State of Maryland. We are also located in
Delaware.
We service an awful lot of people on any given day. We have
been in existence since 1968. We have 91 programs in 51
locations. About 2,300 people a day are in outpatient and
residential programs in the community and about 1,600 of those
people are behind the walls in prison.
Additionally, we have 419 children under the age of 12 that
are not addicted but are in treatment with their parents. We
have six programs that are for women and their children and
their family members. So we are pretty serious about doing
this.
This month we will open up and additional program in the
Park Heights section of Baltimore. By the way, right across the
street from our facility is where they used to have those lines
that Congressman Cummings talked about. I have observed those
lines. Those lines still exist, but they do not exist near our
treatment program, because one of the things that addicts don't
like to be around is jails and treatment programs, while they
are actively addicted. When they are not addicted, that is the
place that you will find them.
I am presently also the president of Therapeutic
Communities of America, which represents over 700 programs in
32 States, including Puerto Rico and the Virgin Islands. I have
been witness, many of our TCA members are located in places
like the central valley of California, where 100 percent of
their treatment admissions are methamphetamine. Our treatment
programs have been treating these people probably since 1968.
So to just let you know that it depends on where you live
in the country on whether or not your admission is for
methamphetamine. I think there was an earlier discussion in
regard to the economics of this. Where it is more available,
the treatment admissions go up. Where it is cheaper, treatment
admissions go up. So there are many, many variables, and I
think that the scientific panel gave you a lot of history about
that.
But I can tell you that as a counselor, I gave you all my
credentials, and I am going to give you a little bit of a
different perspective. As a counselor, and I think I heard a
little bit of this before, I didn't see differences in regards
to the outcome for methamphetamine addicts. The challenges were
different, the etiology of the disease was a little different.
But what was really necessary was long-term treatment, in order
for people to heal. Some of the psychosis that was talked about
may continue. Some of it, with some of my clients, continued
for years beyond that. Not as great, but you had to stay there
with them, you had to get in there and be with them. The longer
the addiction was, the longer you are going to have to spend
time in treatment.
What I added to this was an attachment A. Attachment A
shows that in the State of Washington, there was a recent study
done where they say for every addict there is a cost offset of
about $296 per person when you treat them. Methamphetamine
treatment, stimulant treatment, is actually more cost effective
than other treatments for other diseases. Not much, it is a
difference of $19 per day that you save. So you save money when
you provide treatment. And that is what I want to discuss.
The problem is that there are giant holes in our national
treatment network. It does not exist in the right amounts in
the right places throughout the country. You heard about the
rural areas. You heard about the lack of family treatment. For
some reason, as a society, we have not invested the kind of
money in treatment programs as we have invested in the criminal
justice system or in the prison system.
And I can attest to that, because I have more people on a
daily basis behind the walls that I am treating on some days
that I do in the community. We have a real problem here that we
need to address. And it didn't just happen today. It is not at
the doorstep of this committee. It has been a problem for the
last decade or so. What we have done is we consistently leveled
off our treatment and we have added things to our treatment
system, such as managed care. It is not managed care, it is
managed cost. And what it has done is it has reduced the length
of stay of treatment. So our treatment system is more damaged
today than it was 10 years ago.
Right now, if you are a crack addict in Philadelphia,
sometimes the decisions on whether or not you are going to get
treated are made on Wall Street. They are not being made where
they need to be made. They are being made based on profit and
loss, and short-term profit and loss, not long-term profit and
loss. And that model does not work for substance abuse
treatment. We have implemented it throughout the country. That
is a problem, and a particular problem for rural areas.
And for women, and for women with children, this is very
difficult to access treatment. When people are ready, keep in
mind, you are going to have to use the criminal justice system.
People don't wake up 1 day and say, you know what, I would
really like to get treatment for my long-term crack addiction
or my long-term methamphetamine addiction. They are psychotic
when you are first talking to them.
So you are going to have to use outside forces to get them
to the treatment door. And when you do, it needs to be the
proper treatment for the proper length of stay. And I can tell
you that we provide Therapeutic Communities, we have been doing
it a long time, there is a tremendous cost offset. It is a lot
cheaper than any other way of treating them, and it is also a
lot cheaper way to provide the help, by doing it long-term and
doing it right the first time, instead of spending tons of
money on the effects of the addiction.
Pennsylvania alone spends $3.4 billion, not treating
addiction, on everything but the treatment itself. And I think
that you can see there, there is a CASA study in 2001 that
shows that across the Nation.
Now, the work force problem, if tomorrow you said we need
to put up a treatment system now, we are going to do it now. It
is going to take 10 years. You can't do it right away. We are
going to have to use the targeted capacity, we are going to
have to follow these epidemics. But think about it long-term.
There is going to be another epidemic.
Right now in Pennsylvania, I have a 100 percent increase in
treatment admissions for methamphetamine in Erie, Erie, PA,
which is in the northwestern corner. I have a 275 percent
increase in heroin in Philadelphia and the southeast of
Pennsylvania. I have programs in the middle of Pennsylvania, it
is moving together.
What happens in Harrisburg, the State capital, when these
two things hit? I have two epidemics, and I don't have any more
treatment programs, and I don't have any more staff. Matter of
fact, most of my staff are getting to retire. Some of them are
the methamphetamine folks that I used to treat in the early
1970's because Pennsylvania, the southeast corner, was where
the Dupont, Allied Chemical, all the major precursors to make
methamphetamine was. And we had an epidemic.
What we did is we moved the labs to southern California and
to San Diego and made that now, it is called Crystal City, is
what they call San Diego. What we did is we just moved it. So
that is what we did, we made it illegal to sell those
precursors in Delaware County, PA, and we moved it to Mexico
and they moved it right back across the border. Eighty percent
of the methamphetamine comes from labs in Mexico, 80 percent.
And if you stop it in Iowa, they are going to produce more of
it in Mexico. If you stop it in Mexico, they are going to
produce it in Canada.
I am not casting aspersions on anybody, and if they can't
get it in Canada, they are going to make it in Maryland,
wherever there is profit in this. We have to reduce the demand.
And to reduce the demand, you are going to need effective law
enforcement, effective treatment and effective prevention.
Right now, we don't have the treatment system to handle this
epidemic. That is what they are telling you, we don't have the
work force, we don't have the facilities and we need help.
It is going to require a long-term plan. There is no magic
cure. And by the way, if you are looking for a magic cure for
methamphetamine, I would guarantee you that same drug we come
up with will end up getting abused and will change the
molecules to that. Our clients look for magic cures. Do not
look for magic cures. Look for long-term, hard-won solutions,
just like these folks have had to do. They have had to work
hard at it. Give them the right resources to do it.
It takes time, it takes effort. I am sorry for being so
passionate about this. But I talk to people who die, we have
many people who succeed. We have a lot of people doing really
well. But I also have the displeasure to speak to families who
can't get their kids into treatment and they have passed away.
We have people dying from this epidemic.
So please, think about a long-term plan for this. I have a
lot of stuff in my testimony. I really don't think you need to
hear that. I think my message is what I would like to get
across, because I only have a limited time, so thank you.
Mr. Souder. Our last witness is Mr. Fleming--are you
Doctor? Or do you want to become one?
Mr. Fleming. Well, if you want, yes, I would love it. I get
more money that way, I guess. [Laughter.]
STATEMENT OF PAT FLEMING
Mr. Fleming. My name is Pat Fleming. I am the director of
the Salt Lake County Division of Substance Abuse Services. I
would like to thank you, Chairman Souder, and Ranking Member
Cummings, for hanging in there all day today. You have asked
some really, really great questions and for your leadership on
this issue.
I am not going to read my whole statement, either, because
I think a lot of it has been repeated. Treatment for
methamphetamine does work, just know that, you have proof of it
sitting at this table. It works.
Our big issue that we have in the United States of America
right now is our capacity. We have one funded slot for every
four people that need treatment. That is really what our big
issue is.
What I would like to talk a little bit about is to give you
a little bit of an idea of what we do in Salt Lake County and
how we talk to our elected officials to get our local elected
officials to pony up some dollars to help us with this issue.
We have been rocked by methamphetamine. We were already on the
ropes in our treatment system. Our treatment system was already
under pressure and then methamphetamine hit. And we really are
hurting right now.
It is an epidemic in Utah, it is an epidemic in Salt Lake
County. Just about everybody that we get in there is using
methamphetamine in some way, shape or form. We have to deal
with this.
When I have talked to all our national organizations, the
National Association of Counties, the National Association of
State Alcohol and Drug Directors, National Association of
County Behavioral Health Directors, I have been talking about
this for 10 years. And it is so nice to have the national
organizations and the Congress looking at this issue, because
we definitely need help in this country with this.
I have 12,000 admissions in my treatment system. We are the
largest treatment system in the inter-mountain west. I have
12,000 admissions a year. I have 48,000 people in Salt Lake
County that need to be treated.
Now, as you know, the burden of providing substance abuse
treatment in the United States of America has been put on the
back of the taxpayers. Seventy-five percent of all of the
services we provide in the United States are publicly funded.
That is the first place we have to look. We cannot do that any
longer. I know Congress will be dealing with health care reform
in the next 3, 4, 5, 6 years. You definitely need to include
this as part of the health care system. Substance abuse
treatment needs to be treated as part of a disease. It is a
disease, it is a chronic disease, it needs to be treated like a
disease. You have to deal with it that way.
The second thing I think you need to do, and I am going to
give you some very specifics here, because I think it is really
important, I don't have very much time with you. By the way, I
have to catch a plane at 6, so if there are any questions, I
would appreciate those so I can get out of here.
The block grant. All due respect to Mr. Curie, I think he
has done a wonderful job, I want more money in the block grant.
Everybody has said that today here. We need $250 million more
in the block grant to put it to $2 billion. Now, it sounds like
a lot of money, but it is not a lot of money in terms of some
of the things we are spending money on these days.
I think what we need to do is, if you want to earmark some
money in the block grant for emerging drugs, whatever you want
to do, go ahead and do that, that is fine. But the short-term
solution is to get us more capacity. We know what to do, we
know how to treat this drug. We can do it. But we need the
money to help us with this.
Then the second thing I would say is, if you can work
something into the health care reform package that starts to
provide primary health care, as to substance abuse treatment,
in the very beginning I think what you will start to see is
maybe less demand on the block grant, less demand on the
taxpayer.
Finally, the thing I would like to say to you right now is,
methamphetamine has really rocked women in Salt Lake and in
Utah. What we see is, we have now women using methamphetamine
at higher rates than we have men using methamphetamine. That
doesn't happen with any other drug. It does not happen with any
other drug. And this is really worrisome to me. I have been
doing this for 19 years, and I am very scared about that trend.
Because what happens is, families fall apart without their
mothers. They really do.
We have started four family treatment programs similar to
the ones the Nobles are talking about. They are very, very
effective. I finance those with Medicaid. If I don't have
Medicaid, I am going to lose three of those four programs. So
when Congress is dealing with the Medicaid issue, and I know it
is real simple to say, optional services, we are going to cut
this, we are going to cut that, there are faces that are
connected with that.
So I think it has to be a three-pronged thing. We have to
have health care and think about this as a health care issue,
get it into health care, we have to have money in the short
term in the block grant, $250 million, and we have to have
Medicaid there, especially for women with their dependent
children. That is how we pay for this.
I look at the obituaries every day. And in Salt Lake, it is
kind of interesting, our obituaries all have pictures. They
have a picture of that individual next to the obituary. And I
have gotten pretty good at reading between the lines in
obituaries to see who is dying of overdoses. And I will tell
you, it is just staggering when you see how many people pop up
in the Salt Lake Tribune every day from this.
So I will conclude. I am just so tickled that you are
dealing with this issue. It is a major national issue for us.
But we need some leadership on this, and we don't need
discretionary dollars. I know people talk about the voucher
system, they talk about putting money in discretionary dollars
are not what we need. We need foundation dollars. The block
grant is the foundation. If Congress puts money into the block
grant, our State legislature will put money in and my county
council will put money in. Without the block grant, we don't
have anything.
So I would just urge you to really pay attention to that,
and thank you very much.
Mr. Souder. Thank you.
Do you have any questions directly for Mr. Fleming? He is
not going to make it in rush hour unless he is out of here in
the next 5 minutes.
Mr. Cummings. Nothing, thank you.
Mr. Souder. I thank you for coming in from Salt Lake. If we
have some additional questions, we will submit them to you in
writing.
Mr. Fleming. Thank you.
Mr. Souder. Let me first thank each of you for coming, for
being with us in this long day. It is, as you can see, a very
diverse hearing and very helpful. I appreciate the personal
testimonies, which are always very helpful as we move into a
hearing process. Partly, it is good to hear success stories,
because sometimes when you go through this business, it just
seems like you jump from one failure to another, are we going
to get blown up on the border because of terrorism coming in,
we have child abuse here and spouse abuse here, and all
different kinds of crime. Of course, we don't know how to pay
for health care, and Social Security is a mess, pensions are a
mess. It just seems like we jump from one issue to the next.
So having some encouragement that in fact some of the money
that taxpayers are investing works is very helpful to hear.
Each of your testimonies were somewhat different from each
other.
I think where I want to start is with Dr. Rawson. I found
it really interesting what Mr. Harle said. So first let me get
a factual thing down left over from the first panel. Let me
start with Mr. Harle. Do you agree, Dr. Rawson, with his
characterization that a lot of this early abuse started over by
Philadelphia and Delaware County and then moved to San Diego,
and that is why you saw some of this in San Diego early?
Because that is a historical factoid that I hadn't heard.
Mr. Rawson. I wasn't aware that it migrated like that. But
yes, in the early 1980's, Philadelphia and the Philadelphia
area was the leading area of methamphetamine abuse and
dependence in the United States. I didn't know what had been
done. I didn't know why it went away there.
But then it moved to San Diego, and that is where we
started to see it, so I wasn't aware of that.
Mr. Harle. A couple of facts. Dupont, Allied Chemical, Rohm
and Haas, all the major chemical companies, actually in South
Jersey, ARCO, all those companies were right there. The
chemists were there, the actual precursors were there. And
there were drug addicts there.
What happened is they hooked up with the chemists and they
started to make it. Also, they first started to hijack it,
because they were making a legal amphetamine. But as time went
on, they started making it out in the community as--they are
doing the same thing now. As we were restricting it and
restricting it, what started to happen is people got creative
and started making it on their own, they started bootlegging
it. And they were selling, because we didn't have the Internet,
they were selling handwritten formulas to each other.
So they were recruiting chemist students out of high school
to make it. It got really, really complicated. The motorcycle
gangs, the Warlocks and the Pagans, took over the distribution
of the drug up and down the east coast. They fanned out with
that. So what happened is, there was a series of hearings,
those drugs became illegal. The DEA was involved, and made
those drugs illegal in the United States at all. I don't know
the scientific, 2P2 I think is what they were called on the
street.
And that was then moved to Mexico. It was very soon, a
couple of years later, you would see, and we were lucky because
we got cocaine to take its place. So I want to let you know,
addiction didn't go away, we just switched chemicals is what we
did. We gave this plague to San Diego.
Mr. Souder. One of the reasons I wanted to ask is that,
given the fact that Philadelphia and San Diego are not usually
considered rural areas out in the national forests, did the
African-American community or other minority communities use
meth at that time, when it first moved to San Diego?
Mr. Harle. I can tell you what was happening. You had
availability. You had heroin in the--matter of fact, you need
to know this, because it is really important. You had $5 per
bag heroin in Philadelphia, in the ghetto or in the projects,
you got it inner city. Inner city, inner city. As you moved
farther away from the inner city, the drug went up in price and
it got cut. So it would get cut in half, that is they would cut
the purity in half, and they would double the price.
So if you lived in the suburbs, you paid $10 a bag and you
got half the purity. You got the availability thing. So what
happened is in the inner city, where they would sell it, very
similar to today, it was more powerful and cheaper.
Methamphetamine was actually a suburban drug that was moving in
toward the city, and if you lived outside, it was $10 for what
they used to call a quarter of a teaspoon, which would have
been a quarter of a teaspoon of it. In the inner city, though,
that would be cut in half and it would cost you $20.
So what would happen is, there was trading going on. The
suburban methamphetamine, speed freaks, we used to call them,
monster, crank, it had all kinds of names, would trade for
heroin, they would trade it, because it really had to do with
who controlled the drug traffic. Keep in mind, the white
motorcycle gangs and the suburban kids controlled, it had more
to do with the availability of--I have a million theories of
why one different than the other. Don't know why.
But I can tell you, the theory that it is different gets
thrown right out the window when you talk about crack cocaine.
Because crack cocaine, although it is not as long-lasting, has
the same effects. And it decimated the inner city.
So I wouldn't get hung up as much in the type of drug as I
would in the treatment. We need long-term quality treatment
that is not drug-specific as much, but is addiction treatment.
Because what happens is people will switch from one drug to
another anyway. So you had better look at drug addiction as a
holistic kind of view. If you don't, you are going to
constantly have problems.
Now, you need to train our whole work force who hasn't seen
methamphetamine in a long time on what the effects are. There
is the Matrix, there are different models that you can use. But
they are really techniques that can be integrated into a
treatment program. You really need a treatment model that is
adaptable across the whole country that can be adapted to
whatever the new epidemic you have.
I have the same counselors treating heroin right now that I
had treating cocaine that I had treating methamphetamine. The
problem is, they are getting old and they are retiring and we
don't have a new work force, we don't have enough resources to
keep that alive.
Mr. Souder. Dr. Rawson, I wanted to ask you, one of the
things, as we have heard from the Nobles, that is in fact
different, at least in the ``home cooker'' group, is it tends
to be more family. In other words, historically the models are
enablers and users. Whereas when they are cooking, because you
can turn people in, unless their whole family is either
involved or at least you may have the kids, they may be
involuntarily involved, but we have had testimony at some
hearings where even the kids are often recruited to get the
chemicals or participate in the cooking.
Does that require different models of treatment? Obviously
today we heard about family treatment. Could you describe a
little bit how your Matrix Model works and how it might be
different in meth there from other types of drugs, or to deal
with enablers and users?
Mr. Rawson. Yes. The basic treatments with addiction are,
as has been said, common across all addictions. Meth, really, a
couple of the things that make it impact the family to a
greater degree are the fact that people cook it in their homes,
and you are seeing 50 percent of the users are women. Heroin is
about three or four to one, men to women. So you are seeing
many more women get involved, which obviously affects the
children.
To do any kind of treatment and not have a family component
with methamphetamine is not supported by any evidence. You have
to work with the family. The family either has to be brought
into treatment, as was described here, which is preferable, or
at least be able to inform them and get them understanding the
addiction, so they can provide appropriate support to the
addict in his or her recovery. So it really means the
individual person as the target really is changed.
With meth users, you really have to address the whole
family, because in general, the addiction has affected the
whole family. And it is not that this isn't true with
alcoholism and cocaine addiction and heroin addiction. But
because of these two factors, because the home literally
becomes saturated with the drug and the kids are often exposed
to the drug and you see it all in that environment, and so many
women are using that it makes it that much more important with
methamphetamine than with other drugs.
Mrs. Noble. I would like to comment on that, if I could.
I tried, I do believe, three to four individual treatment
programs before I went into Bridgeway, the family treatment
program. And those treatments were more on education. And on
the family treatment programs, they offer different services,
like the domestic abuse, the sexual abuse, having a
psychiatrist, psychologist you could talk to. Just so many more
services were available. And for the children, parenting
classes, family therapy, we were offered that.
And like I said in my testimony, I didn't even know I had
issues in that. Addiction, not only to meth, but everything
else, it starts out as an individual problem, but then it
becomes a family problem, and then it becomes the community
problem. So like I said, I went to three or four before that,
and I knew all the just for todays and keep it simple. But I
needed to find out why I kept using, what issues were with me.
Because it is not just as simple as, I came to believe that a
power greater--you have to be able to get the issues also so
that you can intertwine that education in.
Also as a preventive for the future, my family is involved
in it. Therefore, maybe he will be able to make better choices
that I wasn't able to make, because my mom and dad were
alcoholics, and I wasn't given the opportunity to learn and
know that there were more choices to handle certain issues in
life.
Mr. Souder. When you and Darren, Darren, did you have other
abuse problems before meth?
Mr. Noble. Yes. I believe I was an addict at birth, it
started out with alcohol, weed, heroin, cocaine, crack, meth.
Mr. Souder. But meth is what put you, in the end, into
treatment?
Mr. Noble. Yes.
Mr. Souder. When both of you were abusing different types
of drugs, one of the things we have heard from met addicts at
the hearings that is slightly different that we have heard, but
not completely different than other drugs, is that you tend to
often become more isolated because of the impact of paranoia,
fear of being discovered if you are home cooking, and you get
isolated from most support groups. In other words, you are not
necessarily going to be involved in church and community. Often
you even leave your job.
Did you see that differently in the usage of this drug, or
was that kind of a pattern that was developing anyway?
Mr. Noble. The only thing I can add is, outside of my
addiction in general, the cooking the dope, I had been using
since I was home from prison, I haven't cooked since I went to
prison, I thought I could change my ways. But cooking is a high
of its own. I don't know if you know that. But that is
something that is separately addictive from using it and using
my drugs. Cooking drugs, making dope was a high of its own.
That is what dragged me away from my family, because that is
all I was worried about. Forget everything else.
But in my addiction of using methamphetamine, the paranoia
wasn't there the same as when I was cooking. That is how we
have gotten better, through the family therapy.
Mr. Cronkhite. If I could add something into this, first of
all, Mr. Cummings, to perhaps try to answer one of your
questions that you raised earlier, about why there may appear
to be less participation in methamphetamine addiction in the
African-American community, I would be interested to see if
there were any statistics at some point of whether or not there
was less methamphetamine use in the Italian American community.
And one of the reasons is, there is a stronger sense of family,
a stronger sense of community in general.
As the chairman was just stating, methamphetamine use is
isolating, is not necessarily, you don't get together, pass a
pipe around. Because it is so damaging physically, because it
destroys your body so much, you actually end up, this
emaciated, out of the concentration camp look, massive amounts
of weight loss. I have known people who have been heroin
addicts for 15 years and been successful brokers on Wall
Street. You don't necessarily notice that they are having this
kind of a problem.
So part of it, as an adolescent, with extreme acne that
came as a result of this, with this great weight loss, with
this psychosis that came around, it is not a socially active,
group participation drug. So that is why I found for myself,
and this was again, 35 years ago, but the people in the
community who surrounded themselves around my life and helped
me through the process, part of that whole process of course
involved long term psychological counseling. It was not
something that could happen overnight.
I was fortunate, I guess if we can use that term, fortunate
in that I was arrested and I was entered into the California
Youth Authority. So I had this long-term care, which was
provided by the State as a youth offender. Other people may not
have had that.
So I think when we start looking at these kinds of programs
where we want to see somebody who can really be regenerated and
brought back into society and become really the poster boy for
success, you have to start looking at, part of it is, you have
to first treat the victim, the addict, like he's been in a car
wreck. Then there is going to be a long-term period of time of
rehabilitation, just like somebody who goes from being on the
ER stretcher to walking with a crutch to getting physical
therapy to having long-term care before they can really run
again at full speed. So it is not something that is going to
happen overnight.
I was one of those suburban speed freaks in California
whose graduate student friends at UCLA cooked the stuff up in
the Hollywood hills and it was distributed by motorcycle gangs
in Los Angeles. It is interesting, the paradigm does not seem
to have changed much in that period of time. But again, I
wonder whether or not, how much this loss of community, the
loss of community support, we see that in data all over the
country, plays an effect on these kinds of epidemics that are
really isolating and further isolating as we become less
connected to one another.
Mrs. Noble. I would like to go back to the family issue, of
women, why I believe I used meth is because of the role that
the mother plays. It is a tiring job. But with family therapy,
it brought us all together and everybody could distinguish
their roles in the family and the church and the community.
I think the family unit has taken a back seat to a lot of
things today in life. And drugs have gotten into our families
to the extent where families aren't together any more, a lot of
families aren't. And I believe that family therapy worked for
us because it brought us together, it gave us an opportunity to
address our issues, what each of us individually and together
were going through.
Now we can communicate with each other. Now we can tell
each other our hopes, our dreams, our expectations and work
together as a unit, the way that it should be. Because before
we went into this treatment place, we were lost. Before I went
into this treatment place, I knew that jail or death was the
only hope for me. And now, it has opened a lot of doors in my
life. I have a life now.
Mr. Souder. Mr. Cummings.
Mr. Cummings. I was just thinking about something that the
chairman said at the beginning of this hearing. It is something
that I just want to address to the Noble family. What the
chairman said was that a lot of people look at this thing as a
thing of choice, that is the use of drugs. And one of the
things that I have noticed in my community, the Seventh
Congressional District, as I move from place to place, Dr.
Rawson, I have noticed that it seems as if people are becoming
less and less sympathetic and empathetic, because they feel as
if somebody made a choice.
And it is a real tough, it is a tough one. They see their
property values going down, they see their families destroyed,
they say to me, Congressman, I go out there, I bust my butt, I
work hard every day, I can't come into my house at the end of
the day and expect everything to be in place. And then it is
hard for me to get excited, as much as I would love to provide
funding for drug treatment, I don't have a lot of sympathy,
because I go through problems, too. I have psychological
problems, too, I can't afford a psychiatrist. But damn it, I
get up every day, I work and I do the right things. And I can't
even put my kid through school, but yet you want me to say, it
is OK for you to go out there and bust your butt trying to get
treatment for--and these are people who I would normally think
would be sympathetic. But they get tired.
And what I said to a graduating class of African-American
addicts, recovering addicts the other day for a drug court, I
said, you have to understand, the public is saying, OK, I mean,
a lot of the public is saying, you made a choice. And they are
getting less and less tolerant of funding bad choices. And I
think that is something, and I just wonder as you go through,
and I am going to talk to the family in a minute, do you get
any of that when you are moving around to your hundreds of
conferences and all that kind of stuff? Or those are not the
kind of everyday people that you talk to?
Mr. Rawson. No, those are exactly the people I talk to. And
yes, I think that there is a fatigue factor going on with that.
However, if you look at California, in 2000 the California
voters in the voter initiative passed Proposition 36, which put
$600 million into the treatment system, as opposed to into the
jail system. If you make it a choice between treatment, and you
document that treatment works, and particularly if you hook it
with the criminal justice system, the drug court movement, in
my 30 years of working in this field, is the most encouraging
movement I have seen. Because it uses the leverage of the court
system to push people in the door.
As was said earlier by someone, Mr. Curie, I think, people
don't wake up 1 day and say, gee, I think I want to get sober.
That happens in response to something, in response to some
pressure. I think that the California voters, anyway, 6 or 5
years ago, were willing to put their money into treatment as
opposed to the prisons. The voters in California are very sick
of building prisons. We are the champs when it comes to
building prisons.
And one of the places I went was Minnesota, where they are
starting to see, more than starting to see the epidemic. Their
basic model for wanting to put money into treatment was they
didn't want to replicate California's experience with having to
build so many prisons.
So I do think that there is a fatigue. I do think people
are tired of having to deal with the problems in their
communities. But when push comes to shove, and they have to
choose and say, how are we going to deal with this, I think
there is a recognition on the public's part that treating
people with addiction disorders is a better use of money than
locking them up in prisons. Because prisons simply make them
better criminals.
Mr. Cummings. I agree. I think you are absolutely right. I
want you to understand, I am probably the No. 1 advocate of
treatment in this Congress. But at the same time, I know that
there are Members of this Congress who, if I hear this, I know
that there are other people who hear it. And it is something
that we may have to deal with even more so later on as budget
stuff gets tighter and tighter. Because I think you are right,
when you match it up with prison, building more prisons, it
makes a lot of sense.
I have to get back to something, though. Why do you all
think it is that women are more likely, I think it was you, Dr.
Rawson, who said that with heroin, I guess heroin and cocaine,
it is three to one men. With methamphetamine, it is basically
pretty much 47 percent, if I remember correctly, women.
Mr. Rawson. That is right.
Mr. Cummings. Why is that?
Mr. Rawson. I would point at three factors. You have heard
weight loss as being an important one. The rates of depression
among women in the general public are much higher. And
methamphetamine is a very useful anti-depressant when you first
start taking it.
And finally, Mrs. Noble's comments about the role of a
woman in today's society, being a mother, taking care of the
house, getting a job, having to take kids to things,
methamphetamine can help you do all that stuff for a while. So
it is a drug that does have good functional value for a while,
and many of the women we talk to didn't get involved in it as a
party drug. They got involved in it to get things done, to
control their depression, to be able to work a 16 hour day and
take care of all their responsibilities. You take heroin, you
go take a nap.
Mr. Cummings. And nod. Don't forget the nodding.
Mr. Rawson. That is right. [Laughter.]
Cocaine is so short-acting that you can't take it enough,
it is so expensive, you can't take it to extend a day for 16
hours. But methamphetamine is the perfect drug. And if you are
a woman with those demands, it really matches up well with the
demands on a woman in today's society.
Mr. Cummings. Mrs. Noble, I don't want you to repeat things
that you have already said, but based on what he just said, do
you have anything to add that you have not said already?
Mrs. Noble. Yes. I wanted to say, at first, using drugs is
a choice. But once the disease of addiction sets in, it is no
longer a choice. I had so much to say I lost it.
But I was going to say, we are going back to the family
treatment. Maybe if my mom had went into family treatment,
maybe if she would have gone into family treatment, then I
would have learned the coping skills, where my son has had an
opportunity to learn more. Now he can teach his children. Maybe
it might stop the cycle of addiction. Because nothing else has.
Mr. Cummings. Tell me something. One of the things, and I
am going to get back to you, Mr. Harle, but one of the things
we spend a lot of money on in this Congress are ads, anti-drug
ads. And I am just wondering, I see you shaking your head
already, Mrs. Noble, but we want to use our dollars effectively
and efficiently. Have you ever looked at an ad and said, you
know, they have a point here?
Mrs. Noble. No.
Mr. Cummings. No?
Mrs. Noble. No.
Mr. Cummings. So ads just didn't affect you?
Mrs. Noble. No. Too many distractions.
Mr. Cummings. What about you, Mr. Noble?
Mr. Noble. To me, as a kid growing up, I don't think
anything was--I wasn't scared, I wasn't intimidated by things.
When I went out to try something, I went out to try it,
especially drugs. When I am wanting to do something, I am not
trying to shy away from the things they are telling me not to,
as an addict. But me, I am a believer that me, I was born an
addict. This is what I was destined to be.
But the treatment wasn't there for me, for me and my family
to acknowledge. And like you were saying earlier with the lady,
people who are opposed to treatment, say it is a waste of
money, well, you could take that lady my record and ask me if
she wants me to live next to her, in and out of prison and the
shit I have done in my life, or you could take her who I am now
after going through family treatment, or do you want this man
living next to you?
Mr. Souder. Joey, let me ask you the same question. You saw
the narcotics in your family. You got a 3.8 average, you are
going to be a physics teacher, go to college. You made it
through all this with all the activities. Did the ads or any of
the anti-drug programs, your teachers, what helped change you?
Mr. Binkley. Well, I see the ads on TV, and there is so
much else on TV, it is just another thing that is on TV, you
don't really pay attention to it. You know the D.A.R.E.
programs, I was in Teenage Health Consultants, which dealt a
little bit with that. But it was more my home experiences to
kind of let me know that is not good, that is not what I need
to do. Because it just has a negative effect on the whole
family.
You can even see people outside the family looking in,
noticing that it is not a good thing, and they kind of shunned
it. So I made sure to stay away from it.
Mr. Cummings. Mr. Harle, you wanted to say something.
Please.
Mr. Harle. Yes, I think what you bring up, the stigma, the
issue of stigma, our folks, and I say that in a loving kind of
way, are not the kind of folks, when they are actively addicted
to any of the drugs, that are really encouraging a lot of
sympathy from anybody. Matter of fact, the kinds of stuff that
our folks do when they are addicted would make anyone not want
to fund anything. So we are pretty aware of that.
But what we need to do is educate the public that treatment
works. I think people are frustrated. And most people have
this, one out of four families is faced with this. So a lot of
times, when you are talking to people and saying, I am really
frustrated with this, they are talking about somebody that they
know or in their own family. That is how much this is a part of
our culture.
And I think if we can get across to people that this is a
generational disease, and I think it is right here in front of
us, it is a generational disease, and it will grow if we don't
stop somewhere. What you need to know is, we have 8,000
clients, the majority of them, their age of first use was under
11 years old. If you are talking about people making choices,
they are experimenting, and that is why I think prevention, as
you talked about earlier, is important.
But it is really, the decisions that kids are making are
before the age of 11 years old. And many of the kids that we
are talking about are kids who have addiction in their family.
I have 500 of them I see every day. Half of them are going to
become CEOs, and they are going to be just like the young man
right here, they are going to say, you know what, I have seen
this in my family, I am not going to let it happen to me, I am
going to work as hard as I possibly can not to let it happen.
The other 50 percent or 60 percent are going to end up with
the problem themselves for biological or environmental or for
whatever other reasons. This is a generational disease that we
have to stop somewhere. And I agree, you are going to need all
the support in the world to convince the folks in the
community, and we are going to have to get behind you, people
in recovery are going to have to get behind you, treatment
providers are going to have to get behind you. Because I don't
think, though, that the average citizen thinks that locking
these folks any more is going to do anything. I think we have
gotten that across.
Mr. Cummings. I hope that you understand what I was saying.
Mr. Harle. I got it.
Mr. Cummings. And I know Mr. Noble did. I guess the
frustration comes, and I am almost finished, Mr. Chairman, the
frustration comes when people feel that people make bad
decisions.
Mr. Harle. Right.
Mr. Cummings. And that they then have to pay for them. I
think that is the problem. But between the two of you, what you
said, I think is was you, Mrs. Noble, that said the No. 1 thing
may be a choice, but then it is not a choice. But what you just
said is so powerful. It is starting with our kids. Then that
means that we as adults are doing something wrong.
So in some kind of way, you think about a mother's and a
father's love. I just heard what you said, Mr. Noble, about you
getting high. If you have little kids, the one thing that I
think should almost frighten any parent, should make any parent
just go nuts, is to think that they are cutting off the future
possibilities of their children being successful. Any parent.
Mrs. Noble. Can I comment on that?
Mr. Cummings. Yes, please.
Mr. Souder. Actually, we have six votes over on the floor.
So this will be your last comment.
Mrs. Noble. OK. In the addiction process, somewhere along
the line, right became wrong and wrong became right. And that
is what you teach your children. And that is what I taught my
children.
But through the family based treatment programs, you get
the opportunity to turn that around, to teach your kids what I
was doing was not right.
Mr. Cummings. Thank you.
Mrs. Noble. And you can bring the morals and everything
back into your family.
Mr. Cummings. Thank you, Mr. Chairman.
Mr. Souder. I want to thank each of you for coming, for
taking time out. If there are additional comments that you want
to submit, we will continue to try to work for additional
treatment funds. But I want to give you this, you are leaders
in the treatment movement.
And this is one of the facts that you have to face: every
single politician is also going out and talking to people and
they have family experiences. There is no one I have ever met
in any prison or in any treatment program that hasn't said that
they have been through multiple treatment programs. If you
oversell treatment, you will not convince the elected officials
or the voters to do this. It has started to happen in drug
courts, that short-term data that says there is an 85 percent
success rate is not convincing when we start to get long-term
data. This is a hard business.
And as we heard today, there is going to be recidivism with
it, and that you can't take artificial statistics. And partly
overselling of treatment will result in people, and also there
are different types of drug addicts. If the drug addict is
violent, they are going to have a different opinion about
treatment versus locking up, than treatment. And that is
quickly shown, too.
But I think that we are moving into a more sophisticated
period, and drug courts are starting to illustrate that. And if
we can get nuanced approaches.
Then the last thing is, sometimes when you have an epidemic
that hits the news, because there is also fatigue in news
coverage, fatigue in what CSI and Law and Order can cover for
that year or two, and when we have a new phenomenon come up,
you find more willingness of the general public, particularly
where you see something like meth, where they see labs going up
and children getting damaged and the types of problems.
We have an opportunity right now to move the whole
treatment debate as part of the meth debate. And one of my
frustrations with the administration has been a lack of
understanding that, because like you say, these things may not
exactly repeat themselves, but they run. There are nuances to
the differences, they are different, but to some degree, to
avoid the fatigue, we have to have new angles with it.
So thank you very much for your personal testimonies today,
for shedding so much light. I have sat through, and we have sat
through so many of those hearings, and yet every one, today we
have learned so many different angles with this. It has been
tremendously helpful to us and hopefully it will be to anybody
who watched it.
With that, we stand adjourned.
[Whereupon, at 5:18 p.m., the subcommittee was adjourned.]
[Note.--At the time of printing no prepared statements were
available.]