Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction has embedded behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral, and social-context components. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society's overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction.

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Addiction is a brain disease, and it matters.

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Preventing Crime: What Works, What Doesn't, What's Promising. Research in Brief. National Institute of Justice.

OBJECTIVES: To evaluate critically the evidence linking psychotropic drugs with falls in older people.

DESIGN: Fixed-effects meta-analysis.

DATA SOURCES: English-language articles in MEDLINE (1966 – March 1996) indexed under accidents or accidental falls and aged or age factors; bibliographies of retrieved papers.

STUDY SELECTION: Systematic evaluation of sedative/hypnotic, antidepressant, or neuroleptic use with falling in people aged 60 and older.

DATA EXTRACTION: Study design, inclusion and exclusion criteria, setting, sample size, response rate, mean age, method of medication verification and fall assessment, fall definition, and the number of fallers and non-fallers taking specific classes of psychotropic drugs.

RESULTS: Forty studies, none randomized controlled trials, met eligibility criteria. For one or more falls, the pooled odds ratio (95% confidence interval) was 1.73 (95%CI, 1.52-1.97) for any psychotropic use; 1.50 (95%CI, 1.25-1.79) for neuroleptic use; 1.54 (95%CI, 1.40-1.70) for sedative/hypnotic use; 1.66 (95%CI, 1.4-1.95) for any antidepressant use (mainly TCAs); 1.51 (95%CI, 1.14-2.00) for only TCA use; and 1.48 (95%CI, 1.23-1.77) for benzodiazepine use, with no difference between short and long acting benzodiazepines. For neuroleptics in psychiatric inpatients, the pooled OR was 0.41 (95%CI, 0.21-.82); for all other patients, the pooled OR was 1.66 (95%CI, 1.38-2.00). Comparing ≥1 with ≥ 2 falls, mean subject age >75 versus ≥ 75 years old, communities with >35% versus ≥35% fallers, or subject place of residence did not affect the pooled OR. Increased falls occurred in patients taking more than one psychotropic drug.

CONCLUSION: There is a small, but consistent, association between the use of most classes of psychotropic drugs and falls. The evidence to date, however, is based solely on observational data, with minimal adjustment for confounders, dosage, or duration of therapy. The incidence of falls and their consequences in this population necessitate that future large randomized controlled trials of any medication in older persons should measure falls prospectively as an adverse outcome event.

Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: I. Psychotropic Drugs

In 1996, a Federal law required the U.S. Attorney General to provide Congress with an independent review of the Many crime prevention programs work. Others don’t. Most programs have not yet been evaluated with enough scientific evidence to draw conclusions. Enough evidence is available, however, to create provisional lists of what works, what doesn’t, and what’s promising. Those lists will grow more quickly if the Nation invests more resources in scientific evaluations to hold all crime prevention programs accountable for their results. Issues and Findings

Preventing Crime: What Works, What Doesn't, What's Promising

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The growth of incarceration in the United States: exploring causes and consequences

A multistage therapeutic community treatment system has been instituted in the Delaware correctional system, and its effectiveness has captured the attention of the National Institutes of Health, the Department of Justice, members of Congress, and the White House. Treatment occurs in a three-stage system, with each phase corresponding to the client's changing correctional status—incarceration, work release, and parole. In this paper, 18 month follow-up data are analyzed for those who received treatment in: (1) a prison-based therapeutic community only, (2) a work release therapeutic community followed by aftercare, and (3) the prison-based therapeutic community followed by the work release therapeutic community and aftercare. These groups are compared with a no-treatment group. Those receiving treatment in the two-stage (work release and aftercare) and three-stage (prison, work release, and aftercare) models had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for othe...

An Effective Model of Prison-Based Treatment for Drug-Involved Offenders:

Delaware researchers have argued for a continuum of primary (in prison), secondary (work release), and tertiary (aftercare) therapeutic community (TC) treatment for drug-involved offenders. Previous work has demonstrated significant reductions in relapse and recidivism for offenders who received primary and secondary TC treatment 1 year after leaving work release. However, much of the effect declines significantly when the time at risk moves to 3 years after release. Further analyses reveal that program effects remain significant when the model takes into account not simply exposure to the TC program, but, more importantly, program participation, program completion, and aftercare. Clients who complete secondary treatment do better than those with no treatment or program dropouts, and those who receive aftercare do even better in remaining drug- and arrest-free.

Three-Year Outcomes of Therapeutic Community Treatment for Drug-Involved Offenders in Delaware: From Prison to Work Release to Aftercare

With growing numbers of drug-involved offenders, substance abuse treatment has become a critical part of corrections. A multistage therapeutic community implemented in the Delaware correctional system has as its centerpiece a residential treatment program during work release—the transition between prison and community. An evaluation of this program followed 690 individuals. At 5 years, those who participated in the program were significantly more likely to be drug and arrest free. Furthermore, treatment graduates with or without aftercare had significantly greater probabilities of remaining both arrest free and drug free than did ano treatment comparison group in regular work release. Dropouts also were significantly more likely to be drug free, although not significantly less likely to have a new arrest than those without treatment. These data show that the implementation of such programs could bring about significant reductions in both drug use and drug-related crime.

Five-Year Outcomes of Therapeutic Community Treatment of Drug-Involved Offenders after Release from Prison

A variety of surveys and studies are examined in an effort to better understand the scope of prescription drug diversion and to determine whether there are consistent patterns of diversion among various populations of prescription drug abusers. Data are drawn from the RADARS System, the National Survey of Drug Use and Health, the Delaware School Survey, and a series of quantitative and qualitative studies conducted in Miami, Florida. The data suggest that the major sources of diversion include drug dealers, friends and relatives, smugglers, pain patients, and the elderly, but these vary by the population being targeted. In all of the studies examined, the use of the Internet as a source for prescription drugs is insignificant. Little is known about where drug dealers are obtaining their supplies, and as such, prescription drug diversion is a "black box" requiring concentrated, systematic study.

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Steven S. Martin

Papers

An Effective Model of Prison-Based Treatment for Drug-Involved Offenders:

Three-Year Outcomes of Therapeutic Community Treatment for Drug-Involved Offenders in Delaware: From Prison to Work Release to Aftercare

Five-Year Outcomes of Therapeutic Community Treatment of Drug-Involved Offenders after Release from Prison

The "black box" of prescription drug diversion.

Sensation seeking needs among 8th and 11th graders: characteristics associated with cigarette and marijuana use.