Substance Abuse Policy

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Substance Abuse Policy

• Advancing Low-Cost, Evidence-Based Practices for
  Population Level Effects on Treatment,
  Intervention and Prevention

Dennis D. Embry, Ph.D. Oral Testimony on Feb. 13,
2006 before Join Togethers Blueprint for
States Policies to Improve Ways States Organize
and Deliver Alcohol and Drug Prevention and
Treatment
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For whom the bell tolls

• No man is an island,
• Entire of itself.
• Each is a piece of the continent,?
• A part of the main.
• If a clod be washed away by the sea,
• Europe is the less.
• As well as if a promontory were.
• As well as if a manor of thine own?
• Or of thine friend's were.
• Each man's death diminishes me,
• For I am involved in mankind.
• Therefore, send not to know?
• For whom the bell tolls,
• It tolls for thee.
• John Donne, (1572-1631), Devotion 17

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Policy Goal The End in Mind

• 25 reduction in state level prevalence rates in
  5 years.
• 50 reduction in 10 years or less.
• Effects across silos (Syndemics)

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Case Study of Syndemics or Multi-Problem

• Pre-birth infancy 58,000
• Early childhood years 34,300
• Elementary school years 74,100
• Secondary teen years 475,700
• Other adult years 894,00
• Total 1,536,100

Saving 100 Billys can save 150 mil.
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Developmental Perspective
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Lost Cost Prevention Treatment Practices

• Replicated
• Simple to explain
• Simple to use
• Adaptable and flexible to contexts
• Robust to dose and fidelity
• Have multiple syndemic effects

1.Embry, D.D., Community-Based Prevention Using
Simple, Low-Cost, Evidence-Based Kernels and
Behavior Vaccines. Journal of Community
Psychology, 2004. 32(5) p. 575.
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Why states slow to use low-cost?

• Perverse incentives
• No marketing
• Policy makers not exposed
• No perceived compelling need
• Silo thinking and bureaucratic rules

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Coordinating Policy Example
Savings 2.8 mil Saving 10 mil
Data Dashboard monthly
Original research article
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Coordinating Principles
Program Accounting for Outcome Multiple Silo
Outcomes Two-Sides of Coin Prevention and
Treatment
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Who Can Play?
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Strategic Example Prize Bowl for Sobriety

• Selection - NIDA community trials
• Policy/Legis - TANF, reimburse
• Contracts - vouchers, payments, etc.
• Protocols - simple manuals, cards, etc.
• Social marketing
• Data Dashboard

Every 1,000 addicts having this will result 50
treatment outcomes over time for 200 per client
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Strategic Example 2 Omega 3, Folic Acid, MV
Supplementation

• Selection (Why)
• Policy/Legis - (who, what)
• Contracts (who)
• Protocols (dose, gender, condition)
• Social Marketing
• Data Dashboard

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Strategic Example 3 Good Behavior Game

• Selection (why, across silos)
• Policy/Legis (who, what)
• Contracts (for what by whom)
• Protocols - grade, setting DSM-IV
• Social Marketing
• Data Dashboards

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Low-Cost Model Fits IOM
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Summary Next Steps to Stop the Bell Tolling

• Promote low-cost, evidence based protocols that
  have multiple cost-savings footprints
• Share and evolve developing plan for Meth
  prevention, intervention and treatment
• Collaborate on multi-community state trial
• Draft enabling legislation and policies

Dennis D. Embry, Ph.D. 520-299-6770
dde_at_paxis.org www.paxtalk.com