Treating methamphetamine use disorder is particularly challenging for providers in the community because of the lack of effective treatment modalities for the disease, unlike Medication-Assisted Treatment (MAT) which is highly effective for treating opioid addiction. The most evidence-based methamphetamine treatments currently available are long-term behavioral therapies, such as cognitive-behavioral therapy and contingency management interventions. A comprehensive behavioral treatment approach that combines behavioral therapy, family education, individual counseling, 12-step support, drug testing, and encouragement for non-drug-related activities—has been shown to be effective in reducing methamphetamine misuse. Motivational Incentives for Enhancing Drug Abuse Recovery (MIEDAR), an incentive-based method for promoting cocaine and methamphetamine abstinence, has demonstrated efficacy among methamphetamine users through the National Institute on Drug Abuse National Drug Abuse Clinical Trials Network. Unfortunately, key insurers such as Montana Medicaid are often reticent to reimburse for longer-term treatment, limiting the capacity to provide this needed service in the community.
To address the treatment needs of substance abuse disorders, and to prioritize rehabilitation over incarceration, a central community crisis line is necessary to make it easy for individuals to get help from medical and social workers before law enforcement has to get involved. In crimes that possibly involve substance use or mental health issues, a Mobile Crisis Response team composed of an officer and a behavioral health professional will work together to respond to the call. Between the Community Crisis Services, the Law Enforcement and Emergency Services, the Initial Detention and Initial Court Hearing, and Jails and Courts, there is no standardized mental health or substance use assessment. To improve the consistency and cohesiveness between the various intercepts of diversion and treatment we are creating evidence-based guidelines for screening. Such a measure is especially important for resource centers when they are managing risk of violence among methamphetamine users. This new, standardized assessment will ensure that these guidelines are pertinent and accessible to both criminal justice and public health efforts. The Substance Abuse and Mental Health Services Administration (SAMHSA) advocates for the use of Sequential Intercept Models (SIM) to detail how individuals with mental and substance use disorders encounter and move through the criminal justice system. The SIM model helps communities identify existent resources and gaps in services at each intercept to focus the development of local strategic action plans. In July of 2019, a community level map was created to illustrate the interplay between the Community Crisis Services, the Law Enforcement and Emergency Services, the Initial Detention and Initial Court Hearing, and Jails and Courts, so leaders within different agencies and systems could work together in a cohesive effort to divert people with mental and substance use disorders away from the justice system and into treatment. This model provides an opportunity to introduce consistent, evidence-based best practices related to each possible intercept, enhancing the relationship across systems and agencies.
Getting access to treatment is hard for many people. If you want to get help on your own, you often can’t afford to get in or can’t find a place that will treat you. You shouldn’t have to commit a crime to get help. -Former methamphetamine user in Billings
Community Crisis Line
Screening Guidelines
SIM Map
