Transcript Improving Drug Abuse Services in Criminal Justice Settings

Treatment is the Key:
Addressing Drug Abuse in Criminal Justice Settings
Redonna K. Chandler, Ph.D.
Branch Chief
Services Research Branch
Division of Epidemiology, Services, and Prevention
Research
National Institute on Drug Abuse
September 20, 2006
NIDA Advisory Council Meeting
Addressing Drug Abuse
in the Criminal Justice System
ENTRY
PROSECUTION
ADJUDICATION
SENTENCING
CORRECTIONS
(Arrest)
(Court, Pre-Trial
Release, Jail)
(Trial)
(Fines, Community
Supervision,
Incarceration)
(Probation, Jail,
Prison)
COMMUNITY
REENTRY
(Probation,
Parole, Release)
Key Players
Crime victim
Police
FBI
Crime victim
Police
FBI
Judge
Prosecutor
Defense Attorney
Defendant
Jury
Judge
Judge
Jury
Probation
Officers
Correctional
Personnel
Probation/ Parole
Officers
Family
Community-based
providers
Drug
Treatment
Drug treatment
Aftercare
Housing
Employment
Mental Health
Half-way House
TASC
Intervention Opportunities
Screening/ Diversion Programs
Referral
Drug Courts
Community Treatment
TASC
N/A
Drug Court
Terms of
Incarceration
Release Conditions
U.S. Adult Offender Population
In 2003, the combined
federal, state, and local
adult correctional
population reached
almost 6.9 million
Bureau of Justice Statistics (2004)
Drug and Crime are Linked
• 52% women, 44% men in jail meet
alcohol/drug dependence criteria
(Karberg & James, 2005)
• Drug use involved in:
• >50% of violent crimes
• 60-80% reported child abuse/neglect
• 75% drug dealing/manufacturing
(NIJ, 1999)
Approximate Cost of
Drug Abuse in the U.S. in 2002
Regular Drug Abuse
100
200
90
180
80
160
70%
140
Billions of $$
70
Percent
60
50
40
120
100
80
30
60
20
40
9%
10
0
$181 Billion
Individuals in State
Prisons &Local Jails
General
Population
Source: Mumola, C.J., Substance abuse and treatment,
state and federal prisoners, 1997. U.S. Department of Justice
Office of Justice Programs, Bureau of Justice Statistics, 1999.
20
$107 Billion
Associated with
Drug-Related
Crime
0
Source: Office of National Drug Control Policy. The Economic
Costs of Drug Abuse in the United States, 1992-2002,
Washington, DC.: Executive Office of the President, 2004
Addiction is common in Juvenile Justice:
Prevalence of Substance Use and Psychiatric Disorders
(N=1,829)
60
50
% 40
Male
Female
30
20
10
0
Affective
Teplin, et al. (2002)
Anxiety
Behavioral
Substance Use
It Has Been Estimated That In a Given Year…
About 25% of all people
in the US who have HIV
About 33% of all people
in the US who have HCV
and
More than 40% who
have TB will pass
through a correctional
facility that same year
Addressing Drugs and Crime
Public Health Approach
Public Safety Approach
-disease
-treatment
-illegal behavior
-punish
High Attrition
High Recidivism
Integrated Public Health-Public Safety Strategy
Close
supervision
Communitybased
treatment
Blends functions of
criminal justice and
treatment systems to
optimize outcomes
Opportunity to avoid
incarceration or
criminal record
Consequences for
noncompliance are
certain and immediate
Principles of Drug Abuse Treatment
For Criminal Justice Populations
Drug addiction is a brain disease that
affects behavior
Recovery from drug addiction requires
effective treatment, followed by management
of the problem over time
Treatment must last long enough to produce
stable behavioral changes
Assessment is the first step in treatment
1. Drug addiction is a brain disease
that affects behavior.
Brain changes in addiction help explain
continued drug use and relapse.
From the Laboratory of: Dr. Nora Volkow
Principles of Drug Abuse Treatment
For Criminal Justice Populations
Drug addiction is a brain disease that
affects behavior
Recovery from drug addiction requires
effective treatment, followed by management
of the problem over time
Treatment must last long enough to produce
stable behavioral changes
Assessment is the first step in treatment
3.
Treatment must last long enough to
produce stable behavioral changes.
100
< 90 Days
90+ Days
80
60
40
55
54
53
28
19
20
24
15
9
0
Cocaine
(Any Use)*
Simpson, Joe, & Brown (1997)
UA+
Alcohol
(Any Drug)* (Daily Use)*
Any Jail*
Principles of Drug Abuse Treatment
For Criminal Justice Populations
Tailoring services to fit the needs of the
individual is important
Drug use during treatment should be carefully
monitored
Treatment should target factors that are
associated with criminal behavior
Criminal justice supervisions should incorporate
treatment planning for drug abusing offenders
& treatment providers should be aware of
correctional supervision requirements
Offender Treatment Targets:
Criminogenic Needs
• Antisocial feelings, attitudes, orientations, values
• Alcohol/drug problems
• Anger/hostility
• Problem solving
• Conflict resolution skills
• Attitudes toward school/work
• Emotional problems
• Family functioning
• Barriers to care
Targeting Multiple Criminogenic Needs
Reduces Recidivism
0.35
Reduction
in
Recidivism
0.3
0.25
0.2
0.15
0.1
0.05
Increase in
Recidivism
0
-0.05
< 3 criminogenic needs
> 4 criminogenic needs
Adapted from Latessa, 2003. Original Source is Gendreau, P., French, S.A., and A.Taylor (2002). What Works (What Doesn’t Work) Revised
2002. Invited Submission to the International Community Corrections Association Monograph Series Project
Principles of Drug Abuse Treatment
For Criminal Justice Populations
Continuity of care is essential for drug
abusers re-entering the community
A balance of rewards and sanctions encourages
prosocial behavior & treatment participation
Offenders with co-occurring drug abuse & mental
health problems often require an integrated
treatment approach
Medications are an important part of treatment
for many drug abusing offenders
Treatment planning for drug abusing offenders
should include strategies to prevent & treat serious,
chronic medical conditions (HIV/AIDS, Hep B & C & TB)
Aftercare
9. Continuity
of care is Matters
essential.
Delaware Correctional System
3 Years Post Work Release
100
ArrestFree
Drug-Free
80
*
69
55
*
60
*
*
*
40
35
27
29
28
17
20
5
0
Martin, Butzin, Saum, & Inciardi (1999)
Principles of Drug Abuse Treatment
For Criminal Justice Populations
Continuity of care is essential for drug
abusers re-entering the community
A balance of rewards and sanctions encourages
prosocial behavior & treatment participation
Offenders with co-occurring drug abuse & mental
health problems often require an integrated
treatment approach
Medications are an important part of treatment
for many drug abusing offenders
Treatment planning for drug abusing offenders
should include strategies to prevent & treat serious,
chronic medical conditions (HIV/AIDS, Hep B & C & TB)
3.
A balance of rewards and sanctions
encourages prosocial behavior and
treatment participation.
Motivated S tepped Care Vs. S tandard S tepped Care
(n=127)
90%
80%
83%
79%
70%
60%
44%
50%
40%
46%
SSC
30%
20%
10%
0%
Counseling Attendance
Brooner, et al. (2004)
MSC
Treatment Response
Principles of Drug Abuse Treatment
For Criminal Justice Populations
Continuity of care is essential for drug
abusers re-entering the community
A balance of rewards and sanctions encourages
prosocial behavior & treatment participation
Offenders with co-occurring drug abuse & mental
health problems often require an integrated
treatment approach
Medications are an important part of treatment
for many drug abusing offenders
Treatment planning for drug abusing offenders
should include strategies to prevent & treat serious,
chronic medical conditions (HIV/AIDS, Hep B & C & TB)
12. Medication is important part of
treatment.
Maryland Prison Study: Treatment Linkage and Opiate-Free One
Month Post Release
80%
70%
60%
50%
40%
30%
20%
10%
0%
-10%
69%
In Treatment
60%
C vs. C+M, C vs. C+M p< .001
49%
40%
29%
Urine Test Positive
C vs. C+M p< .01
9%
N=166
C
C+T
C+M
C = Counseling Only;
C+T = Counseling & Treatment Referral;
C+M = Counseling & Methadone Started in Prison
Preliminary Analysis: Tim Kinlock, et al., 2006
Evidence-Based Practices used by the
Criminal Justice System
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Substance Abuse
Assessment
Adult-Prisons (n=66)
>90 Days in Treatment
Adult-Community (n=76)
Juvenile-Residential (n=29)
Systems Integration
Juvenile Community (n=46)
Taxman (unpublished data from CJ-DATS National Survey)
Evidence-Based Practices used by the
Criminal Justice System
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Risk Assessment
Adult-Prisons (n=66)
Comprehensive
Treatment
Adult-Community (n=76)
Continuing Care
Juvenile-Residential (n=29)
Drug Testing
Juvenile Community (n=46)
Taxman (unpublished data from CJ-DATS National Survey)
Summary
• NIDA science is being used to change
the criminal justice system.
• Treatment is the key.
• On-going collaboration and research is
essential.
Questions