Transcript Looking Back - The Association of Substance Abuse Programs

Substance Abuse & the Criminal
Justice System:
Looking Back, Looking Forward
Presented By:
Maureen McDonnell
Director for Business Development
TASC, Inc.
TIPPS Conference
Dallas, TX
June 14, 2010
TASC, Inc.
 Designated Agent to provide substance abuse assessments for felony
offenders
 Designated case management provider for parolees
 Services include assessment, advocacy and clinical case management
services. We do not provide substance abuse treatment.
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We serve approximately 25,000 offenders each year in Illinois.
We work with all publicly funded treatment programs in the state.
We work at all points in the CJS: Diversion, Sentencing Alternatives
including Drug Courts, Probation, Jail/Prison pre-release and Re-Entry
We also provide services in the juvenile justice and child welfare
systems.
 Advocate nationally for productive policies
 Provide training and technical assistance on these issues
Addiction: Public Health &
Public Safety Challenge
 In 2008, 2,319,258 prisoners were held in federal or
state prisons or in local jails
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1,596,127 in prison, 723,131 in local jails
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1 out of every 100 citizens for the first time in history
 The number of adults who were being supervised on
probation or parole at the end of 2006 reached
5,035,200
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4,237,000 were on probation (84%)
798,200 were on parole (16%)
Source: Pew Center for the States, Bureau of Justice Statistics
Drugs are a Major Factor
 The justice system is largest catchment area for people with
addictions
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In 2006, alcohol and other drugs were involved in these
inmate offenses:
 78 percent of violent crimes;
 83 percent of property crimes; and
 77 percent of public order, immigration or weapon offenses;
and probation/parole violations.
 Between 77-84% of these offenders were substance-involved
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As many as 87% of arrestees tested positive for at least one
illicit drug & 40% for more than one drug
Source: BJS Arrestee Drug Abuse Monitoring Survey 2008; CASA, "Behind Bars II", February 2010
Effective Treatment is a Necessary Alternative
 The criminal justice system is a “revolving door” – too
many people cycle through the system too often
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Over 2/3 re-arrested w/in 3 years of leaving prison
Avg. cost per inmate per year to states in the U.S.
 = $22,650
 Successful CJS supervision and community based recovery
results in return to productive, healthy citizenship
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No re-arrests
No re-incarceration
Building durable recovery
Building a pro-social life in the community
Sources: West & Sabol, 2008; Langan & Levin, 2002; Glaze & Bonczar, 2008; Mumola, 2000, Stephan, 2004
Major National Trends:
2000 - 2010
Countervailing Forces Through the Decade
 Move Toward More Sensible CJS
Policies & More Effective Practices
 Expansion of “Therapeutic
Jurisprudence”
 Economic Recession: Pressure to Reduce
Prison Populations and Rehabilitative
Services
“Tis the set of the sail that
decides the goal and not the
storm…”
-Ella Wheeler Wilcox
Major National Trends: 2000 - 2010
 Dramatic increases in penalties for drug
possession slowed from previous decade
Not reduced, but leveled out
 Reductions in penalties for marijuana possession
 Exceptions
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Trend to making DUI/DWI cases felony offenses (increases
penalties)
 Escalating penalties for methamphetamine
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Impact: Stopped escalating sentences, slowed the growth of
incarceration
Major National Trends: 2000 - 2010
 Expanded focus on “Therapeutic Justice”
 Focus on reducing recidivism through combined court
supervision and mandatory treatment
 Proliferation of Specialty Courts
 More drug courts – more than 2,500 nationwide
 New in this decade:
Mental Health Courts – more than 300 nationwide
 Veterans Courts – new since 2008
 DUI Courts – growing interest
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Impact: Strong results, but overall reach a small percentage of
people in the CJS who could benefit from treatment
Major National Trends: 2000 - 2010
 Expanded Focus on Successful Reentry
 Focus on reducing recidivism through
In-prison treatment
 Post-release treatment & supervision
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New in this decade
Comprehensive, full-scale models in place
 Sheridan and Southwestern Illinois Correctional Centers
 Includes in-prison treatment, post-release treatment & case
management, vocational programs pre- and post-release
 Graduates 85% less likely to return to prison than control group
 Use of graduated sanctions as alternative to re-incarceration in
case of parole violations
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Major National Trends: 2000 - 2010
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New types of providers and partners for offenders
Recovery homes, faith-based providers and other non-traditional
community-based organizations
 Created diversity of options and some expansion of capacity
 As yet no research that demonstrates improved outcomes
 Focus on community partnerships to sustain reentry and recovery
 Community Re-Entry Councils
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• Texas: Travis, Tarrant & Bexar Counties
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Expansion of Treatment Capacity Run by CJS
 Greater control
 Addresses gaps in the system
 May not establish long-term community support for recovery
Major National Trends: 2000 - 2010
 Return to System Thinking: Courts/Diversion
 Proposition 36 – California
Approved November 2000
 Required that non-violent drug offenders be sentenced to
probation with treatment
 Few penalties for non-compliance
 Overwhelmed the treatment system
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Evidence-Based Probation Pilots (NIC)
Based in criminological research
 Substance abuse as one of 8 factors determining risk
 Increased focus on probation officer as agent of change, not just
compliance
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Major National Trends: 2000 - 2010
 Economic analysis resulting in greater interest in
more cost effective strategies, economic crisis driving
solutions.
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Justice Reinvestment
www.justicereinvestment.org
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Second Chance Act
www.ojp.usdoj.gov/BJA/grant/SecondChance.html
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Focus on the aggregate impact of decision-making
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“One in 31”
www.pewcenteronthestates.org/report_detail.aspx?id=49382
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Disproportionate Confinement of Minorities
State budget crises create pressure
to reduce prison populations
Figures from September 8, 2009
Figures from February 25, 2010
(Center on Budget & Policy Priorities, 2009, 2010; Vandivort, 2010)
Major National Trends: 2000 - 2010
 Much Better Understanding of What Works in
Offender Treatment and Rehabilitation
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National Criminal Justice—Drug Abuse Treatment Studies
(CJ-DATS) – Multisite research program
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Texas Christian University IBR
Aimed at improving the treatment of offenders with drug
use disorders and integrating criminal justice and public
health responses to drug involved offenders
 Goal: Establish a research base that definitively supports
“what works” in substance abuse rehabilitation with
offenders
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http://www.cjdats.org/Wiki%20Pages/Home.aspx
Now & Next 5 Years
 Economic pressure at the state and county levels will
continue
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Focus on reducing prison populations
Creates more opportunities to build services that divert people
from prison to treatment in the community
 At sentencing and on violations
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Tremendous pressure on treatment system funding
 Some balance from federal programs
 Second Chance Act
 SAMHSA Offender Reentry Programs
 Drug Court Enhancement & BJA partnerships
 Access to Recovery
Health System Developments
 New Parity Law Requirements
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Changes in the treatment system will impact CJS access
Implementation: Paradox
 Could result in a “race to the bottom” with shorter stays, less care
 With proper advocacy, could result in better standards of care
 National Health Care Reform
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Medicaid Expansion for people under 133% FPL (2014)
Could result in major changes to services offered & providers
Need to partner with CJS to say what is needed
 Local cross-system planning
 State level advocacy
What Services Will be Covered?
Medical Model
Assess &Link to Service
Primary PS Treatment
Prevention & Screening
Stress Management
Family/Relationship Groups
Role Modeling & Mentoring
Recovery Coaching
Social Services
Residential Part of RT
Employment Support
Drug Free Recreation
Drop In Centers
Peer Counseling
Housing in Oxford & TCs
Instead of Disease Model, Need Health/Wellness Model
Source: Vandivoort, Rita M., SAMHSA, “Health Care Reform and Its Implications for Treatment of
Substance Use Disorders”, 2010 (Modified based on conference call, 3/5/10)
Best Case Scenario
 Communities will use new funds to build capacity
 Ensure rapid entry into the right level of care
 Virtually all alcohol and drug-dependent offenders would have
funding to go to treatment
 Communities will design better systems
 Expand use of high-quality services
 Effective at keeping people safe, healthy drug- and crime-free in
the community
 Communities will establish systems to integrate the
criminal justice and treatment systems
 Communities will establish better integration with
medical care providers
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Federally Qualified Health Centers
New Strategies:
Medication-Assisted Treatment
 MAT is an evidence-based treatment practice
 One of the treatment strategies endorsed by NIDA and
SAMHSA*
 Includes current medications for:
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Opiate addiction (Methadone, Buprenorphine, Naltrexone)
Alcohol dependence (Vivitrol)
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Medications are under development to treat cocaine addiction
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 Manages cravings so people can participate in treatment
 Psycho-social rehabilitation is still necessary, especially for
drug-involved offenders
*Principles of Drug Abuse Treatment for Criminal Justice Populations - A Research-Based Guide
http://www.nida.nih.gov/PODAT_CJ/
New Strategies: SBIRT
SBIRT = Screening, Brief Intervention and Referral to
Treatment
 Developed in SAMHSA
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Model developed to identify substance abuse in primary care
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World Health Organization – screening tools
Extensive demonstration projects in the U.S. since 2003
 ONDCP is interested in its application to the criminal
justice system
How Would This Work in the CJS?
 Screening at all feasible points to get as close to universal
intervention as possible
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Police lock-up
Jail
Bond court
In courtrooms
Probation
 Brief Intervention by specialized staff, again in all settings
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Option: Require participation in alcohol/drug education
classes
State’s Attorney’s Drug Abuse Program (Chicago)
 85% of people are not re-arrested within 3 years
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Presenter Contact Information
Maureen McDonnell
Director For Business Development
TASC, Inc.
[email protected]
312-573-8222
www.tasc-il.org
www.centerforhealthandjustice.org