Treatment is the Key: Addressing Drug Abuse in Criminal Justice Settings

1. 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

2. Addressing Drug Abuse in the Criminal Justice System ENTRY (Arrest) PROSECUTION (Court, Pre-Trial Release, Jail) ADJUDICATION (Trial) SENTENCING (Fines, Community Supervision, Incarceration) CORRECTIONS (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 Intervention Opportunities Screening/ Referral Diversion Programs Drug Courts Community Treatment TASC N/A Drug Court Terms of Incarceration Release Conditions Drug Treatment Drug treatment Aftercare Housing Employment Mental Health Half-way House TASC

3. 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)

4. 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)

5. Approximate Cost of Drug Abuse in the U.S. in 2002 Regular Drug Abuse 100 90 80 70 60 50 40 30 20 10 0 200 $181 Billion 180 160 70% 140 120 Billions of $$ 100 Percent 80 $107 Billion Associated with Drug-Related Crime 60 40 9% 20 0 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. 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

6. Addiction is common in Juvenile Justice:Prevalence of Substance Use and Psychiatric Disorders(N=1,829) % Teplin, et al. (2002)

7. 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

8. Addressing Drugs and Crime Public Health Approach -disease -treatment Public Safety Approach -illegal behavior -punish High Attrition High Recidivism

9. Integrated Public Health-Public Safety Strategy Close supervision Community-based treatment Blends functions of criminal justice and treatment systems to optimize outcomes Consequences for noncompliance are certain and immediate Opportunity to avoid incarceration or criminal record

11. Principles of Drug Abuse Treatment For Criminal Justice Populations Drug addiction is a brain disease that affects behavior Recovery from drug addiction requireseffective 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

12. 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

13. Principles of Drug Abuse Treatment For Criminal Justice Populations Drug addiction is a brain disease that affects behavior Recovery from drug addiction requireseffective 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

14. 3. Treatment must last long enough to produce stable behavioral changes. Simpson, Joe, & Brown (1997)

15. 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

16. 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

17. Targeting Multiple Criminogenic Needs Reduces Recidivism 0.35 0.3 Reduction in Recidivism 0.25 0.2 0.15 0.1 0.05 0 Increase in Recidivism -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

18. 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)

19. CREST Completers + Aftercare CREST Completers + Aftercare No Treatment No Treatment CREST Dropouts CREST Dropouts CREST Completers CREST Completers Aftercare Matters 9. Continuity of care is essential. Delaware Correctional System 3 Years Post Work Release * Arrest-Free * Drug-Free * * * Martin, Butzin, Saum, & Inciardi (1999)

20. 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)

21. 3. A balance of rewards and sanctions encourages prosocial behavior and treatment participation. Brooner, et al. (2004)

22. 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)

23. In Treatment Urine Test Positive C vs. C+M, C vs. C+M p< .001 C vs. C+M p< .01 12. Medication is important part of treatment. Maryland Prison Study: Treatment Linkage and Opiate-Free One Month Post Release N=166 C = Counseling Only; C+T = Counseling & Treatment Referral; C+M = Counseling & Methadone Started in Prison Preliminary Analysis: Tim Kinlock, et al., 2006

24. Evidence-Based Practices used by theCriminal Justice System Taxman (unpublished data from CJ-DATS National Survey)

25. Evidence-Based Practices used by theCriminal Justice System Taxman (unpublished data from CJ-DATS National Survey)

26. Summary • NIDA science is being used to change the criminal justice system. • Treatment is the key. • On-going collaboration and research is essential.

27. Questions