# Presentation: 395400

## Treatment is the Key:Addressing Drug Abuse 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

**(Arrest)**

**ADJUDICATION**
**(Trial)**

**PROSECUTION**
**(Court, Pre-Trial Release, Jail)**

**SENTENCING**
**(Fines, Community **
**Supervision,**
**Incarceration)**

**CORRECTIONS**
**(Probation, Jail, Prison)**

**COMMUNITY **
**REENTRY**
**(Probation, Parole, Release)**

- Crime victim
- Police
- FBI

- Crime victim
- Police
- FBI
- Judge

**	****             ****Key Players**

- Screening/
- Referral

-                  **Intervention Opportunities**

- Prosecutor
- Defense Attorney
- Defendant
- Jury
- Judge

- Judge
- Jury

- Probation
-    Officers
- Correctional
-   Personnel

- Probation/ Parole
-      Officers
- Family
- Community-based
-     providers

- Diversion Programs
- Drug Courts
- Community Treatment
- TASC

- Drug Court
- Terms of
- Incarceration
- Release Conditions

- Drug     Treatment

- Drug treatment
- Aftercare
- Housing
- Employment
- Mental Health
- Half-way House
- TASC

- N/A

**Addressing Drug Abuse ****in the Criminal Justice System**

## 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)

## Slide 5

## Addiction is common in Juvenile Justice:Prevalence of Substance Use and Psychiatric Disorders(N=1,829)

**Addiction is common in Juvenile Justice:****Prevalence of Substance Use and Psychiatric Disorders**(N=1,829)

- %

- Teplin, et al. (2002)

**Notes:**
General introduction:  
The Northwestern Juvenile Project, conducted in Chicago, provides important information on the prevalence and consequences of drug use and disorder among youth in the juvenile justice system.  
The Northwestern Juvenile Project is the first large-scale longitudinal study of health needs and outcomes in juvenile justice youth.  
Their racially/ethnically diverse sample is comprised of 1829 persons (1172 males, 657 females), originally sampled between 1995 and 1998 when they were aged 10-18 years. 
At the baseline interview, 90.1% of youth reported having used illegal drugs (not including alcohol). (CONTINUED BELOW)

SLIDE 2:  This chart shows the prevalence of psychiatric disorders in the sample.  Substance use disorder is the most prevalent disorder (51% among males, 47% among females);  45% of males and 41% of females had drug use disorders (not including alcohol disorders). (END SLIDE 2)

## It Has Been Estimated That In a Given Year...

**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**
- -disease
- -treatment

**Public Safety Approach**
- -illegal behavior
- -punish

- High Attrition

-  High Recidivism

**Integrated Public Health-Public Safety Strategy**

- Blends functions of criminal justice and treatment systems to optimize outcomes

- Community-based treatment

- Opportunity to avoid incarceration or criminal record

- Close supervision

- Consequences for noncompliance are certain and immediate

## Slide 10

## Principles of Drug Abuse Treatment 

**of the problem over time**

**Treatment must last long enough to produce**
**stable behavioral changes**

**Assessment is the first step in treatment**

**Principles of Drug Abuse Treatment***** ***
***For Criminal Justice Populations***

**Drug addiction is a brain disease that**
**affects behavior**

## 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 

**of the problem over time**

**Treatment must last long enough to produce**
**stable behavioral changes**

**Assessment is the first step in treatment**

**Principles of Drug Abuse Treatment***** ***
***For Criminal Justice Populations***

**Drug addiction is a brain disease that**
**affects behavior**

## 3.	Treatment must last long enough to produce stable behavioral changes.

- Simpson, Joe, & Brown (1997)

## Principles of Drug Abuse Treatment 

**individual is important**

**Drug use during treatment should be carefully**
**monitored**

**Treatment should target factors that are **
**associated with criminal behavior**

**Principles of Drug Abuse Treatment***** ***
***For Criminal Justice Populations***

**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

**Reduction in Recidivism**

**Increase in Recidivism**

- 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

**-0.05**

**0**

**0.05**

**0.1**

**0.15**

**0.2**

**0.25**

**0.3**

**0.35**

**< 3 criminogenic needs**

**> 4 criminogenic needs**

## Principles of Drug Abuse Treatment 

**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)**

**Principles of Drug Abuse Treatment***** ***
***For Criminal Justice Populations***

## 9. 	Continuity of care is essential.

- *

- *

- *

- *

- *

**Drug-Free**

**Arrest-Free**

**Martin, Butzin, Saum, & Inciardi (1999)**

- Delaware Correctional System
- 3 Years Post Work Release

**9. ****	****Continuity of care is essential.**

## Principles of Drug Abuse Treatment 

**abusers re-entering the community**

**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)**

**Principles of Drug Abuse Treatment***** ***
***For Criminal Justice Populations***

**A balance of rewards and sanctions encourages prosocial behavior & treatment participation**

## 3.    A balance of rewards and sanctions encourages prosocial behavior and treatment participation.

- Brooner, et al. (2004)

## Principles of Drug Abuse Treatment 

**abusers re-entering the community**

**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)**

**Principles of Drug Abuse Treatment***** ***
***For Criminal Justice Populations***

**A balance of rewards and sanctions encourages prosocial behavior & treatment participation**

## 12. 	Medication is important part of treatment.

**C+T = Counseling & Treatment Referral; **
**C+M = Counseling & Methadone Started in Prison**

**Maryland Prison Study: Treatment Linkage and Opiate-Free One Month Post Release**

- Preliminary Analysis:  Tim Kinlock, et al., 2006

**12. ****	****Medication is important part of treatment.**

- N=166

**Notes:**
The data are from the first 100 participants in the Prison Methadone study.
The proportions of participants in treatment at 1-month post-release are:
-Counseling only, 9%
-Counseling+ Transfer, 42%
-Counseling + Methadone, 65% 
Chi-square goodness-of-fit tests found that there were significant differences between Counseling Only and Counseling+Methadone (p<.001) and Counseling+Transfer (p<.01).
The proportion of participants testing positive for opiates are:
-Counseling only, 76%
-Counseling + Transfer, 50%
-Counseling + Methadone, 34%
Chi-square goodness-of-fit tests found significant differences between Counseling Only and Counseling + Methadone (p<.05). 

## Evidence-Based Practices used by theCriminal Justice System

**Evidence-Based Practices used by the****Criminal Justice System**

- Taxman (unpublished data from CJ-DATS National Survey)

## Evidence-Based Practices used by theCriminal Justice System

**Evidence-Based Practices used by the****Criminal Justice System**

- 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

**Questions**