A Treatment 

Improvement 

Protocol 

Substance Abuse Treatment 

For Adults in the Criminal 

Justice System 

TIP 

44 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

CJr CRIMINAL

JUSTICE

U.S. DEPARTMENT OF HE

Substance Abuse and Menta

Center for Substance Abuse 

www.samhsa.gov 

KnowledgeApplica

KAP KEYS Based on TIP 44 

Substance Abuse Treatment for 

Adults in the Criminal Justice System 

KAP K

For Clini

Based on TIP 4

Substance Abus

For Adults in the 

Ju

Sy
KAP KEYS Based on TIP 44 

Substance Abuse Treatment for Adu

in the Criminal Justice System 

Introduction
 

KAP Keys were developed to accomp

Improvement Protocol (TIP) Series p

Substance Abuse Treatment (CSAT), 

Mental Health Services Administrati

Keys are based entirely on TIP 44 an

the needs of the busy clinician for co

“how-to” information. 

For more information on the topics i

are referred to TIP 44. 

Other Treatment Improvem

that are relevant to these K

TIP 21: Combining Alcohol and Othe

With Diversion for Juveniles in the Ju

TIP 23: Treatment Drug Courts: Inte

Treatment With Legal Case Processi

TIP 30: Continuity of Offender Treatm

Disorders From Institution to Comm

TIP 38: Integrating Substance Abuse 

Services BKD381 

TIP 41: Substance Abuse Treatment

Substance Abuse and Trauma (Due 
KAP KEYS Based on TIP 44 

Substance Abuse Treatmen

in the Criminal Justice Syste

Common Myths Abou

Assessment 

Following are several comm

abuse screening and asses

debunk those myths. 

• Myth: Screening and asse

intuition in detecting a pe

Fact: Objective screening 

can result in treatment th

client’s needs, resulting in 

• Myth: Only a single screen

people in different levels 

Fact: Accurate evaluation 

instruments that examine 

affected all the domains o

treatment options are sev

basic screening may be s

bility and suitability for tre

• Myth: Untrained professio

ing and assessments. 

Fact: Although some scre

tered and scored without 

ment decisions are greatl

made by professionally tra

staff with relevant certific

treatment, those with adv

degrees, and those with s

use of particular screening 

ments. For those screenin

approaches that require a

er, specialized training is a

seling techniques such as 

tive listening. Use of traine

triage and placement proc

number of inappropriate re

• Myth: Screening and asse

promised because you ca

mation from offenders. 

Fact: Research generally v

to some degree, the valid

through self-reports. Colla

offender’s family and frie

bility of the information ga

ture”). Offenders do supp

information in some settin

sequences, however. 
KAP KEYS Based on TIP 44 

Substance Abuse Treatment for Adu

in the Criminal Justice System 

• Myth: All screening and assessme

effective. 

Fact: Research shows significant v

and validity of different instrumen

tions. 

• Myth: Because an instrument is w

effective. 

Fact: Many highly marketed and w

not have a research base support

In fact, many of the widely market

have been shown to be less effect

the public domain. 

• Myth: Screening and assessment 

history of physical and sexual abu

because this may aggravate the of

and psychological instability, and s

deal effectively with the conseque

Fact: Screening and assessment o

essential for both male and femal

now recognized that the effects of 

psychiatric disorders. Clinical outc

promised if these abuse and traum

and if strategies addressing these 

and integrated into treatment plan

stance use disorders. However, it 

that in screening for a history of tr

to ask the client to describe traum

screen, it is important to limit que

general questions, such as “Have 

hood physical abuse? Sexual abus

Violence or the threat of it? Have t

your life that were so traumatic th

with day-to-day life?” 
KAP KEYS Based on TIP 44 

Substance Abuse Treatmen

in the Criminal Justice Syste

Screening Guidelines 

Screening content should identify ke

addressed in placing offenders in tre

specific to several domains, includin

involvement, physical health, menta

siderations. 

DomainInd

Substance Use • S

• M

tr

• S

u

• D

in

• Tr

n

e

Criminal Involvement • C

• C

• P

• P

• A

• Ty

• N

• P

of 

u

• P

si

• H

p

Health • In

e

ti

e

• P

• G

• A
KAP KEYS Based on TIP 44 

Substance Abuse Treatment for Adu

in the Criminal Justice System 

Domain Ind

Mental Health • S

• H

p

• Tr

• C

ti

• A

• P

Special Considerations • E

• R

• La

• P

• D

• Le

• H

re

• H

• D

• H

a

in

a 

u
Recommended Scree

in Criminal Justice Se

KAP KEYS Based on TIP 44 

Substance Abuse Treatmen

in the Criminal Justice Syste

Instrument Purpose 

Alcohol 

Dependence 

Scale 

(ADS) 

A 25-item 

instrument 

developed to 

screen for alcohol dependence 

symptoms; performs adequately in community and 

institutional settings 

T

w

ti

s

u

o

m

th

a

(8

re

S

fo

A

C

Simple 

Screening 

Instrument for

Substance 

Abuse 

(SSI-SA) 

A 16-item 

screening 

 instrument that 

examines symptoms of both 

alcohol and 

drug dependence 

A

th

re

w

w

it

a

ti

a

u

a

d

is 

S

In

fo

A

D

d

ti

A

P

D
KAP KEYS Based on TIP 44 

Substance Abuse Treatment for Adu

in the Criminal Justice System 

Instrument Purpose 

TCU Drug 

Screen 

(TCUDS) 

A 15-item substance abuse 

diagnostic 

screen 

T

c

a

ti

h

e

T

In

D

S

fo

tr

m

T

in

w

Source: Peters, R.H., Greenbaum, 

Carter, C.R. Effectiveness of screen

ing substance use disorders among 

Substance Abuse Treatment 18(4):
KAP KEYS Based on TIP 44 

Substance Abuse Treatmen

in the Criminal Justice Syste

Instruments for Read

Mental Disorders 

Instruments for Evaluating Re

Instrument 

The University of 

Rhode Island 

Change Assessment 

Scale (URICA) 

URICA was de

vidual’s stage 

ment is know

populations i

Research has 

useful, reliab

cerated wome

URICA and ot

are reprinted 

Motivation fo

Abuse Treatm

The TCU Treatment 

Motivation Scales 

The TCU Trea

can be used t

change in tre

ther informat

The Circumstances, 

Motivation, 

Readiness, and 

Suitability Scales 

(CMRS) 

The CMRS sc

dict retention 

factors relate

ing in treatme

scale is defin

sure to engag

ment. The Mo

as the interna

Readiness sc

ceived need f

Suitability sca

vidual’s perce

modality or se

himself. A pri

developed. A 

CMRS, the CM

CMR is copyr

obtained by c

Development 

Inc., 71 W. 23

York 10010, o
KAP KEYS Based on TIP 44 

Substance Abuse Treatment for Adu

in the Criminal Justice System 

Instrument 

Stages of Change, 

Readiness, and 

Treatment 

Eagerness Scale 

(SOCRATES) 

SOCRATES in

focused on a

used as a sta

A Spanish tra

SOCRATES an

ments are re

Enhancing M

Substance Ab

Instruments for Screening and Ass

Instrument 

Beck Depression 

Inventory II (BDI-II) 

• A 21-item s

that screen

sion 

• Requires no 

administer 

• Found to be 

ment in det

individuals 

• Should not 

tor of depre

with other i

Brief Symptom 

Inventory (BSI) 

• A short form 

Checklist 9

• Comprising 

global indic

(General Se

Symptom T

Distress Ind

chiatric sym

• Brief to adm

significant 

• Only a 6th-g

required 

• May be mo

cator of psy
KAP KEYS Based on TIP 44 

Substance Abuse Treatmen

in the Criminal Justice Syste

Barriers to Effective 

Criminal Justice Clie

Problem 

Area Description of Prob

Assessment Assessment uses br

definitions of drug a

and applies criteria 

lated to addiction. A

result, inmates are n

always matched with 

appropriate level of 

ices, and some inma

who do not have sub

stance abuse proble

are placed in treatm

Staff training Many newer prisons 

been constructed in 

areas where local co

munities have a sma

pool of treatment pr

sionals and fewer pe

in recovery as poten

staff members. 

Staff redeployment Effective correctiona

cers and treatment 

selors often move “u

and out.” 

Overreliance 

on institutional 

sanctions 

In successful treatm

programs, noncomp

participants face pe

pressure and eventu

develop internal con

Often, however, insti

tional sanctions are 

imposed before pee

can have a positive 

impact. 
KAP KEYS Based on TIP 44 

Substance Abuse Treatment for Adu

in the Criminal Justice System 

Problem 

Area Description of Prob

Aftercare Many participants d

out of treatment as 

as they can; many 

providers in the com

nity hesitate to work 

ex-prisoners, especia

those sentenced for 

lent or sexual offens

Coercion Often inmates do no

unteer for treatment 

because peers attac

stigma to it, program

demand more rules 

structure, and partic

pants often lose sen

and job opportunitie

the facility. 

Source: Farabee, D., Prendergast, M

Knight, K., and Anglin, M.D. Barriers 

correctional drug treatment program

79(2):150–162, 1999. 
Considerations for S

Criminal Justice Sett

KAP KEYS Based on TIP 44 

Substance Abuse Treatmen

in the Criminal Justice Syst

Setting Purpose of Screening 

Jails • For early identificat

getting out of jail ea

• To determine eligibi

drug courts and pre

diversion programs 

• For diversion to spe

ized mental health 

or programs focuse

behavioral problem

• To determine behav

management proble

and acute needs (in

ing crisis interventio

• To identify suitabilit

placement in jail tre

ment programs 

• For classification to 

ent housing units 

Prisons • To match time left t

serve with time for 

ing treatment or for 

tody level classifica

• To identify suitabilit

placement in prison 

ment programs 

Pretrial and 

Community 

Supervision 

• To determine the ne

housing, transporta

employment, or eco

benefits 

• To identify suitabilit

placement in comm

treatment programs 

• To assess for public 

risk and level of sup

sion needed, pursu

consideration for pl

ment in diversion p

grams 

Traits of Major Personality 

Disorders (According to the 

KAP KEYS Based on TIP 44 

Substance Abuse Treatment for Adu

in the Criminal Justice System 

Antisocial Personality D

• Deceitfulness, as indicated by rep

es, or conning others for persona

• Irritability and aggressiveness, as 

physical fights and assaults 

• Consistent irresponsibility, as indic

sustain consistent work behavior o

• Failure to conform to social norm

behaviors as indicated by repeate

are grounds for arrest 

• Impulsivity or failure to plan ahea

• Reckless disregard for safety of s

• Lack of remorse, as indicated by 

rationalizing having hurt, mistrea

Source: Hare, R., Hart, S., and Harp

DSM-IV criteria for antisocial perso

Abnormal Psychology 100(3):391–

Traits of Borderline Person

People diagnosed with BPD must h

lowing behaviors: 

• Frantic efforts to avoid real or im

• A pattern of unstable and intense 

ships characterized by alternating 

alization and devaluation 

• Identity disturbance or markedly 

self-image or sense of self 

• Impulsivity in at least two areas t

damaging (e.g., spending, sex, su

driving, binge eating) 

• Recurrent suicidal behavior or gestu

• Affective instability due to marked 

intense episodic dysphoria, irritab

lasting a few hours and only rare

• Chronic feelings of emptiness 

• Inappropriate, intense anger or d

(e.g., frequent displays of temper

physical fights) 

• Transient, stress-related paranoid 

ciative symptoms 

Source: American Psychiatric Assoc

Statistical Manual of Mental Disord

Washington, DC: American Psychiat
Components of Drug 

Suggestions for Cou

KAP KEYS Based on TIP 44 

Substance Abuse Treatmen

in the Criminal Justice Syste

10 Key Components o

The following components were dev

mittee of experts for the Office of Ju

Courts Program Office: 

1. Drug courts integrate alcohol a

es with justice system case pro

2. Using a nonadversarial approac

defense counsel promote publi

participants’ due process rights

3. Eligible participants are identifi

placed in the drug court progra

4. Drug courts provide access to a 

drug, and related treatment an

5. Abstinence is monitored by freq

drug testing. 

6. A coordinated strategy governs 

participants’ compliance. 

7. Ongoing judicial interaction wit

pant is essential. 

8. Monitoring and evaluating achi

is necessary to gauge effective

9. Continuing interdisciplinary edu

drug court planning, implement

10. Forging partnerships among dr

and community-based organiza

port and enhances drug court p

Suggestions for Counselors Opera

• Maintain a client’s confidentiality

discussing the client’s criminal ca

• Bear firmly in mind that the client 

before trial. 

• Be realistic about the responsibil

ble of handling in pretrial settings

istic to believe that a defendant w

model citizen, meeting all of his o

ply because of an arrest. 

• Avoid allowing individuals to be in

enrolling in treatment. 

• Be aware that clients may be mor

case” than on recovery. 
Outcome Information 

KAP KEYS Based on TIP 44 

Substance Abuse Treatment for Adu

in the Criminal Justice System 

Outcome evaluations involve measu

mine how effective a program is for 

such as drug relapse and employme

outcome evaluation. The following a

mation that might be collected. 

Drugs • Urinalysis re

• Drug-related 

• Drug-related 

Crime • Parole rule i

• Time until pa

• New misdem

• New felony a

ed crimes 

• New felony a

crimes 

• New felony a

• Time until a

• Re-incarcera

Social adjustment • Employment 

• Family (e.g., 

marital, etc.

• Substance a

• Community 

nity service) 

HIV risk behaviors • Intravenous 

• Sexual beha

• HIV test resu

Cost information • Cost estimat

• Cost estimat

• Cost estimat

family (e.g., 

• Criminal just

tion costs 

Tracking 

information 

• Tracking loca

social secur

addresses o
Ordering Info

TIP 44 

Substance Abuse Trea

in the Criminal Jus

Three Ways to Obta

of All TIPs Pr

1.	 Call SAMHSA’s National Clearin

Drug Information (NCADI) at 80

TDD (hearing impaired) 800-48

2. 	Visit NCADI’s Web site at www

3. 	You can also access TIPs online 

www.kap.samhsa.gov. 

Do not reproduce or distribute this p

out specific, written authorization fr

Communications, Substance Abuse 

Services Administration, U.S. Depar

Human Services. 

DHHS Pub