Paving the Pathway to Transformation · stimuli as main culprits in relapse. Alcohol can have a...
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Paving the Pathway to Transformation Rethinking Alcohol Monitoring in Treatment Courts Matthew Mitchell Director of Evidence Based Programs
Transcript of Paving the Pathway to Transformation · stimuli as main culprits in relapse. Alcohol can have a...
Paving the Pathway to Transformation Rethinking Alcohol Monitoring in Treatment CourtsMatthew MitchellDirector of Evidence Based Programs
TableofContentsToday’s Topics
DrugCourtPrincipals
AlcoholasDoC
AlcoholMonitoringOptions
Q&A
The link between alcohol & crime
United States• 10,322 alcohol related fatalities in 2012
• 80% of those supervised struggle with substance abuse
• 75% of domestic violence cases involve alcohol
• 70% of drivers in fatal crashes had a BAC > .15
• 40% of probationers were intoxicated at time of arrest
Sources: (1) National Center on Addition and Substance Abuse at Columbia University, (2) www.drinkinganddriving.org (3) The Century Council (4) National Institute of Alcohol Abuse and Alcoholism (NIAAA)
Judicially Supervised Treatment
Primary Risk and Needs that Influence Recovery
OffenderOutcomes
Fina
ncia
l Res
ourc
es
Rewards for Doing Well
Immediate Sanctions are
Imposed for Not Living Up to
Their Obligations
Blending of Treatment and Accountability: Detection is Key!
Without accurate detection of participant behavior, lasting change is an unrealistic expectation.
“I don’t have a problem with booze”
Alcohol is the primary drug of choice among adult Drug Court participants
Urban = 27% report ALC as PDoC
Suburban = 33% report ALC as PDoC
Rural = Alcohol 30% report ALC as PDoC
Huddleston & Marlowe (2011). Painting the Current Picture: A National Report on Drug Courts and Other Problem Solving Courts.
Alcohol is the primary drug of choice among adult Drug Court participants
Urban = 38% report ALC as PDoC76% report alcohol as 1st, 2nd or 3rd DoC
Suburban = 29% report ALC as PDoC58% report alcohol as 1st, 2nd or 3rd DoC
Rural = Alcohol 38% report ALC as PDoC76% report alcohol as 1st, 2nd or 3rd DoC
Marlowe et. al. (2016). Painting the Current Picture: A National Report on Drug Courts and Other Problem Solving Courts.
Question for Audience
You’ve supervised hundreds of drug court participants throughout your career, what’s your take on alcohol use/abuse among our population? Do these stats surprise you?
Five Reasons to Rethink Alcohol Monitoring in Treatment Courts
1. Standards and best practices require it for best outcomes;
2. Provides initial and ongoing assessment of alcohol use disorder;
3. Relapse prevention;
4. Deterrent effect & extrinsic motivation;
5. Peace of mind
Fidelity to the Model and Best Practice Standards
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Ten Key Components: Key Component #5:
“Abstinence is monitored by frequent alcohol and other drug testing.”
NADCP Adult Drug Court Best Practice Standards, Vol. II # 7
“Unless Drug Courts have accurate and timely information as to whether participants are maintaining abstinence from illicit drugs and alcohol, they have no way to apply incentives, sanctions, or treatment adjustments effectively...in a population that is often highly motivated and surprisingly adept at avoiding detection by standard testing methods.”
Adult Drug Courts
DWI Courts
The Ten Guiding Principles of DWI Courts # 4
“Integrates alcohol monitoring technology, and specifically transdermal testing, as a tool to support supervision, case management, and program evaluation.”
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Alcohol Monitoring as Assessment
In addition to using validated risk and need assessment tools, SCRAM CAM and SCRAM RB can assess over time (e.g., first 90 days) the extent to which an offender has an alcohol use disorder, giving agencies better data to determine a successful course of treatment.
Using alcohol monitoring technology as an assessment tool also ensures the proper supervision model is deployed.
Deterrent Effect & Extrinsic Motivation
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Out of 100 offenders wearing SCRAM...
80 won’t drink at all for the entire 98 days(80% FULL compliance)
…the 20 that did drink are sober 96 of the 98 days while on SCRAM.
(99.3% Sober Days)
Certainty is Increased as is Deterrence
88% said CAM deterred their drinking
“With SCRAM I didn‘t feel like a criminal. The bracelet saved my life and perhaps even someone else’s.”
“It kept me from my first drink, so I could get back on my feet and makethe right choices.”
Relapse Prevention Tool
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50% of the alcohol relapses occur within the first three months after alcohol cessation.
During this period, it has been shown that many patients experience anxious symptoms that have been neurobiologicallyrelated to withdrawal symptoms. Early relapse in alcohol dependence may result from late withdrawal symptoms (Simioni, et. al, 2012).
Relapse Prevention Tool
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Considerable evidence implicates both neurochemical and environmental stimuli as main culprits in relapse.
Alcohol can have a significant triggering effect on drug and nicotine relapse. Relapse to alcohol and drug use among individuals diagnosed with co-occuring mental health and substance us disorders. Bradizza & Stasiewicz, 2006
Relapse Prevention: Maintenance strategies in the treatment of addictive behaviors.Marlatt & Donovan 2005
A 33-year follow-up of narcotics addicts. Hser et.al., 2001
Compulsive drug-seeking behavior and relapse. Weiss et. al., 2001
Predicting relapse to alcohol and drug abuse . Bauer, 2001
The reinstatement model of drug relapse: history, methodology and major findings.Shaham, et al., 1996
Relevance of cue reactivity to understanding alcohol and smoking relapse. Sinha, 1988
Peace of Mind• Effective alcohol monitoring shortens the
window of detection so that if someone drinks, the court or agency will quickly know;
• This allows courts and agencies to implement swift and certain incentives and sanctions with confidence;
• Without proper alcohol detection, clients may be reinforced for being clean and sober, when they are actually not.
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Peace of Mind• Ensure that a client is not drinking,
putting innocent citizens in danger;
• Be confident that a pregnant participant is not putting their fetus at risk of Fetal Alcohol Spectrum Disorder;
• While batterers are addressing their power and control issues in DV counseling, guarantee they are not increasingly volatile with alcohol consumption.
“With Continuous Alcohol Monitoring, the recovering alcoholic can be empowered with evidence of their own sobriety.”
R. Thomas Gentry, PhDNational Institute on Alcohol Abuse & Alcoholism
Peace of Mind:
Alcohol Monitoring Methodologies
Breathalyzer Test7 AM
Offender StartsDrinking
10 PM
Breathalyzer Test5 PM
Offender Peaks0.14 BrAC
Alcohol burns off by6 AM
Breathalyzer Test7 AM
Higher risk offenders can get drunk around breath testing.
Alcohol Absorption & Burn-off:
Challenge: Alcohol Metabolism
Is EtG/EtS Testing Adequate?
“Consensus cutoff for Drug Courts is 500 ng/mL for EtG and 100 ng/mL for EtS. Detection window - up to 48 hours (but realistically 24-hours).” Paul Cary• Does not quantify amount of alcohol;• No standardized cutoff (ranges from 50 to 1000
ng/mL);• Cost verses benefit: $20 - $25/test. Test at least four
times per week, including weekends. Very labor intensive;
• Client hardships. Disruptive to a client’s employment, school, etc.
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Continuous Alcohol Monitoring Overview
Offender StartsDrinking
10 PMOffender Peaks
0.14
Offender is Sober6 AM
SCRAM CAM detects the entire drinking event
CAM continuously monitors and records an alcohol reading every 30 minutes, 24x7
= SCRAM CAM Alcohol Test
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Alcohol Monitoring
Products SCRAM Continuous Alcohol Monitoring™24/7 transdermal alcohol testing for high-risk clients
• Continuous alcohol monitoring and reports quantity upon a drinking event;
• Distinguishes between consumption and environmental alcohol;
• Independently tested, peer-reviewed, admissible in court;
Research Findings
• 90 days on CAM significantly decreased the risk of recidivism up to 43%.
• Less than 2% of CAM users recidivated while on the device.
• Recidivism rates for repeat DWI offenders who wore CAM was 50% less than those who were alternatively sentenced.
• 98% of the offenders did not commit a new offense while wearing CAM.
Tison, J., Nichols, J. L., Casanova-Powell, T., & Chaudhary, N. K. (2015, April). Comparative study and evaluation of SCRAM use, recidivism rates, and characteristics. (Report No. DOT HS 812 143). Washington, DC: National Highway Traffic Safety Administration.
Flango, G. and Cheesman, F. (2009). The Effectiveness of the SCRAM Alcohol Monitoring Device. Drug Court Review, 6(2), 109-134.
Five Reasons to Rethink Alcohol Monitoring in Treatment Courts
1. Standards and best practices require it for best outcomes;
2. Provides initial and ongoing assessment of alcohol use disorder;
3. Relapse prevention;
4. Deterrent Effect & Extrinsic Motivation;
5. Peace of mind
Family Drug CourtsBenefits of CAM/RB
• Fetal Alcohol Spectrum Disorder is the number one preventable cause of mental retardation;
• Reduces risk of current or future alcohol or other drug endangered children.
Veterans Treatment CourtsBenefits of CAM/RB
• Improvement of PTSD/MH treatment outcomes;
• Reduce risk of impaired driving;
• Reduce risk of violence (e.g., spousal abuse, assault).
DWI/DUI/Sobriety CourtsBenefits of CAM/RB
• No DWI Court participant should ever drink again;
• Reduce risk of DWI recidivism and related crashes pre/in/post program;
• Increases buy-in of law enforcement, victims, MADD;
• Relapse prevention tool to other drugs – drugged driving
Programs TargetingMultiple DUI Offenders
York County Target 25 Initiative
• Serves as a complementary program to DUI Treatment Courts and other DUI sentencing programs;
• Targets Repeat/Multiple Offenders with Prior Convictions or Pending Offenses within Ten Years;
• Conditions of bail include mandated sobriety, supervised by SCRAM Continuous Alcohol Monitoring for an average 90 days. SCRAM CAM is also used as an assessment tool to match defendants with the treatment they need;
• Approximately 1/3rd of program participants are placed on CAM with house arrest;
• Defendants are responsible for the costs associated with monitoring.
York County Target 25 Initiative
• 84% of Target 25 participants had no rearrests, no infractions, no failures to appear, and no revocations;
• Reduced DUI recidivism during pretrial by 91.3% (46 to 4);
• Reduced crashes resulting in an injury or fatality due to drinking drivers by 21%;
• Reduced jail overcrowding by keeping an estimated 150 offenders out of the county jail each month;
• Reduced number of DUI victims served by the DA’s office by over 60% (down to 6% by year two).
With over 400 offenders each year, Target 25 has had a dramatic impact on repeat drunk driving
It’s the only way to quantifySober Days
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ü Automated testing, around the clock, every 24-hour period
ü Transdermal testing, in order to ensure continuous monitoring
ü Scientifically Accepted, Court-validated testing
A Sober Day™ is a 24-hour period in which a monitored individual has had no confirmed consumption of alcohol and no confirmed attempt to tamper with the testing device.
You can only determine true Sober Days if your program has:
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The greater good… Participant quotes:
“The SCRAM program saved my life. I was lost in alcohol. SCRAM CAM should be recommended in every DUI program.”
“This was an awakening for me and made me not want to drink − ever.Living is a lot better now. I got my life back!”
“Easy choice of go clean or go back to jail. [SCRAM CAM] does work.”
“[With SCRAM CAM] I didn‘t feel like a criminal. The bracelet saved my life and perhaps even someone else’s.”
“It kept me from my first drink so I could get back on my feet and makethe right choices.”
“It allowed me to keep my job, stay with my family, and stay alive.”
Paving the Pathway to Transformation
