Treatment is the Key: Addressing Drug Abuse in Criminal Justice Settings Redonna K. Chandler, Ph.D....
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Transcript of Treatment is the Key: Addressing Drug Abuse in Criminal Justice Settings Redonna K. Chandler, Ph.D....
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
ENTRY(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
JudgeJury
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)
Individuals in StatePrisons &Local Jails
Per
cen
t
General Population
70%
9%
100
90
80
70
60
50
40
30
20
10
0
Regular Drug Abuse
Source: Mumola, C.J., Substance abuse and treatment,state and federal prisoners, 1997. U.S. Department of JusticeOffice of Justice Programs, Bureau of Justice Statistics, 1999.
00
2020
4040
6060
8080
100100
120120
140140
160160
180180
200200
Bill
ion
s of
$$
Bill
ion
s of
$$
$181 Billion$181 Billion
$107 BillionAssociated withDrug-Related Crime
$107 BillionAssociated withDrug-Related Crime
Approximate Cost of Drug Abuse in the U.S. in 2002
Approximate Cost of Drug Abuse in the U.S. in 2002
Source: Office of National Drug Control Policy. The EconomicCosts of Drug Abuse in the United States, 1992-2002, Washington, DC.: Executive Office of the President, 2004
0
10
20
30
40
50
60
Affective Anxiety Behavioral Substance Use
MaleFemale
Addiction is common in Juvenile Justice:Prevalence of Substance Use and Psychiatric Disorders
(N=1,829)
%
Teplin, et al. (2002)
It Has Been Estimated That In a Given Year…
About 25% of all people in the US who have HIVAbout 25% of all people in the US who have HIV
About 33% of all people in the US who have HCV
and
About 33% of all people in the US who have HCV
and
More than 40% who have TB will pass through a correctionalfacility that same year
More than 40% who have TB will pass through a correctionalfacility 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
Recovery from drug addiction requireseffective treatment, followed by managementof the problem over time
Recovery from drug addiction requireseffective treatment, followed by managementof the problem over time
Treatment must last long enough to producestable behavioral changesTreatment must last long enough to producestable behavioral changes
Assessment is the first step in treatmentAssessment is the first step in treatment
Principles of Drug Abuse Treatment For Criminal Justice Populations
Principles of Drug Abuse Treatment For Criminal Justice Populations
Drug addiction is a brain disease thataffects behaviorDrug addiction is a brain disease thataffects 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
Recovery from drug addiction requireseffective treatment, followed by managementof the problem over time
Recovery from drug addiction requireseffective treatment, followed by managementof the problem over time
Treatment must last long enough to producestable behavioral changesTreatment must last long enough to producestable behavioral changes
Assessment is the first step in treatmentAssessment is the first step in treatment
Principles of Drug Abuse Treatment For Criminal Justice Populations
Principles of Drug Abuse Treatment For Criminal Justice Populations
Drug addiction is a brain disease thataffects behaviorDrug addiction is a brain disease thataffects behavior
3. Treatment must last long enough to
produce stable behavioral changes.
55
28
53
1915
9
54
24
0
20
40
60
80
100
Cocaine (Any Use)*
UA+ (Any Drug)*
Alcohol (Daily Use)*
Any Jail*
< 90 Days 90+ Days
Simpson, Joe, & Brown (1997)
Tailoring services to fit the needs of the individual is importantTailoring services to fit the needs of the individual is important
Drug use during treatment should be carefullymonitoredDrug use during treatment should be carefullymonitored
Treatment should target factors that are associated with criminal behaviorTreatment should target factors that are associated with criminal behavior
Principles of Drug Abuse Treatment For Criminal Justice Populations
Principles of Drug Abuse Treatment For Criminal Justice Populations
Criminal justice supervisions should incorporatetreatment planning for drug abusing offenders& treatment providers should be aware of correctional supervision requirements
Criminal justice supervisions should incorporatetreatment 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
Continuity of care is essential for drug abusers re-entering the communityContinuity of care is essential for drug abusers re-entering the community
A balance of rewards and sanctions encourages prosocial behavior & treatment participationA balance of rewards and sanctions encourages prosocial behavior & treatment participation
Offenders with co-occurring drug abuse & mentalhealth problems often require an integrated treatment approach
Offenders with co-occurring drug abuse & mentalhealth problems often require an integrated treatment approach
Medications are an important part of treatment for many drug abusing offendersMedications 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)
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
Principles of Drug Abuse Treatment For Criminal Justice Populations
Aftercare MattersAftercare MattersAftercare MattersAftercare Matters
5
17
27
3529 28
55
69
0
20
40
60
80
100
No No
Treat
men
t
Treat
men
t
CREST
CREST
Dropouts
Dropouts
CREST
CREST
Comple
ters
Comple
ters
CREST
CREST
Comple
ters
+
Comple
ters
+
Afterc
are
Afterc
are
*
*
**
*Drug-FreeDrug-Free Arrest-Arrest-FreeFree
No No
Treat
men
t
Treat
men
t
CREST
CREST
Dropouts
Dropouts
CREST
CREST
Comple
ters
Comple
ters
CREST
CREST
Comple
ters
+
Comple
ters
+
Afterc
are
Afterc
are
Martin, Butzin, Saum, & Inciardi (1999)
Delaware Correctional SystemDelaware Correctional System3 Years Post Work Release3 Years Post Work Release
9. Continuity of care is essential.
Continuity of care is essential for drugabusers re-entering the communityContinuity of care is essential for drugabusers re-entering the community
Offenders with co-occurring drug abuse & mentalhealth problems often require an integrated treatment approach
Offenders with co-occurring drug abuse & mentalhealth problems often require an integrated treatment approach
Medications are an important part of treatment for many drug abusing offendersMedications 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)
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
Principles of Drug Abuse Treatment For Criminal Justice Populations
A balance of rewards and sanctions encourages prosocial behavior & treatment participationA balance of rewards and sanctions encourages prosocial behavior & treatment participation
3. A balance of rewards and sanctions encourages prosocial behavior and treatment participation.
Motivated Stepped Care Vs. Standard Stepped Care(n=127)
83%
46%44%
79%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Counseling Attendance Treatment Response
MSC
SSC
Brooner, et al. (2004)
Continuity of care is essential for drug abusers re-entering the communityContinuity of care is essential for drug abusers re-entering the community
Offenders with co-occurring drug abuse & mentalhealth problems often require an integrated treatment approach
Offenders with co-occurring drug abuse & mentalhealth problems often require an integrated treatment approach
Medications are an important part of treatment for many drug abusing offendersMedications 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)
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
Principles of Drug Abuse Treatment For Criminal Justice Populations
A balance of rewards and sanctions encourages prosocial behavior & treatment participationA balance of rewards and sanctions encourages prosocial behavior & treatment participation
C = Counseling Only; C+T = Counseling & Treatment Referral; C+M = Counseling & Methadone Started in Prison
9%
60%
49%40%
69%
29%
-10%
0%
10%
20%
30%
40%
50%
60%
70%
80%
C C+T C+M
Maryland Prison Study: Treatment Linkage and Opiate-Free One Maryland Prison Study: Treatment Linkage and Opiate-Free One Month Post ReleaseMonth Post Release
Preliminary Analysis: Tim Kinlock, et al., 2006
C vs. C+M, C vs. C+M p< .001
In Treatment
C vs. C+M p< .01
Urine Test Positive
12. Medication is important part of treatment.
N=166
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Substance AbuseAssessment
>90 Days in Treatment Systems Integration
Adult-Prisons (n=66) Adult-Community (n=76) Juvenile-Residential (n=29) Juvenile Community (n=46)
Evidence-Based Practices used by theCriminal Justice System
Taxman (unpublished data from CJ-DATS National Survey)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Risk Assessment ComprehensiveTreatment
Continuing Care Drug Testing
Adult-Prisons (n=66) Adult-Community (n=76) Juvenile-Residential (n=29) Juvenile Community (n=46)
Evidence-Based Practices used by theCriminal 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.