Treatment is the Key: Addressing Drug Abuse in Criminal Justice Settings Redonna K. Chandler, Ph.D. Branch Chief Services Research Branch Division of Epidemiology,

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


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


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



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



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



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


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)




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









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









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.

Questions

Documents

Treatment is the Key: Addressing Drug Abuse in Criminal Justice Settings Redonna K. Chandler, Ph.D. Branch Chief Services Research Branch Division of Epidemiology,