1. 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

2. 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 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

3. 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)

4. 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)

5. Individuals in State Prisons &Local Jails Percent 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 Justice Office of Justice Programs, Bureau of Justice Statistics, 1999. 0 0 20 40 60 80 100 120 140 160 180 200 Billions of $$ $181 Billion $107 Billion Associated with Drug-Related Crime $107 Billion Associated with Drug-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 Economic Costs of Drug Abuse in the United States, 1992-2002, Washington, DC.: Executive Office of the President, 2004

6. Addiction is common in Juvenile Justice: Prevalence of Substance Use and Psychiatric Disorders (N=1,829) % Teplin, et al. (2002)

7. It Has Been Estimated That In a Given Year… About 25% of all people in the US who have HIV About 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 correctional facility that same year More than 40% who have TB will pass through a correctional facility that same year

8. Addressing Drugs and Crime Public Health Approach -disease -treatment Public Safety Approach -illegal behavior -punish High Attrition High Recidivism

9. 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

11. Recovery from drug addiction requires effective treatment, followed by management of the problem over time Recovery from drug addiction requires effective treatment, followed by management of the problem over time Treatment must last long enough to produce stable behavioral changes 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 Principles of Drug Abuse Treatment For Criminal Justice Populations Drug addiction is a brain disease that affects behavior Drug addiction is a brain disease that affects behavior

12. 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

13. Recovery from drug addiction requires effective treatment, followed by management of the problem over time Recovery from drug addiction requires effective treatment, followed by management of the problem over time Treatment must last long enough to produce stable behavioral changes 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 Principles of Drug Abuse Treatment For Criminal Justice Populations Drug addiction is a brain disease that affects behavior Drug addiction is a brain disease that affects behavior

14. 3.Treatment must last long enough to produce stable behavioral changes. Simpson, Joe, & Brown (1997)

15. Tailoring services to fit the needs of the individual is important Tailoring services to fit the needs of the individual is important Drug use during treatment should be carefully monitored Drug use during treatment should be carefully monitored Treatment should target factors that are associated with criminal behavior Treatment 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 incorporate treatment planning for drug abusing offenders & treatment providers should be aware of correctional supervision requirements Criminal justice supervisions should incorporate treatment planning for drug abusing offenders & treatment providers should be aware of correctional supervision requirements

16. 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

17. 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

18. Continuity of care is essential for drug abusers re-entering the community Continuity of care is essential for drug 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 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) 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

19. Aftercare Matters No Treatment CREST Dropouts CREST Completers CREST Completers + Aftercare * * * * * Drug-Free Arrest- Free No Treatment CREST Dropouts CREST Completers CREST Completers + Aftercare Martin, Butzin, Saum, & Inciardi (1999) Delaware Correctional System 3 Years Post Work Release 9. Continuity of care is essential.

20. Continuity of care is essential for drug abusers re-entering the community Continuity of care is essential for drug abusers re-entering the community Offenders with co-occurring drug abuse & mental health problems often require an integrated treatment approach 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) 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 participation

21. 3. A balance of rewards and sanctions encourages prosocial behavior and treatment participation. Brooner, et al. (2004)

22. Continuity of care is essential for drug abusers re-entering the community Continuity of care is essential for drug abusers re-entering the community Offenders with co-occurring drug abuse & mental health problems often require an integrated treatment approach 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) 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 participation

23. C = Counseling Only; 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 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

24. Evidence-Based Practices used by the Criminal Justice System Taxman (unpublished data from CJ-DATS National Survey)

25. Evidence-Based Practices used by the Criminal Justice System Taxman (unpublished data from CJ-DATS National Survey)

26. Summary NIDA science is being used to change the criminal justice system. Treatment is the key. On-going collaboration and research is essential.

27. Questions