1. 1 Community-Based Research with Substance Dependent Offenders Randall Brown MD, PhD Health Improvement & Research Partnerships Forum Madison, WI 9/15/2011 Funding: NIH-NIDA 1K23 DA017283; UW ICTR Pilot Award; UW DFM Small Grant

2. 2 Overview Substance dependence Chronic illness Associated crime Criminal justice interventions Adjudication/incarceration ‘Therapeutic jurisprudence’ Our research Randomized trial: medication-assisted Tx in primary vs specialist setting Future directions

3. 3 3 Addiction is a Treatable Brain Disease Meth Addict 2 Yrs Abstinence Meth Addict 1 Mo Abstinence Never Used Meth

4. 4 Drug Use & Crime Arrests for drug-related offenses have increased ~ 300% since 1980 –(580k  1.7 million) Criminal justice system overwhelmed –Non-violent users & addicted Incarceration does not ↓ use 1.Crime in America: FBI Uniform Crime Reports 2008 2.Simpson DD. Addiction 2001.

5. 5 “Therapeutic Jurisprudence” & Drug Court Treatment improves outcomes –Including criminal behavior Drug treatment court –Community-based treatment –Case management Treatment assignment/monitoring Urine screening –Court appearances Sanctions/rewards Patkar et al. J Add Diseas 2004. Belenko. CASA 2001.

6. 6 Drug Court “Explosion” Operational drug court programs in the U.S. 1990-2008 Huddleston et al. Natl. Drug Court Inst. 2008.

7. 7 Drug Court Research (1) Program evaluations – ↓ crime & drug use 2 RCTs –Gottfredson et al 2003 Rearrest: 83% vs 66%, p < 0.05 –Marlowe et al 2003 Urine drug screens (no difference) Rearrest (no difference) Effect for high risk subgroup

8. 8 Drug Court Research (2) Program evaluations –Aggregate statistics only –Time/resources of grantees Important covariates/potential confounders unexamined Scant research on ongoing drug use Brown RT. Translational Research. In press.

9. 9 Drug Treatment Court (DTC) “Flow”

10. 10 Medication-Assisted Treatments Opioid dependence –Methadone –Buprenorphine/naloxone Specialist facilities Office-based

11. 11 Study: Treatment of Opioid- Dependent Offenders Opioid dependent offenders Community supervision + treatment Incarceration/traditional adjudication Specialist care + methadone + counseling Specialist care + buprenorphine + counseling Primary care + buprenorphine + counseling Addiction severity, opioid use, treatment retention, health status, HIV risk behaviors, quality of life, new crime 12 months

12. 12 Sample GenderMale10 Female6 Age< 201 20-258 26-304 31-351 > 352 Education< HS2 ≥ HS14

13. 13 Early Opioid Use Outcomes

14. 14 Results by Tx Group

15. 15 Conclusions Treatment prevents drug use and complications Drug treatment courts are booming & probably work better than jail Treatment matching? –Medication-assisted treatment –Employment/education –“Cultural sensitivity” –Mental health & drug use

16. 16 Future Directions Pilot OWI Court study –Injectable naltrexone Expansion of opioid dependence treatment “Specialist stablization study”