Treating Substance Use Disorders in the Criminal Justice System
- 1.7k Downloads
The large number of individuals with substance use disorders involved in the nation’s criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health. Unfortunately, a low proportion of those who could benefit from treatment actually receive it while involved in the CJS. This article presents a review of recent research on the effectiveness of major substance abuse treatment interventions used at different possible linkage points during criminal justice case processing, including diversion, jail, prison, and community supervision. This is followed by a discussion of key research and practice issues, including low rates of treatment access and under-utilization of medication-assisted treatment. Concluding comments discuss principles of effective treatment for offenders and identify key gaps in research and practice that need to be addressed to improve and expand provision of effective treatment for offenders.
KeywordsCriminal justice Drug treatment Substance abuse Offenders Implementation Psychiatry
This paper was supported in part by NIDA grant U01DA025284.
Compliance with Ethics Guidelines
Conflict of Interest
Steven Belenko has received research support from NIDA and royalties from Springer.
Matthew Hiller declares that he has no conflict of interest.
Leah Hamilton has received research support from NIDA.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Federal Bureau of Investigation. Crime in the United States, 2011. Washington, DC: Federal Bureau of Investigation; 2013.Google Scholar
- 2.Maruschak LM, Parks E. Probation and Parole in the United States, 2011. Bureau of Justice Statistics Bulletin. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics; 2012.Google Scholar
- 3.Minton TD. Jail inmates at mid-year 2012: Statistical tables (NCJ Publication No. 241264). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics; 2012.Google Scholar
- 4.Mumola C, Karberg J. Drug use and dependence, state and federal prisoners, 2004. NCJ 213530. Washington, DC: Bureau of Justice Statistics; 2006.Google Scholar
- 6.• Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009;301:183–90. This article summarizes key issues related to treatment drug use disorders for offenders, documenting both the substantial need for treatment and the limited access to treatment. Using the perspective of addiction as a brain disease causing neurochemical changes in the brain, Chandler et al. propose that incorporating the brain disease model for criminal justice treatment will substantially enhance treatment effectiveness for offenders. With effective existing treatment models and principles, it is argued that improving collaboration and coordination the criminal justice and treatment systems can come together to increase access to effective treatment for offenders.PubMedCrossRefGoogle Scholar
- 7.Office of National Drug Control Policy. ADAM II: 2012 annual report. Washington, DC: The White House; 2013.Google Scholar
- 9.Karberg JC, James DJ. Substance dependence, abuse, and treatment of jail inmates,2002 (NCJ Publication No. 209588). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics; 2005.Google Scholar
- 10.Abuse S, Administration MHS. Results from the 2011 National Survey on Drug Use and Health: Summary of national findings. NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012.Google Scholar
- 11.Bonczar TP, Mumola CJ. Substance abuse and treatment of adults on probation, 1995 (Publication No.NCJ-166611). Washington, DC: Bureau of Justice Statistics; 1998.Google Scholar
- 12.Langan PA, Levin DJ. Recidivism of prisoners released in 1994. Washington, DC: Bureau of Justice Statistics, U.S. Department of Justice; 2002.Google Scholar
- 13.• Mitchell O, Wilson DB, MacKenzie DL. Does incarceration-based drug treatment reduce recidivism? A meta-analytic synthesis of the research. J Exp Criminol. 2007;3:353–75. Mitchell et al. examined published and unpublished studies of prison drug treatment in North America or western Europe since 1979 (n = 26 yielding 32 effect sizes). Seventeen outcomes were calculated from TC programs; ten from counseling or drug education programs (including 12-step programs); three from boot camp programs; and two from a jail-based methadone maintenance program. Eleven of the studies used randomized experimental or rigorous quasi-experimental designs. Three-quarters of the studies had outcomes that favored the treatment group over the comparison group, with an overall mean odds ratio of 1.25 (roughly equivalent to a modest reduction in recidivism from 50% to 44.5%). TC programs produced the strongest overall effect (mean odds ratio = 1.47).CrossRefGoogle Scholar
- 14.• National Institute on Drug Abuse. Principles of drug abuse treatment for criminal justice populations: A research-based guide (4th rev).Rockville, MD: National Institute on Drug Abuse. 2012. http://www.drugabuse.gov/sites/default/files/podat_cj_2012.pdf. Accessed 12 Jul 2013. Recognizing that the delivery of effective addiction treatment in the criminal justice system can be much more challenging than in standard community settings, NIDA’s monograph summarizes 13 key principles for effective treatment in the CJS. Building on the original set of NIDA addiction treatment principles, this guide is based on a review of the research literature and consensus from experts in addiction research and practice. As with NIDA’s general treatment principles, some have a substantial research base, as well as being derived from what is considered effective clinical practice, but others have not been rigorously tested empirically. There is much overlap between NIDA’s general set of principles and the principles for criminal justice populations. Treatment principles unique for criminal justice populations include 1) tailoring services to fit the needs of the individual; 2) targeting criminogenic factors associated with criminal behavior; 3) incorporating treatment planning into criminal justice supervision and being sure that treatment providers are aware of correctional supervision requirements; 4) providing continuity of care for drug abusers re-entering the community from prison or jail; 5) providing a balance of rewards and sanctions to encourage prosocial behavior and treatment participation; and 6) using an integrated treatment approach for offenders with co-occurring drug abuse and mental health disorders.
- 16.Belenko S. The challenges of integrating drug treatment into the criminal justice process. Albany Law Rev. 2000;63:833–76.Google Scholar
- 17.Peyton E. TASC in the 21st century: A guide for practitioners and policymakers. Washington, DC: National TASC; 2001.Google Scholar
- 18.Belenko S, Sung H-E, Swern A, Donhauser C. Prosecutors and treatment diversion: The Brooklyn (NY) DTAP Program. In: Worrall JL, Nugent ME (eds). The changing role of the American prosecutor. Albany, NY: State University of New York Press; 2008.Google Scholar
- 19.Hynes C, Swern A. Drug Treatment Alternative-to-Prison: Twenty-second annual report. Brooklyn, NY: Office of the Kings County District Attorney; 2013.Google Scholar
- 20.Belenko S. Drug courts. In: Leukefeld CG, Tims F, Farabee D, editors. Treatment of drug offenders: Policies and issues. New York: Springer; 2002. p. 301–18.Google Scholar
- 22.Marlowe DB. Integrating substance abuse treatment and criminal justice supervision. Sci Pract Perspect. 2003; August; 2:4–14.Google Scholar
- 26.• Taxman FS, Perdoni ML, Harrison LD. Drug treatment services for adult offenders: the state of the state. J Subst Abuse Treat. 2007;32:239–54. As part of NIDA’s Criminal Justice Drug Abuse Treatment Studies cooperative agreement, a nationally representative survey of administrators of prisons, jails, and community corrections officials was conducted. One focus of the survey was on the types of drug treatment services available for offenders and the utilization of services. Other survey questions addressed the use of evidence-based practices. To date, this has been the only national survey of treatment practices and services access in correctional facilities and systems. Taxman et al. found that there was relatively limited access to clinical treatment in prisons, jails, and community corrections agencies. For example, in prison facilities a range of 4–19 % of the inmate population was involved in various types of treatment services. For jails the range of involvement was 3–11 %, and for community corrections less than 10% participated in any type of drug treatment intervention.PubMedCrossRefGoogle Scholar
- 28.De Leon G. The therapeutic community: Theory, model and method. New York: Springer-Verlag; 2000.Google Scholar
- 31.Belenko S, Fabrikant N, Wolff N. The long road to treatment: models of screening and admission into drug courts. Crim Justice Behav. 2011;38:1222–43.Google Scholar
- 33.National TASC. About National TASC. http://www.nationaltasc.org/about/. Accessed 10 Aug 2013.
- 44.Begun AL, Rose SJ, LeBel TP. How jail partnerships can help women address substance abuse problems in preparing for community reentry. In: Stojkovic S, editor. Managing special populations in jail and prisons. Kingston, NJ: Civic Research Institute; 2010. p. 1–29.Google Scholar
- 52.Gaes GG, Flanagan TJ, Motiuk LL, Stewart L. Adult correctional treatment. In: Tonry M, Petersilia J, editors. Prisons. Crime and justice, a review of research, vol. 26. Chicago: University of Chicago Press; 1999. p. 361–426.Google Scholar
- 53.Belenko S, Houser K, Welsh W. Understanding the impact of drug treatment in correctional settings. In: Petersilia J, Reitz KR, editors. The Oxford handbook of sentencing and corrections. Oxford: Oxford University Press; 2012. p. 463–91.Google Scholar
- 55.Koehler JA, Humphreys DK, Akoensi TD, Sánchez de Ribera O, Lösel FA. A systematic review and meta-analysis of European drug treatment programs on reoffending. Psychol Crime Law. 2013. doi: 10.1080/1068316X.2013.804921
- 57.Lattimore PK, Visher CA. The Multi-site Evaluation of SVORI: Summary and Synthesis. Research Triangle Park, NC: RTI International &The Urban Institute; 2009.Google Scholar
- 59.Government Accountability Office. Adult Drug Courts: Evidence indicates recidivism reductions and mixed results for other outcomes (GAO Publication No.05-219). Washington, DC: U.S. Government Printing Office; 2005.Google Scholar
- 60.Huddleston W, Marlowe DB. Painting the current picture: A national report on drug courts and other problem solving courts in the United States. Alexandria, VA: National Drug Court Institute; 2011.Google Scholar
- 61.Office of Justice Programs. Defining drug courts: The key components (National Criminal Justice Reference No. NCJ 205621). Washington, DC: Office of Justice Programs; 2004.Google Scholar
- 62.Belenko S. Research on drug courts: A critical review. 2001 update. New York: The National Center on Addiction and Substance Abuse at Columbia University; 2001.Google Scholar
- 63.Lowenkamp CT, Holsinger AM, Latessa EJ. Are drug courts effective: a metaanalytic review. J Community Correct. 2006;15:5–11.Google Scholar
- 64.• Mitchell O, Wilson D, Eggers A, MacKenzie D. Drug court’s effects on criminal offending for juveniles and adults. Campbell Systematic Reviews 2012:8. This meta-analysis updated several previous studies examining the effects of drug courts on recidivism. Mitchell et al. included 154 independent published and unpublished evaluations, of which 92 were conducted in adult drug courts. The authors concluded that adult drug courts reduce general and drug-related recidivism, and the effects remain after 3 years. The mean random effects odds ratios were 1.66 for overall recidivism and 1.70 for drug crime recidivism (both statistically significant). The average effect on overall recidivism was equivalent to a reduction from 50 % for offenders not in the drug court to 38 % for drug court participants. Google Scholar
- 72.• Pearson FS, Prendergast ML, Podus D, Vazan P, Greenwell L, Hamilton Z. Meta-analyses of seven of the National Institute on Drug Abuse’s principles of drug addiction treatment. J Subst Abuse Treat. 2012;43:1–11. This meta-analysis sought to determine the evidence base for a subset of NIDA’s Principles of Drug Addiction Treatment, first published in 1999 and updated in 2009. Pearson et al. reviewed studies addressing seven of the 13 NIDA principles, and found that five of them were supported by the research literature. These included 1) matching treatment to client needs; 2) addressing multiple client needs; 3) behavioral counseling interventions; 4) reassessment of treatment plans; and 5) HIV risk reduction counseling. Adequate treatment length and drug testing were not supported by the evidence.PubMedCrossRefGoogle Scholar
- 73.Burdon WM, Farabee D, Prendergast ML, Messina NP, Cartier J. Prison-based therapeutic community substance abuse programs—Implementation and operational issues. Fed Probat. 2003;66:3–8.Google Scholar
- 81.Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;3.Google Scholar
- 82.Egli N, Pina M, Skovbo Christensen, P, Aebi M, Killias M. Effects of drug substitution programs on offending among drug addicts. Campbell Systematic Reviews 2009;3.Google Scholar
- 83.• Kinlock T, Gordon M, Schwartz R, Fitzgerald T, O’Grady K. A randomized clinical trial of methadone maintenance for prisoners: results at 12 months post-release. J Subst Abuse Treat. 2009;37:277–85. This article reports findings from the first RCT of the efficacy of methadone maintenance for prison inmates. Male inmates (n = 204) were randomly assigned to 1) counseling in prison with referral to community treatment at release; 2) counseling in prison and upon release with transfer to methadone maintenance upon release; and 3) counseling and methadone maintenance in prison, continued in the community after release. Inmates receiving counseling plus methadone in and after prison had significantly more days in community treatment were less likely to test positive for opiates or cocaine 12 months after release (although self-reported drug use was not significantly different among the three groups. There were no significant effects on recidivism, however. This initial trial demonstrated the feasibility of providing methadone maintenance in prisons, with some evidence of efficacy in several outcome measures, and suggested the importance for further testing of use of methadone and other MAT in prisons in the USA.PubMedCrossRefGoogle Scholar
- 91.Andrews DA, Bonta J. The psychology of criminal conduct. 2nd ed. Cincinnati, OH: Anderson; 2010.Google Scholar
- 93.Crime and Justice Institute at Community Resources for Justice. Implementing Evidence-Based Policy and Practice in Community Corrections (2nd edition). Washington, DC: National Institute of Corrections; 2009.Google Scholar
- 94.National Institute on Drug Abuse. Principles of effective drug abuse treatment. Rockville, MD: National Institute of Drug Abuse; 1999.Google Scholar
- 95.Cohen TH, Kyckelhahn T. Felony defendants in large urban counties, 2006.(NCJ Publication No. 228944). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics; 2010.Google Scholar
- 96.• McKay JR. Continuing care research: what we've learned and where we're going. J Subst Abuse Treat. 2009;36:131–45. This review of research on continuing care includes a full range of interventions through detoxification and post-treatment recovery monitoring. Studies reviewed include 10 RCTs of clients with drug dependence problems. McKay concludes that continuing care models were more effective than acute care models, although some studies did not find significant effects and there was variation in patient responses to continuing care interventions. More effective interventions were those with longer duration of clinical contact or that made greater efforts to adapt the treatment to patient needs.PubMedCrossRefGoogle Scholar
- 101.Barnoski R, Aos S. Washington State's drug courts for adult defendants: Outcome evaluation and cost-benefit analysis. Olympia, WA: Washington State Institute for Public Policy; 2003.Google Scholar
- 105.Taxman FS, Perdoni ML, Caudy M. The plight of providing appropriate substance abuse treatment services to offenders: modeling the gaps in service delivery. Vict Offenders Int J Evid -Based Res Policy Pract. 2013;8:70–93.Google Scholar