The Role of Criminal Justice in Addiction Treatment

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Is incarceration enough to address the problem of drug abuse? The answer is no, because criminal behavior associated with illegal drug-seeking activities results from changes in the brain caused by repeated drug use; to truly reduce criminal behavior for drug offenders, the root of the problem – substance abuse addiction – must be addressed with addiction treatment within the criminal justice system.(1) After analyzing various data sources from federal and state law enforcement, corrections and health agencies, The Pew Charitable Trusts did not find any strong association between incarceration and its impact on the nation’s drug problems. Instead, the findings confirm prior research that stiffer prison terms are ineffective in reducing substance use and drug-law violations.

Many drug offenders do not have prior or other criminal convictions, but they are propelled to commit crimes to satisfy their drug addiction. The United States Department of Justice released a report in 2015 examining drug offenders based on demographics, basic offense characteristics and sentence imposed. The study, based on 94,678 offenders whose most serious offense was a drug offense, revealed that 99.5% of offenders were imprisoned for drug trafficking and about 35% of these offenders had either no previous or minimal criminal history.

Incarceration has been the traditional answer for drug offenses

Historically, the United States government has passed laws that punished drug offenders with incarceration rather than treating them as patients with substance use disorders. According to the NIH Fact Sheet, the 1914 Harrison Anti-Narcotic Act was passed to reduce negative effects associated with drug use by allowing the government to regulate narcotic drug sales. In 1939, this law was further enforced by incriminating anyone who violated this Act. Violations resulted in imprisonment where offenders received no addiction treatment for the underlying causes of the crime. Once discharged, offenders would re-enter the vicious cycle of crimes that lead them back to prison. Fast forward to the 21st century, research shows that the numbers of drug offenders have soared from 1.8 million in 1980 to 7.3 million in 2007. History shows that incarceration for drug crimes has minimal impact on reducing substance use and recidivism rates.

Is addiction treatment different for the criminal justice population?

The characteristics of drug-involved offenders in the justice system versus individuals with substance use disorders in the community influence intervention efforts in addiction treatment, according to an article published in The Journal of Substance Abuse Treatment. The extent of differences is not yet known, but the differences between the two populations play a role in relapse and recidivism factors in treatment outcomes. The article cited a study which examined the characteristics of drug-involved offenders initiating methadone treatment. They had more severe drug use and criminal justice profiles, which put them at higher risk for recidivism in the future than individuals who entered community-based addiction treatment. Aside from legal situations that offenders face, their criminal thinking and values make them more resistant to treatment than other substance abuse treatment populations. (2)

Two public safety perspectives for addiction treatment
There are two public safety perspectives that differentiate addiction treatment for drug-involved offenders, the first of which favors more consistent and intensive criminal justice supervision over the other. Proponents of the purer form of public safety believe that the community would be safer if drug involved offenders stayed behind bars and received addiction treatment within the justice system. The other is a thoroughgoing perspective, which holds that offenders would fare better if they were allowed to develop an effective therapeutic alliance on their own under community supervision.(3)

The approach that has shown more promise for reducing drug use and recidivism is the integrated public health and safety strategy that combines community-based addiction treatment with ongoing criminal justice supervision. In other words, drug-involved offenders can receive addiction treatment outside of correctional facilities as long as they stay in touch with their probation officers. The challenge that probationers face is greater access to drugs and alcohol, which puts them at higher risk for relapse than the incarcerated population.(4)

Modification strategies for addiction treatment in the criminal justice system
Substance abuse treatment within the criminal justice system is modified according to the offenders’ specific situation and their stage in the recovery process. While offenders are mandated to complete a court-ordered addiction treatment program, clinicians have to utilize specific engagement strategies to motivate offenders to stay committed to change and recovery. Program components consist of incentives for participation, emphasis on personal accountability and cognitive behavioral interventions that correct criminal thinking, address identity issues and instruct basic problem-solving skills.

Efficacy of drug offender treatment programs
For any drug program to be effective, it needs to be tailored to meet the needs of the individual receiving addiction treatment. Offender treatment programs aim to reduce substance abuse and recidivism, the tendency of convicted offenders to re-offend. This would mean using evidence-based practices (EBPs) such as cognitive-behavioral therapy to address the certain attitudes and beliefs specific to this population. These may include feelings of self-entitlement, failure to take responsibility for one’s own actions, and consistent inability to recognize the consequences of one’s behavior.

The effectiveness of offender treatment programs depends on the availability of evidence-based practices. In 2004, a national sample of correctional administrators and treatment program directors from 384 programs providing substance abuse treatment for adult offenders was collected; the survey results showed that most of these programs offered less than 60% of the specified EBPs to drug-involved offenders.(5) Another study suggests the need for implementing addiction treatment that embodies the principles of neuroscience, which would reduce criminal behavior stemming from brain changes associated with repeated drug use.(6)

Reducing recidivism rates with education, post-release drug treatment and counseling

Education is the key to upward mobility in society. Educational programs within the correctional systems have a positive impact on individuals upon release from incarceration. The United States Department of Justice cited a meta-analysis examining the effects of correctional education programming on recidivism and post-release employment, revealing that the odds of recidivism are reduced by 43% when inmates participate in an education program, and secondary degree programs yielded a 30% decrease in recidivism.

Correctional populations: Level of education and types of jobs held prior to incarceration
A closer look at the populations in the correctional system shows that the majority of inmates do not have a college education. The average educational levels of incarcerated individuals, according to a 2003 report on Education and Correctional Populations published by the Office of Justice Programs, are described as follows:

• About 18% of the general population aged 18 and older have not finished 12th grade
• Approximately 41% overall of inmates in America’s State and Federal prisons and local jails have not completed high school or its equivalent
• About 68% of State prison inmates have not received a high school diploma

A longitudinal study on prisoner reentry in three states revealed that the majority of inmates held entry level jobs in the construction, maintenance, cleaning, automotive and food service industries prior to incarceration. About 35% of these inmates resorted to illegal income as a source of financial support, and an estimated 11% of prisoners resorted to criminal activities as full-fledged sources of income before they were sentenced to time in prison or jail.

Low-skilled jobs seem to be the only options for individuals exiting the correctional systems, and if their highest level of education is a high school diploma at best, chances are they might resort to illegal activities again to financially support themselves and their loved ones. The story of Bob, a former inmate who faced employment challenges after re entering society, illustrates this point very well. Like most former prisoners trying to reintegrate into the community, Bob was intentional in finding a job that would support him and his family, but after an extensive job search, most likely being turned down by many employers because of his criminal record, Bob finally gained employment, albeit a low-paying one. Living from paycheck to paycheck, Bob subsisted on minimum income to pay the bills and could not afford to buy Christmas gifts. Resorting to illegal activities to provide gifts for his family during the holidays, he broke his parole and returned to prison.

Education about Substance Abuse Addiction
The American Psychological Association cited several studies that show the value of substance abuse treatment and education within the correctional system. Dr. Harry K. Wexler, a leader in prison reform, published his research in the 1990s that documented how prison-based addiction treatment, combined with aftercare, drastically reduced rates of recidivism. Another study led by researcher Steven S. Martin found that a significantly higher percentage of inmates who participated in any aspect of a substance abuse program remained drug-free and arrest-free one year after release, compared to those who were just assigned to the usual work release program. After three years of post-release, those who continued with the therapeutic community (TC) aftercare had significantly lower rates of drug use and recidivism than those who dropped out of the program. Diversion models such as TASC, DTAP and SACPA have been effective in reducing drug use and recidivism (Belenko, Hiller & Hamilton, 2013). Although therapeutic communities have been proven effective in reducing recidivism rates in correctional facilities, only a small fraction of state prisons provide alcohol and drug dependency, counseling and awareness programs compared to federal prisons (Stephan, 2005). Recognizing that such a small fraction of former inmates receives TC treatment for substance abuse, linking them to alcohol and drug treatment programs in the community is vital to their reintegration into society.

Education: Raising the Academic Standards for Former Inmates
Fortunately, former inmates do not have to be limited to low-paying jobs after prison release. There are a number of high paying jobs that would hire individuals with prior convictions for blue-collar positions. Affordable college programs are available for ex-felons who cannot attain financial aid, and there are ways to honestly answer questions on a college application with regard to one’s criminal background. Traditionally, students with criminal records have not been eligible for financial aid, but the good news now is the opportunity to apply for a Pell Grant, made available through the Second Chance Pell Experimental Sites Initiative. Through this initiative, about 65 colleges – most of which are community colleges – have offered training and education for 12,000 prisoners on an annual basis, according to an article published in The Chronicle of Higher Education.

The importance of education for incarcerated individuals is recognized by institutions of higher education. As noted by the Center for American Progress, initiatives such as the Harvard Organization for Prison Education and Reform as well as the Petey Greene Program have sent trained volunteers to mentor, educate and inspire individuals within the prison systems in order to empower them upon release.

References

1 Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009). Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA , 301 (2), 183-90.

2 Center for Substance Abuse Treatment. Substance Abuse Treatment for Adults in the Criminal Justice System. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 44.) 5 Major Treatment Issues and Approaches. Available from: https://www.ncbi.nlm.nih.gov/

3 Marlowe D. B. (2003). Integrating substance abuse treatment and criminal justice supervision. Science & practice perspectives , 2 (1), 4-14.

4 Center for Substance Abuse Treatment. Substance Abuse Treatment for Adults in the Criminal Justice System. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 44.) 10 Treatment for Offenders Under Community Supervision. Available from: https://www.ncbi.nlm.nih.gov/

5 Friedmann, P. D., Taxman, F. S., & Henderson, C. E. (2007). Evidence-based treatment practices for drug-involved adults in the criminal justice system. Journal of substance abuse treatment , 32 (3), 267-77.

6 Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009). Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA, 301(2), 183-90.

7 Belenko, S., Hiller, M., & Hamilton, L. (2013). Treating substance use disorders in the criminal justice system. Current psychiatry reports, 15(11), 414.

8 Stephan, J. (2005). Census of State and Federal Correctional Facilities, 2005 (Washington: U.S. Department of Justice, 2008), 6, https://www.bjs.gov/content/pub/pdf /csfcf05.pdf.

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