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Implementing Effective

Implementing Effective. Substance Abuse Treatment. In the Criminal Justice System. Nora D. Volkow, M.D. Director National Institute on Drug Abuse. U.S. Adult Offender Population. Corrections officials estimate 70-85% of inmates need drug treatment (GAO, 1991) 68% of jail inmates

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Implementing Effective

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  1. Implementing Effective Substance Abuse Treatment In the Criminal Justice System Nora D. Volkow, M.D. Director National Institute on Drug Abuse

  2. U.S. Adult Offender Population Corrections officials estimate 70-85% of inmates need drug treatment (GAO, 1991) 68% of jail inmates report regular drug use (BJS, 2005) In 2007, an estimated 7.3 million adults were involved in the criminal justice system

  3. Share of adults under correctional control, year end 2007 Source: Pew Center on the States, March 2009.

  4. 1 19 4 6 15 12 11 16 58 70 65 23 Incarcerated for Drug Offense *** Drug Abuse/ Population Dependence * Incarceration for Drug Offenses Disproportionately Affects Minority Populations 100% 80% 60% 40% 20% 0% White Black Hispanic Other Sources: * 2002 NSDUH, DHHS, SAMHSA, 2003. ** CDC HIV/AIDS Surveillance Report 2002. *** Prisoners in 2002, BJS Bulletin, DOJ/OJP, July 2003. (estimated number of sentenced prisoners under State jurisdiction, 2001)

  5. Many Offenders Have a Drug Use Disorder … But Few Receive Treatment Mumola & Karberg. Drug use and dependence, state and federal prisoners, 2004. BJS, 2006 (rev 07)

  6. Without Treatment & Aftercare Drug Use & Recidivism Rates are High CREST Completers + Aftercare CREST Completers + Aftercare No Treatment No Treatment CREST Dropouts CREST Dropouts CREST Completers CREST Completers Delaware Work Release TC (Crest) + Aftercare Drug-Free an Arrest-Free 3 Years After Release (N=448) 100 * 80 69 Arrest-Free Drug-Free * 55 60 * 35 * 29 40 28 27 * 17 20 5 0 Martin, Butzin, Saum, & Inciardi (1999), The Prison Journal * p < .05 from Comparison

  7. Relative Risk of Death Among Former Inmates of the Washington State Department of Corrections Compared to Other State Residents @ 2 Weeks Post Release 14 12 10 8 Relative Risk of Death 6 4 2 0 Liver Overdose CV Homicide Suicide MV Disease Disease Accident Binswanger, IA et al., NEJM 356(2):157-165, 2007.

  8. drug use/ incarceration Landscape of Consequences adverse life events increase risk for substance abuse

  9. ADDICTION IS A DISEASE OF THE BRAIN Dopamine D2 Receptors are Lower in Addiction DA DA Cocaine DA DA DA DA DA DA DA DA DA DA Reward Circuits Non-Drug Abuser Meth DA D2 Receptor Availability DA DA DA Alcohol DA DA DA Reward Circuits Drug Abuser Heroin Adapted from Volkow et al., Neurobiology of Learning and Memory 78:610-624, 2002. control addicted

  10. Dominant Subordinate Individually Housed Group Housed 50 40 30 Reinforcers (per session) * * Dominant 20 10 0 S .003 .01 .03 .1 Cocaine (mg/kg/injection) Subordinate Morgan, D. et al. Nature Neuroscience, 5: 169-174, 2002.

  11. Treatment Linkage & Days Used Heroin 6 Months Post-release Days In Treatment Days Used Heroin 90% 85% 80% 64% 70% 57% 60% 50% 46% 35% 40% 30% 20% 11% 10% 0% C C + T C + M C = Counseling Only C+T = Counseling & Treatment Referral C+M = Counseling & Methadone Started in Prison Source: Gordon, MS et al., Addiction 103:1333-1342, 2008.

  12. Treating Addiction in the Criminal Justice System is Cost-Effective Cost of Treatment (average cost for 1 year of methadone maintenance treatment) Cost of Incarceration $4,700 $24,000 (cost of one full year of imprisonment)

  13. Although Treatments For Addiction Are Available, They Are Not Being Widely Used By Those Who Need Them Location TX Received In 2007 An Estimated 22.3 Million Americans Were Dependent On or Abused Any Illicit Drugs or Alcohol But…Only 3.9 Million (17%) of These Individuals Had Received Some Type of Treatment In the Past Year 2.2 Self Help Group Outpatient Rehab Inpatient Rehab Outpatient Mental Health Center Hospital Inpatient Private Doctor’s Office Emergency Room Prison or Jail 1.7 1.0 0.9 0.8 0.6 0.5 0.3 0 .5 1.0 1.5 2.0 2.5 Numbers in Millions Source: 2007 NSDUH, National Findings, SAMHSA, OAS, 2008.

  14. Research Center Blending Research & Practice CJ-DATS Focus Areas • Understanding systems • Assessing offender problems • Measuring progress in treatment • Linking criminal justice & drug treatment • Adolescent interventions • HIV & hepatitis risk reduction NIDA Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) Research Centers & CJ Partner Sites

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