Substance Abuse & the Criminal Justice System: Looking Back, Looking Forward

1. Substance Abuse & the Criminal Justice System:Looking Back, Looking Forward Presented By: Maureen McDonnell Director for Business Development TASC, Inc. TIPPS Conference Dallas, TX June 14, 2010

2. TASC, Inc. • Designated Agent to provide substance abuse assessments for felony offenders • Designated case management provider for parolees • Services include assessment, advocacy and clinical case management services. We do not provide substance abuse treatment. • We serve approximately 25,000 offenders each year in Illinois. • We work with all publicly funded treatment programs in the state. • We work at all points in the CJS: Diversion, Sentencing Alternatives including Drug Courts, Probation, Jail/Prison pre-release and Re-Entry • We also provide services in the juvenile justice and child welfare systems. • Advocate nationally for productive policies • Provide training and technical assistance on these issues

3. Addiction: Public Health & Public Safety Challenge • In 2008, 2,319,258 prisoners were held in federal or state prisons or in local jails • 1,596,127 in prison, 723,131 in local jails • 1 out of every 100 citizens for the first time in history • The number of adults who were being supervised on probation or parole at the end of 2006 reached 5,035,200 • 4,237,000 were on probation (84%) • 798,200 were on parole (16%) Source: Pew Center for the States, Bureau of Justice Statistics

4. Drugs are a Major Factor • The justice system is largest catchment area for people with addictions • In 2006, alcohol and other drugs were involved in these inmate offenses: • 78 percent of violent crimes; • 83 percent of property crimes; and • 77 percent of public order, immigration or weapon offenses; and probation/parole violations. • Between 77-84% of these offenders were substance-involved • As many as 87% of arrestees tested positive for at least one illicit drug & 40% for more than one drug Source: BJS Arrestee Drug Abuse Monitoring Survey 2008; CASA, "Behind Bars II", February 2010

5. Effective Treatment is a Necessary Alternative • The criminal justice system is a “revolving door” – too many people cycle through the system too often • Over 2/3 re-arrested w/in 3 years of leaving prison • Avg. cost per inmate per year to states in the U.S. • = $22,650 • Successful CJS supervision and community based recovery results in return to productive, healthy citizenship • No re-arrests • No re-incarceration • Building durable recovery • Building a pro-social life in the community Sources: West & Sabol, 2008; Langan & Levin, 2002; Glaze & Bonczar, 2008; Mumola, 2000, Stephan, 2004

6. Major National Trends: 2000 - 2010

7. Countervailing Forces Through the Decade • Move Toward More Sensible CJS Policies & More Effective Practices • Expansion of “Therapeutic Jurisprudence” • Economic Recession: Pressure to Reduce Prison Populations and Rehabilitative Services “Tis the set of the sail that decides the goal and not the storm…” -Ella Wheeler Wilcox

8. Major National Trends: 2000 - 2010 • Dramatic increases in penalties for drug possession slowed from previous decade • Not reduced, but leveled out • Reductions in penalties for marijuana possession • Exceptions • Trend to making DUI/DWI cases felony offenses (increases penalties) • Escalating penalties for methamphetamine Impact: Stopped escalating sentences, slowed the growth of incarceration

9. Major National Trends: 2000 - 2010 • Expanded focus on “Therapeutic Justice” • Focus on reducing recidivism through combined court supervision and mandatory treatment • Proliferation of Specialty Courts • More drug courts – more than 2,500 nationwide • New in this decade: • Mental Health Courts – more than 300 nationwide • Veterans Courts – new since 2008 • DUI Courts – growing interest Impact: Strong results, but overall reach a small percentage of people in the CJS who could benefit from treatment

10. Major National Trends: 2000 - 2010 • Expanded Focus on Successful Reentry • Focus on reducing recidivism through • In-prison treatment • Post-release treatment & supervision • New in this decade • Comprehensive, full-scale models in place • Sheridan and Southwestern Illinois Correctional Centers • Includes in-prison treatment, post-release treatment & case management, vocational programs pre- and post-release • Graduates 85% less likely to return to prison than control group • Use of graduated sanctions as alternative to re-incarceration in case of parole violations

11. Major National Trends: 2000 - 2010 • New types of providers and partners for offenders • Recovery homes, faith-based providers and other non-traditional community-based organizations • Created diversity of options and some expansion of capacity • As yet no research that demonstrates improved outcomes • Focus on community partnerships to sustain reentry and recovery • Community Re-Entry Councils • Texas: Travis, Tarrant & Bexar Counties • Expansion of Treatment Capacity Run by CJS • Greater control • Addresses gaps in the system • May not establish long-term community support for recovery

12. Major National Trends: 2000 - 2010 • Return to System Thinking: Courts/Diversion • Proposition 36 – California • Approved November 2000 • Required that non-violent drug offenders be sentenced to probation with treatment • Few penalties for non-compliance • Overwhelmed the treatment system • Evidence-Based Probation Pilots (NIC) • Based in criminological research • Substance abuse as one of 8 factors determining risk • Increased focus on probation officer as agent of change, not just compliance

13. Major National Trends: 2000 - 2010 • Economic analysis resulting in greater interest in more cost effective strategies, economic crisis driving solutions. • Justice Reinvestment www.justicereinvestment.org • Second Chance Act www.ojp.usdoj.gov/BJA/grant/SecondChance.html • Focus on the aggregate impact of decision-making • “One in 31” www.pewcenteronthestates.org/report_detail.aspx?id=49382 • Disproportionate Confinement of Minorities

14. State budget crises create pressure to reduce prison populations Figures from September 8, 2009 Figures from February 25, 2010 (Center on Budget & Policy Priorities, 2009, 2010; Vandivort, 2010)

15. Major National Trends: 2000 - 2010 • Much Better Understanding of What Works in Offender Treatment and Rehabilitation • National Criminal Justice—Drug Abuse Treatment Studies (CJ-DATS) – Multisite research program • Texas Christian University IBR • Aimed at improving the treatment of offenders with drug use disorders and integrating criminal justice and public health responses to drug involved offenders • Goal: Establish a research base that definitively supports “what works” in substance abuse rehabilitation with offenders http://www.cjdats.org/Wiki%20Pages/Home.aspx

16. Now & Next 5 Years • Economic pressure at the state and county levels will continue • Focus on reducing prison populations • Creates more opportunities to build services that divert people from prison to treatment in the community • At sentencing and on violations • Tremendous pressure on treatment system funding • Some balance from federal programs • Second Chance Act • SAMHSA Offender Reentry Programs • Drug Court Enhancement & BJA partnerships • Access to Recovery

17. Health System Developments • New Parity Law Requirements • Changes in the treatment system will impact CJS access • Implementation: Paradox • Could result in a “race to the bottom” with shorter stays, less care • With proper advocacy, could result in better standards of care • National Health Care Reform • Medicaid Expansion for people under 133% FPL (2014) • Could result in major changes to services offered & providers • Need to partner with CJS to say what is needed • Local cross-system planning • State level advocacy

18. What Services Will be Covered? Medical Model Social Services Assess &Link to Service Residential Part of RT Primary PS Treatment Employment Support Prevention & Screening Drug Free Recreation Stress Management Drop In Centers Family/Relationship Groups Peer Counseling Role Modeling & Mentoring Housing in Oxford & TCs Recovery Coaching Instead of Disease Model, Need Health/Wellness Model Source: Vandivoort, Rita M., SAMHSA, “Health Care Reform and Its Implications for Treatment of Substance Use Disorders”, 2010 (Modified based on conference call, 3/5/10)

19. Best Case Scenario • Communities will use new funds to build capacity • Ensure rapid entry into the right level of care • Virtually all alcohol and drug-dependent offenders would have funding to go to treatment • Communities will design better systems • Expand use of high-quality services • Effective at keeping people safe, healthy drug- and crime-free in the community • Communities will establish systems to integrate the criminal justice and treatment systems • Communities will establish better integration with medical care providers • Federally Qualified Health Centers

20. New Strategies: Medication-Assisted Treatment • MAT is an evidence-based treatment practice • One of the treatment strategies endorsed by NIDA and SAMHSA* • Includes current medications for: • Opiate addiction (Methadone, Buprenorphine, Naltrexone) • Alcohol dependence (Vivitrol) • Medications are under development to treat cocaine addiction • Manages cravings so people can participate in treatment • Psycho-social rehabilitation is still necessary, especially for drug-involved offenders *Principles of Drug Abuse Treatment for Criminal Justice Populations - A Research-Based Guide http://www.nida.nih.gov/PODAT_CJ/

21. New Strategies: SBIRT SBIRT = Screening, Brief Intervention and Referral to Treatment • Developed in SAMHSA • Model developed to identify substance abuse in primary care • World Health Organization – screening tools • Extensive demonstration projects in the U.S. since 2003 • ONDCP is interested in its application to the criminal justice system

22. How Would This Work in the CJS? • Screening at all feasible points to get as close to universal intervention as possible • Police lock-up • Jail • Bond court • In courtrooms • Probation • Brief Intervention by specialized staff, again in all settings • Option: Require participation in alcohol/drug education classes • State’s Attorney’s Drug Abuse Program (Chicago) • 85% of people are not re-arrested within 3 years

23. Presenter Contact Information Maureen McDonnell Director For Business Development TASC, Inc. mmcdonnell@tasc-il.org 312-573-8222 www.tasc-il.org www.centerforhealthandjustice.org