1 / 36

Implementing Effective Substance Abuse Treatment in the Criminal Justice System: The Public Safety and Public Health Ben

Implementing Effective Substance Abuse Treatment in the Criminal Justice System: The Public Safety and Public Health Benefits of Expanding Treatment Services . Steven Belenko, Ph.D. Temple University Department of Criminal Justice. Congressional Briefing and Panel Discussion Washington, DC

lotus
Download Presentation

Implementing Effective Substance Abuse Treatment in the Criminal Justice System: The Public Safety and Public Health Ben

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Implementing Effective Substance Abuse Treatment in the Criminal Justice System: The Public Safety and Public Health Benefits of Expanding Treatment Services Steven Belenko, Ph.D. Temple University Department of Criminal Justice Congressional Briefing and Panel Discussion Washington, DC March 27, 2009

  2. Overview • Scope of the problem • drug use and drug dependence • co-occurring disorders • Treatment need and utilization • The benefits of treating drug-involved offenders • Expanding treatment access

  3. Drug Crime And Drug Use Among Arrestees • 1.8 million drug arrests in 2007 (15% of all arrests) • 82.5% for possession, 17.5% sale • 2/3 of all arrestees test positive for illegal drug • 1/3 cocaine • 40% marijuana • 6% opiates • Arrestees at risk for drug dependence: 43.1% • Source: NIJ Arrestee Drug Abuse Monitoring Program

  4. Federal & State Prison Population 1980-2005

  5. Severity of Substance Abuse Disorders Among Inmates • 70-80% inmates have used illegal drugs • Adults--31% Males, 52% Females need intensive tx services • 53% meet criteria for abuse/dependence • Juveniles—50% need services SOURCE: Belenko & Peugh (2005)

  6. Offenders Under Community Supervision • 37% of state prison commitments are for violations of parole or other release conditions (BJS, 2000) • Substance use is major contributing factor • More than two-thirds of adults on probation or parole have history of illegal drug use (Mumola, 1998) • only 25% of probationers with drug use histories receive treatment (Mumola, 1998)

  7. Justice-Involved 4 Times More Likely to have Substance Use Disorder than General Population SOURCE: National Household Survey on Drug Use and Health, 2005.

  8. Co-Occurring Substance Abuse and Other Disorders

  9. Co-Occurring Disorders Common among State Inmates

  10. Comparisons With Community Samples NOTE: Diagnostic criteria vary slightly by survey. All data past 12 months. SOURCES: Belenko et al., 2008; Falk et al. (2008); Grant et al. (2005)

  11. Infectious Disease Rates Are High • 18% of state prison inmates • have history of injection drug use • 1.8% of state prison inmates have HIV/AIDS • AIDS rate 2.5 times higher than general population • Estimated 16%–41% ever infected with HCV, compared with 1%–1.5% in the non-inmate population (CDC, 2008) • primarily associated with a history of injection drug use • 24.2 TB cases per 100,000 inmates, compared with 6.7 among non-inmate population

  12. Treatment Utilization 13

  13. % of Adult ADP in SA Treatment Services (Missed Opportunities) Estimates of Residential Tx Need (Belenko & Peugh, 2005): 31.5% Males, 52.3%Females % of ADP in SA Tx Services

  14. Treatment Received Since Admission to Prison

  15. Effective Treatment 16

  16. Beneficial Effects of Offender Treatment Reduced recidivism and relapse, increased social productivity: Findings from Randomized Clinical Trials and meta-analyses Prison therapeutic community treatment with aftercare Multisystemic Therapy with juvenile offenders Multidimensional Family Therapy Drug Treatment Alternative to Prison program (DTAP) Drug courts Diversion and case management (TASC) Cognitive Behavioral Therapy Motivational Enhancement Addiction medications

  17. Prison-Based Therapeutic Communities • Data for Key Crest and Kyle New Vision based on 3 year outcome studies • Date for Amity based on 5 year outcome study

  18. The High Costs of Corrections $31.4 billion state expenditures for institutional corrections $6.9 billion state expenditures for community institutional corrections Annual cost per prison bed $27,500 (adjusted to 2008 $) Source: Bureau of Justice Statistics

  19. Economic Benefits of CJ Treatment 2/3 of the annual $168 billion social costs of illegal drug use due to drug-related crime (Belenko et al., 2005; ONDCP, 2001) Four comprehensive drug court cost analyses show net economic benefits (mostly because of reduced use of incarceration) Benefit/cost ratio of 2.17 for diversion to TC treatment, through 6 years post-admission (Zarkin et al., 2003) Benefit/cost ratios from 1.79 to 5.74 for different prison treatment modalities (Daley et al., 2004) Prison treatment + aftercare is cost effective (McCollister et al., 2003, 2004)

  20. Multiple Treatment Options and Linkage Points 21

  21. Substance Abuse Treatment Programs • In prison • Residential Therapeutic Communities* • Cognitive behavioral therapy* • Self help groups (e.g. AA, NA) • Relapse prevention* • Transitional Treatment • Aftercare* • In the community • Brief interventions • Pharmacotherapy (e.g. methadone maintenance)* • Drug Courts* • Diversion • Motivational enhancement* • Self help groups (e.g. AA, NA) • * Evidence-based practice

  22. Over Half of CJ Facilities Offer Some Type of Services

  23. What type of treatment should offenders receive ? No Use 30% Depen-dent 31% Abuse 20% User 19% Education Outpatient Intensive OPT Residential Belenko & Peugh, 2005; Taxman, et al., 2007

  24. A Public Health Perspective Population Impact = [Effect Size] * [Rate of Treatment Utilization] Tucker & Roth (2006), Coreia (2003)

  25. Implementation of Effective Treatment 27

  26. Improved Treatment → Improved Public Safety

  27. Addressing Drug Abuse in the Criminal Justice System ARREST/PRETRIAL PROSECUTION (Court, Pre-Trial Release, Jail) ADJUDICATION (Trial) SENTENCING (Fines, Community Supervision, Incarceration) CORRECTIONS (Probation, Jail, Prison) COMMUNITY REENTRY (Probation, Parole, Release) Intervention Opportunities Drug Court Terms of Incarceration Probation Conditions Deferred sentence Drug treatment Aftercare Housing Employment Mental Health Half-way House TASC Screening/ Referral/ Brief intervention Diversion Drug Courts Community Treatment TASC N/A Drug Treatment

  28. Drug Courts Judicially supervised treatment Nonadversarial, problem-solving team approach Long term treatment with case management Accountability through drug testing, sanctions, and incentives Higher treatment retention and completion rates Systematic reviews and meta-analyses find significant reductions in post-program recidivism (Belenko, 1998, 1999, 2001; GAO, 2005; Wilson et al., 2006) Significant federal and state support BUT, only serve <10% of eligible population

  29. Diverting High-Risk Drug Offenders: The DTAP Program Drug Treatment Alternative to Prison Program Kings County (NY) district attorney began program in 1991 Drug sale, facing mandatory prison sentence Diverted to 18-24 months residential treatment in TCs One-year retention 71%, completion 62% Significant reduction in post-program drug use

  30. Cumulative Costs and Benefits per DTAP Participant

  31. Medications Treatment Effective with Offenders -- signif. diff from referral -- signif. diff from treatment only on release Methadone Experiment: 6 Mo Post Release (N=201) Source: Gordon, M.S., Kinlock, T.W., Schwartz, R.P., O’Grady, K.E. (2008).

  32. Infectious Disease Services in Adult CJS % Facilities Providing Service Source: CJ-DATS National Criminal Justice Treatment Practices Survey, NIDA

  33. Risk-Needs-Responsivity (Taxman & Thanner, 2006) Appropriate targeting and matching Importance of proper and ongoing assessments Continuity of care Step-down, step-up models Expanding service access in jails and community corrections Expanding Treatment Access for Offenders

  34. Improving Treatment Outcomes for Offenders CJ staff training on addictions and treatment Improving balance between social control and clinical needs Positioning addiction professional as equal partner Educating the CJS staff and policy makers about public safety and economic benefits of treatment Strengthen treatment infrastructure Align public safety and public health missions

  35. High prevalence of drug abuse and co-occurring disorders EB treatment for offenders exists, but not sufficiently implemented Public safety and economic benefits of treatment Expand treatment access at multiple linkage points, including medications treatment Diversion from prosecution or prison when appropriate Better assessment and continuity of care needed HIV/HCV prevention, testing, and treatment Enhancing the “Public Health” side of the partnership Conclusions

  36. Contact Steven Belenko, Ph.D. Professor Department of Criminal Justice Temple University Philadelphia, PA 215-204-2211 sbelenko@temple.edu Supported in part by: National Institute on Drug Abuse Grants R01-DA09075, R01-DA11837, R01-DA021320, U01-DA025284 38

More Related