Public Policy Solution #3
Coordination with Addiction Treatment and Recovery Service Providers Should Occur at Each Point of Entry into the Criminal Justice System

Research has demonstrated that the most effective approaches to addressing addiction in the criminal justice system are those that integrate criminal justice supervision and the full range of effective addiction treatment and recovery support services. Integrating addiction treatment services in the criminal justice system yields the best results by optimizing the quality of both supervision and services and sending the clear and strong message from all parts of the law enforcement community—judiciary, prosecutor, defender, incarceration facilities, and supervision staff—that treatment is a central aspect of the sentence issued or of a pretrial release condition.¹

“In general, the most effective programs integrate criminal justice and drug treatment systems and services. Treatment and criminal justice personnel work together on plans and implementation of screening, placement, testing, monitoring, and supervision, as well as on the systematic use of sanctions and rewards for drug and alcohol dependent people in the criminal justice system. Treatment for this population must include continuing care, monitoring, and supervision after release and during parole.”²

In truly integrated programs, the criminal justice system retains ultimate jurisdiction or authority over individuals.³ Programs that jointly allocate responsibility to criminal justice and addiction treatment professionals are in the best position to adjust their efforts, depending upon the person’s progress in the program.  This arrangement provides maximum flexibility and access to resources for handling an often impaired and potentially resistant population.⁴ However, treatment professionals should be authorized to make decisions about treatment, based on individual assessments and progress.  The degree to which criminal justice authorities and treatment practitioners actively coordinate their functions should be based upon a careful assessment of the person’s risk status and ongoing monitoring of his or her progress in treatment.  The need for systematic assessment of drug-involved offenders is crucial and is being addressed through development of several instruments as part of NIDA’s CJ-DATS program.

Key Ingredients for Successful Integration:

An integrated model is more than merely providing treatment services for select individuals or programs; rather it creates a service delivery system that provides a framework for decision-making on treatment issues, regardless of an individual’s legal status. In addition, addiction treatment for people in the criminal justice system should also focus on the attitudes and beliefs that support and lead to criminal behavior; effective treatment includes skills development that helps individuals recognize past errors in judgment and teaches them how to make choices that avoid drug and alcohol use and criminal activity in the future.⁵

An integrated system must ensure that the policies and procedures of each decision point incorporate scientific principles of effective care, including:

 
• An assessment process that integrates treatment and criminal justice information.
 
• A comprehensive treatment plan that is designed to reduce the risk of recidivism, and the frequency and consumption of alcohol and other drugs.
 
• Treatment that stabilizes the person and assists them in becoming a more productive member of society.
 
• Behavioral management techniques that leverage rewards and consequences to increase compliance and improve overall outcomes.⁶ and
 
• Treatment that recognizes addiction as a chronic, relapsing condition and provides clinically appropriate responses to relapse.

Much of the responsibility for individuals moving from incarceration to the community lies with community supervision agencies, known in many jurisdictions as parole or post-prison supervision. To reach the levels of system collaboration and services integration required, staffs from criminal and juvenile justice supervision and addiction treatment agencies must reach beyond traditional roles and service boundaries by brokering services across systems, sharing information, and facilitating the treatment process.⁷ As each agency brings its own culture, agenda, and operational differences to the planning process, administrators from each of the participating agencies must work together to establish compatible goals, policies, and procedures.⁸ When the correctional system and the treatment system collaborate effectively, they can increase the likelihood of treatment success and reduce the risk of relapse and future criminal behavior.⁹

Utilizing the Full Range of Research- and Evidence-Based Approaches to Treatment Service Delivery:

Studies have consistently demonstrated that the full range of addiction treatment and recovery support services is effective in reducing drug and alcohol use and future crime among the criminal justice population: these include residential, medication-assisted, drug and alcohol-free out-patient, relapse prevention and other recovery supports.¹⁰

Residential Treatment/Therapeutic Communities

Residential programs have a well-documented ability to successfully treat individuals in the criminal justice system successfully. The Therapeutic Community (TC) model has been studied extensively and has been shown to be effective in reducing drug and alcohol use and criminal behavior.¹¹ TC’s use treatment approaches that include individual and group counseling, drug and alcohol education, relapse prevention and cognitive-behavioral skill-building activities designed to address criminogenic risk factors (e.g. criminal thinking, poor decision making skills, anti-social attitudes, etc).¹² TCs have proven to be effective as part of a community sanction (e.g., through a diversion program), as a condition of probation, or as an option during and after incarceration.¹³

Research indicates that prison-based treatment alone does not achieve the full potential for preparing addicted inmates to reenter society; rather, in-prison TCs with follow-up drug and alcohol treatment once the individual is released into the community have proven to be the most effective and cost-beneficial. (See Public Policy Lesson 4 below)

 
• A cost-benefit analysis conducted on the Amity prison TC program by the California legislature concluded that if the impacts of the Amity TC could be replicated more broadly throughout the California prison system, projected prison expansion over the next seven years could be reduced by 4,700 beds, for an annual savings of over $80 million.¹⁴
 
• An evaluation of the KEY-CREST prison TC and community aftercare program in Delaware found that inmates who completed all phases of treatment had a rearrest rate of only 31 percent after three years, compared with 71 percent for similar inmates without treatment.¹⁵
 
• A separate evaluation also found that inmates who had completed KEY-CREST had significantly higher levels of employment and legitimate income after release than did untreated individuals.¹⁶

Medication-Assisted Treatment

Medications for the treatment of alcohol and drug addiction are seriously underutilized in the criminal justice system despite the fact that several medications have demonstrated success in reducing substance use and crime among court-involved individuals.¹⁷ Methadone maintenance treatment, in particular, has been consistently demonstrated in numerous experimental studies to reduce drug use and criminal activity among opiate addicts.¹⁸ One study on the use of methadone treatment indicated a decrease in criminal behavior by as much as 80 percent.¹⁹Researchers at the University of Pennsylvania found that Federal probationers who received naltrexone, another medication used for the treatment of opioid dependence, in combination with counseling had lower rates of opioid-positive drug tests and were less likely to be reincarcerated for probation violations than those receiving counseling alone.²⁰

Out-Patient Treatment

Outpatient treatment programs encompass a wide variety of programs for individuals with addiction histories who visit a clinic at regular intervals. Studies have shown that both inpatient and outpatient treatment programs are effective in producing positive outcomes for people who are addicted to alcohol and other drugs. Examples of studies demonstrating the effectiveness of outpatient treatment follow:

 
• Data from a Massachusetts treatment outcomes report (2000) indicated a 46 percent drop in arrests among outpatients at three months-post discharge. In addition, the abstinence rate for outpatient clients rose from 55 percent to 71 percent at three months after discharge.²¹
 
• Outcomes assessments for Wisconsin outpatient programs found that at six months post-discharge individuals who received outpatient treatment had an abstinence rate of 69 percent, that the person’s ability to function on the job increased from 55 to 95 percent for outpatient clients, and that self-reports of good to excellent health increased from 55 to 77 percent for outpatients.²²

Relapse Prevention and Other Recovery Support Services

Because addiction is often a chronic relapsing condition, recovery support strategies should be integrated into reentry services that help formerly incarcerated individuals make the transition back into the community successfully (see Key Question 4 above). Relapse prevention helps individuals learn new ways of acting and thinking that will help them stay off drugs, ,avoid situations that lead to drug use and increase drug refusal skills. Research indicates that the skills individuals learn through relapse prevention therapy remain following treatment completion. In one study, most people maintained the gains they made in treatment throughout the year following treatment.²³

Recovery support services (see Key Question 6 above) help individuals with addiction histories maintain their recovery. Frequently led by people who are themselves in recovery, these support services include recovery circles and other types of support groups, recovery coaching and additional forms of peer mentoring, case management and referral services, and workshops that help individuals develop necessary skills. Research has shown that individuals with addiction histories need continued supports; recovery support services are effective in helping people to stay sober and healthy.²⁴

Case Management

People under the supervision of the criminal justice system in the community are often referred to addiction treatment through a case management program, which provides a liaison between the criminal justice system and addiction treatment programs. These programs usually assess individuals needs, provide a monitoring function, and either provide or refer individuals to services.²⁵ Activities take place within the context of an ongoing relationship.

The goal of case management is continuity of treatment, which, for the individual in the criminal justice system, can be defined as the ongoing assessment and identification of needs and the provision of treatment without gaps in services or supervision.²⁶ Ideally, case management activities should begin in the courts for individuals who may be appropriately be referred to community-based treatment, and, for those who are incarcerated, should begin in the institution before release and continue without interruption throughout the transition period and into the community. Transition planning should begin at least 90 days before release from prison, and as soon as possible for individuals incarcerated for shorter lengths of time in jail. Early initiation of transition planning is important because it establishes a long-term, consistent treatment process from institution to community that increases the likelihood of positive outcomes.²⁷

In a research study of 1,400 arrestees in two metropolitan jurisdictions, case management was shown to reduce drug use and recidivism and increase use of substance abuse treatment among drug-involved arrestees released after booking. Case management has also been shown to encourage entry into treatment, and to reduce the time to treatment admission.²⁸ According to the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment, case management may be an effective adjunct to substance abuse treatment because it focuses on the whole individual and stresses comprehensive assessment, service planning, and service coordination to address multiple aspects of a person’s life. A principal goal of case management is to keep individuals engaged in treatment and moving toward recovery and independence.

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