Drug Addiction Treatment in the Criminal Justice System

Drug Use, Crime, and Incarceration

The connection between drug use and crime is well known. Drug use is implicated in at least five types of drug-related offenses:^[i]

1. Offenses related to drug possession or sales
2. Offenses directly related to obtaining drugs (e.g., stealing to get money for drugs)
3. Offenses related to a lifestyle that includes association with other offenders or with illicit markets
4. Offenses related to abusive and violent behaviors, including domestic violence and sexual assault
5. Offenses related to driving while intoxicated or under the influence, which can include property damage, accidents, injuries, and fatalities.^[ii]

Incarceration

Drug use and intoxication can impair judgment, resulting in criminal behavior, poor anger management, and violent behavior. Sometimes drug users steal money or property to be able to buy drugs. Often they will commit crimes while “high” on drugs, and many drug users are sent to jail or prison. In 2012, nearly 7 million adults were involved with the criminal justice system (State or Federal prisons, local jails), including nearly 5 million who were under probation or parole supervision.^[iii] A 2004 survey by the U.S. Department of Justice (DOJ) estimated that about 70 percent of State and 64 percent of Federal prisoners regularly used drugs prior to incarceration.^[iv]  The study also showed that 1 in 4 violent offenders in State prisons committed their offenses under the influence of drugs.

Most prisoners serving time for drug-related crimes were not arrested for simple possession. Among sentenced prisoners under State jurisdiction in 2008, 18 percent were sentenced for drug offenses and only 6 percent were incarcerated for drug possession alone. Just over 4 percent (4.4%) were drug offenders with no prior sentences. In 2009 about half (51 percent) of Federal prisoners, who represent 13 percent of the total prison population, had a drug offense as the most serious offense. Federal data show that the vast majority (99.8 percent) of Federal prisoners sentenced for drug offenses were incarcerated for drug trafficking.^[v]

Simple possession is even less of a factor with crimes related to marijuana. Only one-tenth of 1 percent (0.1 percent) of State prisoners were marijuana possession offenders with no prior sentences.^[vi]

Drug Abuse Treatment

Treatment offers the best alternative for interrupting the drug use/criminal justice cycle for offenders with drug problems. Jail or prison should be a place where people can get the help they need, and offenders should ask if treatment is available. Untreated substance using offenders are more likely to relapse into drug use and criminal behavior, jeopardizing public health and safety and taxing criminal justice system resources. Additionally, treatment consistently has been shown to reduce the costs associated with lost productivity, crime, and incarceration caused by drug use.^[vii]

Scientific research shows that treatment can help many drug using offenders change their attitudes, beliefs, and behaviors; avoid relapse; and successfully remove themselves from a life of substance use and crime. Treatment can cut drug use in half, decrease criminal activity, and reduce arrests. It is true that legal pressure might be needed to get a person into treatment and help them stay there. Once in a treatment program, however, even those who are not initially motivated to change can become engaged in a continuing treatment process. In fact, research suggests that mandated treatment can be just as effective as voluntary admission to rehab centers.^[viii]

Drug abuse treatment can be incorporated into criminal justice settings in a variety of ways. These include:

• Treatment as a condition of probation
• Drug courts that blend judicial monitoring and sanctions with treatment
• Treatment in prison followed by community-based treatment after discharge
• Treatment under parole or probation supervision.

Why Family Support is Critical

Drug use often leads to violence; separation of parents and children; loss of jobs; feelings of hopelessness; serious money problems; single parenthood and worry over childcare needs; harmful relationships; emotional and behavioral difficulties in children; and dangerous driving that can result in the death of the drug user, family members, or innocent travelers on the road. 

In 2007, 53 percent of prisoners in Federal and State prisons reported having children under the age of 18.^[ix] Children with parents who use drugs and abuse alcohol are widely considered at high risk for a range of physical and behavioral problems, including substance use. Juvenile justice systems are also affected; as many as two-thirds of juveniles who have been detained may have a substance use disorder.^[x]

Effective treatment decreases future drug use and drug-related criminal behavior, and can improve a person’s relationship with his or her family. In addition, the family needs tools and support to help deal with the offender’s incarceration, rehabilitation, and loss of income.

More Treatment Is Needed

Many prisons are not making treatment a priority, despite clear benefits to offenders, their families, and communities shown in multiple studies.^[xi] A 2004 survey showed that 40 percent of State and 49 percent of Federal inmates took part in some kind of drug program, but most were self-help or peer counseling groups. Only 15 percent of State prisoners and 17 percent of Federal prisoners took part in drug treatment programs with a trained professional.^[xii]

Coordination between criminal justice professionals, substance abuse treatment providers, and other social service agencies can improve outcomes for people with substance use problems. By working together, the criminal justice and treatment systems can optimize resources to benefit the health, safety, and well-being of these offenders, their families, and their communities.

Treatment Principles: An Overview

Principles for Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide provides research-based principles of addiction treatment. The 13 principles are:

1. Drug addiction is a brain disease that affects behavior. It affects people both physically and mentally. It can alter the brain and body chemistry for months or even years after a person stops using, so relapse is often part of the recovery process. It should be treated like any other disease.
2. Recovery from drug addiction requires effective treatment, followed by management of the problem over time. Drug users cannot alter their behavior without taking care of their addiction. Treatment that starts in prison or jail must continue after release. Treatment and recovery is hard work that must continue throughout a user’s life.
3. Treatment must last long enough to produce stable behavioral change. Without the right treatment, most drug users will use again once they return to their neighborhoods, even though drugs might put them right back in prison. Treatment should last long enough (90 days or more) to help drug users learn to manage their own drug problems.
4. Assessment is the first step in treatment. Drug users need to be examined by a doctor. The doctor might prescribe medicine, and will look for other possible problems, such as depression and anxiety, or medical conditions such as hepatitis, tuberculosis, or HIV/AIDS.
5. Tailoring services to fit the needs of the individual is an important part of effective drug use treatment for criminal justice populations. Each drug user has different needs regarding addiction counseling and treatment. The best approaches take each person’s age, gender, ethnicity, culture, and needs into account.
6. Drug use during treatment should be carefully monitored. Individuals recovering from drug addiction sometimes return to drug use, called relapse. Testing for continued drug use is an important part of treatment.
7. Treatment should target factors that are associated with criminal behavior. Offenders often have patterns of behavior, attitudes, and beliefs that support a “criminal” lifestyle. Treatment that helps offenders avoid negative thinking patterns can be effective.
8. Criminal justice supervision should incorporate treatment planning for drug using offenders, and treatment providers should be aware of correctional supervision requirements. It is important that corrections personnel work with treatment providers to make sure the individual treatment plan meets the needs of both the offender and the institution.
9. Continuity of care is essential for drug users re-entering the community. People who start receiving treatment while incarcerated need to continue treatment after release.
10. A balance of rewards and sanctions encourages pro-social behavior and treatment participation. During treatment, it is important that both positive and negative behaviors are recognized.
11. Offenders with co-occurring drug use and mental health problems often require an integrated treatment management approach. Drug treatment can sometimes help people who have depression or other mental health problems. It is important that these issues are addressed in treatment programs.
12. Medications are an important part of treatment for many drug using offenders. Medicines like methadone have been shown to help reduce heroin use. Medicines for mental health issues can also be used as part of treatment.
13. Treatment planning for drug using offenders who are living in or re-entering the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, hepatitis B and C, and tuberculosis. Drug users and offenders are more likely to have infectious diseases like HIV/AIDS, hepatitis, and tuberculosis. People seeking treatment should be tested for these diseases and receive counseling on risky behaviors and seeking medical advice.

Where to Get Treatment Information

When a drug user is arrested, he or she should ask if treatment is available. The websites listed below can offer information on treatment in your area.

• U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Substance Abuse Treatment Facility Locator (searchable directory of alcohol and drug treatment programs) www.findtreatment.samhsa.gov or call the Treatment Helpline at 1-800-662-4357
• National TASC/Treatment Accountability for Safer Communities (offers leadership, advocacy, and policy recommendations for innovative treatment and recovery supports that result in opportunities for justice-involved individuals with behavioral health needs to achieve healthy and productive lives with their families and communities)  www.nationaltasc.org
• National Institute on Drug Abuse, Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide

References