Treatment of
Substance Abusers
Introduction
ˇ
Substance
abuse has long been associated with violence and criminal behavior.
ˇ
80%
of offenders were intoxicated during their assaultive
crimes (Mayfield, 1976).
ˇ
68%
tested positive for one or more illicit drugs at the time of their arrest in
1996.
Introduction
ˇ
Substance
abuse assessments help to identify an offender’s treatment needs,
ˇ
Can be matched with an appropriate treatment and
release risk management strategy.
Introduction
ˇ
The
increasingly large amount of drug abusing inmates in today's criminal justice
system requires an expansion of drug treatment programs.
ˇ
The
combination of these increasing numbers of substance abusers
with institutional cutbacks force decisions to be made in regards to
which inmates will receive treatment (Peters, 1992).
ˇ
In
order to make such valid treatment decisions appropriate assessments must be
carried out
Introduction
ˇ
Approximately
94 percent of Federal prisons, 56 percent of State prisons, and 33 percent of
jails provided on-site substance abuse treatment to inmates
ˇ
The
most common type of substance abuse treatment reported was treatment for
patients remaining in the general inmate population rather than residing in
treatment units apart from other inmates.
ˇ
Nearly
84% of facilities with treatment reported this type of treatment
Introduction
ˇ
Almost
70% of the inmates in treatment were treated in the general facility
population.
ˇ
About
28% of the inmates in treatment were in specialized substance abuse treatment
units
ˇ
2%
were in hospital inpatient treatment units
ˇ
Private
organizations operated 22% of the substance abuse treatment programs in state
prisons, 21% of the treatment programs in jails, and 52% of the treatment
programs in juvenile facilities
Assessment
ˇ
Currently
correctional substance abuse assessment techniques have many problems that effect the validity of evaluations:
l
Contextual
concerns
l
Issues
with valid populations
l
Instrument
design problems
Assessment
ˇ
Brochu and Levesque (1990) recommend that an ideal
substance abuse assessment instrument for a correctional context consists of
evaluations of:
l
(1)
the sequence between alcohol and drug use and first
criminal activity
l
(2)
family history of alcohol and drug abuse
l
(3)
reasons for alcohol/drug use
l
(4)
reasons for criminal behavior
l
(5)
previous treatments for abuse
l
(6)
the willingness and ability towards change
Assessment
Instruments
ˇ
Computerized Assessment of Substance Abuse
(CASA).
ˇ
315-item
CASA Identifies critical substance abuse related static and dynamic factors and
their link to criminal offending.
ˇ Assess the reliability
of self-report using the Paulhus Deception Scale
ˇ Identify topography and
density of alcohol and drug use
Assessment
Instruments
ˇ Assess severity and
consequences of drug and alcohol abuse using the following measures:
l
Michigan Alcoholism Screening
Test (MAST)
l
Alcohol
Dependence Scale (ADS)
l
Problems
Related to Drinking (PRD)
l
Severity
of Dependence Scale (SDS)
l
Drug
Abuse Screening Test (DAST)
ˇ Identify poly-substance
use
ˇ Family History of
substance use
ˇ Identify prior
programming involvement including Methadone Maintenance Treatment
ˇ Assess treatment
readiness
ˇ Recommend program
intensity levels
ˇ Generate automated
summary reports to assist decision makers
Residential
Facilities
ˇ
Substance
abuse treatment programs within state and local correctional and detention
facilities
ˇ
Prisoners
are incarcerated for a period of time sufficient to permit substance abuse
treatment.
ˇ
Goal is to reduce recidivism by implementing
programs that provide individual and group treatment activities for offenders
in residential facilities operated by the state.
Residential
Facilities
ˇ
These
programs must:
l
Last
between 6 and 12 months
l
Be
provided in a residential treatment facility set apart from general
correctional population
l
Focus
on the substance abuse problems of the inmate
l
Develop
the inmate's cognitive, behavioral, social, vocational, and other skills to
solve the substance abuse and related problems
Residential
Programs
ˇ
As
of January 2000, NIJ had awarded 18 individual site outcome evaluations.
ˇ
Compare
RSAT program participants with nonparticipating inmates on such measures as rearrest rates, participation in aftercare, mental health
status, and employment.
ˇ
Too
early to draw definitive conclusions about RSAT
Drug Courts
ˇ
Started
in the late 1980s
ˇ
Started in response to rising rates of
drug-related court cases and the inability of traditional law enforcement and
justice policies to reduce the supply and demand for illegal drugs.
ˇ
Increase
in drug offenders accounted for nearly 3/4ths of the growth in prison
populations between 1985 and 1995.
Drug Courts
ˇ
The
first drug court was created in Miami
in 1989.
ˇ
promising results, especially in
terms of reduced recidivism.
ˇ
Drug
courts now exist in all 50 states, by 2000 there were more than 700 U.S. courts in
existence
ˇ
Focus on facilitating treatment for first time and
misdemeanor drug-involved criminal justice populations.
Drug Courts
ˇ
Designed
to deal with non-violent offenders who are offered an opportunity to complete a
drug treatment program in return for:
l
a dismissal of charges (diversion or
pre-sentencing model) or
l
reduction in custody or probation time
(post-sentence model)
ˇ
generally exclude individuals charged with drug
trafficking
Drug Courts
ˇ
Drug
courts combine:
l
Intense
judicial supervision
l
Comprehensive
substance abuse treatment (including detoxification)
l
Random
and frequent drug testing
l
Incentives
and sanctions
l
Clinical
case management
ˇ
The
over-riding goal of the drug court is abstinence and law-abiding behavior.
Drug Courts
ˇ
Evidence
suggests that drug courts may offer a less costly alternative to incarceration.
ˇ
Significantly
reduce jail and prosecution expenditures when defendants are successfully
diverted from the traditional court and correction systems.
ˇ
In 1998, drug courts cost about $2,000 (USD) annually pp,
compared to $20,000 - $50,000 pp for incarceration.
Drug Courts
ˇ
To
date, approximately 200,000 persons have entered U.S. drug courts (including 140,000
graduates or current participants)
ˇ
A
recent review of 30 evaluations concluded:
l
Drug
courts are able to engage and retain offenders.
l
Among
adults, 60% remain in treatment after one year; almost double the retention
rate for community-based programs.
Drug Courts
l
Provide
more comprehensive and closer supervision than community programs.
l
Most
(55%) require at least 2 drug tests per week.
l
In
the majority of programs (74%) status hearings are held bi-weekly
l
Nearly
all courts (88%) have weekly contact with treatment providers.
Drug Courts
l
Drug
use and criminal behavior is substantially reduced during and up to one year
following participation.
l
Drug
courts generate cost savings, at least in the short term, from reductions in
jail time and prison use, court and other justice system costs, and reduced
criminality.
Methadone
Programs
ˇ
Methadone
is a synthetic narcotic analgesic.
ˇ
Derived
from opium
ˇ
Used
for treatment of heroin addiction
ˇ
Pioneered
by Vincent Dole and Marie Nyswander in the 1960s -
had a theory that heroin addicts developed a biological adaptation to opiates
such that they needed them to maintain some level of opiate in their body to
feel “normal.”
Methadone
Programs
ˇ
Hypothesized
that heroin addicts, even after withdrawal, would never feel “normal” unless
they resumed having some level of opiate in their system.
ˇ
Developed
as a substitute for heroin, and was intended as a maintenance medication, much
as insulin is used to treat diabetes
ˇ
Methadone
has a longer half-life than heroin and only needs to be taken once a day,
usually orally.
Methadone
Programs
ˇ
Methadone
is not an exact substitute for heroin
ˇ
Analgesic
effect is far less strong than that of heroin
ˇ
Competes
with heroin for access to sites of action in the brain
ˇ
If
methadone is present in a sufficiently high dose, it will occupy many of the
sites of action, and if heroin is consumed the heroin will have little effect
Methadone
Programs
ˇ
Typically
methadone treatment is accompanied by behavioral counseling
ˇ
Methadone
found to be extremely effective in certain regards:
l
Reduces
users' consumption of illicit drugs
l
Reduces
criminal activity
l
More
socially productive
l
More
psychologically stable
Methadone
Programs
ˇ
Treatment
surrounded by moral debate
ˇ
Much
of the public considers it reprehensible to offer heroin addicts a medically
prescribed substitute drug
ˇ
Major
problems:
l
Given
less than therapeutic dose (60 mg)
l
Methadone
withdrawal versus maintenance
l
Not
allowed in many prisons
Methadone
Programs
ˇ
Relapse
rates for methadone withdrawal is 90%
ˇ
Early
studies for methadone found relapse rates on the order of 85%.
ˇ
Later
studies found individuals who have become socially stable, probability of
successful detoxification is high
ˇ
83%
who met these criteria were drug free over a follow-up period averaging
slightly over two years
Methadone
Programs
ˇ
individuals who did not meet these criteria, only
14% to 21% were drug free.
ˇ
only 17% of all patients met the criteria (social
stability)
ˇ
Thoughts????
ˇ
Also
Antibuse/Temposil
Cognitive
Behavioral Programs
ˇ
Psychoeducation about substance Abuse
ˇ
Problem
Solving Skills
ˇ
Decision
Making Skills
ˇ
Social/Communication
Skills
ˇ
Developing
Alternative Methods Seminar (DAM)
12-Step
Programs
1. Admitted we were
powerless over alcohol -- that our lives had become unmanageable.
2. Came to believe
that a Power greater than ourselves could restore us to sanity.
3. Made a
decision to turn our will and our lives over to the care of God as we
understood Him.
4. Made a searching
and fearless moral inventory of ourselves.
5. Admitted to God, to
ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready
to have God remove all these defects of character.
12-Step
Programs
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make
amends to them all.
9. Made direct amends to such people wherever possible, except when to do
so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly
admitted it.
11. Sought through prayer and meditation to improve our conscious contact
with God as we understood Him, praying only for knowledge of His will
for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we
tried to carry this message to other alcoholics, and to practice these
principles in all our affairs.