“Dr. Chandler will discuss why punishment alone is an ineffective response to the problem of drug abuse in the criminal justice system … Dr. Chandler will also highlight evidence-based principles of addiction treatment based on an integrated public health/public safety strategy.” Topics discussed include: drugs of abuse and crime are linked; smoking in criminal justice; mental health disorders among incarcerated populations; key participants in the criminal justice system and intervention opportunities; what addiction is—a disease of the brain; reward circuits; dopamine; memory circuits; cocaine craving; treatments for relapse prevention—medications and behavioral; evidence-based principles of drug abuse treatment for criminal justice populations; what recovery looks like on average; assessing risks, needs, and progress; criminal justice CEST (Client Evaluation of Self and Treatment); and tailoring supervision to fit the needs of the individual is important.
“CJ-DATS (the national Criminal Justice Drug Abuse Treatment Studies) was created in 2002 with the goal of improving both the public health and public safety outcomes for substance abusing offenders leaving prison or jail and returning to the community by integrating substance abuse treatment into the criminal justice system.” Access points on this webpage are: CJ-DATS-II research centers; CJ-DATS-II studies—Medication-Assisted Treatment Implementation in Community Correctional Environments (MATICCE), HIV Services and Treatment Implementation in Corrections (HIV-STIC), and Assessment Organizational Process Improvement Intervention (OPII); CJ-DATS-I research centers; CJ-DATS-I studies—adolescent interventions; CJ-DATS-I studies—assessing offender problems; CJ-DATS-I studies—HIV and hepatitis risk reduction; CJ-DATS-I studies—linking criminal justice and drug abuse; CJ-DATS-I studies—measuring progress in treatment and recovery; CJ-DATS-I studies—understanding systems; and CJ-DATS bibliography.
"Prisoners experience high rates of drug dependence, health problems and premature mortality. Without intervention, they often come into further contact with the criminal justice system, creating further health risk. Opioid dependence is common among prisoners, yet treatment with opioid substitution therapy (OST) may reduce or prevent morbidity, mortality and offending … The results highlight that the prison setting provides an important opportunity to engage people in OST. Notably, OST treatment in prison and immediately post-release was found to be highly protective against mortality both while incarcerated and after release. Considering some of the known benefits of OST, this study provides strong evidence to support the value of OST programs within the criminal justice system" (p. 1). Results are provided for: the natural history of criminal justice system involvement among opioid-dependent people, 1993–2011; the extent of imprisonment of opioid-dependent people, 2000–12; potential differences in the impacts of buprenorphine and methadone on treatment retention and mortality; gender differences in opioid substitution therapy engagement; The association between retention in opioid substitution therapy and crime among opioid-dependent people; the impact of opioid substitution therapy provision in prison upon in-prison mortality; the impact of opioid substitution therapy on mortality following release from prison; and cost effectiveness of opioid substitution therapy in reducing mortality post-release among this group.
The need to replace the incarceration of those arrested for non-violent drug possession in Texas with community-based drug treatment is examined. The strategies described in this publication can be effectively used in other agencies. Sections of this report include: background of substance abuse and drug offenses in Texas—costly incarceration, incarceration vs. treatment costs, community supervision as an alternative to incarceration, and recidivism and revocation among individuals with drug offenses; understanding the cycle of drug addiction—related crimes and special considerations; treatment options and information; legislative efforts to improve responses to low-level drug offenses; solutions; and conclusion. “For those with addiction, drug treatment is a more effective strategy to treat the individual, reduce recidivism, and lower costs to the state. Texas should take steps to aggressively and proactively address drug addiction, and thereby decrease associated crime, by promoting medical and public health responses to this issue” (p. 1).
New England Journal of Medicine, v. 374 n. 13, p. 1232-1242, March 31, 2016
"Extended-release naltrexone, a sustained-release monthly injectable formulation of the full mu-opioid receptor antagonist, is effective for the prevention of relapse to opioid dependence. Data supporting its effectiveness in U.S. criminal justice populations are limited … In this trial involving criminal justice offenders, extended-release naltrexone was associated with a rate of opioid relapse that was lower than that with usual treatment. Opioid-use prevention effects waned after treatment discontinuation" (p. 1232).
The contingency management component of a cognitively-behaviorally based substance abuse treatment program in a probation setting is examined. Individuals looking to set up a similar treatment program will find this article very informative. The program is called "Supporting Offenders to Avoid Recidivism and Initiate New Goals (SOARING)". Sections following an abstract include: contingency management (CM) overview; CM intervention settings; CM intervention in substance use treatment; CM in criminal justice settings; a test of CM in community supervision; discussion about target behaviors (or goals) and related issues, contingency issues, and urinalysis issues; and implications.
If you are looking for an introduction to the use of evidence-based practice (EBP) in corrections based drug treatment, then this is for you. EBP "applies the principles and techniques of evidence-based decision making to interventions intended to improve, or ameliorate, the social or clinical problems of affected individuals, including offenders with drug abuse problems. This article provides a general overview of EBP, particularly as it applies to treatment and other interventions for offenders with problems involving drugs (including alcohol). The discussion includes a definition of EBP, notes the implications of using EBPs to make policy and clinical decisions, lists the various efforts by government and academic organizations to identify practices that can be considered evidence based, describes the criteria used by such organizations to evaluate programs as being evidence based, raises some cautions about the use of EBPs, and ends with some challenges in disseminating and implementing EBPs" (p. 10). Following an abstract, this article covers: a definition and implications; evidence-based practice initiatives; meta-analyses of treatment programs for offenders; limitations of randomized designs for evidence-based practices; challenges in disseminating and implementing EBPs; and EPBs having valid yet tentative knowledge about "what works".
This toolkit, supported by funding from the Centers for Disease Control and Prevention (CDC) and Bloomberg Philanthropies, provides correctional administrators and health care providers recommendations and tools for implementing medication-assisted treatment (MAT) in correctional settings and strategies for overcoming challenges. Informed by real-world practice, the toolkit provides examples from the field that can be widely applied and adapted.
Montgomery County DOCR, YouTube Video (18:57 minutes)
The most effective therapy for people with opioid use disorder (OUD) involves the use of Food and Drug Administration-approved medications—methadone, buprenorphine, and naltrexone. Despite evidence that this approach, known as medications for opioid use disorder (MOUD), reduces relapse and saves lives, the vast majority of jails and prisons do not offer this treatment. This brief examines what policymakers should consider when exploring how to best manage OUD in incarcerated populations.
It helps to first answer this question: How common is OUD in incarcerated populations? Data from 2007-2009 (the most recent available) showed that more than half of individuals in state prisons or those with jail sentences met the criteria for a non-alcohol and nicotine-related substance use disorder (SUD), meaning a problematic pattern of using a drug that results in impairment in daily life or noticeable distress, compared with only 5 percent of adults in the general population.
The gold standard of care is MOUD. In community-based settings, such as opioid treatment programs and primary care facilities, methadone and buprenorphine have been proved to reduce overdose deaths and illicit opioid use as well as the transmission of infectious diseases such as HIV and hepatitis C. A growing body of literature also exists on the benefits of naltrexone, the third Food and Drug Administration-approved medication.