Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System
Treatment Improvement Protocol (TIP) Series 17

Principles Guiding the Panel

No single answer will be found to the complex problems related to AOD abuse among criminal offenders. Rather, steps can be taken to promote the goals of reducing the prevalence of AOD abuse in this population and thereby decreasing crime, violence, and the spread of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and other sexually transmitted diseases and tuberculosis (TB). The panel that developed this TIP brought to the table expert knowledge of offenders and criminality, the current problems faced by the criminal justice system, and AOD abuse and effective treatment. The panel agreed on several key points that formed a framework for developing recommendations:

• Drug users are not a homogeneous group. Drug users range from citizens who experiment with drugs and experience few or no adverse consequences, to those whose use of drugs brings severe and adverse consequences.
• Treatment works. As discussed above, the last 20 years of research have repeatedly shown that treatment can reduce drug use and crime.
• A single treatment program or approach will not be successful for all offenders. Although advocates of different treatment models promote specific regimens, treatment success depends on matching treatment to offender needs. For example, some offenders who have not demonstrated serious antisocial behavior and who have adequate social supports can be treated successfully in the community. However, many severely antisocial offenders require long-term residential treatment combined with additional services. Other offenders may benefit from outpatient opioid substitution therapy (methadone or levo-acetyl-methadol [LAAM]), with varying degrees of counseling and adjunct services.
• Incarceration alone usually does little to change behavior. Although the fear of arrest or incarceration may deter some offenders from drug use, there is little evidence that incarceration without treatment does anything to effect behavioral change. Incarceration may not even interrupt the offender's drug use, since it is well known that illegal drugs are available in some jails and prisons.
• People without a stake in society may view antisocial behavior as a way to maintain a sense of power. Citizens who have a stake in society generally guard against losing their position, status, and possessions. Those who feel disenfranchised -- who believe they have no status, power, or possessions and no legitimate way to acquire them -- may behave antisocially. Offenders frequently do not share the values of mainstream America, and efforts to change behaviors in this population must address issues of disenfranchisement.
• Long-term reduction of drug use is dependent on changes in society's attitudes about the justice system's role in prevention. The majority of criminal justice resources now are dedicated to drug interdiction, arrest, prosecution, and sanctions -- that is, the problems are addressed after they occur. Recently, in many areas of American society, individuals and groups have joined the struggle to prevent AOD abuse. The criminal justice system has increasingly recognized the power of prevention measures at the community level, and it is vital that leaders inside and outside of the system communicate to the public the appropriateness of the criminal justice system's participation in prevention efforts.
• Long-term reduction in drug use is dependent on changes in society's ambivalent attitudes about drug use. Prevention and treatment efforts are hampered by ambivalence at all levels of society about drug use. Until the unacceptability of drug use becomes widespread, we will continue to cycle people through the criminal justice system in ever-increasing numbers and at increasing cost.

The delivery of AOD abuse treatment to a criminal justice population can best be grounded in the following principles, which also guided the panel's efforts:

• Treatment is not a substitute for punishment or sanctions.
• Treatment should be universally available as needed for persons who come to the attention of the criminal justice system.
• AOD treatment services should be tailored to the needs of the specific offender, based on a thorough assessment that should occur as early as possible after the offender enters the criminal justice system.
• Offender supervision should not be relinquished once an individual enters treatment.
• Offenders should remain accountable to the sentencing judge or the probation or parole authority.

The Scope of the Problem

More than one million people are in jails and prisons, and 3.5 million are on probation and parole in our communities. The number of drug-abusing offenders in the justice system has increased dramatically. In 1991, drug offenders accounted for 56 percent of the population of Federal correctional facilities, up from 25 percent in 1979. Arrests related to AOD use increased by 126 percent during the last decade. The National Justice Institute estimates that up to 80 percent of offenders, parolees, and probationers have some degree of substance abuse problem related to their criminal activity.

Many offenders cycle in and out of the justice system; these repeat offenders account for a significant proportion of crime. Given these facts, it is logical to assume that intervening with the offender population to prevent and treat AOD use and abuse will have a major impact on reducing crime. However, components of the criminal justice system often work at cross-purposes, and it has been the exception rather than the rule when the criminal justice and AOD systems work well together.

System Differences

A basic difference between the criminal justice and AOD systems is that the primary responsibility of the former is to protect public safety. This serious responsibility entails a focus on laws, procedures, and processes that are largely designed to incapacitate and punish individuals who threaten the lives and well-being of others. The AOD abuse treatment system has a serious responsibility to address the great harm that AOD abuse and dependence exact on individuals, their families and friends, and the organizations and communities in which they interact. This responsibility often entails a focus on providing support and understanding to facilitate individual change.

It is the basic differences in these systems that have created obstacles to understanding and cooperation. Personnel in each system often have incomplete views of each other. Traditionally, treatment system personnel see those in the criminal justice system as narrowly focused on punishment, and criminal justice personnel see treatment providers as "do-gooders" who know nothing about holding people accountable for their behavior. Although evidence can be found in both systems to support these biases, each system has more depth than the stereotypes suggest. Even though the two systems work from different incentives, values, training, and standards, they share common goals for the benefit of society: the reduction of deviant behavior and the reduction of AOD use and associated criminal activity.

It is also important to recognize that neither system is homogeneous. There are different "cultures" within each system. In the AOD abuse treatment system, for example, methadone maintenance program staff and therapeutic community staff may have different points of view. Similarly, within the criminal justice system, probation officers often have different perspectives from public defenders.

Lack of Knowledge

Not only do criminal justice personnel often have little understanding of what treatment can do and how the AOD treatment system provides services, justice system personnel (and the general public) often have little understanding of different treatment models and philosophies. Some criminal justice personnel believe that treatment providers often choose to treat offenders who have minimal behavior problems and respond well to treatment. After repeated contact with offenders who appear to be "failures," criminal justice staff conclude that AOD treatment is ineffective. On the other hand, treatment providers may believe that the criminal justice system refers offenders who are unsuitable for treatment, creating situations conducive to treatment failure.

Situations that result in "failure" are often created by a lack of knowledge. For example, criminal justice staff may refer an offender to the wrong treatment provider because they don't know which provider is appropriate and so place the offender in any available treatment slot. On the other hand, treatment providers may not clearly understand a criminal justice procedure, such as chain of custody for urine samples. In addition, justice system personnel may not realize that, like any treatment for a serious, chronic condition, AOD treatment takes time, and the amount of time allowed for treatment for many offenders is brief because of limits on sentences and sanctions. Although criminal justice system staff may want treatment for "hard-core" users, treatment providers generally prefer to use slots for offenders who are at an earlier stage of their addiction and who have greater likelihood of success within a limited treatment period. Providers' funding may depend in part on demonstrating that they are providing effective treatment.

Who Should Be Served?

Questions arise about which AOD-involved offenders are being served and who should be served. Who decides? Do the decisionmakers have the knowledge and qualifications required for performing this task? Where should clients be served? If it were left to each system to give subjective responses to these questions, two very different positions might emerge. Treatment providers, who work with limited resources, usually want clients who have the best chances of success. As a result, they may deny the serious drug dependencies of some AOD-involved offenders who are referred to their programs, or they may deny services to some offenders.

The offender's views and situations often create additional problems, especially those related to noncompliance. Many offenders prefer "doing time" to entering treatment, framing the choice as a "manhood" or power issue. Often, the nonincarcerated offender's home environment cannot support a drug-free life-style because the offender has no job around which to structure his or her day.

Fortunately, personnel throughout both systems are beginning to realize that court sanctions can be an important part of the treatment process. "Leveraging" offenders into treatment under criminal justice sanctions often adds the accountability that the criminal justice system requires, while providing the treatment system with clients more willing to comply with the demands of treatment. (Another TIP in this series, TIP 12: Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System, addresses issues surrounding noncompliance and the leverage that sanctions provide.)

A Change in Thinking: Public Education

The goals of the AOD treatment and criminal justice systems are closely related. Both systems seek to reduce AOD abuse. The ultimate goal of both systems is to ensure that individuals can interact in positive and constructive ways to improve personal and community welfare; they just approach this goal in different ways. A specific goal of the criminal justice system is to protect the community. Positive treatment outcomes support this goal by helping to reduce criminal recidivism.

Even though both systems share goals, accepting the recommendations of this TIP -- linking the two systems -- may require program planners, managers, legislators, and the public to change some of their basic views. The discussions included here about the relationships among treatment, crime, the criminal justice system, and community protection may include ideas that some people will find difficult to accept.

A major public education effort will be required to bring about a change in thinking. To reallocate some financial resources used for building prisons and other correctional facilities and use the money to establish treatment for persons in the criminal justice system instead will require significant financial reordering. For such a reallocation of resources to become a reality, people must believe that establishing treatment in the criminal justice system is in their own best interests.

In addition to educating the public about needed changes, it is vital that the public know what methods are already working. For example, each area of the criminal justice system can prepare and release annual reports similar to corporate annual reports developed for the community and showing the number of individuals who need treatment and the number who have successfully completed programs. The media also can play a major role in influencing public opinion about AOD abuse and the effectiveness of treatment. While negative publicity can hurt both the criminal justice and treatment systems, the media can be very helpful if approached in an open way and provided with facts from the justice system and AOD treatment perspectives. Communication with the media is an area where shared views between systems are all important.

Drug Courts and Diversion

It should be noted here that extensive cooperative efforts have already been undertaken in the form of drug courts and other efforts to divert some substance-abusing offenders into treatment rather than into extensive, costly, and often repeated involvement with the justice system. The national crime bill passed in late 1994 allocated $1.8 billion to drug courts. Drug courts are special courtrooms that integrate substance abuse treatment and justice system case processing under close supervision of a judge. This approach has evolved and attained significant success over a period of 20 years. There are dozens of well-established programs, including those in Oakland, California; Fort Lauderdale, Florida; Portland, Oregon; Phoenix, Arizona; and Washington, D.C. New programs are in development across the country.

No two programs are exactly alike, but these treatment-oriented drug court programs have some common threads. All of them build on an underlying premise that drug use, possession, and sale do not represent simply a law enforcement problem -- these activities are just as much a public health problem as a criminal justice problem. Accordingly, drug court proponents generally recognize that the traditional punitive model of drug enforcement and prosecution has failed to have much impact on the drug problem and has overwhelmed the criminal justice system with cases. Proponents of the drug court model argue that solutions to the drug crisis are more likely to lie in using AOD treatment to effect long-term solutions.

All of these programs involve a conception of the role of the court (and of judges and lawyers) that goes well beyond the traditional narrow view of the court as simply an adjudicative institution. This approach places at least as much emphasis on effective treatment of individuals with substance abuse problems as on the adjudication of cases. Drug courts involve the close collaboration of courts with the AOD treatment community and with other societal institutions in the design and ongoing operation of the program. These programs share the understanding that substance abuse is a chronic, progressive, relapsing disorder that can be treated successfully.

The conviction that treatment works -- not in every case, but often enough to make implementation of treatment-oriented drug courts a better alternative than conventional case processing for some types of cases -- is a key premise of the programs. Successful operation of these programs involves the cooperation and collaboration of many institutions and individuals. It is beyond the scope of this TIP to describe in detail the concepts and operations of drug courts and diversion processes. However, other TIPs in this series (e.g., TIP 23: Treatment Drug Courts: Integrating Substance Abuse Treatment with Legal Case Processing and TIP 21: Combining Substance Abuse Treatment With Diversion for Juveniles in the Criminal Justice System) examine the cooperation of the two systems in these areas.