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

Supporting and Creating Linkages

Two other CSAT Treatment Improvement Protocols (TIPs) in this series describe diversion of certain individuals from the criminal justice system into treatment in the early stages of their involvement with the justice system. TIP 23: Integrating Alcohol and Other Drug Abuse Treatment With Pretrial Processing of Criminal Cases and Combining Alcohol and TIP 21:Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System address the many issues involved with linking the two systems. The former TIP describes the drug courts that have evolved over the years to handle the increase in drug-related arrests. The latter TIP describes a process of diverting juvenile offenders into treatment before they become entrenched in the criminal justice system.

In addition, a third TIP in this series, TIP 12: Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System, provides detailed guidelines for creating linkages between the two systems primarily after adjudication (trial or sentencing).

Criminal Justice Referrals

Several different categories of criminal justice system personnel can refer an individual into treatment. However, persons in the AOD treatment system should recognize that the source of the referral is important because it determines whether the individual enters treatment voluntarily or is mandated into treatment. Also, different personnel in the justice system have different motives for referring an individual to treatment and thus will refer in different situations. For example, the bail commissioner may only refer individuals who otherwise would fill the jails, regardless of whether they have AOD problems. Judges tend to recommend treatment only if it relates to the current charge and falls within the requirement for the least restrictive environment. A public defender may refer to treatment only if it will help his or her client's case. If the client needs treatment, but the current charge is unrelated to alcohol or other drugs, there may be no referral because sending the client to treatment could negatively affect the case.

In many of these decisions, the system is focused on the present (and possibly the past) of the client and not on the larger issues of what is good for the client and society as a whole. Many who consider the big picture would say that it is better to get the individual into treatment (regardless of the charge) because recovery will not only improve the health of the individual but also result in decreased crime, safer streets, and reduced cost to society.

Presentencing

Presentencing is the period after a guilty plea is entered (in cases that are plea bargained) or after a conviction is handed down (in cases that go to trial).

Prior to sentencing, a presentence investigation is conducted. The investigation is conducted after the plea is entered or after the conviction is handed down. In some plea-bargained cases, a plea may be withdrawn after the presentence investigation is completed and sentencing recommendations are made.

Many jurisdictions have presentence investigation agencies, which specialize in writing the report. Elsewhere, probation officers compile the report. The sentence or penalty handed down by the judge is based on the information that has been compiled in the presentence report. Therefore, with more relevant information available, the judge will be better equipped to make an appropriate sentencing decision.

This is another point where linkages between the two systems are critical. It is suggested that some sort of AOD intake and preliminary assessment be provided at this stage, if one has not yet occurred in the earlier stages.

In many States, there are serious legal constraints on sharing information contained in the presentence investigation. In some States, only the judge can see the report -- not even the defendant can see it. However, the presentence investigation report may contain information highly relevant to developing an AOD treatment plan for the individual. To avoid duplication of efforts in gathering needed information at various stages of the justice-treatment continuum, planners should investigate ways to facilitate information sharing without breaching confidentiality and to ensure that critical information follows the individual through the process.

Trial

A trial is a court hearing in which a prosecutor presents a case against the defendant to show that he or she is guilty of an accused crime. A judge or jury decides the verdict. If the verdict is "guilty," the sentence or the penalty imposed in the case is determined by the judge, or, as in several States including Texas and Virginia, the jury determines the sentence. In many States, the sentence or penalty is based partially on the information that has been compiled in the presentence investigation report. Increasingly, States are passing laws to ensure that the penalty is based on the offense without regard to information contained in the report.

Sentencing

Sentencing is the disposition of a case in which penalties are imposed. Once the defendant is adjudicated (either by plea or jury trial), information in the presentencing report will generally be used to assist in sentencing decisions. The goals of sentencing are to reduce community risk and punish the offender fairly. Some States continue to recognize rehabilitation of the offender as a goal. Deterrence of crime by others by creating an example can also be thought of as a goal of sentencing. Although victim restitution is not a goal of sentencing, a judge may be authorized to require it.

Sentences can be fines, probation or incarceration, or a combination of the two. Sentencing can include house arrest, electronic monitoring, and other community sanctions. Sentencing can also be linked with AOD treatment without increasing the length of the sentence. Sentencing may include outpatient treatment, family therapy, medical care, or placement in a halfway house. In many jurisdictions, public and private agencies have created a wide variety of intermediate sanctions programs, which are described below in a separate section.

Some jurisdictions, such as the State of Colorado, have developed and are implementing a standard set of policies and procedures for offender treatment that includes the items the judge needs to consider in making a sentencing decision. Each offender is assessed and receives a validated assessment score that is used in recommending levels and types of treatment. In San Francisco, the probation staff periodically updates the court, both in writing and in person, about various treatment options that are available to the court at the time of sentencing.

In combining treatment with judicial sanctions, judges have to think creatively, look for innovative approaches, and possibly take risks. Some examples of successful approaches include intensive outpatient treatment, day reporting centers, intensive supervision, curfew or house arrest (with or without electronic monitoring), residential treatment and halfway houses, and boot camps. Judges need a policy that can be used as a basis for decisionmaking and that includes a menu of available options. (See the companion TIP Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System for more discussion of these issues.)

Probation

Probation is a sentence of community-based supervision. Probation includes stipulations and prohibitions on certain activities and often includes fines imposed by the court at the time of sentencing.

Understanding the purpose and functions of probation requires an understanding of probation's place within the criminal justice continuum. Probation provides supervision for offenders while they engage in a community-based process intended to modify or change behavior. The efficacy of probation is measured by a reduction in the offender's criminal activity and by the offender's ability to perform productively in the community after completing probation. Constructive and positive change by the offender is a tangible demonstration that the system is working effectively. Probation's goals have been statutorily defined by both State and Federal legislative bodies. Probation officers are required to prepare written court reports, advise judges on sentencing recommendations, supervise offenders placed on probation by the court, and report to the court about the conduct and actions of offenders who violate probation.

Over the years, the role of probation has changed substantially. Probation was initially designed to carry out well-tailored community correction programs for nonviolent offenders. The goal was to aid in rehabilitation by providing a wide range of services for offenders who posed no risk to the community. This is no longer the goal. Increasingly, probation is used to supervise the activities of serious offenders whose needs are dramatically different from those of offenders 30 years ago. Today's probation officers can no longer be concerned with rehabilitation alone, but must be prepared to address offender risk management, crime control, correctional treatment, and habilitation. This change does not mean that today's caseloads are more violent. The great majority of offenders -- about nine out of ten -- who receive probation have not committed violent crimes. However, the needs of current offenders are more complex and require a greater array of specialized services, such as those used in supervising AOD-involved individuals.

Despite the growing emphasis on incarceration since 1980, probation is still the dominant sentencing sanction. The Bureau of Justice Statistics (1994) reported that in 1990, the last year for which data are available, the probation population represented more than 2.5 million offenders; this population has been growing at the rate of 13 percent per year. Although probation is the most frequently used sanction and is employed to supervise the most offenders, its effectiveness is often undermined by a lack of several kinds of support. Carrying out the goals of probation is critically compromised in many jurisdictions by a lack of resources, inadequate funding, and significant reductions in personnel.

To be effective, probation must provide a meaningful sentence from among a range of options available to meet the needs of an increasingly diverse population. Probation officers have had to expand their roles as behavioral specialists in order to match the offender with an appropriate program. Increasingly, probation is being viewed as existing in two forms -- traditional probation and intensive probation. At least two levels of probation should be available to the judge, and supervision should be predicated on community safety and offenders' needs.

For probation officers working with AOD abusers, the maximum caseload suggested by the consensus panel that developed this TIP is 35 clients; this also is the caseload limit recommended by the Federal probation system. In many jurisdictions, however, the probation officer's caseload may be four times that number, an unmanageable size in terms of fulfilling recommended goals.

Although the role of the probation officer has changed in recent years, reflecting the diverse needs of offender populations, many aspects of the role remain unchanged. Probation is a legal disposition. Therefore, controlling, monitoring, surveilling, and enforcing the court-ordered conditions of probation should not be subordinated to the task of helping the offender, but should remain primary tasks. However, out of necessity, many have broadened this conception of the probation officer's role to include that of a case manager, with added responsibilities of bridging and linking systems to engage needed supports and advocating for the offender where appropriate. Probation officers have a critical role in linking the AOD and criminal justice systems.

While the probation officer can be viewed correctly as a behavioral specialist, it is important to note that the probation relationship is not a clinical one in the usual sense. First, a relationship between an adult client and therapist is in virtually all cases a voluntary one that the client can terminate at any time. In addition, except in certain well-defined circumstances, such as when a client reports abusing a child, the client-therapist relationship is protected by ethical and legal confidentiality requirements. (Issues surrounding offender's confidentiality rights are discussed in detail in Chapter 8.)

For example, a client who seeks therapy for bipolar disorder might tell a therapist that he wrote bad checks during a manic episode. The therapist might deal with this issue therapeutically, by discussing the client's feelings about the behavior or its consequences, with the aim of helping the client avoid repeating these behaviors in the future. The client's confession of this criminal activity would reflect his understanding of the special nature of the clinical relationship, which would be encouraged by the therapist. However, if an offender told a probation officer that he had written bad checks, he would not have the same expectation. The probation officer must supervise the offender during probation and ensure compliance with court-ordered sanctions, and would have to report the incident.

It can be seen in these examples that the overall goal of helping the offender avoid criminal activity in the future is the same. When that goal is the focus, especially in jurisdictions that have implemented collaboration between the criminal justice system and the AOD abuse treatment system, the roles of personnel in both systems are not as clear-cut as in the example provided. For true collaboration, there must be a blurring of roles, backed up by accountability. These issues are described more fully in subsequent chapters of this TIP.

Jail

A jail is a facility that holds both pretrial and sentenced offenders in lawful custody while they await trial, serve short-term sentences of up to 1 year, go on work release, or are subject to weekend incarceration. Jails range in size from tiny rural jails with less than a dozen cells to massive urban facilities housing thousands of inmates. In some jurisdictions, large jails operate like prisons.

With a high turnover rate and relatively short terms of incarceration, jails experience a specialized set of problems. Traditionally, jails have afforded few opportunities for any sustained offender involvement in an AOD treatment program, but this situation is beginning to change. In recent years, jails have begun incorporating programming to address AOD interventions. In some large jails with significant numbers of inmates who may remain for extended periods of time, it is necessary to provide programming similar to that provided by prisons, which includes AOD treatment. For short-term pretrial defendants, the goal of jailing is to ensure their presence at trial. However, for sentenced offenders, treatment goals can be similar to those in some prisons. For jails where there are long pretrial confinements, appropriate AOD treatment also is a concern.

A full range of AOD services can be made available in larger jails. In particular, the jail setting is in several ways an appropriate setting for detoxification programs. Detoxification is a structured medical or social milieu in which an individual who is dependent on alcohol and/or other drugs is monitored during withdrawal from the acute physical and psychological effects of addiction. The jail setting provides the high level of structure and the opportunity for monitoring -- which sometimes involves 24-hour physician or nurse supervision -- that are necessary for detoxification. Detoxification is an essential first step in moving clients into AOD treatment, a step which can be completed in the jail setting even for those having long pretrial confinements or serving short sentences. In particular, detoxification and methadone programs, which address opiate addiction within the jail setting, can engage many individuals in treatment who might not otherwise seek it. Another TIP in this series, TIP 19:Detoxification from Alcohol and Other Drugs, describes safe regimens for detoxification in a variety of settings.

A medical unit is an essential jail component that includes outpatient care and inpatient hospitalization. Comprehensive services include health and medical programs for AOD-abusing individuals with mental illnesses and for patients with human immuno- deficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), sexually transmitted diseases, or tuberculosis (TB). These services also include care for women's specialized needs. An enhanced voluntary program for HIV counseling and testing should be considered. Procedures should also be established to provide AOD treatment and other needed health-related services to inmates in protective custody or administrative segregation.

It must be noted here that it is an unfortunate reality that AOD abuse often can continue in jails. Therefore, another important component of a jail program is the monitoring of AOD use.

Prison

A prison is an institution in which felony offenders are confined to terms of at least 1 year after sentencing. Prisons are operated by States and by the Federal Government. Prisons are classified as minimum-, medium-, or maximum-security facilities, based on the need for internal institutional safety and perimeter security. Each inmate is classified by severity of offense or other behavior and is usually assigned to a prison with a corresponding level of security.

Prison inmates are generally sentenced to a minimum of 1 or 2 years, depending on the State's laws. In some States, such as New York, California, Florida, and Illinois, prison sentences may be shorter than 1 year. Prisons, unlike jails, do not hold pretrial detainees. Because of the longer time periods involved for most offenders in prison, prison programs can have long-term components that are not options in jail programs. Historically, prisons have existed for punishment and incapacitation. It has only been in recent decades that policies have been implemented to emphasize habilitation and rehabilitation. Since many AOD-abusing individuals are sent to prison, a full range of AOD treatment services should be available in prisons.

A number of issues relate specifically to prisons and AOD treatment:

• Comprehensive pregnancy management for AOD abusers can enable a woman to carry her baby to term while incarcerated. Foster care services may be needed, and medical services should be available for both mother and child.
• Medical treatment for prisoners with chronic and communicable diseases, including TB and HIV/AIDS, should be available in prison.
• Psychiatric treatment for prisoners with mental illnesses should be offered. Pharmacotherapy for disorders such as bipolar disorder and major depression should be incorporated into these services.
• AOD abuse treatment should extend across institutional boundaries when offenders are transferred to different correctional facilities, and to the community after release.
• Special arrangements should be made for AOD treatment and healthcare services for offenders in protective custody and administrative segregation.
• Prerelease group programs and transitional community programming should be offered to all offenders, in particular to those who have been incarcerated for long periods of time.
• Education about HIV/AIDS and its risk factors should be a critical component of prison programs.
• Relapse prevention for AOD abusers should be a part of transitional programming.

The recognition of the overwhelming AOD problems of prison inmates has led to increasing acknowledgment of the needs of this population in prisons. In many cases, this need has created a dilemma. Should an AOD abuser be sent to prison, which may offer the best treatment opportunities, or be placed in a community setting, which may offer fewer opportunities? The answer to this dilemma is not to take treatment out of prisons, but to create treatment options in the community.

Parole

Parole is a form of supervised release into the community following a term of incarceration. In most States, a parole board decides on a case-by-case basis which inmates to release from prison, when (at what point in the total sentence), and under what conditions. In the same way that a judge orders specific conditions of probation, the parole board orders specific conditions of parole. Failure to comply with the conditions can result in a motion to the board to revoke parole and return the parolee to prison. AOD abuse treatment and some of the intermediate sanctions described in Exhibit 4-1 are common conditions of parole release.

Not all States have parole as part of their sentencing laws. In California, Washington, and Minnesota, for example, an offender serves the term specified by the judge at the time of sentencing, minus time off for good behavior or program credits, if those are available in the State. In that case, the offender leaves prison under mandatory release and usually has no conditions on that release.

Parolees are supervised by parole officers, sometimes called parole agents. Parolees may have prohibitions on certain activities imposed by a paroling authority. Parole officers have the same authority with parolees as probation officers do with offenders on probation. The primary goal of parole is community reintegration after release from prison. The parole officer's role has evolved from supervisor to case manager, particularly for AOD-involved offenders.

The primary goal of the parole officer is to ensure community safety. Other goals are to help offenders in the transitional process of returning to society and to assist them in making appropriate choices from available community options. The parole officer often gradually reintroduces choices that the offender will need to make to become self-sufficient and adjust to the community. Specific objectives should be individualized for each offender. Thus, parole officers must be change agents. Sanctions should be used to assist treatment and habilitation outcomes and to encourage the offender to participate in community programs.

The location of the parole department within the State governmental structure has an effect on services. Parole departments are located in different divisions of government throughout the country. In one State, parole may be located within the corrections department and probation within the judiciary. Location translates into differences in communication, cooperation, interaction, and philosophical perspective. Location also can be related to service fragmentation and shifting departmental responsibility.

Although the parole board usually is the final arbiter, decisions involving parole should be made with input from the parole board and officers, the offender, and the treatment providers. A parole plan should be based on clear objectives so that all involved personnel know what is needed to reach the stated goals. This process also will assist parole officers in monitoring parolees and will help parolees know specifically what is expected of them.