This chapter discusses some training needs of staff in both the
criminal justice and the alcohol and other drug (AOD) abuse treatment
systems with the primary focus on coordinated training. Topics that
should be included in training efforts are suggested.
To effectively administer AOD treatment within the criminal justice
system, staff in both systems should receive cross-training. They
should become familiar with the philosophy, approach, goals, objectives,
language, and boundaries of both systems. Treatment providers should
understand the importance of security issues, and criminal justice
personnel should understand the dynamics of AOD treatment and its
potential to reduce recidivism and relapse.
Joint training should be discussed and planned at the highest
policymaking levels. Establishing and overseeing training can be an
important responsibility for a criminal justice and AOD treatment
coordinating council. Training is necessary for personnel at every
stage of the criminal justice continuum. For example, police and
pretrial officials should know about available AOD treatment options for
different types of addiction. Judges and prosecutors also should be
familiar with the range of treatment options and how AOD treatment plans
can be adapted to an offender's particular circumstances.
Issues for systems that serve criminal justice clients include the
following:
Judges, prosecutors, and defense attorneys need to update their
information about AOD community treatment programs and resources to
refer defendants and offenders for treatment.
Counseling staff should have specialized training about the multiple
needs of offenders.
Personnel in all parts of the criminal justice continuum should be
knowledgeable about the types and benefits of AOD treatment. Examples
of special target groups include States' attorneys, correctional
personnel, and jail and prison administrators.
Training for probation and parole officials should emphasize relapse
prevention and management (see Chapter
5).
Training in the AOD treatment system may be targeted to parole
boards and to State and county legislators. Parole boards are usually
autonomous, with politically appointed members. These members often
have other jobs or are recently retired, and they may vary in their
knowledge and expertise regarding the criminal justice system, AOD
abuse, and AOD-involved offenders. Legislators need current information
about both systems in order to draft effective legislation.
AOD treatment staff must be trained in the legal mandates and
responsibilities imposed by the criminal justice system.
Judges must have an understanding of addiction, craving, and
relapse.
AOD treatment providers must understand the goals of the criminal
justice system in order to develop effective AOD treatment plans for
offenders and to earn support from justice personnel. AOD providers
should also understand the operational responsibilities of the justice
system, the importance of public safety, and the security concerns that
are at the heart of criminal justice. Many AOD treatment providers may
have only a layperson's familiarity with the criminal justice system;
may use such terms as intermediate sanctions, diversion, and
supervision interchangeably; and may not understand the important
distinctions between arrest and arraignment, and parole and probation.
Just as criminal justice personnel must understand the roles of AOD
treatment program personnel and the different types and levels of AOD
treatment, providers must understand the different roles and functions
of justice system personnel. For example, they should have knowledge
about the specific responsibilities of criminal justice personnel as
cases flow from arrest through trial and sentencing, as described in the
Center for Substance Abuse Treatment (CSAT) Criminal Justice Treatment
Planning Chart (Appendix B).
Since the late 1980s, CSAT has provided technical assistance to
States seeking to establish cross-training programs. Early efforts
focused on training probation officers and treatment staff. More recent
efforts have focused on creating multidisciplinary teams of staff from a
spectrum of the systems that collaborate to engage and retain offenders
in treatment.
Many of the Treatment Improvement Protocols (TIPs) in this series can
be used or adapted for use in training staff in both systems. For
example, the TIP entitled Assessment and Treatment of Patients With
Coexisting Mental Illness and Alcohol and Other Drug Abuse (TIP 10)
has a chapter on identifying and treating persons with personality
disorders, including antisocial personality disorder, which is a common
disorder among offenders. The TIP provides materials for helping people
with this disorder identify dysfunctional thinking and response patterns
and work effectively in 12-step programs.
The TIP Detoxification From Alcohol and Other Drugs (in
development) can be used to give staff a broad understanding of this
step, which is the first in the treatment process for many persons.
Intensive outpatient treatment may provide an appropriate
community-based level of care for many nonviolent offenders, and the TIP
Intensive Outpatient Treatment for Alcohol and Other Drug Abuse
describes one approach to this level of care. The TIPs on Pregnant
Substance-Abusing Women, Simple Screening Instruments for
Outreach for Alcohol and Other Drug Abuse and Infectious Diseases,
and Treatment for HIV-Infected Alcohol and Other Drug Abusers
contain material especially relevant for work with offender populations.
Many persons in the justice system may have a poor understanding of
treatment with methadone or LAAM, and three TIPs describe current
practices in this area: State Methadone Treatment Guidelines,
Matching Treatment to Patient Needs in Opioid Substitution Therapy
and LAAM in the Treatment of Opiate Addiction (in
development).
Four other TIPs in this series address current efforts to link the
treatment and criminal justice systems and would be especially useful in
training treatment staff in justice system issues. These other TIPs are
TIP 7:Screening and Assessment for Alcohol and Other Drug Abuse Among
Adults in the Criminal Justice System, TIP 12: Combining Substance Abuse
Treatment With Intermediate Sanctions for Adults in the Criminal Justice
System, TIP 23:
Treatment Drug Courts; Integrating Substance Abuse Treatment with Legal
Case Processing, and TIP 21:
Combining Alcohol and Other Drug Abuse Treatment Services With
Diversion for Juveniles in the Justice System.
In order to make effective legal decisions, judges must stay informed
about issues in many areas. Organizations such as the American Bar
Association, the National Judicial College, the National Association of
State Court Judges, the American Judicature Society, and the National
Association of State Judicial Educators ensure that judges receive many
kinds of information and training. Substance abuse may play a role in
any case that comes before a judge -- not just drug-related
offenses -- and recognizing its role can improve judicial
decisionmaking. For example, settling some custody disputes requires
judges to understand the dynamics of substance abuse in family systems.
In making decisions about AOD-involved offenders, judges must understand
the spectrum of addiction from both a medical and behavioral
perspective, as well as the various types of interventions and
treatments available. They should have knowledge of the dynamics of
self-help groups and their role in recovery from AOD dependence. They
should also receive information about the costs of treatment and various
third-party payers, including private- and public-sector sources. Such
basic information is the core of most AOD treatment education for
judges.
In making decisions about AOD-involved
offenders, judges need to understand the spectrum of addiction, from
both a medical and behavioral perspective, as well as the various types
of interventions and treatments available.
However, in addition, judges often need training about the extent of
their authority to require offenders to participate in treatment or
other types of interventions. Many judges are not aware of the extent
of their authority to implement innovative sentencing alternatives. For
example, in some jurisdictions judges have taken the initiative in
establishing Victim Impact Panels in their communities. The panels are
composed of victims of crime, such as individuals who have been injured
by drunk drivers or the family members of those who have been killed.
As part of an offender's sentence, a judge requires attendance at one or
several of the panel's sessions. At the session, victims of crimes
speak directly to offenders about how their lives have been
affected.
In addition, judges may benefit from discussions with peers about the
extent of judicial responsibilities and how an individual judge's
beliefs about these responsibilities influence his or her decisions;
many training courses and workshops offer this additional benefit of
peer support. Some training courses attempt to increase judges'
understanding of the difficulties that an AOD-involved offender might
have in accepting help for the AOD problem. Role-playing with peers may
be used in this situation. Learning to offer help in a way that
motivates a person to accept help can also be a training focus.
In a few States, AOD training for judges has evolved beyond basic
information. In the State of Wisconsin, for example, judges also receive
training in how to recognize "functional misfits," that is, individuals
who may be functioning at a high level in some environments (for
example, those who have reached important positions in their profession)
but not in others (for example, those who may be physically or
emotionally abusive with their families). The judges are taught to look
for the strategies these individuals use to hide their dysfunction. The
Wisconsin judges are also trained to recognize early signs of AOD abuse
problems in lawyers and other justice personnel, including other judges,
and to offer help in a way that is more likely to be accepted.
Professional peer support and self-help play an important role in the
training.
Training can target such issues as the goal of prevention, Federal
confidentiality regulations, relapse prevention, infectious diseases,
cultural competence, and the high levels of stress experienced by those
who work with substance-abusing clients. Each of these areas is
described in detail in the following sections.
Prevention -- of AOD abuse and crime -- is a primary goal of both
systems. Prevention offers communities an opportunity to stop AOD
problems before they start and provides hope for effecting community
change to support healthy behaviors. While there is no single
definition of AOD abuse prevention, there is general agreement on the
positions taken by AOD practitioners on the overall principles of
prevention:
Alcohol use is acceptable only for those of legal age and only
when the risk of adverse consequences is minimal.
Prescription and over-the-counter drugs are used only for the
purposes for which they were intended.
Other abusable substances are used only for their intended
purposes.
Illegal drugs and tobacco are not used at all.
Because AOD use plays a role in the transmission of human
immunodeficiency virus (HIV) disease and a variety of other illnesses,
the importance of prevention cannot be overemphasized. A key component
of all prevention efforts is education. Personnel from both the AOD
treatment system and the justice system should receive prevention
education and training in a variety of topics. They should also learn
ways to enhance the prevention messages among offender populations.
Since 1986 the Center for Substance Abuse Prevention (CSAP) has
provided guidance and leadership in the Nation's prevention efforts.
From its efforts, several basic prevention premises have emerged that
can form the basis for sound prevention training and education (Center for Substance Abuse Prevention, 1993).
These premises are
Prevention strategies must be comprehensively structured to
reduce individual and environmental risk factors and to increase
resiliency factors in high-risk populations.
Community involvement is a necessary component of an effective
prevention strategy.
Prevention must be interwoven with general healthcare and social
services delivery systems and it must provide a full continuum of
services.
Prevention approaches and messages that are tailored to differing
population groups are most effective.
As prevention strategies have evolved over the last 20 years, several
have proved effective, especially when used in combination:
Information dissemination. This strategy promotes
awareness and knowledge of the nature and extent of AOD abuse and
addiction and the resulting effects on individuals, families, and
communities. It also provides awareness of prevention policies,
programs, and services. It helps set and reinforce norms (for example,
drug dealers will not be tolerated in this neighborhood).
Prevention education. The goal of this strategy is to affect
critical life and social skills, including decisionmaking, refusal
skills, critical analysis (of media messages, for example), and
judgment.
Alternatives. This strategy establishes constructive and
healthy activities that do not include AOD use and encourages
individuals to use alternative methods of meeting needs usually filled
by the use of alcohol and other drugs.
Problem identification and referral. This strategy calls for
identification, education, and counseling for individuals, especially
youth, who are at high risk of developing AOD problems.
Community-based process. This strategy aims to enhance the
ability of the community to provide prevention and treatment services
more effectively. Activities include organizing, planning, enhancing
efficiency and effectiveness of the implementation of services,
collaborating with other agencies, building coalitions, and networking.
Building healthy communities encourages healthy life-style choices.
Environmental approach. This strategy sets up or changes
written and unwritten community standards, codes, and attitudes to
reduce AOD problems in the community. Included in this approach are
laws to restrict availability and access, price increases, and
communitywide actions.
Topics for prevention training might include
Discussion of needle sharing and its effects on HIV
transmission
High-risk sexual behaviors and their consequences
AIDS prevention efforts targeted to adolescents
Discussion of community policing and its role in prevention
Mobilization of community prevention efforts -- for example, to
counter advertising of alcohol in inner-city neighborhoods or to close
crack houses
Establishment of mentoring programs and recreation leagues for youth
and provision of positive role models
Self-esteem and its role in prevention
Designated driver programs
Parents and their roles in prevention
Parenting skills training as a prevention tool.
CSAP has published numerous books, training guides, and curricula on
prevention of AOD abuse, many of which would be suitable for use in
training personnel in the AOD treatment and criminal justice systems and
encouraging them to develop creative ways to prevent recidivism and
reduce the offender population. A catalog that lists prevention
materials available for use in training can be ordered from the National
Clearinghouse for Alcohol and Drug Information (NCADI). (See phone
numbers for NCADI on page v of this TIP.)
Personnel in both systems need specific training in the Federal
confidentiality regulations related to substance abuse and the
protection of certain types of information about persons receiving
treatment (42 U.S.C. §§290 dd-3 and ee-3 and 42 C.F.R. Part
2). These regulations should be thoroughly understood by staff who come
into contact with the AOD-involved criminal offender. Chapter 8 of this TIP provides detailed
guidelines for operating treatment programs in compliance with these
regulations. The chapter could be used as a training document or
reference guide for staff.
Confidentiality regulations are sometimes interpreted by criminal
justice officials and some AOD treatment providers as obstructions to
getting needed information. However, most AOD treatment personnel
consider confidentiality a key element of the treatment system because
it builds clients' trust in the treatment process. Offenders, in
particular, may have a great deal of fear about entering AOD treatment
and may not consider treatment if they are not assured that their
confidentiality will be protected.
Specific topics that could be addressed in training about
confidentiality rules include
Personnel in the criminal justice system should be educated about the
fact that relapse is a normal part of the addiction and recovery
process. Consequently, strict requirements such as dismissal from the
AOD treatment program on the basis of one or two positive urine samples
are not realistic but indicate the need for sanctions and for
reassessment of the offender and the treatment plan. In 1993, CSAT
published a Technical Assistance Publication on relapse, entitled
Relapse Prevention and the Substance-Abusing Criminal Offender,
which can be used in training staff from both systems. In addition to
providing guidelines for staff, it describes specific Federal, State,
and local relapse prevention programs that have operated successfully in
correctional institutions and in the community.
Specific topics that should be addressed in the area of relapse
prevention are
Why offenders are especially vulnerable to relapse, including
stressors related to release from the system and psychosocial factors
related to crime and AOD use
The recovery process and its various stages
The unstabilized and stabilized relapse-prone individual
"Stuck points" in recovery and how to get past them
Basic principles of relapse prevention therapy, including
self-knowledge and identification of warning signs, coping skills and
management of warning signs, and involvement of significant others in
the relapse prevention plan
The timing of relapse prevention efforts, especially in advance of
the release date.
Initial and ongoing training must be provided about a range of
communicable diseases, from the common cold to tuberculosis (TB) and
sexually transmitted diseases (STDs) including HIV disease. Staff will
benefit from understanding today's four major public health
problems-substance abuse, TB, HIV and acquired immunodeficiency syndrome
(AIDS), and other STDs -- and from knowing that substance abuse is the
common thread linking the other health problems.
Particular attention should be paid to training staff members about
transmission of HIV disease so that fears and misunderstandings will not
interfere with the provision of treatment.
Specific topics that might be included in staff training about
medical issues are
Transmission of HIV, TB, and STDs, including the role of unsafe
behaviors
Tests for HIV, TB, and STDs and what the test results
mean
Pre- and posttest counseling
Medical information about HIV disease and AIDS, an overview of the
stages of disease, and treatments for various complications
HIV case management, including available primary care resources
Recognizing the common manifestations of STDs (sores, rash,
discharge)
HIV/STDs and the law, including partner notification and
confidentiality requirements.
Another TIP in this series, TIP 11: Simple Screening Instruments
for Outreach for Alcohol and Other Drug Abuse and Infectious
Diseases, has an appendix that summarizes a curriculum developed by
the Centers for Disease Control and Prevention (CDC) that has been used
for the last 4 years to train outreach workers and HIV educators. The
curriculum emphasizes prevention education.
CDC has prepared a variety of training and educational materials
specific to TB, including a Core Curriculum on Tuberculosis,
which contains material applicable to the correctional setting. A
narrative text on Tuberculosis in Correctional Facilities is also
available, with 67 accompanying slides, a videotape, and a wallchart on
administering and interpreting the purified protein derivative (PPD)
skin test for TB. Doing Time With TB, a brochure for inmates,
contains five fact sheets covering exposure, the PPD skin test, TB
prevention, treatment for TB, and the relationship between TB and HIV
disease. CDC has also issued Control of Tuberculosis in Correctional
Facilities: A Guide for Health Care Workers, which provides
information on implementing CDC's guidelines on TB control and outlines
recommended regimens of TB treatment.4
Cultural competence includes the behaviors, attitudes, and policies
in a system or agency or among professionals that enhance effectiveness
in cross-cultural situations. Cultural competence is based on
understanding and respect for differences among people and groups. It
is important to recognize that culture plays a complex role in peoples'
lives and in the development of AOD use problems and their
treatment.
Cultural competence is based on acceptance
and respect for differences between people and groups. It is important
to recognize that culture plays a complex role in peoples' lives and in
the development of specific AOD use problems and their treatment.
Delivering culturally competent services is a basic tenet of AOD
abuse treatment that must be presented and discussed in training for
both AOD abuse providers and criminal justice personnel. Practical
examples of cultural competence in program development and operation
should be reviewed. Staff should be trained in cultural diversity and
issues specific to the cultural populations that they serve. Topics to
include in training might include
Stereotypes and biases
Language and terminology and their role in perpetuating
stereotypes
Diversity within groups (i.e., avoiding the belief that all members
of a group are the same)
Ethnic minority groups and their diverse heritages, especially as
cultural beliefs relate to AOD use and criminal activity
Women, including effects of AODs on women and stereotypes about
women AOD abusers
Gay men and lesbians, including effects of intolerance on treatment
seeking.
Information should also be presented about people who are
economically deprived, because they represent a majority of the offender
population.
Two TIPs in this series present important information on providing
culturally competent treatment. TIP 12: Combining Substance Abuse
Treatment With Intermediate Sanctions for Adults in the Criminal Justice
System has an appendix that describes a continuum of competence; it
also contains a useful self-assessment tool, the Cultural Competence
Checklist. The checklist can be used as the basis for a staff
discussion of these issues. In addition, TIP 6: Simple Screening
Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious
Diseases reprints two articles in Appendix C that can be used in
training sessions. In one forum-type article, a variety of treatment
professionals discuss personal and professional experiences with
prejudice and its effect on treatment. The other article describes a
self-instructional comic-book-formatted guide that has been successfully
used to prevent HIV infection among African American and Hispanic
American adolescents.
Staff should receive specific training in
cultural diversity and issues specific to the cultural populations that
they serve.
Persons working with AOD abusers in the criminal justice system
experience high levels of stress, especially those who work directly
with clients. Some staff may suffer from burnout or even posttraumatic
stress disorder. Some personnel, particularly those working in
correctional facilities, also may be victims of physical or verbal
abuse. Frequently, there is little staff support when abusive
situations occur. As a consequence of all of these issues, staff should
receive training focused on burnout and handling stressful
environments.
Specific topic areas might include
Recognition of the signs of burnout in oneself and others
How burnout affects significant others
The role of peer support in preventing and dealing with burnout
The importance of institutional policy and response to staff
burnout
Formation of groups within the institution to address sequelae of
violent incidents, especially stress syndromes such as posttraumatic
stress disorder
How to deescalate or otherwise respond to potentially violent
situations
Stress management strategies, including relaxation techniques.
In summary, staff training needs can be immense. Currently, few
staff members in either system are trained to use comprehensive and
integrated approaches, to identify which approaches are appropriate for
various situations and populations, and to use these approaches
comfortably. For example, when working with clients who are fairly new
to the criminal justice system and who do not have full-blown AOD abuse
disorders, the staff should use approaches that differ from those used
with offenders who have been in the criminal justice system for a long
time. In the area of early intervention, staff training can help
identify those at risk who may not exhibit robust signs and symptoms of
AOD abuse or addiction. Staff can identify client life-style issues and
behaviors associated with high risk for developing later AOD problems,
even if the clients do not perceive these issues and behaviors as
current concerns.
1. Requests for CDC publications should
be directed to the CDC's Information Service, 1600 Clifton Road N.E.,
Mailstop E-06, Atlanta, Georgia 30333; telephone (404) 639-1819.
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