Jail Terms Without Treatment Contribute To Drug Addicts’ Relapse

A recent report on how corrections systems deal with substance abusers may have implications in Connecticut, and even here at the Garner Correctional Center in Newtown. In its first report aimed at improving how the criminal justice system deals with drug addicts, the National Institute on Drug Abuse offered 13 guidelines Monday for what works — and what fails.

The key is understanding that drug addiction is a brain disease that affects behavior, and that it requires carefully monitored, personalized treatment, including access to medication such as methadone after the drug offender is released into society, the institute said.

 “What does not work? Putting a person who is addicted to drugs in jail for five or ten years and thinking that will cure him with no treatment,” said Dr Nora Volkow, director of the antidrug abuse agency. “The likelihood of that person relapsing is very high.”

The guidelines urge a mix of traditionally liberal and conservative approaches.

The institute argues that prisons and court-ordered treatment programs do not use methadone and other addiction medications enough. At the same time, the guidelines support pressuring offenders into treatment as a condition of probation and advocate urine testing during treatment to track and prevent relapses.

“The criminal justice system offers an extraordinary opportunity to help people with drug problems,” Dr Volkow said.

Every $1 spent on drug treatment programs also saves the nation an estimated $4 in crime costs, she said. The annual estimated cost to the United States for drug crimes is $107 billion.

The drug treatments Cheryl Cline started in an Illinois prison after using crack cocaine for nine years probably saved the 29-year-old’s life. This week, she is marking her third drug-free year, and her life has been turned around.

While she was using, Ms Cline said, she lived in an abandoned building or a car, and she shoplifted to support her habit. Today, she works as a waitress, has reunited with her family, and is studying to be a drug counselor.

“I’d like people to know that everybody deserves an opportunity for treatment, but when you’re on the outside and running wild most people won’t take it,” said Ms Cline, who lives in Aurora, Ill. “Prison is one of the best places to do it because you are confined. You have nothing but time on your hands.”

Maia Szalavitz, a drug policy expert not involved with the report, said the guidelines are excellent. Methadone is rarely used in the criminal justice system despite evidence that it helps people addicted to opioids such as heroin, she said.

She faulted the system’s current reliance on 12-step programs modeled after Alcoholics Anonymous, which she said works for some people but not everyone.

“If these guidelines help addicts in the justice system to get more sensitive and appropriate care, they will be highly useful,” said Ms Szalavitz, a senior fellow at the media watchdog group Statistical Assessment Service. “But if systems are not put in place to ensure that the system rewards treatment excellence and drops harmful and ineffective methods, they won’t do much.”

The following are the National Institute on Drug Abuse research-based guidelines for drug treatment in the criminal justice system:

1. Drug addiction is a brain disease that affects behavior.

2. Recovery from drug addiction requires effective treatment, followed by management of the problem over time.

3. Treatment must last long enough to produce stable behavioral changes.

4. Assessment is the first step in treatment.

5. Tailoring services to fit the needs of the individual is an important part of effective drug abuse treatment for criminal justice populations.

6. Drug use during treatment should be carefully monitored.

7. Treatment should target factors that are associated with criminal behavior.

8. Criminal justice supervision should incorporate treatment planning for drug abusing offenders, and treatment providers should be aware of correctional supervision requirements.

9. Continuity of care is essential for drug abusers reentering the community.

10. A balance of rewards and sanctions encourages prosocial behavior and treatment participation.

11. Offenders with co-occurring drug abuse and mental health problems often require an integrated treatment approach.

12. Medications are an important part of treatment for many drug abusing offenders.

13. Treatment planning for drug abusing offenders reentering the community should include strategies to prevent and treat medical conditions such as HIV/AIDS, hepatitis, and tuberculosis.