Reducing Substance Use Disorders and Related Offending: A Continuum of Evidence-Informed Practices in the Criminal Justice System

Lily Gleicher, Ph.D.  |  Updated: April 16, 2019  |  
Print  

In the United States, more than 20 million individuals have substance use disorders (SUDs)—not including individuals with more mild or moderate substance use and misuse.[1] Of those with SUDs, just over 10 percent ultimately receive treatment.[2] On average, costs incurred in the United States from alcohol and drug use due to lost work productivity, health care expenses, motor vehicle accidents, and criminal justice costs exceeds $400 billion. Almost half of the cost is at the taxpayers’ expense.[3]

READ MORE

Of the 20 million individuals with SUDs, a subset is involved with the criminal justice system. More than half of the 2.2 million individuals housed in U.S. prisons and jails meet the clinical diagnosis criteria for SUDs.[4] Seventy-eight percent of violent crimes and 77 percent of property crimes involve drugs and/or alcohol.[5] The government spends an estimated $74 billion dollars on court processing, community supervision, and imprisonment of individuals with SUDs, but just 1 percent of that amount on prevention and treatment for these individuals.[6] In addition, about 11 percent of prisoners with SUDs or substance misuse receive treatment.[7]

Today, SUDs and substance misuse and abuse are considered a public health issue, as well as a criminal justice concern. Public health, treatment providers, medical, and criminal justice professionals, as well as community members, legislators, and other stakeholders, are encouraged to collaborate to develop a comprehensive approach to SUDs.[8] Together, they can increase access to substance use, misuse, and SUD treatment and the use of harm reduction tactics to reduce substance use, overdose, and criminal justice involvement.[9]

A multipronged approach to addressing drug availability and use in Illinois communities entail interdiction efforts aimed at those who traffic large quantities of illicit substances, as well as prevention, deflection, diversion, and treatment of those who use. Traditional law enforcement tactics work to combat traffickers and suppliers to reduce influx of drugs in the community.[10] At the same time, the system can offer diversion, outreach, and referrals to treatment services.

Several substance use treatment models are effective, some more so than others.[11] Over the past several decades, research and rigorous evaluation has provided insight on effective practices for individuals with SUDs and other substance use issues and the importance of treatment over criminal justice system involvement.[12] By integrating evidence-informed practices, criminal justice agencies and communities can save lives, decrease costs to the criminal justice system, healthcare systems, and taxpayers.[13]

ICJIA researchers developed this continuum to share evidence-informed practices for addressing SUDs and substance misuse to guide local-level assessment, planning, and implementation efforts around SUD prevention and intervention. These practices range from early prevention to services to support successful reintegration back into the community following time spent in jail or prison. Communities are encouraged to use this continuum to examine the gaps and needs that exist in their areas and explore the options available to address those gaps.

DEFINING EVIDENCE-BASED PRACTICES
TerminologyDescription[14]Effect
Anecdotal or Not Evidence-Informed or Evidence-BasedThere is little or no evidence, through the use of reliable, replicable, and generalizable research, indicating the programs achieve what they are intended to achieve.Anecdotal, No Effect, Unknown Effect
Evidence-InformedThere is some evidence, through the use of reliable, replicable, and generalizable research, indicating the programs achieve what they are intended to achieve.Promising Practice
Evidence-BasedThere is strong evidence, through the use of reliable, replicable, and generalizable research, indicating the programs achieve what they are set out to achieve.Effective Practice
EVIDENCE-BASED RISK AND PROTECTIVE FACTORS

Prevention of substance use requires an understanding of factors that may decrease the potential for substance use (protective factors) and factors that may put individuals at risk, or increase potential for substance use (risk factors). Evidence-informed prevention programs can target risk factors and enhance protective factors.[15] There are five, evidence-based ecological domains that have been shown to be the most predictive of delinquency, including substance use: individual, family, peer, school, and community.

Risk factors include:[16]

Individual/Peer

  • Early initiation of substance use.
  • Persistent and early problem behavior.*
  • Rebelliousness.
  • Favorable attitudes toward substance use.
  • Peer substance use
  • Genetic susceptibility to substance use.

Family

  • Poor family management skills (expectations, supervision, monitoring, inappropriate punishment).
  • Family conflict.
  • Parental attitudes favorable toward substance use.
  • Family history of substance misuse.

School

  • Late elementary school academic failure.
  • Lack of commitment to school.

Community

  • Low cost of alcohol.
  • High availability of substances.
  • Community laws/norms favorable toward substance use.
  • Media portrayal of alcohol use.*
  • Low level of neighborhood bonding/attachment.*
  • Community disorganization (e.g. high population density, physical deterioration, high rates of adult crime).*
  • Low socioeconomic status.*
  • High rates of mobility within or between communities.*

Protective factors include:[17]

Individual/peer

  • Social, emotional, behavioral, cognitive, and moral competence; interpersonal skills.
  • Self-efficacy.
  • Spirituality.
  • Resiliency.

Family, school, and community

  • Opportunities for positive social involvement.
  • Recognition for positive behavior (reinforcements).
  • Bonding (attachment or commitment).
  • Healthy beliefs and standards for behavior.
  • Marriage or committed relationship.**
References

  1. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: HHS.

  2. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: HHS.

  3. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: HHS.

  4. The National Center on Addiction and Substance Abuse. (2010). Behind bars II: Substance abuse and America’s prison population. Columbia, NY: Columbia University.; Caulkins, J. P., & Kleiman, M. A. R. (2014). How much crime is drug-related? History, limitations, and potential improvements of estimation methods. Washington, DC: U.S. Department of Justice.

  5. Centers for Disease Control and Prevention. (2016). Understanding the epidemic. Last modified June 21, 2016. Retrieved from http://bit.ly/2oqfbEf.

  6. The National Center on Addiction and Substance Abuse. (2010). Behind bars II: Substance abuse and America’s prison population. Columbia, NY: Columbia University.

  7. The National Center on Addiction and Substance Abuse. (2010). Behind bars II: Substance abuse and America’s prison population. Columbia, NY: Columbia University.

  8. Pelan, M. (2015). Re-visioning drug use: A shift away from criminal justice and abstinence-based approaches. Social Work and Society International Online Journal, 13(2).

  9. Harm Reduction Coalition. (n.d.). Principles of harm reduction. Retrieved from http://bit.ly/1I4t27D.

  10. Reichert, J., Sacomani, R., Medina, E., DeSalvo, M., & Adams, S. (2016). Drug trends and distribution in Illinois: A survey of drug task forces. Chicago, IL: Illinois Criminal Justice Information Authority.

  11. Bahr, S. J., Masters, A. L., & Taylor, B. M. (2012). What works in substance abuse treatment programs for offenders? The Prison Journal, 92(2), 155-174.; Police Executive Research Forum. (2016). Building successful partnerships between law enforcement and public health agencies to address opioid use. COPS Office Emerging Issues Forums. Washington, DC: Office of Community Oriented Policing Services.

  12. Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2014). Treatment drug abuse and addiction in the criminal justice system: Improving public health and safety. Journal of the American Medical Association, 30(12), 183-190.

  13. Office of National Drug Control Policy. (2012). Costs and benefits of investing early in substance abuse treatment. Executive Office of the President. Washington, D.C.

  14. Crimesolutions.gov. (2011). Glossary. National Institute of Justice, Office of Justice Programs. Washington,DC Retrieved from http://bit.ly/2oieUTg.; Blueprints Program Model. (2012-2016). Program criteria. Blueprints for Healthy Youth Development. Boulder, CO. Retrieved from http://bit.ly/2oFVhqG.; see also Orchowsky, S. (2014). An introduction to evidence-based practices. Washington, DC: Justice Research and Statistics Association, Bureau of Justice Assistance, U.S. Department of Justice, and National Criminal Justice Association.

  15. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: Author.; see also Catalano, R. F., Fagan, A. A., Gavin, L. E., Greenberg, M. T., Irwin, C. E., Ross, D. A., & Shek, D. T. (2012). Worldwide application of prevention science in adolescent health. The Lancet, 379(9826), 1653-1664.; Stone, A. L., Becker, L. G., Huber, A. M., & Catalano, R. F. (2012). Review of risk and protective factors of substance use and problem use in emerging adulthood. Addictive Behaviors, 37(7), 747- 775.; Shek, D. T. L., Sun, R. C. F., & Merrick, J. (2012). Positive youth development constructs: Conceptual review and application. The Scientific World Journal.; Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). Adolescence and the social determinants of health. The Lancet, 379(9826), 1641-1652.

  16. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: Author.

  17. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: Author.

Intervention at Criminal Justice Intercepts

Prevention
This intercept involves community partnerships, prevention, and behavioral health services. The goal is to provide the earliest intervention effort to prevent criminal justice involvement.

Intercept 0

Law Enforcement
This intercept involves first contact with the criminal justice system, including dispatch, law enforcement, and emergency services or crisis response teams.

Intercept 1

Initial Detention / Initial Court Hearings
This intercept involves post-arrest, initial detention, or initial court hearings. This includes pre-trial programs and public defender or prosecution programs.

Intercept 2

Courts and Jails
This intercept involves the jail or court and includes specialty court dockets and jail-based services.

Intercept 3

Institutions and Reentry
This intercept involves prison or reentry from prison or jail. This includes prison-based services for reentry and coordination of community-based services.

Intercept 4

Community Corrections
This intercept involves probation and parole programs and services. This includes connecting individuals to appropriate community-based services and resources.

Intercept 5

Things to Consider

In any type of program, practice, or initiative for individuals with SUDs, it is imperative that they are evidence-informed, meaning that rigorous evaluation and research proves the practices and program components have produced significant, replicable positive outcomes. Implementing these programs and practices with a high degree of fidelity can help improve and save lives as well as improve public safety and decrease taxpayer and criminal justice system expenses.[1] In fact, for every $1 spent on SUD treatment, there is in an estimated $4 to $7 return in the form of reduced drug-related crime, and criminal justice costs, and health care cost savings.[2] Criminal justice professionals, in conjunction with other policymakers, stakeholders, and providers, can be more effective at reducing recidivism and substance use with limited resources when they use initiatives that have been shown to work. This continuum outlined several ways in which schools, communities, families, law enforcement, courts and supervision, and correctional institutions can refer, divert, and treat individuals with SUDs, based on evidence-informed practices and offered research, resources, and examples.

There are several important things to consider prior to and during implementation of SUD and substance misuse treatment:

  1. Capacity and quality of SUD treatment and services in communities and in correctional institutions, in addition to the use of evidence-informed practices.[3]
  2. Net-widening—the potential to inadvertently increase the number of individuals under criminal justice control that would not otherwise have been under criminal justice control.[4]
  3. Collaboration between different criminal justice professionals, treatment and service providers, policymakers, and stakeholders is necessary for successful deflection, diversion, and intervention.[5]
  4. Criminal justice professionals should be formally trained in behavioral health and mental health, with an understanding of SUDs.[6]
  5. Continuing research regarding current and new SUD and substance use treatment and service models; many practices do not have enough research to consider them evidence-based, only evidence-informed.[7]
  6. Despite the evidence, participation or use of evidence-informed programs or practices may not be adequate to address all of an individuals’ needs. Thus, it is important to consider multi-model, individualized treatment plans when implementing SUD and substance use treatment.[8]
  7. Make sure that a program or practice is an appropriate fit and addresses a relevant need in the community.[9]
  8. Plan out the initial implementation and what sustainability may necessitate (i.e. funds, programming, staff, training) for successful implementation and sustainability.[10]
  9. Implementation is a process that takes time. Collect data to inform your organization about what is going on, what changes may be necessary, and assess whether there is fidelity to the practice (quality assurance processes, continuous quality improvement). This is key for sustainability.[11]

Additional Resources

The following list provides an inventory of organizations, programs and practices, and national repositories that provide further detail on information presented in this continuum as well as additional information on other evidence-informed programs and practices. This is not exhaustive nor an endorsement for any agency, initiative, or practice. It is provided for possible additional information on evidence-informed SUD and substance misuse prevention, deflection, diversion, and treatment.

LAW ENFORCEMENT RESOURCES
COURTS & SUPERVISION RESOURCES
CORRECTIONAL INSTITUTIONS RESOURCES
NATIONAL REGISTRIES & RESOURCES FOR EVIDENCE-INFORMED AND EVIDENCE-BASED PRACTICES

National registries each use varying standards and requirements in how they deem programs and practices as evidence-informed or evidence-based, and should be taken into consideration. This information can be found within each of the national resource websites.

References

  1. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: HHS.; Andrews, D. A, & Bonta, J. (2012). The psychology of criminal conduct (5th ed.). New York, NY. Routledge.

  2. Police Executive Research Forum. (2016). Building successful partnerships between law enforcement and public health agencies to address opioid use. COPS Office of Emerging Issues Forums. Washington, DC: Office of Community Oriented Policing Services.; National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide (3rd ed.). National Institute of Health, U.S. Department of Health and Human Services. Bethesda, MD: HHS.

  3. Cooney, S. M., Huser, M., Small, S., & O’Connor, C. (2007). Evidence-based programs: An overview. Madison, WI: University of Wisconsin-Madison and University of Wisconsin-Extension.

  4. Leone, M. C. (2002). Net widening. In the Encyclopedia of Crime and Punishment (Volume 1).

  5. National Heroin Task Force. (2015). National heroin task force: Final report and recommendations. Washington, DC. Retrieved from https://www.justice.gov/file/822231/download.

  6. National Center for Mental Health and Juvenile Justice (2012). Law enforcement-based diversion: Strategic innovations from the mental health/juvenile justice action network. Delmar, NY: Policy Research, Inc.

  7. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: HHS.

  8. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: HHS.

  9. Bertram, R. M., Blase, K. A., & Fixsen, D. L. (2015). Improving programs and outcomes: Implementation frameworks and organization change. Research on Social Work Practice, 25(4), 477-487.; Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

  10. Bertram, R. M., Blase, K. A., & Fixsen, D. L. (2015). Improving programs and outcomes: Implementation frameworks and organization change. Research on Social Work Practice, 25(4), 477-487.; Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

  11. Bertram, R. M., Blase, K. A., & Fixsen, D. L. (2015). Improving programs and outcomes: Implementation frameworks and organization change. Research on Social Work Practice, 25(4), 477-487.; Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).