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Lily Gleicher, Ph.D.  |  Updated: April 16, 2019
Reducing Substance Use Disorders and Related Offending: A Continuum of Evidence-Informed Practices in the Criminal Justice System

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]

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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.

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 RESOURCESCOURTS & 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).

Intercept 0: 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.

FAMILY-BASED PREVENTION PROGRAMS

Description: Families are important factors in the lives of youth; parenting skills and the modeling of prosocial behavior and attitudes can influence youths’ substance use.[1] Factors that may increase a youth’s likelihood to exhibit antisocial behaviors, such as substance use include

  • inconsistent and harsh punishment practices;
  • lack of parental supervision and monitoring;
  • low levels of family bonding; and/or
  • high levels of family conflict.[2]

Goals:

  • Increase opportunities for appropriate involvement in activities with family.
  • Increase parental use of reinforcement and parental management skills.
  • Increase attachment and commitment to family.
  • Enhance family resilience.
  • Increase effective communication skills among family members.[3]

Family-Based Prevention Program Examples and Research

Guiding Good Choices (GGC) aims to increase healthy, protective parent-youth interactions while targeting youths’ risk for early substance use using a family-competency training program. The five-session weekly program led by trained facilitators incorporates

  • family management skills;
  • parent-youth bonding; and
  • youth peer resistance skills. [4]

Research findings. GGC is a promising program; compared to a control group, youth in GGC had

  • lower alcohol initiation scores;
  • significant reduction in youth engaging in substance use;
  • lower new user proportions for intoxication and marijuana after 3.5-years; and
  • were more likely to remain drug-free at a 2-year follow-up if they had not initiated substance use at 1-year follow-up.[5]

Strengthening Families Program (SFP) targets family protective factors and resiliency through a seven-session program led by trained facilitators to decrease substance use and abuse in addition to other behavioral problems.[6] The program aims to

  • build parental skills;
  • create stronger family units; and
  • increase social, emotional, communication, conflict resolution, and coping skills.[7]

Research findings. SFP is a promising program; youth in SFP had

  • slower overall growth in substance use among adolescents;[8]
  • increased parenting competency;[9]
  • lower substance use behaviors when compared to the control group;[10]
  • delayed onset of substance use;[11] and
  • lower likelihood of substance use initiation at 2.5-year follow-up when youth had not initiated substance use at 1.5-year follow-up.[12]

Creating Lasting Family Connections (CLFC) targets families and at-risk youth in high-risk environments to increase youth resiliency and reduce substance use.[13] The program aims to

  • educate on drugs and alcohol;
  • increase communication and conflict resolution skills;
  • enhance coping and resistance skills;
  • encourage use of community services; and
  • improve self-knowledge, personal responsibility, and respect for others.[14]

CLFC can be implemented in schools, places of worship, recreation centers, or through court-based services. [15]

Research findings. CLFC is a promising program; at 3- and 12-months, CLFC reduced substance use frequency. [16] When family pathology decreased, CLFC participants demonstrated reduction in frequency of other drug use and alcohol use at a 12-month follow-up.[17]

Brief Strategic Family Therapy (BSFT) targets substance use and other antisocial behaviors for diverse populations.[18] A trained therapist uses a curriculum and leads 8 to 24 sessions to target family patterns that support problem behavior.[19] BSFT aims to

  • join youth, family, and therapist;
  • examine patterns associated with antisocial youth behavior; and
  • restructure family’ interaction patterns.[20]

Research findings. BSFT is a promising program. BSFT has reduced

  • youth substance abuse, conduct problems;
  • maladaptive family functioning;
  • antisocial peer associations;[21]
  • decreased alcohol use;[22] and
  • significantly reduced marijuana use.[23]

Multidimensional Family Therapy (MDFT) can be used in a residential or outpatient setting, and targets substance use and other behavioral issues, while also improving overall family functioning.[24] Trained therapists work with the individual, parents/guardians, and other family members to

  • improve family conflict-resolution strategies;
  • improve family relationships and management practices;
  • transforming lifestyle to a more developmentally appropriate lifestyle; and
  • enhance protective factors.[25]

Sessions are delivered between 1 and 3 times per week over a 4- to 6-month time-frame.[26]

Research findings. MDFT is an effective program; compared to individual cognitive-behavioral therapy, MDFT can significantly

  • reduce substance use problem severity at 6- and 12-month follow-ups;
  • reduce drug use after 12 months; and
  • better outcomes for youth with co-occurring disorders.[27]

MDFT has also been found to

  • increase school functioning—returning to school and receiving higher grades;
  • reduce antisocial behaviors related to substance use (delinquency); and
  • reduce antisocial behaviors and association with antisocial peers.[28]

Multisystemic Therapy (MST) aims to

  • reduce criminal activity among youth;
  • decrease other types of antisocial behavior like drug abuse; and
  • achieve these outcomes cost-effectively by decreasing rates of incarceration and out-of-home placements.[29]

Trained therapists target individual risk factors using a holistic approach in order to enhance protective factors of the individual and family.[30] MST programs are a minimum of 3 months with gradual decrease in contact.[31]

Research findings. MST is an effective program. MST has been effective with

  • inner-city juvenile offenders and their families;
  • parent-child relationships;
  • adolescent sexual offenders; and
  • individual substance use and abuse.[32]

Research indicates MST can effectively

  • reduce delinquency;
  • reduce reports of drug use;
  • decrease alcohol use at 4- and 12-month follow-ups; and
  • decrease in multiple drug use at 12-month follow-ups.[33]

Other effective family therapies include Functional Family Therapy (FFT), Treatment Foster Care Oregon, and Nurse-Family Partnership.

SCHOOL-BASED PREVENTION PROGRAMS

Description: These programs target factors related to youth substance use, including peers and attachment to conventional institutions (e.g. school, community), as well as opportunities like leisure activities, religious organizations.[34]

Goals:

  • Increase engagement in school.
  • Develop and maintain relationships with teachers, peers, and other mentors.
  • Increase involvement in prosocial activities.
  • Increase positive behavior.
  • Reduce drug use and other antisocial behaviors.[35]

School-Based Prevention Programs Examples and Research

Project Towards No Drug Abuse (TND) is a high school-based program targeting youth risk for substance use. The program can be a universal program or selective. A trained teacher uses a curriculum focusing on

  • social skills training;
  • decision-making components; and
  • motivation to not use drugs.[36]

Students engage in games, worksheets, group discussions, and watch videos. The program targets substance use, violent behavior, and other behavioral problems.[37]

Research findings. TND is an effective program that has

  • reduced drug use by 25 percent;[38]
  • reduced monthly marijuana use by 22 percent;
  • reduced monthly drug use by 26 percent;[39] and
  • reduced monthly hard drug use continued for 4- and 5-years.[40]

Positive Action (PA) targets youth’s intrinsic motivation to develop and maintain positive behaviors.[41] The program can address

  • substance use;
  • violence-related behavior;
  • positive social-emotional learning; and
  • youth development.[42]

Lessons include a focus on

  • social and emotional skills;
  • self-improvement;
  • responsibility; and
  • how thinking influences behavior.[43]

School administrators, faculty, or other school personnel may be trained to deliver scripted lessons.[44]

Research findings. PA is an effective program; when compared to a control group, youth in PA had

  • 31 percent fewer substance use behaviors; and
  • 37 percent fewer violence-related behaviors.[45]

Length of time in PA matters. Youth who completed PA for 3 to 4 years had significantly fewer antisocial behaviors, including substance use, than youth in PA for less than 3 years.[46]

Good Behavior Game (GBG) targets aggressive and disruptive classroom behavior, as well as future delinquency, in grades K -3, by using a reward system to reinforce compliance with classroom rules and expectations.[47]

Research findings. GBG is a promising program that can

  • reduce externalizing behavior and problems;
  • increase acceptance by peers;
  • increase mutual friends; and
  • increase closeness to others compared to non-GBG participants.[48]

LifeSkills Training (LST) has trained school staff lead a curriculum to target key social and psychological factors that increase risk for substance use through cognitive-behavioral skills training techniques.[49] This includes

  • modeling (demonstration) and behavioral rehearsal (practice);
  • feedback;
  • reinforcement; and
  • behavioral homework assignments.[50]

The program develops skills in

  • drug resistance (peers, media, misconceptions);
  • personal self-management (self-image and behavior, how decisions influence others; problem-solving skills); and
  • interpersonal and understanding choices.[51]

Research findings. LST is an effective program for diverse populations (rural, urban, suburban, varying races). LST has demonstrated decreased

  • binge drinking;
  • polysubstance use;
  • lower weekly use of cigarettes, marijuana, and alcohol; and
  • decreased substance use initiation.[52]

Brief Alcohol Screening Intervention for College Students (BASIC) targets college students who drink heavily and at-risk for potential alcohol-related issues (e.g. lack of class attendance, missed/late assignments, incidents, sexual assault, or violent behavior).[53] Trained facilitators use a harm reduction approach, incorporating cognitive-behavioral components, to increase healthier choices and provide information on use of coping skills to reduce risk.[54]

Research findings. BASIC is an effective program that can

  • decrease levels of drinking and binge drinking behavior;
  • decrease number of drinks per drinking occasion;
  • reduce blood-alcohol content levels;[55]
  • reduce quantity and frequency of alcohol use after 4-years;[56] and
  • decrease negative consequences associated with drinking when compared to a control group.[57]
MULTI-MODAL PREVENTION PROGRAMS

Description: Many programs identified previously incorporate more than one mode of prevention, though tend to focus on one in particular. Multi-modal programs incorporate several components—community, school, family, and individual—to target for substance use prevention. Below are other prevention programs defined as multi-modal.[58]

Goals:

  • Increase protective factors and youth resiliency.
  • Decrease risk factors.
  • Decrease substance use.

Multi-Modal Prevention Program Examples and Research

Raising Healthy Children (RHC) incorporates teacher, parent, and student components to increase socially and developmentally appropriate behaviors.[59] This includes workshops and sessions in each component area to help enhance protective factors and reduce risk factors related to substance use and other antisocial behaviors.[60]

Teachers work on

  • positive classroom management;
  • cooperative learning tactics;
  • practices to increase student motivation;
  • interpersonal skill development; and
  • other educational strategies.[61]

Research findings. RHC is a promising program that can

  • significantly improve school grades and achievement;
  • reduce reports of violent behavior; and
  • reduce reports of heavy alcohol use within the previous year.[62]

Communities That Care (CTC) is a community-based prevention approach that targets youth health and behavioral issues through focusing on scientifically validated risk and protective factors.[63] The program includes five key components:

  • Opportunities: creation of developmentally acceptable opportunities for positive and active participation and interaction with other prosocial individuals.
  • Skills: teaching skills necessary for successful development.
  • Recognition: providing praise and reinforcement for participation, improvement, and achievement.
  • Bonding: Increase youths’ sense of attachment, emotional bonding, and commitment to prosocial individuals and groups in the community (i.e. family, teachers, employers, neighbors, mentors).
  • Clear standards for behavior: increasing motivation to live within healthy standards of the group or person whom they are bonded to.[64]

These key components are developed and implemented by a community coalition who designs the strategic prevention plan based on risk and protective factors most important to the community.

Research findings. CTC is a promising program. A large-scale research study using a randomized controlled trial found CTC participants were

  • 32 percent less likely to have initiated alcohol use;
  • 25 percent less likely to have initiated delinquent behavior;
  • 33 percent less likely to have initiated cigarette use; and
  • maintained these behaviors through 10th grade.[65]

Another study found lower levels of risk factors, including delinquency and alcohol/drug use in CTC communities.[66]

Positive Family Support (PFS) targets at-risk youth using a multilevel, family-centered approach that is adaptable and flexible to different family needs. PFS consists of 3 levels administered in a middle school setting:

  • Creation of a Family Resource Center (FRC) using a Parent Consultant, and implementation of Success, Health, and Peace (SHAPe).
  • Incorporation of brief interventions, with collaboration from parents for youth demonstrating signs of academic or behavioral problems not met in level 1.
  • Family-checkups for students not responding as well to level 2, which aims to enhance parent motivation and increase family engagement in interventions.[67]

Research findings. PFS is a promising program shown to

  • reduce substance use;
  • reduce antisocial behavior;
  • reduce arrests;[68]
  • increase self-regulation;
  • decrease substance use over time;
  • decrease growth in antisocial behavior; and
  • reduce associations with antisocial peers.[69]

Linking the Interests of Families and Teachers (LIFT) targets at-risk youth and families via class-based social skill development, playground Good Behavior Game (GBG), and parent management training.[70] There is a LIFT telephone line in each classroom that allows for youth or families to use for questions or concerns, while also allowing teachers to provide information on the class daily.[71]

Research findings. LIFT is an effective program, most notable for its impact on aggressive behavior. LIFT youth participants compared to non-LIFT youth participants indicated a

  • slowed down rate of substance use over adolescence; and
  • significant decrease in average use of tobacco, alcohol, and illicit drug use through 12th grade.[72]
References

  1. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  2. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  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: Author.

  4. Crimesolutions.gov. (2011). Program profile: Guiding good choices. National Institute of Justice, Office of Justice Programs. Washington, DC. Retrieved from http://bit.ly/1VSdvk8.

  5. Blueprints Program Model. (2012-2016). Guiding good choices. Blueprints for Healthy Youth Development. Boulder, CO. Retrieved from http://bit.ly/1T7Wl1B.

  6. Molgaard, V., & Spoth, R. (2001). The strengthening families program for young adolescents: Overview and outcomes. Residential Treatment for Children & Youth, 18(3), 15-29.

  7. Molgaard, V., & Spoth, R. (2001). The strengthening families program for young adolescents: Overview and outcomes. Residential Treatment for Children & Youth, 18(3), 15-29.

  8. Spoth, Richard L., Redmond, C., Shin, C., & Azevedo, K. (2004). Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Journal of Consulting and Clinical Psychology, 72(3), 535–42.

  9. Spoth, R. L., Randall, K. G. & and Shin, C. (2008). Increasing school success through partnership-based family competency training: Experimental study of long-term outcomes. School Psychology Quarterly, 23(1), 70–89.

  10. Molgaard, V., & Spoth, R. (2001). The strengthening families program for young adolescents: Overview and outcomes. Residential Treatment for Children & Youth, 18(3), 15-29.

  11. Thompson, S. J., Pomeroy, E. C., & Gober, K. (2005). Family-based treatment models targeting substance use and high-risk behaviors among adolescents: A review. Journal of Evidence-Based Social Work, 2(1/2), 207-233.

  12. Molgaard, V., & Spoth, R. (2001). The strengthening families program for young adolescents: Overview and outcomes. Residential Treatment for Children & Youth, 18(3), 15-29.

  13. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  14. National Registry of Evidence-based Programs and Practices. (n.d.). Creating lasting family connections (CLFC)/creating lasting connections (CLC). Washington, DC: Substance Abuse and Mental Health Services Administration.

  15. Strader, T. (n.d.). Creating lasting family connections. Louisville, KY, Kentucky Department of Health Promotion and Education.

  16. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  17. Johnson, K., Strader, T., Berbaum, M., Bryant, D., Bucholtz, G., Collins, D., & Noe, T. (1996). Reducing alcohol and other drug use by strengthening community, family, and youth resiliency: An evaluation of the Creating Lasting Connections program. Journal of Adolescent Research, 11(1), 36-67.

  18. Robbins, M. S., & Szapocznik, J. (2000). Brief strategic family therapy. Juvenile Justice Bulletin, Office of Juvenile Justice and Delinquency Prevention. Washington, DC: Office of Justice Programs.

  19. Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior. Couple Family Psychology, 1(2), 134-145.

  20. Robbins, M. S., & Szapocznik, J. (2000). Brief strategic family therapy. Juvenile Justice Bulletin, Office of Juvenile Justice and Delinquency Prevention. Washington, DC: Office of Justice Programs.

  21. Hirgian, V. E., Feaster, D. J., Brincks, A., Robbins, M. S., Perez, M. A., & Szapocznik, J. (2014). The effects of brief strategic family therapy (BSFT) on parent substance use and the association between parent and adolescent substance use. Addictive Behaviors, 42, 44-50.

  22. Hirgian, V. E., Feaster, D. J., Brincks, A., Robbins, M. S., Perez, M. A., & Szapocznik, J. (2014). The effects of brief strategic family therapy (BSFT) on parent substance use and the association between parent and adolescent substance use. Addictive Behaviors, 42, 44-50.

  23. Santisteban, D. A., Perez-Vidal, A., Coatsworth, J. D., Kurtines, W. M., Schwartz, S. J., LaPerriere, A., & Szapocznik, J. (2003). Efficacy of brief strategic therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17(1), 121-133.

  24. Crimesolutions.gov. (2011). Program profile: Multidimensional family therapy. National Institute of Justice, Office of Justice Programs. Washington, DC: Retrieved from http://bit.ly/2oiMhVW.

  25. Crimesolutions.gov. (2011). Program profile: Multidimensional family therapy. National Institute of Justice, Office of Justice Programs. Washington, DC: Retrieved from http://bit.ly/2oiMhVW.

  26. Henderson, C. E., Dakof, G. A., Greenbaum, P. E., & Liddle, H. A. (2010). Effectiveness of multidimensional family therapy with higher-severity substance abusing adolescents: Report from two randomized controlled trials. Journal of Consulting and Clinical Psychology, 78, 885-897.

  27. Liddle, H. A., Rowe, C. L., Dakof, G. A., Henderson, C. E., & Greenbaum, P. E. (2009). Multidimensional family therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(1), 12-25.

  28. Liddle, H. A. (2010). Multidimensional family therapy: A science-based treatment system. Australian & New Zealand Journal of Family Therapy, 31(2), 133-148.

  29. Henggeler, S. W., with the assistance of Sharon F. Mihalic, Lee Rone, Christopher Thomas, Jane Timmons-Mitchell. (1998). Multisystemic therapy— Book six in the blueprints in violence prevention series. Boulder, CO: Center for the Study and Prevention of Violence, University of Colorado.

  30. Henggeler, S. W., with the assistance of Sharon F. Mihalic, Lee Rone, Christopher Thomas, Jane Timmons-Mitchell. (1998). Multisystemic therapy— Book six in the blueprints in violence prevention series. Boulder, CO: Center for the Study and Prevention of Violence, University of Colorado.; Henggeler, S.W. (1997). Treating serious anti-social behavior in youth: The MST approach. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.

  31. Henggeler, S.W. (1997). Treating serious anti-social behavior in youth: The MST approach. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.

  32. Henggeler, S. W., with the assistance of Sharon F. Mihalic, Lee Rone, Christopher Thomas, Jane Timmons-Mitchell. (1998). Multisystemic therapy— Book six in the blueprints in violence prevention series. Boulder, CO: Center for the Study and Prevention of Violence, University of Colorado.

  33. Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 868-874.

  34. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  35. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  36. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.; Blueprints Program Model. (2012-2016). Project towards no drug abuse. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2pO8USv

  37. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.; Blueprints Program Model. (2012-2016). Project towards no drug abuse. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2pO8USv.

  38. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  39. Blueprints Program Model. (2012-2016). Project towards no drug abuse. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2pO8USv.

  40. Blueprints Program Model. (2012-2016). Project towards no drug abuse. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2pO8USv.; Lisha, N. E., Sun, P., Rohrbach, L. A., Spruijt-Metz, D., Unger, J. B. & Sussman, S. (2012). An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: Project Toward No Drug Abuse (TND). Journal on Drug Education, 42(1), 33-57.

  41. Crimesolutions.gov. (2011). Program profile: Positive action. Washington, DC: National Institute of Justice, Office of Justice Programs. http://bit.ly/2pduFz8.; Li, K. K., Washburn, I., DuBois, D. L., Vuchinich, S., Ji, P., Brechling, V…Flay, B. R. (2011). Effects of the positive action programme on problem behaviours in elementary school students: A matched-pair randomized control trial in Chicago. Psychology & Health, 26(2), 187-204.

  42. Blueprints Program Model. (2012-2016). Positive action. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/1sb9laY

  43. Crimesolutions.gov. (2011). Program profile: Positive action. Washington, DC: National Institute of Justice, Office of Justice Programs. http://bit.ly/2pduFz8.

  44. Blueprints Program Model. (2012-2016). Positive action. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/1sb9laY

  45. Li, K. K., Washburn, I., DuBois, D. L., Vuchinich, S., Ji, P., Brechling, V…Flay, B. R. (2011). Effects of the positive action programme on problem behaviours in elementary school students: A matched-pair randomized control trial in Chicago. Psychology & Health, 26(2), 187-204.

  46. Beets, M. W., Flay, B. R., Vuchinich, S., Snyder, F. J., Acock, A. C., Li, K. K., Burns, K., Washburn, I. J., & Durlak, J. (2009). Use of social and character development program to prevent substance use, violent behaviors, and sexual activity among elementary-school students in Hawaii. American Journal of Public Health, 99(8), 1438-1445.

  47. Witvliet, M., van Lier, P.A.C, Cuijpers, P., & Koot, H. M. (2009). Testing links between childhood positive peer relations and externalizing outcomes through a randomized controlled study. Journal of Consulting and Clinical Psychology, 77(5), 905–915.

  48. Witvliet, M., van Lier, P.A.C, Cuijpers, P., & Koot, H. M. (2009). Testing links between childhood positive peer relations and externalizing outcomes through a randomized controlled study. Journal of Consulting and Clinical Psychology, 77(5), 905–915.

  49. Blueprints Program Model. (2012-2016). LifeSkills training. Boulder, CO: Blueprints for Healthy Youth Development. . Retrieved from http://bit.ly/2bkyFaJ.

  50. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.; Botvin LifeSkills® Training. (2011). Home. Retrieved at http://bit.ly/1bvxGvV.

  51. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  52. Crimesolutions.gov. (2011). Program profile: LifeSkills training. Washington, DC: National Institute of Justice, Office of Justice Programs. http://bit.ly/2oVnA5e.

  53. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  54. Blueprints Program Model. (2012-2016). Brief alcohol screening and intervention for college students (BASICS). Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/1RBSdT8.

  55. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  56. Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3): 505-526.

  57. Baer, J. S., Kivlahan, D. R., Blume, A. W., McKnight, P. & Marlatt, A. G. (2001). Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. American Journal of Public Health 91(8), 1310–1316.

  58. 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.

  59. Blueprints Program Model. (2012-2016). Raising healthy children. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2osetoJ.

  60. Blueprints Program Model. (2012-2016). Raising healthy children. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2osetoJ.

  61. Blueprints Program Model. (2012-2016). Raising healthy children. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2osetoJ.

  62. Hawkins, J. D., Smith, B. H., Hill, K. G., Kosterman, R., & Catalano, R. F. (2007). Promoting social development and preventing health and behavior problems during the elementary grades: Results from the Seattle social development project. Victims and Offenders, 2, 161-181.

  63. Blueprints Program Model. (2012-2016). Communities That Care (CTC). Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2ont85c.

  64. Center for Communities that Care. (2016). CTC’s social development strategy. Seattle, WA: University of Washington, Social Development Research Group.

  65. Hawkins, J. D., Oesterle, S., Brown, E. C., Arthur, M. W., Abbot, R. D., Fagan, A. A., & Catalano, R. F. (2009). Results of a type 2 translational research trial to prevent adolescent drug use and delinquency: A test of Communities That Care. Archives of Pediatric Adolescent Medicine, 163(9), 789-798.

  66. Feinberg, M. W., Greenberg, M. T., Osgood, D. W., Sartorius, J., & Bontempo, D. (2007). Effects of the Communities That Care model in Pennsylvania on youth risk and problem behaviors. Prevention Science, 8, 261-270.

  67. Blueprints Program Model. (2012-2016). Positive family support. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2oneStg.

  68. Blueprints Program Model. (2012-2016). Positive family support. Boulder, CO: Blueprints for Healthy Youth Development. Retrieved from http://bit.ly/2oneStg.

  69. Fosco, G. M., Frank, J. L., Stormshak, E. A., & Dishion, T. J. (2013). Opening the “black box": Family check-up intervention effects on self-regulation that prevents growth in problem behavior and substance use. Journal of School Psychology, 51, 455-468.

  70. Crimesolutions.gov. (2011). Program profile: Linking the interests of families and teachers (LIFT). Washington, DC: National Institute of Justice, Office of Justice Programs. Retrieved from http://bit.ly/2oOZCGE.

  71. Crimesolutions.gov. (2011). Program profile: Linking the interests of families and teachers (LIFT). Washington, DC: National Institute of Justice, Office of Justice Programs. Retrieved from http://bit.ly/2oOZCGE.

  72. DeGarmo, D.S., Eddy, J. M., Reid, J. B., & Fetrow, R. A. (2009). Evaluating mediators of the impact of the linking the interests of families and teachers (LIFT) multimodal preventive intervention on substance use initiation and growth across adolescence. Prevention Science, 10: 208-220.

Intercept 1: Law Enforcement

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

OPIOID OVERDOSE REVERSAL

Description: Naloxone, a medication that can be administered by nasal spray or injection, can be administered to an individual to reverse an opioid overdose. Naloxone blocks opioid receptor sites in the brain for up to 90 minutes to reverse respiratory distress.[1] Use of naloxone is and effective practice in reducing overdose fatalities. However, further research should be conducted as to follow-ups to non-fatal overdoses and how those individuals may or may not benefit from connection to appropriate services.

Goals:

  • Prevent death from opioid-related overdose.
  • Increase the use of harm reduction tactics related to opioid use.

Eligibility: First responders, including law enforcement, and laypersons can administer naloxone to an individual who may be overdosing on opioids (including heroin).

Research findings:

  • A study of 2,912 individuals in 19 communities over seven years, found communities with naloxone programs had significantly lower opioid overdose fatalities than those that did not.[2]
  • Further, this study found that take-home naloxone coupled with educational and training interventions significantly decreased overdose-related deaths by 54 to 73 per 100,000 over a 7-year period.[3]
  • A meta-analysis of 21 studies suggests that among available studies, naloxone provisions among drug users and their caregivers can be an effective strategy to combat fatal overdoses.[4]

Medication types: generic name is naloxone; brand names include Narcan® and Evzio®.

Examples in the field: These programs help provide information, training, and distribution of naloxone and naloxone use, in addition to other harm reduction strategies (i.e. syringe exchanges, overdose awareness, and health-related issues like Hepatitis C).[5] The following are examples of naloxone distribution and training locations:

Other resources:

A State and National Overview of the Opioid and Heroin Crisis

Harm Reduction Overview and Understanding Naloxone

Harm Reduction Coalition

LAW ENFORCEMENT DEFLECTION INITIATIVES

Description: Law enforcement deflection initiatives help individuals with SUDs access treatment. Individuals—without fear of arrest—can ask for assistance in receiving substance use treatment.[6] A law enforcement officer completes an intake and arranges for transport to services for further clinical assessment as to appropriate treatment (or clinician may be on-site at the police station), typically by a volunteer.[7] These initiatives feature collaboration between law enforcement, the community, hospitals, public health providers, substance use treatment providers, and other community service providers.

Goals:

  • Intervene in cycle of substance use and potential crime or criminal justice involvement.
  • Improve public safety.

Eligibility: Some departments have selected the following as criteria for assistance:

  • Voluntarily ask for assistance.
  • Turn in drugs and/or drug paraphernalia (if applicable).
  • Consent from a parent or guardian if a juvenile.
  • Pose no threat to person transporting to treatment.
  • No outstanding warrants.
  • Have no more than three prior drug-related arrests.
  • No prior arrest for possession with intent to distribute, trafficking, or have a drug violation in a school zone.[8]

Research/evidence: These are promising initiatives, but there currently is not enough substantial research to identify these practices as evidence-based. In an analysis of 200 participants of ANGEL initiative in Gloucester, Mass. pre-arrest diversion program, researchers reported 70 percent completed treatment and follow-up services. However, out of 100 of those individuals, 40 percent had returned to substance use.[9]

Preliminary data indicates a

  • reduction in fatal drug overdoses; and
  • 31 percent decrease in drug-related crime.[10]

Examples in the field: At least 140 law enforcement agencies in 25 states have joined PAARI to create initiatives, including:

  • ANGEL (Gloucester, Mass.).
  • ANGEL/Hope (North Carolina).
  • A Way Out (Lake County, Ill.).
  • Safe Passage (Lee, Livingston, Whiteside Counties, Ill.).

The Arlington Outreach Model (Arlington, Mass.) and Conversations for Change (Dayton, Ohio) are both slightly different initiatives that are generally more proactive in connecting individuals with SUD to treatment and services through outreach to those in need.

Other resources:

Rethinking law enforcement’s role on drugs: Community drug intervention and diversion efforts

COPS: Building Successful Partnerships between Law Enforcement and Public Health

PRE-BOOKING COMMUNITY-BASED DIVERSION

Description: Police may exercise discretion to divert individuals with potential SUDs or other substance use issues in lieu of standard jail booking and criminal justice prosecution for non-violent, non-felony offenses.[11] An arresting officer goes through initial arrest protocols (arresting person, writing case report, collecting evidence), but then flags the case and asks the prosecutor to not immediately file charges.[12] The arrestee is assigned a case manager who facilitates an entry evaluation and refers them to a variety of services that can include

  • substance use treatment and/or services;
  • housing assistance;
  • job and educational services;
  • legal advocacy; and/or
  • counseling.[13]

The individual may be prosecuted if he/she does not initiate services within 30 days from entry evaluation.[14] Programs may operate similar to this, but as deferred prosecution programs. However, there is limited research related to deferred prosecution programs.

Goals:

  • Divert to treatment rather than jail and prosecution to individuals with SUDs.
  • Intervene in cycle of substance use, crime, and criminal justice involvement.
  • Reduce recidivism.
  • Decrease monetary costs for criminal justice system.
  • Improve public safety.
  • Improve public health.
  • Reduce reliance on formal criminal justice processing
  • Long-term behavioral changes--which may or may not include complete abstinence (harm reduction approach instead of zero-tolerance approach).[15]

Eligibility: Example eligibility criteria from the Law Enforcement-Assisted Diversion (LEAD) program out of Seattle, Washington is as follows:

  • Individual suspected of a controlled substance offense, prostitution offense, or minor property crime offenses related to substance use (non-violent and non-felony).
  • Police believe individual is amenable to diversion.
  • Offense does not involve delivery, possession with intent to deliver, or dealing with intent to profit.
  • Offense does not involve exploitation of minors in dealing or distributing drugs.
  • Offense does not involve promotion of prostitution.
  • Individual does not have previous convictions for murder, arson, robbery, assault, kidnapping, sex offense, or attempt of any of these crimes (this may vary by department and may include other offenses like domestic violence within a specific time-frame).
  • Individual has not participated or is not currently participating in other criminal justice diversion programs.
  • The individual is willing to participate.[16]

Research/evidence: To date, the Law Enforcement-Assisted Diversion (LEAD) program in Seattle has been the only such program evaluated extensively with a report on recidivism , criminal and legal system costs and utilization, client outcomes (housing, employment, income/benefits). LEAD is a promising program; there currently is not enough substantial research to identify it as evidence-based. During the first six months of evaluation, 30 percent of LEAD participants were less likely to be arrested compared to the control group.[17] After a little more than four years, participants were 58 percent less likely to be arrested compared to the control group after their entry evaluation.[18] Participants subsequent to entry into LEAD, on average, demonstrated significantly lower likelihood of

  • felony cases (64 percent);
  • King County jail bookings (69 percent);
  • days in jail (68 percent); and
  • days in state prison (87 percent).[19]

In addition, it costs less to connect people to services via LEAD than it does to formally process them into the criminal justice system.[20] The cost of LEAD participants from pre to post entry evaluation, cost reductions were $2,100 , whereas the control group (system-as-usual) demonstrated cost increases ($5,961). After initial start-up of LEAD, program costs decreased from $899 per month to $532 per month.[21] Further, the program had a positive effect on participants’ income and housing.[22]

Examples in the field: Many agencies are developing programs similar to the LEAD program in Seattle and the following are operational:

  • Santa Fe, N. M.
  • Albany, N.Y.
  • Huntington, W. Va.
  • Canton, Ohio.

Several others are in final stages of implementation:

  • Baltimore, Md.
  • Portland, Maine.
  • San Francisco.
  • Atlanta (DeKalb & Fulton counties).[23]

Other resources:

Rethinking law enforcement’s role on drugs: Community drug intervention and diversion efforts

LEAD National Support Bureau

Police Assisted Addiction and Recovery Initiatives

References

  1. Kim, D., Irwin, K. S., & Khoshnood, K. (2009). Expanded access to naloxone: Options for critical response to the epidemic of opioid overdose mortality. American Journal of Public Health, 99(3), 402-427.

  2. European Monitoring Centre for Drugs and Drug Addiction. (2015). Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone. EMCDDA Papers, Publications Office of the European Union, Luxembourg. Retrieved from http://bit.ly/2pCNKr9.

  3. Minozzi, S., Amato, L., Davoli, M., & Cochrane Drugs and Alcohol Group. (2015). Preventing fatal overdoses: A systematic review of the effectiveness of take-home naloxone. Lisbon, Portugal: European Monitoring Centre for Drugs and Drug Addiction.; Walley, A. Y., Doe-Simkins, M., Quinn, E. Pierce, C., Xuan, Z., and Ozonoff, A. (2013a). Opioid overdose prevention with intranasal naloxone among people who take methadone. Journal of Substance Abuse Treatment, 44, 241-247.

  4. European Monitoring Centre for Drugs and Drug Addiction. (2015). Preventing fatal overdoses: a systematic review of the effectiveness of take-home naloxone. EMCDDA Papers, Publications Office of the European Union, Luxembourg. Retrieved from http://bit.ly/2pCNKr9.

  5. Harm Reduction Coalition. (n.d.). Our work. New York, NY and Oakland, CA. Retrieved from http://bit.ly/1JXkLnE.

  6. Police-Assisted Addiction and Recovery Initiative. (2016). About us. Newton, MA. Retrieved from http://bit.ly/2jynY3S.

  7. Police-Assisted Addiction and Recovery Initiative. (2016). About us. Newton, MA. Retrieved from http://bit.ly/2jynY3S.

  8. 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.

  9. Hasan, S. (June 2016). One year later: Gloucester’s opioid program inspires policy reform. Nonprofit Quarterly, Retrieved from http://bit.ly/1XWyGB4.

  10. Hasan, S. (June 2016). One year later: Gloucester’s opioid program inspires policy reform. Nonprofit Quarterly, Retrieved from http://bit.ly/1XWyGB4.

  11. 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. Beckett, K. (2014). Seattle's law enforcement assisted diversion program: Lessons learned from the first two years. Seattle, WA: University of Washington.; 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.

  13. Collins, S.E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Recidivism report. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction Research and Treatment Lab.; National Support Bureau. (n.d.). What is LEAD? Retrieved from http://bit.ly/2qftnzT.

  14. 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.

  15. 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.; National Support Bureau. (n.d.). What is LEAD? Retrieved from http://bit.ly/2qftnzT.

  16. 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.

  17. Beckett, K. (2014). Seattle's law enforcement assisted diversion program: Lessons learned from the first two years. Seattle, WA: University of Washington.

  18. Collins, S.E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Recidivism report. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction Research and Treatment Lab.

  19. Collins, S.E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Recidivism report. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction Research and Treatment Lab.; 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.

  20. Collins, S. E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Criminal justice and legal system utilization and associated costs. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction.

  21. 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.

  22. Collins, S. E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Criminal justice and legal system utilization and associated costs. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction.

  23. 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.

Intercept 2: 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.

PRE-BOOKING COMMUNITY-BASED DIVERSION

Description: Police may exercise discretion to divert individuals with potential SUDs or other substance use issues in lieu of standard jail booking and criminal justice prosecution for non-violent, non-felony offenses.[1] Based on the Law Enforcement Assisted Diversion (LEAD) program out of Seattle, an arresting officer goes through initial arrest protocols (arresting person, writing case report, collecting evidence), but then flags the case and asks the prosecutor to not immediately file charges.[2] The arrestee is assigned a case manager who facilitates an entry evaluation and refers them to a variety of services that can include

  • substance use treatment and/or services;
  • housing assistance;
  • job and educational services;
  • legal advocacy; and/or
  • counseling.[3]

In some cases, the individual may be prosecuted if he/she does not initiate services within 30 days from entry evaluation.[4] Programs may operate similar to this, but as deferred prosecution programs. However, there is limited research related to deferred prosecution programs.

Goals:

  • Divert to treatment rather than jail and prosecution to individuals with SUDs.
  • Intervene in cycle of substance use, crime, and criminal justice involvement.
  • Reduce recidivism.
  • Decrease monetary costs for criminal justice system.
  • Improve public safety.
  • Improve public health.
  • Reduce reliance on formal criminal justice processing.[5]

Eligibility: Example eligibility criteria from the Law Enforcement-Assisted Diversion (LEAD) program out of Seattle, Washington is as follows:

  • Individual suspected of a controlled substance offense, prostitution offense, or minor property crime offenses related to substance use (non-violent and non-felony).
  • Police believe individual is amenable to diversion.
  • Offense does not involve delivery, possession with intent to deliver, or dealing with intent to profit.
  • Offense does not involve exploitation of minors in dealing or distributing drugs.
  • Offense does not involve promotion of prostitution.
  • Individual has previous convictions for murder, arson, robbery, assault, kidnapping, sex offense, or attempt of any of these crimes (this may vary by department and may include other offenses like domestic violence within a specific time-frame).
  • Individual has participated or is currently participating in other criminal justice diversion programs.
  • The individual is willing to participate.[6]

Police typically have full discretion for referral to program based on initial contact with individual. Further, police may also refer known substance users from previous contacts and increasingly engage in outreach efforts.[7]

Research findings: To date, the Law Enforcement-Assisted Diversion (LEAD) program in Seattle has been the only such program evaluated extensively with a report on recidivism , criminal and legal system costs and utilization, and client outcomes (housing, employment, income/benefits). LEAD is a promising program; there currently is not enough substantial research to identify it as evidence-based. During the first six months of evaluation, 30 percent of LEAD participants were less likely to be arrested compared to the control group.[8] After a little more than four years, participants were 58 percent less likely to be arrested compared to the control group after their entry evaluation.[9] Participants subsequent to entry into LEAD, on average, demonstrated significantly lower likelihood of

  • felony cases (64 percent);
  • King County jail bookings (69 percent);
  • days in jail (68 percent); and
  • days in state prison (87 percent).[10]

In addition, it costs less to connect people to services via LEAD than it does to formally process them into the criminal justice system.[11] The cost of LEAD participants from pre- to post entry evaluation, cost reductions were $2,100, whereas the control group (system-as-usual) demonstrated cost increases ($5,961). After initial start-up of LEAD, program costs decreased from $899 per month to $532 per month.[12] Further, the program had a positive effect on participants’ income and housing.[13]

Examples in the field: Many agencies are developing programs similar to the LEAD program in Seattle and the following are operational:

  • Santa Fe, N. M.
  • Albany, N.Y.
  • Huntington, W. Va.
  • Canton, Ohio.

Several others are in final stages of implementation:

  • Baltimore, Md.
  • Portland, Maine.
  • San Francisco.

Read More

Rethinking law enforcement’s role on drugs: Community drug intervention and diversion efforts

For more information on developing deflection/diversion initiatives:

COPS: Building Successful Partnerships between Law Enforcement and Public Health

LEAD National Support Bureau

Police Assisted Addiction and Recovery Initiative

References

  1. 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.; There are currently several other types of law enforcement deflection and diversion programs and initiatives; however, there is currently none or not enough research or evidence to report identify them as evidence-informed programs due to lack of evaluation research. These include: STEER, Civil Citations Pre-Arrest Diversion, the Arlington Outreach Model, and Conversations for Change.

  2. Beckett, K. (2014). Seattle's law enforcement assisted diversion program: Lessons learned from the first two years. Seattle, WA: University of Washington.; 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.

  3. olice 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.

  4. Collins, S.E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Recidivism report. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction Research and Treatment Lab.; National Support Bureau. (n.d.). What is LEAD? Retrieved from http://bit.ly/2qftnzT.

  5. 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.

  6. 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.; National Support Bureau. (n.d.). What is LEAD? Retrieved from http://bit.ly/2qftnzT.

  7. 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.

  8. Beckett, K. (2014). Seattle's law enforcement assisted diversion program: Lessons learned from the first two years. Seattle, WA: University of Washington.; Collins, S.E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Recidivism report. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction.

  9. Collins, S.E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Recidivism report. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction.; 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.

  10. Collins, S. E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Criminal justice and legal system utilization and associated costs. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction.

  11. 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. Collins, S. E., Lonczak, H. S., & Clifasefi, S. L. (2015). LEAD program evaluation: Criminal justice and legal system utilization and associated costs. Seattle, WA: University of Washington LEAD Evaluation Team, Harm Reduction.

  13. 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.

Intercept 3: Courts and Jails

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

DRUG COURT

Description: Drug court probation features

  • frequent drug tests;
  • weekly and/or monthly appearances before the drug court judge;
  • meetings with case manager(s);
  • participation in treatment programs deemed appropriate for the individual; and
  • use of graduated sanctions and incentives.[1]

Drug court participants move through a phase process, ending in the participants' graduation from drug court. Phase progression is generally based on

  • time in the program;
  • number of clean/sober days; and
  • cooperation and participation in their individualized drug court program including substance use disorder treatment and other services.[2]

The 10 key components of drug court can be found here.

Goals:

  • Reduce substance use.
  • Reduce recidivism.
  • Increase treatment retention.
  • Decrease criminal justice costs--reduced victimization and costs related to healthcare, incarceration, and recidivism.
  • Reunite families.[3]

Eligibility: Eligibility criteria varies by state and jurisdiction, but generally, non-violent offenders charged with drug or drug-related (or drug-driven) offenses are eligible.[4] Who refers cases (public defender, private attorney, state’s attorney, or probation officer) varies by state and local jurisdiction. Ideally, eligibility should be based on a clinical and validated tool or validated risk/needs assessment by a trained criminal justice professional for referral to appropriate services. Examples of assessments facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Research findings: Drug courts are considered an effective practice when implemented with fidelity. Research on drug courts indicates that, compared to those on standard probation, drug court participation

  • moderately reduced recidivism depending on drug court implementation;
  • reduced recidivism—10 to 15 percent,[9] lasting three to 14 years;[10]
  • reduced incarceration rates;
  • increased time to re-arrest;
  • decreased frequent re-arrest; and
  • decreased drug use and positive drug tests.[11]

Program examples: According to the National Association for Drug Court Professionals, as of December 2014, there were 2,734 drug courts, servicing over 136,000 individuals. According to the former llinois Center of Excellence for Behavioral Health and Justice, Illinois has 116 adult drug courts (including hybrid DWI courts), 7 juvenile drug courts, in addition to other types of problem-solving courts.

Read more
Fidelity to the evidence-based drug court model: An examination of Adult Redeploy Illinois programs
National Association of Drug Court Professionals
National Institute of Justice: Drug courts
Center for Court Innovation: Drug courts
National Drug Court Institute
Drug Court Overview

COGNITIVE AND BEHAVIORAL THERAPIES

Description: Cognitive and behavioral therapies include those that reinforce and provide incentives for abstinence, enhancing life and coping skills surrounding situations and emotions that may trigger drug use, and help change attitudes and behaviors related to substance use. Some therapies focus more on the behavioral aspect of substance use; some focus more on the cognitive aspect of substance use. Others use both approaches, called cognitive-behavioral therapy.[12] Cognitive-behavioral therapy (CBT) is a general classification of therapeutic techniques that focus on two aspects:

  • The thought processes, attitudes, and values underlying antisocial behavior (cognitive).
  • The observable behaviors (behavioral).

Ultimately, CBT helps individuals understand how thoughts and feelings influence choices in behavior, in addition to providing behavioral alternatives. In order to help change antisocial behavior, such as substance use, CBT helps individuals identify and replace thoughts, attitudes, and beliefs that lead may to substance use.[13] Further, CBT helps individuals by teaching social and emotional skills, while also using positive and negative consequences to shape behavior. This helps provide tools for individuals to use when encountering situations that may lead to substance use or other antisocial behaviors.[14] CBT incorporates several distinct interventions that may be used alone or in combination, in an individual or group format. In particular, CBT incorporates some combination of

  • cognitive restructuring;
  • social skill building;
  • emotional regulation skills;
  • modeling and role-playing;
  • homework assignments;
  • motivational enhancement/interviewing techniques;
  • contingency management principles;
  • psychoeducation; and
  • systematic training of alternative responses to triggers (high-risk situations).[15]

Some treatment focuses more on cognitions (considered cognitive therapy), some more on behaviors (considered behavioral therapy), and some provide a balance of both (considered cognitive-behavioral therapy).[16]

Goals:

  • Develop and increase use of appropriate social and emotional skills.
  • Understand how thinking leads to behavior.
  • Target maladaptive thinking patterns.
  • Improve moral and critical reasoning.
  • Develop and use interpersonal skills.
  • Manage or cope with risky situations that may lead to relapse.
  • Increase self-control and impulse management.
  • Increase public safety and community safety.
  • Increase number of individuals in the workforce.
  • Increase self-efficacy and self-control.[17]

Eligibility: Ideally, eligibility should be based on a validated clinical tool or validated risk/needs assessment conducted by trained professionals. Examples of assessments facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Program Examples:The programs below have substantial and rigorous research identifying them as effective intervention programs when implemented with fidelity. This is not a comprehensive list.

Relapse Prevention (RP) is a CBT-based program that specifically and systematically trains individuals to engage in alternate responses to high-risk situations related to substance use.[22] RP incorporates the use of cognitive and behavioral strategies to reduce relapse through identification of “triggers”— individually specific high-risk situations that may precede or contribute to relapse.[23] Additional aspects of RP include

  • enhancing self-efficacy;
  • managing relapses;
  • identifying and coping with high-risk situations;
  • eliminating myths and placebo effects (countering misperceptions of use); and
  • balancing and modifying lifestyle factors.[24]

Contingency management (CM) is an incentive-based intervention with a behavioral focus that uses reinforcements to meet specific behavioral goals such as remaining clean and sober, providing negative urine screens, or completing treatment sessions.[25] Reinforcements shape or control behavior through consequences and non-drug-related reinforcers to help counter the reinforcing effects of drugs.[26] Two common types of CM programs:

  • Voucher-Based Reinforcement Therapy (VBRT) which uses vouchers with differing monetary values each time an individual engages in specific positive behaviors that may be exchanged for goods or services.[27]
  • Prize-Based (PB) contingency management which uses a drawing for a prize when an individual engages in positive behavior, but not all drawings will result in a tangible prize.[28]

Research findings. Cognitive-behavioral therapies are effective types of treatment that generally have a moderate effect on reducing

  • substance use;
  • substance abuse; and
  • reoffending.[29]

Further, research indicates that CBT and behavioral intervention programs can be more effective than

  • abstinence-based approaches;
  • standard case management; and
  • 12-step counseling.[30]

Research also suggests that behavioral therapies with CM can result in more positive outcomes than behavioral interventions alone.[31]

In a meta-analysis, CBT showed a 26 percent reduction in recidivism for CBT program participants compared to a control group.[32] Further, CBT-based programs are effective with a variety of individuals, including those with SUDs or substance abuse/misuse.[33]

Behavioral (including CBT) programs or interventions produce the greatest effects when they adhere to the following principles:

  • Target those at higher-risk to recidivate (moderate- and high-risk) based on a validated risk/needs assessment.
  • Target criminogenic risk factors most highly associated with recidivism based on a validated risk/needs assessment.
  • Are responsive to individual needs and barriers (i.e. language, mental health, intellectual or cognitive disabilities).
  • Use well-trained professionals.
  • Maintain adherence to the program or practice components (fidelity, or using a program or practice as it is meant to be delivered based on training).[34]

Other Effective and Promising Cognitive and/or Behavioral Interventions

Thinking for a Change
Moral Reconation Therapy (MRT) Dialectical Behavior Therapy (DBT)Motivational Enhancement Therapy (MET)Motivational Interviewing (MI)Contingency Management programs (CM)
Trauma-informed substance use disorder treatment such as: TARGET, Seeking Safety, and TAMAR
Matrix Model
Multisystemic Therapy-Substance Abuse
Voucher-Based Reinforcement (VBR) and Prize-Based (PB) CM
Adolescent Community Reinforcement Approach (A-CRA)/Assertive Continuing Care (ACC)
Behavioral Couples Therapy
Aggression Replacement Training (ART)
Cognitive Interventions Program
Reasoning and Rehabilitation

Read More

Risk-Need-Responsivity Model for offender assessment and rehabilitation

Integrating substance abuse treatment and criminal justice supervision

National Commission on Correctional Health Care

Addressing Opioid Use through the Criminal Justice System

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix

Risk and Needs Assessment in the Criminal Justice System

TCU Institute of Behavioral Research

PHARMACOLOGICAL METHODS: MEDICATION-ASSISTED TREATMENT (MAT)

Description: Medication-Assisted Treatment (MAT) programs incorporate the use of medicine to treat opioid or alcohol use disorders, in conjunction with behavioral therapies or counseling to treat individuals with SUDs.[35] With regard to opioids, the use of medication alone is called opioid replacement therapy (ORT), which alone, can also be effective to treat opioid use disorders (OUDs).[36] MAT programs help with treatment retention and abstinence by decreasing withdrawal symptoms and cravings; increasing quality of life; reducing risk of HIV and hepatitis C; reducing risky behaviors associated with substance use; as well as decreasing risk for overdose.[37] MAT programs can be in the community [healthcare office, methadone maintenance clinic, primary care physicians’ office, certified opioid treatment programs (OTPs)] or correctional settings.[38] Each type of medication for MAT is Food and Drug Administration (FDA) approved and is most effective when coupled with other counseling or therapy and/or support services for SUDs; however, research also suggests benefits from medication alone without counseling.[39]

Medications to treat Opioid Use Disorders (OUDs)
Buprenporphine offers a partial opioid agonist, producing similar, but lessened, effects of opiates. To increase the safety of buprenorphine and decrease the likelihood of diversion or misuse, naloxone—an opioid receptor blocker—is added to the medication.[40] Medications include, but are not limited to

  • Bunavail® (buccal film);
  • Suboxone® (film);
  • Zubsolv® (sublingual tablets);
  • Subutex® (transmucosal);
  • Buprenex® (intramuscular or intravenous;
  • Butrans® (transdermal patch); and
  • Probuphine® (implant).[41]

Medication is prescribed and administered by a physician, nurse practitioner, or physician's assistent trained by the Drug Enforcement Agency (DEA) and given a special license and waiver by Substance Abuse and Mental Health Services Administration (SAMHSA). The medication can be administered in an office, hospital, health department, or correctional facility.[42] Physicians can prescribe only to a limited number of patients—275—per the Federal Registrar, U.S. Department of Health and Human Services, under section 303(g)(2) of the Controlled Substances Act (CSS).[43]

Methadone uses a synthetic opioid agonist taken in pill, liquid, or water form once a day. An opioid agonist tricks the brain and body as if it were taking opiates, without adverse side effects in order to reduce physiological cravings and withdrawal symptoms. First administered and monitored by a physician, it then can be obtained through an opioid treatment program (OTP) certified by the SAMHSA.[44] Methadone can be addictive, so it must be taken as prescribed to prevent adverse effects.[45]

Naltrexone is an opioid antagonist, blocking receptors in the brain from responding to opioids (or alcohol) and comes in pill (ReVia®, Depade®) or extended-release injectable (Vivitrol®) forms.[46] Any healthcare professional that is licensed to prescribe medications can prescribe naltrexone, without additional training.[47]

However, research on the use of naltrexone for OUDs is more limited than methadone and buprenorphine, particularly regarding rigorous, generalizable, long-term evaluations. While promising, more research is needed as to long-term outcomes.[48]

Medications to treat Alcohol Use Disorders (AUDs)

In addition Naltrexone can be used for AUDs, as it mediates or blocks the opioid activity within the brain related to alcohol use (see description above in OUDs).

Disulfiram is an alcohol abuse deterrent prescription medication taken daily in tablet form (Antabuse). When combined with alcohol, it causes severe physical reactions (i.e. heart palpitations, nausea, vomiting, dizziness, flushing). It is only effective if the individual is compliant with taking the medication.[49]

Acamprosate is a prescription drug taken orally (Campral®) that helps reduce cravings and withdrawal symptoms by normalizing alcohol-related neurochemical changes in the brain.[50] It targets neurochemical systems that may be biological factors of alcohol dependence.[51]

Goals:

  • Reduce cravings and withdrawal symptoms related to substance use.
  • Reduce risk for overdose.
  • Reduce substance use and relapse.
  • Increase treatment retention.
  • Decrease illegal activity.
  • Increase positive outcomes related to health (HIV, Hepatitis C).
  • Increase abstinence rates.[52]
  • Improve patient survival.[53]

Eligibility: Individuals with opioid or alcohol use disorders may be eligible for MAT programs. Individuals should be assessed with a clinical and validated substance abuse tool that includes assessment of medical, psychiatric, and substance use history; an evaluation of family and psychosocial supports; assessment of the state’s prescription drug monitoring program for detection of unreported use of other medications; a physical exam, and testing for recent opioid use and/or other drugs.[54] Some examples of assessments using self-report answers facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

In a medical setting, physicians can ask patients about compulsive drug or alcohol use or loss of control over drinking or drug use during the past year.[59] It is also important to consider insurance coverage related to MAT programs (specifically, for the medications) for funding purposes, or other outside funding sources including low-cost drug programs, to help supplement those who may not be covered.

Research on medications to treat OUDs

Methadone can

  • decrease heroin and other opioid use;
  • decrease use of injection;
  • decrease in crime/criminal behavior;
  • improve social functioning and physical symptoms;[60] and
  • improve maternal and fetal outcomes for women who are pregnant or breastfeeding.[61]

Buprenorphine can

  • significantly decrease in opioid use;
  • increase in overall well-being and social functioning;
  • reduce potential to contract HIV or hepatitis B or C;
  • decrease mortality;[62] and
  • decrease cravings and withdrawal symptoms.[63]

Naltrexone (extended-release injectable) for OUDs can

  • increase abstinence, and
  • increase retention in treatment.[64]

Research on medications to treat AUDs

Naltrexone for alcohol can

  • reduce drinking;
  • reduce rewarding effects of alcohol; and
  • increase days abstinent.[65]

Disulfiram (Antabuse) can

  • be more effective than a placebo for sobriety;[66]
  • have a moderate effect on short-term abstinence;[67]
  • be most effective with those who are already motivated to stop drinking;[68] and
  • be most effective with close monitoring for better outcomes.[69]

Acomprosate can

  • decrease withdrawal symptoms; and
  • increase abstinence for those already motivated.[70]

Research also suggests the importance of MAT programs within correctional institutions for those transitioning from jail or prison into the community—as it can help

  • reduce recidivism;
  • increase offender engagement and retention in treatment; and
  • reduce risk for relapse and/or overdose.[71]

Examples in the field: Visit a local health care professional for information on naltrexone, buprenorphine, and methadone maintenance. See the buprenorphine treatment physician locator , Opioid Treatment Program Directory-Illinois.

Read More
SAMHSA MAT
MAT comprehensive guide
National Commission on Correctional Health Care
Program profile: Buprenorphine Maintenance Treatment
Program profile: Methadone Maintenance Treatment
Opioid Treatment Program Directory-Illinois
SAMHSA Behavioral Health Treatment Services Locator
buprenorphine treatment physician locator
Buprenorphine Information
Methadone Information
SAMHSA Division of Pharmacologic Therapies (DPT)

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment AppendixRisk and Needs Assessment in the Criminal Justice SystemTCU Institute of Behavioral Research

THERAPEUTIC COMMUNITIES (TCs)

Description: Therapeutic communities (TCs) in prisons and jails are peer- and staff-led, residential programs that provide substance use treatment, mental health counseling, and other health support services, with participants generally housed separate from the prison or jail’s general population.[72] This type of program generally lasts between 12- and 18-months, focusing on overall lifestyle changes and examination of individuals’ thinking and behavior.[73] Further, relapse prevention strategies, including coping and social skills, thinking and behavior awareness, as well as development of care coordination and support networks, are provided as participants’ transition for release into the community. [74] Typically, TCs are more frequently found in prisons, but can be implemented in a jail setting.

Goals:

  • Sustain abstinence and sobriety.
  • Develop and maintain social and coping skills.
  • Reduce recidivism (re-arrest, re-conviction, re-incarceration).

Eligibility: Individuals with SUDs or who misuse substance incarcerated in a jail or prison may be eligible. Eligibility varies between facilities, and may include

  • referral to a TC by correctional staff or treatment provider;
  • voluntary participation in TC;
  • classification as a drug-involved offender; and/or
  • deemed to have a high need area related to substance use—through a risk/needs assessment (high need on substance use) and a clinical substance use assessment in order to identify appropriate services.

Some examples of assessments using self-report answers facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Research findings

In a meta-analysis of 35 evaluations found incarceration-based TCs can

  • reduce rates in post-release drug use;[79]
  • increase time to re-incarceration;
  • reduce levels of re-incarceration; and
  • increase levels of employment.[80]

In another study of five TCs, individuals who did not participate in TCs were

  • 1.6 times more likely to be re-incarcerated, and
  • 1.5 times more likely to be re-arrested.[81]

Examples in the field: Illinois’ Sheridan Correctional Center TC, Amity In-Prison TC in San Diego, California.

Read More
Sheridan Correctional Center Therapeutic Community: Year 6
A process and impact evaluation of the Southwestern Illinois Correctional Center Therapeutic Community program during fiscal years 2007 through 2010
Community reentry after prison drug treatment: learning from Sheridan Therapeutic Community program participants
A process and impact evaluation of the Sheridan Correctional Center Therapeutic Community program during fiscal years 2004 through 2010

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

CORRECTIONAL RESIDENTIAL SUBSTANCE USE AND SUD TREATMENT

Description: Substance use treatment programs in state prisons and local jails integrate more comprehensive programming for those in correctional institutions, as well as offer community-based aftercare services.[82] Ideally, this residential substance use treatment allows incarcerated offenders separation from the general population in order to focus exclusively on substance abuse and substance-related issues. The Residential Substance Abuse Treatment (RSAT) program, through the Bureau of Justice Assistance, grants funding to all states to administer funds for RSAT in prisons, which may incorporate MAT.[83] Further, the Federal Bureau of Prisons (BOP) currently implements Residential Drug Abuse Programs (RDAP) within their institutions—a nine-month, 500-hour program with separate housing, focused on substance use treatment. RDAP also incorporates Community Transition Drug Abuse Treatment/Community Treatment Services that integrates reentry services post-release.[84]

Goals:

  • Increase focus on recovery.
  • Increase staff and resources to address substance use and related issues.
  • Increase inmate skills to remain substance-free, gain employment, and be productive members of their communities.[85]
  • Reduce relapse.
  • Increase continuity of care post-release.
  • Reduce inmate and detainee misconduct.
  • Reduce recidivism (re-arrest, re-conviction, and re-incarceration) and antisocial behavior;
  • Improve physical and mental health symptoms and conditions.[86]
  • Reduce local, state, and federal government costs related to substance use and related crimes.[87]

Eligibility: There is the possibility for federal funding specifically for RSAT. However, this eligibility is only for funding, though these guidelines incorporated evidence-based SUD or substance misuse/abuse treatment practices. To obtain RSAT funding, programs must

  • Be six- to 12-months long (3-months for jail-based programs);
  • provide residential facilities separate from the general jail or prison population;
  • predominately focus on SUD treatment;
  • teach inmates social, cognitive, behavioral, and vocation skills related to substance use issues;
  • require drug and alcohol testing; and
  • run by government agencies that provide treatment to inmates.[88]

RDAP eligibility includes the following, per the BOP guidelines:

  • Have a documented SUD per the American Psychiatric Associations Diagnostic and Statistical Manual (DSM).
  • DSM diagnosis within 12-months prior to arrest.
  • Sign program agreement.
  • Completion of three-component program.
  • Have approximately 24-months left on sentence.[89]

Eligibility should be based on a validated clinical tool identifying a SUD or substance misuse. This can include (but is not limited to):

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Research findings

RSAT is a promising practice that can

  • decrease positive drug/alcohol tests;
  • reduce positive drug/alcohol tests;
  • reduce positive drug/alcohol tests for aftercare clients;[94]
  • significantly lower relapse at 6, 12, and 18 months compared to no treatment;
  • statistically lower arrest rates at 12 months compared to no treatment; and
  • significantly lower relapse, recidivism, and arrest rates for RSAT participants who completed community aftercare compared to those who did not.[95]

RDAP is a promising program that can, when compared to the control group

  • prolonged time to relapse;
  • lower probability of rearrest; and
  • lower probability of revocation.[96]

Examples in the field: In 2015, there were approximately 132 programs funded through RSAT in the U.S.

Read MoreFor more information on reentry for individuals with SUDs and other substance use issues:

In-Custody Treatment and Offender ReentryCorrectional Health Care and Substance Use Treatment
Bureau of Prisons Substance Abuse Treatment
Offender reentry: Correctional Statistics, Reintegration into the Community, and Recidivism

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

INCARCERATION-BASED INDIVIDUAL AND GROUP SUBSTANCE USE AND SUD TREATMENT

Description: The same evidence-informed cognitive-behavioral therapies and MAT programs can be used in jails and prisons. Unfortunately, most prisons and jails do not have an adequate quality or quantity of treatment.[97] Researchers have identified several feasible corrections-based SUD and substance misuse treatment programs.

Treatment and other services to support individuals with SUDs or other substance use issues in correctional settings include (but is not limited to):

  • Cognitive-behavioral therapy, both individual or group (see Cognitive and Behavioral Therapies).
  • Individual, group, or family counseling.
  • Self-help or peer recovery support groups.
  • Medication-Assisted Treatment (MAT) (see Pharmacological Treatment ).
  • Educational and vocational training.[98]

In addition, there are residential based treatments that include:

  • Therapeutic Communities (see Therapeutic Communities).
  • Residential Substance Abuse Treatment (RSAT) programs funded by the federal government (see Residential Correctional Treatment).
  • Residential Drug Abuse Programs (RDAP) (see Residential Correctional Treatment ).

Limitations and things to consider about SUD and substance use treatment in corrections:

  • Individual traumatic experiences and difficulty coping within a prison environment (potential post-traumatic stress disorder symptoms).
  • Co-occurring disorders (SUD or substance use in conjunction with another mental illness).
  • Breaking inmate identity and culture—treatment as a sign of “weakness.”
  • Gender-specific issues
  • Capacity to separate those in treatment from general population.
  • Quality assurance capacity to assess effectiveness of treatment.
  • Capacity and quality of treatment providers.
  • Nature of the population.
  • Length of stay and estimated time of release.[99]

Goals:

  • Decrease substance use.
  • Increase connection and engagement in aftercare services upon release from jail or prison.
  • Decrease risk for overdose.
  • Decrease recidivism (re-arrest, re-conviction, and re-incarceration).

Eligibility: Individuals in corrections with SUDs. Eligibility varies greatly between correctional facilities (jails and prisons). Some examples of assessments by correctional staff or clinicians to identify appropriate individuals include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Research findings: Overall, incarceration-based treatment research indicates significant reductions[104] in drug use and drug-related crime post-release.[105]

Overall, incarceration-based cognitive-behavioral therapy outcomes found

  • recidivism reduction (re-arrest, re-conviction, and re-incarceration);[106] and
  • reduction in substance use and relapse.[107]

Research also suggests the importance of MAT programs within correctional institutions for those transitioning from jail or prison into the community—as it can help

  • reduce recidivism;
  • increase offender engagement in treatment; and
  • reduce risk for relapse and/or overdose.[108]

Examples in the field: IMPACT program-Cook County Jail, Second Chance Act funded programs for reentry, recidivism, and individuals with SUD and mental health issues (as well as co-occurring disorders).

Additional program examples:

Reasoning and Rehabilitation
Thinking for a Change
Moral Reconation Therapy (MRT)
Motivational Enhancement Therapy/Motivational Interviewing (MET/MI)
Mind-Body Bridging Substance Abuse Program (MBBSAP)
Contingency Management programs (CM)
Trauma-informed substance use disorder treatment such as: TARGET, Seeking Safety, and TAMAR
Matrix Model
Voucher-Based Reinforcement (VBR) and Prize-Based (PB) CM
Aggression Replacement Training (ART)
Cognitive Interventions Program

Read More

Drug-addicted offenders and treatment needs in Illinois
What works? Short-term, in-custody treatment programs

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

RESEARCH UPDATE--PHARMACOLOGICAL METHODS: MEDICATION-ASSISTED TREATMENT

New research indicates patient success in the use of extended-release naltrexone (Vivitrol®) for medication-assisted treatment. While buprenorphine and methadone remain the gold standard for treatment of opioid use disorders (OUDs), naltrexone appears to have a place in treating OUDs with some success.[109]

In a 2017 study, researchers employed a 24-week, randomized, controlled clinical trial at eight U.S. community-based inpatient services and followed up with participants as outpatients. A total of 570 participants with an OUD were randomly assigned to use Vivitrol® (n=283) or Suboxone® (n=287).

Researchers found that while both medications can be effective for treating OUDs, it was substantially more difficult to initiate patients on Vivitrol® due to the required prior detoxification period of at least three days (though this varies by individual) and opioid-negative urine screen. Full detoxification is not necessary for those inducted on Suboxone® and was not required in this study.

The study found for the 570 who agreed to take part in the study, 238 participants were assigned to take Vivitrol® and 287 participants were assigned to take Suboxone®. Researchers found:

  • Most on Suboxone successfully initiated treatment (94 percent; n=270), while those on Vivitrol® had less success, with 72 percent successfully initiating (n=204).
  • 65 percent of participants on Vivitrol® experienced relapse events, defined by four consecutive missing urine screens, compared to 57 percent of participants on Suboxone®.[110]

The study found of the 474 successfully initiated individuals to treatment using Vivitrol® (n=204) or Suboxone® (n=270):

  • Similar results were seen among the participants receiving the two types of medications on outcomes of opioid-negative screens and opioid-abstinent days.
  • Initially, those taking Vivitrol® self-reported fewer cravings; however, by 24 weeks no difference was noted between the two groups.
  • For both groups, the challenge of medication retention remained.[111]

The results of this study aligned with a 2015 Norwegian study comparing Vivitrol® and Suboxone®.[112] In that study, 159 adult opioid-dependent patients were randomly assigned to Vivitrol® (n=80) or Suboxone® (n=79) in a 12-week, randomized clinical trial. Of those, 71 ultimately received Vivitrol® as assigned and 72 were received Suboxone® as assigned.

Overall, researchers found:

  • Similar retention time on the medication between both groups.
  • No difference in opioid use and adverse event outcomes between both groups.
  • Overall, there was similar short-term abstinence from illicit drugs for both groups, including illicit use. [113]

These studies support the need for pharmacological options to treat substance use disorders when medically appropriate, including opioid use disorders. Treatment should be individualized and increased patient access is needed for all medications: methadone, buprenorphine, and naltrexone.

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  74. Mitchell, O. Wilson, D. B., & MacKenzie, D. L. (2012). The effectiveness of incarceration-based drug treatment on criminal behavior: A systematic review. The Campbell Collaboration: Systematic Reviews, 18.; Welsch, W. N. (2007). A multisite evaluation of prison-based therapeutic community drug treatment. Criminal Justice and Behavior, 34(11), 1481-1498.

  75. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  76. Texas Christian University. (2016). TCU drug screen. Fort Worth, TX: TCU Institute of Behavioral Research. Retrieved from http://bit.ly/2qwj5jm.

  77. Northpointe Institute for Public Management, Inc. (2010, January 14). COMPAS risk & need assessment system: Selected questions posed by inquiring agencies. Retrieved from http://bit.ly/2nT8LPy.

  78. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  79. Welsch, W. N. (2007). A multisite evaluation of prison-based therapeutic community drug treatment. Criminal Justice and Behavior, 34(11), 1481-1498.; Mitchell, O. Wilson, D. B., & MacKenzie, D. L. (2012). The effectiveness of incarceration-based drug treatment on criminal behavior: A systematic review. The Campbell Collaboration: Systematic Reviews, 18.

  80. Prendergast, M. L., Hall, E. A., Wexler, H. K., Melnick, G., & Cao, Y. (2004). Amity prison-based therapeutic community: 5-year outcomes. Criminology & Penology, 84(1), 36-60.

  81. Welsch, W. N. (2007). A multisite evaluation of prison-based therapeutic community drug treatment. Criminal Justice and Behavior, 34(11), 1481-1498.

  82. Bureau of Justice Assistance. (2005). Residential substance abuse treatment for state prisoners (RSAT) program. Washington, DC: Office of Justice Programs, Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from http://bit.ly/2rhgiYL.

  83. Bureau of Justice Assistance (2005). Program performance report: Residential Substance Abuse Treatment (RSAT) program. Washington, DC: Office of Justice Programs, Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from http://bit.ly/2rhgiYL.; Miller, N. (2013). RSAT training tool: Medication Assisted Treatment (MAT) for offender populations. Washington, DC: Treatment Alternatives for Safe Communities, Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from http://bit.ly/2sbpiP2.

  84. Federal Bureau of Prisons. (2008). Report to the Congress. Washington, DC: Author. Retrieved from http://bit.ly/2rldGL8.

  85. Bureau of Justice Assistance (2005). Program performance report: Residential Substance Abuse Treatment (RSAT) program. Washington, DC: Office of Justice Programs, Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from http://bit.ly/2rhgiYL.

  86. Federal Bureau of Prisons. (n.d.) Substance abuse treatment. Washington, DC: Author. Retrieved from http://bit.ly/1OciEL8.

  87. Bureau of Justice Assistance (2005). Program performance report: Residential Substance Abuse Treatment (RSAT) program. Washington, DC: Office of Justice Programs, Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from http://bit.ly/2rhgiYL.

  88. Harrison, L. D., & Martin, S. S. (2003). Residential substance abuse treatment for state prisoners: Implementation lessons learned. National Institute of Justice, Bureau of Justice Assistance, Washington, DC: U.S. Department of Justice.

  89. Federal Bureau of Prisons. (n.d.) Substance abuse treatment. Washington, DC: Author. Retrieved from http://bit.ly/1OciEL8.

  90. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  91. Texas Christian University. (2016). TCU drug screen. Fort Worth, TX: TCU Institute of Behavioral Research. Retrieved from http://bit.ly/2qwj5jm.

  92. Northpointe Institute for Public Management, Inc. (2010, January 14). COMPAS risk & need assessment system: Selected questions posed by inquiring agencies. Retrieved from http://bit.ly/2nT8LPy.

  93. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  94. Bureau of Justice Assistance. (2016). Residential Substance Abuse Treatment (RSAT) program. Biannual Grantee Feedback Report, April-September, 2015. Washington, DC: U.S. Department of Justice. Retrieved from http://bit.ly/2r8mWlu.

  95. Boyd, C. J., Pimlott-Kubiak, S., Harrell, Z., Morales, M, Roach, J., Slayden, J., & Young, A. (2001). Program evaluation of Michigan department of corrections Residential Substance Abuse Treatment (RSAT): A descriptive assessment of prison and community-based treatment programs. Ann Arbor, MI: Substance Abuse Research Center, University of Michigan.

  96. Pelissier, B., S. Camp, G. Gaes, W. Rhodes, & W. Saylor. (n.d.) Federal prison residential drug treatment: A comparison of three-year outcomes for men and women. Washington, DC: Federal Bureau of Prisons.; What Works in Reentry Clearinghouse. (n.d.) Pellisier et a. 2000-2003 (2). Counsel of State Governments.Retrieved from http://bit.ly/2r8Dr10.

  97. Taxman, F. S., Perdoni, M. L., & Caudy, M. (2013). The plight of providing appropriate substance abuse treatment services to offenders: Modeling the gaps in service delivery. Victims & Offenders: An International Journal of Evidence-based Research, Policy, and Practice, 8(1), 70-93.; Taxman, F. S., Perdoni, M. L., & Harrison, L. D., (2007). Drug treatment services for adult offenders: The state of the state. Journal of Substance Abuse Treatment, 32(3), 239-254.

  98. Center for Substance Abuse Treatment. (2005). Substance abuse treatment for adults in the criminal justice system: 9 treatment issues specific to prisons. Rockville, MD: Treatment Improvement Protocol (TIP) Series, 44, Substance Abuse and Mental Health Services Administration. Retrieved from http://bit.ly/2qxcBRr.

  99. Center for Substance Abuse Treatment. (2005). Substance abuse treatment for adults in the criminal justice system: 9 treatment issues specific to prisons. Rockville, MD: Treatment Improvement Protocol (TIP) Series, 44, Substance Abuse and Mental Health Services Administration. Retrieved from http://bit.ly/2qxcBRr.

  100. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  101. Texas Christian University. (2016). TCU drug screen. Fort Worth, TX: TCU Institute of Behavioral Research. Retrieved from http://bit.ly/2qwj5jm.

  102. Northpointe Institute for Public Management, Inc. (2010, January 14). COMPAS risk & need assessment system: Selected questions posed by inquiring agencies. Retrieved from http://bit.ly/2nT8LPy.

  103. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  104. Quality and capacity are important. Fidelity to “what works” to treat individuals with SUDs is vital in order to see desired outcomes.

  105. Mumola, C. J., & Karberg, J. C. (October 2004). Drug use and dependence, state and federal prisoners, 2004. Washington DC: Bureau of Justice Statistics, U.S. Department of Justice. Retrieved from http://bit.ly/2rhmbVR.; Karberg, J. C., & James, D. J. (2002). Substance dependence, abuse, and treatment of jail inmates, 2002. Washington, DC: Bureau of Justice Statistics, U.S. Department of Justice. Retrieved from http://bit.ly/2sjgoOP.

  106. Mitchell, O. Wilson, D. B., & MacKenzie, D. L. (2012). The effectiveness of incarceration-based drug treatment on criminal behavior: A systematic review. The Campbell Collaboration: Systematic Reviews, 18.

  107. Pearson, F. S., Lipton, D. S., Cleland, C. M., & Yee, D. S. (2002). The effects of behavioral/cognitive-behavioral programs on recidivism. Crime and Delinquency, 48(3), 476- 496.

  108. Taxman, F. S., Perdoni, M. L., & Caudy, M. (2013). The plight of providing appropriate substance abuse treatment services to offenders: Modeling the gaps in service delivery. Victims & Offenders: An International Journal of Evidence-based Research, Policy, and Practice, 8(1), 70-93.

  109. Lee, J. D., Nunes Jr., A. V., Novo, P., Bachrach, K., Bailey, G. L., Bhatt, S…..Rotrosen, J. (2017). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): A multicenter, open-label, randomized controlled trial. The Lancet, 50, 253-264.; Lott, D. C. (2017). Extended-release naltrexone: Good but not a panacea. The Lancet, 391, 283-284.

  110. Lee, J. D., Nunes Jr., A. V., Novo, P., Bachrach, K., Bailey, G. L., Bhatt, S…..Rotrosen, J. (2017). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): A multicenter, open-label, randomized controlled trial. Contemporary Clinical Trials, 50, 253-264.

  111. Lee, J. D., Nunes Jr., A. V., Novo, P., Bachrach, K., Bailey, G. L., Bhatt, S…..Rotrosen, J. (2017). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): A multicenter, open-label, randomized controlled trial. Contemporary Clinical Trials, 50, 253-264.

  112. Kunoe, N. l., Opheim, A., Solli, K. K., Gaulen, Z., Sharma-Haase, K., Latif, Z. E., & Tanum, L. (2016). Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX). BMC Pharmacology & Toxicology, 17, 18.; Tanum, L., Solli, K. K., Latif, Z. E., Benth, J.S., Sharma-Haase, K., Krajci, P., & Kunoe, N. (2017). Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: A randomized clinical noninferiority trial. JAMA Psychiatry, 74(12), 1197-1205.

  113. Tanum, L., Solli, K. K., Latif, Z. E., Benth, J.S., Sharma-Haase, K., Krajci, P., & Kunoe, N. (2017). Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: A randomized clinical noninferiority trial. JAMA Psychiatry, 74(12), 1197-1205.

Intercept 4: 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.

COGNITIVE AND BEHAVIORAL THERAPIES

Description: Cognitive and behavioral therapies include those that reinforce and provide incentives for abstinence, enhancing life and coping skills surrounding situations and emotions that may trigger drug use, and help change attitudes and behaviors related to substance use. Some therapies focus more on the behavioral aspect of substance use; some focus more on the cognitive aspect of substance use. Others use both approaches, called cognitive-behavioral therapy.[1] Cognitive-behavioral therapy (CBT) is a general classification of therapeutic techniques that focus on two aspects:

  • The thought processes, attitudes, and values underlying antisocial behavior (cognitive).
  • The observable behaviors (behavioral).

Ultimately, CBT helps individuals understand how thoughts and feelings influence choices in behavior, in addition to providing behavioral alternatives. In order to help change antisocial behavior, such as substance use, CBT helps individuals identify and replace thoughts, attitudes, and beliefs that lead may to substance use.[2] Further, CBT helps individuals by teaching social and emotional skills, while also using positive and negative consequences to shape behavior. This helps provide tools for individuals to use when encountering situations that may lead to substance use or other antisocial behaviors.[3] CBT incorporates several distinct interventions that may be used alone or in combination, in an individual or group format. In particular, CBT incorporates some combination of

  • cognitive restructuring;
  • social skill building;
  • emotional regulation skills;
  • modeling and role-playing;
  • homework assignments;
  • motivational enhancement/interviewing techniques;
  • contingency management principles;
  • psychoeducation; and
  • systematic training of alternative responses to triggers (high-risk situations).[4]

Some treatment focuses more on cognitions (considered cognitive therapy), some more on behaviors (considered behavioral therapy), and some provide a balance of both (considered cognitive-behavioral therapy).[5]

Goals:

  • Develop and increase use of appropriate social and emotional skills.
  • Understand how thinking leads to behavior.
  • Target maladaptive thinking patterns.
  • Improve moral and critical reasoning.
  • Develop and use interpersonal skills.
  • Manage or cope with risky situations that may lead to relapse.
  • Increase self-control and impulse management.
  • Increase public safety and community safety.
  • Increase number of individuals in the workforce.
  • Increase self-efficacy and self-control.[6]

Eligibility: Ideally, eligibility should be based on a validated clinical tool or validated risk/needs assessment conducted by trained professionals. Examples of assessments facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Program Examples:The programs below have substantial and rigorous research identifying them as effective behavioral intervention programs. This is not a comprehensive list.

Relapse Prevention (RP) is a CBT-based program that specifically and systematically trains individuals to engage in alternate responses to high-risk situations related to substance use.[11] RP incorporates the use of cognitive and behavioral strategies to reduce relapse through identification of “triggers”— individually specific high-risk situations that may precede or contribute to relapse.[12] Additional aspects of RP include

  • enhancing self-efficacy;
  • managing relapses;
  • identifying and coping with high-risk situations;
  • eliminating myths and placebo effects (countering misperceptions of use); and
  • balancing and modifying lifestyle factors.[13]

Contingency management (CM) is an incentive-based intervention with a behavioral focus that uses reinforcements to meet specific behavioral goals such as remaining clean and sober, providing negative urine screens, or completing treatment sessions.[14] Reinforcements shape or control behavior through consequences and non-drug-related reinforcers to help counter the reinforcing effects of drugs.[15] Two common types of CM programs:

• Voucher-Based Reinforcement Therapy (VBRT) which uses vouchers with differing monetary values each time an individual engages in specific positive behaviors that may be exchanged for goods or services.[16]
• Prize-Based (PB) contingency management which uses a drawing for a prize when an individual engages in positive behavior, but not all drawings will result in a tangible prize.[17]

Research findings. CBT and behavioral therapies are effective types of treatment, that generally has a moderate effect on reducing

  • substance use;
  • substance abuse; and
  • reoffending.[18]

Further, research indicates that CBT and behavioral intervention programs can be more effective than

  • abstinence-based approaches;
  • standard case management; and
  • 12-step counseling[19].

Research also suggests that behavioral therapies with CM can result in more positive outcomes than behavioral interventions alone.[20]

In a meta-analysis, CBT showed a 26 percent reduction in recidivism for CBT program participants compared to a control group.[21] Further, CBT-based programs are effective with a variety of individuals, including those with SUDs or substance abuse/misuse.[22]

Behavioral (including CBT) programs or interventions produce the greatest effects when they adhere to the following principles:

  • Target those at higher-risk to recidivate (moderate- and high-risk) based on a validated risk/needs assessment.
  • Target criminogenic risk factors most highly associated with recidivism based on a validated risk/needs assessment.
  • Are responsive to individual needs and barriers (i.e. language, mental health, intellectual or cognitive disabilities).
  • Use well-trained professionals.
  • Maintain adherence to the program or practice components (fidelity, or using a program or practice as it is meant to be delivered based on training).[23]

Other Effective and Promising Cognitive and/or Behavioral Interventions

Thinking for a Change
Moral Reconation Therapy (MRT) Dialectical Behavior Therapy (DBT)Motivational Enhancement Therapy (MET)Motivational Interviewing (MI)Contingency Management programs (CM)
Trauma-informed substance use disorder treatment such as: TARGET, Seeking Safety, and TAMAR
Matrix Model
Multisystemic Therapy-Substance Abuse
Voucher-Based Reinforcement (VBR) and Prize-Based (PB) CM
Adolescent Community Reinforcement Approach (A-CRA)/Assertive Continuing Care (ACC)
Behavioral Couples Therapy
Aggression Replacement Training (ART)
Cognitive Interventions Program
Reasoning and Rehabilitation

Read More

Risk-Need-Responsivity Model for offender assessment and rehabilitation
Integrating substance abuse treatment and criminal justice supervision
National Commission on Correctional Health CareAddressing Opioid Use through the Criminal Justice System

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

PHARMACOLOGICAL METHODS: MEDICATION-ASSISTED TREATMENT (MAT)

Description: Medication-Assisted Treatment (MAT) programs incorporate the use of medicine to treat opioid or alcohol use disorders, in conjunction with behavioral therapies or counseling to treat individuals with SUDs.[24] With regard to opioids, the use of medication alone is called opioid replacement therapy (ORT), which alone, can also be effective to treat opioid use disorders (OUDs).[25] MAT programs help with treatment retention and abstinence by decreasing withdrawal symptoms and cravings; increasing quality of life; reducing risk of HIV and hepatitis C; reducing risky behaviors associated with substance use; as well as decreasing risk for overdose.[26] MAT programs can be in the community (healthcare office, methadone maintenance clinic, primary care physicians’ office, certified opioid treatment programs (OTPs)) or correctional settings.[27] Each type of medication for MAT is Food and Drug Administration (FDA) approved and is most effective when coupled with other counseling or therapy services for SUDs; however, research also suggests benefits from medication alone without counseling.[28]

Medications to treat Opioid Use Disorders (OUDs)

Buprenporphine offers a partial opioid agonist, producing similar, but lessened, effects of opiates. To increase the safety of buprenorphine and decrease the likelihood of diversion or misuse, naloxone—an opioid receptor blocker—is added to the medication.[29] Medications include

  • Bunavail® (buccal film);
  • Suboxone® (film);
  • Zubsolv® (sublingual tablets);
  • Subutex® (transmucosal);
  • Buprenex® (intramuscular or intravenous); and
  • Probuphine® (implant).[30]

Medication is prescribed and administered by a physician trained by the Drug Enforcement Agency (DEA) and given a special license and waiver by Substance Abuse and Mental Health Services Administration (SAMHSA). The medication can be administered in an office, hospital, health department, or correctional facility.[31] Physicians can prescribe only to a limited number of patients—275—per the Federal Registrar, U.S. Department of Health and Human Services, under section 303(g)(2) of the Controlled Substances Act (CSS).[32]

Methadone uses a synthetic opioid agonist taken in pill, liquid, or water form once a day. An opioid agonist tricks the brain and body as if it were taking opiates, without adverse side effects in order to reduce physiological cravings and withdrawal symptoms. First administered and monitored by a physician, it then can be obtained through an opioid treatment program (OTP) certified by the SAMHSA.[33] Methadone can be addictive, so it must be taken as prescribed to prevent adverse effects.[34]

Naltrexone is an opioid antagonist, blocking receptors in the brain from responding to opioids (or alcohol) and comes in pill (ReVia®, Depade®) or extended-release injectable (Vivitrol®) forms.[35] Any healthcare professional that is licensed to prescribe medications can prescribe naltrexone, without additional training.[36]

However, research on the use of naltrexone for OUDs is more limited than methadone and buprenorphine, particularly regarding rigorous, generalizable, long-term evaluations. While promising, more research is needed as to long-term outcomes.[37]

Medications to treat Alcohol Use Disorders (AUDs)

In addition Naltrexone can be used for AUDs, as it mediates or blocks the opioid activity within the brain related to alcohol use (see description above in OUDs).

Disulfiram is an alcohol abuse deterrent prescription medication taken daily in tablet form (Antabuse). When combined with alcohol, it causes severe physical reactions (i.e. heart palpitations, nausea, vomiting, dizziness, flushing). It is only effective if the individual is compliant with taking the medication.[38]

Acamprosate is a prescription drug taken orally (Campral®) that helps reduce cravings and withdrawal symptoms by normalizing alcohol-related neurochemical changes in the brain.[39] It targets neurochemical systems that may be biological factors of alcohol dependence.[40]

Goals:

  • Reduce cravings and withdrawal symptoms related to substance use.
  • Reduce risk for overdose.
  • Reduce substance use and relapse.
  • Increase treatment retention.
  • Decrease illegal activity.
  • Increase positive outcomes related to health (HIV, Hepatitis C).
  • Increase abstinence rates.[41]
  • Improve patient survival.[42]

Eligibility: Individuals with opioid or alcohol use disorders may be eligible for MAT programs. Individuals should be assessed with a clinical and validated substance abuse tool that includes assessment of medical, psychiatric, and substance use history; an evaluation of family and psychosocial supports; assessment of the state’s prescription drug monitoring program for detection of unreported use of other medications; a physical exam, and testing for recent opioid use and/or other drugs.[43] Some examples of assessments using self-report answers facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

In a medical setting, physicians can ask patients about compulsive drug or alcohol use or loss of control over drinking or drug use during the past year.[48] It is also important to consider insurance coverage related to MAT programs (specifically, for the medications) for funding purposes, or other outside funding sources including low-cost drug programs, to help supplement those who may not be covered.

Research on medications to treat OUDs

Methadone can

  • decrease heroin and other opioid use;
  • decrease use of injection;
  • decrease in crime/criminal behavior;
  • improve social functioning and physical symptoms;[49] and
  • improve maternal and fetal outcomes for women who are pregnant or breastfeeding.[50]

Buprenorphine can

  • significantly decrease in opioid use;
  • increase in overall well-being and social functioning;
  • reduce potential to contract HIV or hepatitis B or C;
  • decrease mortality;[51] and
  • decrease cravings and withdrawal symptoms.[52]

Naltrexone (extended-release injectable) for OUDs can

  • increase abstinence, and
  • increase retention in treatment.[53]

Research on medications to treat AUDs

Naltrexone for alcohol can

  • reduce drinking;
  • reduce rewarding effects of alcohol; and
  • increase days abstinent.[54]

Disulfiram (Antabuse) can

  • be more effective than a placebo for sobriety;[55]
  • have a moderate effect on short-term abstinence;[56]
  • be most effective with those who are already motivated to stop drinking;[57] and
  • be most effective with close monitoring for better outcomes.[58]

Acomprosate can

  • decrease withdrawal symptoms; and
  • increase abstinence for those already motivated.[59]

Research also suggests the importance of MAT programs within correctional institutions for those transitioning from jail or prison into the community—as it can help

  • reduce recidivism;
  • increase offender engagement and retention in treatment; and
  • reduce risk for relapse and/or overdose.[60]

Examples in the field: Visit a local health care professional for information on naltrexone, buprenorphine, and methadone maintenance. See the buprenorphine treatment physician locator, Opioid Treatment Program Directory-Illinois.

Read More

SAMHSA MAT
MAT comprehensive guide
National Commission on Correctional Health Care
Program profile: Buprenorphine Maintenance Treatment
Program profile: Methadone Maintenance Treatment
Opioid Treatment Program Directory-Illinois
SAMHSA Behavioral Health Treatment Services Locator
buprenorphine treatment physician locator
Buprenorphine Information
Methadone Information
SAMHSA Division of Pharmacologic Therapies (DPT)

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

THERAPEUTIC COMMUNITIES

Description: Therapeutic communities (TCs) in prisons and jails are peer- and staff-led, residential programs that provide substance use treatment, mental health counseling, and other health support services, with participants generally housed separate from the prison or jail’s general population.[61] This type of program generally lasts between 12- and 18-months, focusing on overall lifestyle changes and examination of individuals’ thinking and behavior.[62] Further, relapse prevention strategies, including coping and social skills, thinking and behavior awareness, as well as development of care coordination and support networks, are provided as participants’ transition for release into the community. [63] Typically, TCs are more frequently found in prisons, but can be implemented in a jail setting.

Goals:

  • Sustain abstinence and sobriety.
  • Develop and maintain social and coping skills.
  • Reduce recidivism (re-arrest, re-conviction, re-incarceration).

Eligibility: Individuals with SUDs or who misuse substance incarcerated in a jail or prison may be eligible. Eligibility varies between facilities, and may include

  • referral to a TC by correctional staff or treatment provider;
  • voluntary participation in TC;
  • classification as a drug-involved offender; and/or
  • deemed to have a high need area related to substance use—through a risk/needs assessment (high need on substance use) and a clinical substance use assessment in order to identify appropriate services.

Some examples of assessments using self-report answers facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Research findings

In a meta-analysis of 35 evaluations found incarceration-based TCs can

  • reduce rates in post-release drug use;[68]
  • increase time to re-incarceration;
  • reduce levels of re-incarceration; and
  • increase levels of employment.[69]

In another study of five TCs, individuals who did not participate in TCs were

  • 1.6 times more likely to be re-incarcerated, and
  • 1.5 times more likely to be re-arrested.[70]

Examples in the field: Illinois’ Sheridan Correctional Center TC, Amity In-Prison TC in San Diego, California.

Read More

Sheridan Correctional Center Therapeutic Community: Year 6
A process and impact evaluation of the Southwestern Illinois Correctional Center Therapeutic Community program during fiscal years 2007 through 2010
Community reentry after prison drug treatment: learning from Sheridan Therapeutic Community program participants
A process and impact evaluation of the Sheridan Correctional Center Therapeutic Community program during fiscal years 2004 through 2010

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

CORRECTIONAL RESIDENTIAL SUBSTANCE USE AND SUD TREATMENT

Description: Substance use treatment programs in state prisons and local jails integrate more comprehensive programming for those in correctional institutions, as well as offer community-based aftercare services.[71] Ideally, this residential substance use treatment allows incarcerated offenders separation from the general population in order to focus exclusively on substance abuse and substance-related issues. The Residential Substance Abuse Treatment (RSAT) program, through the Bureau of Justice Assistance, grants funding to all states to administer funds for RSAT in prisons, which may incorporate MAT.[72] Further, the Federal Bureau of Prisons (BOP) currently implements Residential Drug Abuse Programs (RDAP) within their institutions—a nine-month, 500-hour program with separate housing, focused on substance use treatment. RDAP also incorporates Community Transition Drug Abuse Treatment/Community Treatment Services that integrates reentry services post-release.[73]

Goals:

  • Increase focus on recovery.
  • Increase staff and resources to address substance use and related issues.
  • Increase inmate skills to remain substance-free, gain employment, and be productive members of their communities.[74]
  • Reduce relapse.
  • Increase continuity of care post-release.
  • Reduce inmate and detainee misconduct.
  • Reduce recidivism (re-arrest, re-conviction, and re-incarceration) and antisocial behavior;
  • Improve physical and mental health symptoms and conditions.[75]
  • Reduce local, state, and federal government costs related to substance use and related crimes.[76]

Eligibility: There is the possibility for federal funding specifically for RSAT. However, this eligibility is only for funding, though these guidelines incorporated evidence-based SUD or substance misuse/abuse treatment practices. To obtain RSAT funding, programs must

  • Be six- to 12-months long (3-months for jail-based programs);
  • provide residential facilities separate from the general jail or prison population;
  • predominately focus on SUD treatment;
  • teach inmates social, cognitive, behavioral, and vocation skills related to substance use issues;
  • require drug and alcohol testing; and
  • run by government agencies that provide treatment to inmates.[77]

RDAP eligibility includes the following, per the BOP guidelines:

  • Have a documented SUD per the American Psychiatric Associations Diagnostic and Statistical Manual (DSM).
  • DSM diagnosis within 12-months prior to arrest.
  • Sign program agreement.
  • Completion of three-component program.
  • Have approximately 24-months left on sentence.[78]

Eligibility should be based on a validated clinical tool identifying a SUD or substance misuse. This can include (but is not limited to):

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Research findings

RSAT is a promising practice that can

  • decrease positive drug/alcohol tests;
  • reduce positive drug/alcohol tests;
  • reduce positive drug/alcohol tests for aftercare clients;[83]
  • significantly lower relapse at 6, 12, and 18 months compared to no treatment;
  • statistically lower arrest rates at 12 months compared to no treatment; and
  • significantly lower relapse, recidivism, and arrest rates for RSAT participants who completed community aftercare compared to those who did not.[84]

RDAP is a promising program that can, when compared to the control group

  • prolonged time to relapse;
  • lower probability of rearrest; and
  • lower probability of revocation.[85]

Examples in the field: In 2015, there were approximately 132 programs funded through RSAT in the U.S..

Read More

For more information on reentry for individuals with SUDs and other substance use issues:

In-Custody Treatment and Offender Reentry

Correctional Health Care and Substance Use Treatment

Bureau of Prisons Substance Abuse Treatment

Offender reentry: Correctional Statistics, Reintegration into the Community, and Recidivism

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix

Risk and Needs Assessment in the Criminal Justice System

TCU Institute of Behavioral Research

INCARCERATION-BASED INDIVIDUAL AND GROUP SUBSTANCE USE AND SUD TREATMENT

Description: The same evidence-informed cognitive-behavioral therapies and MAT programs can be used in jails and prisons. Unfortunately, most prisons and jails do not have an adequate quality or quantity of treatment.[86] Researchers have identified several feasible corrections-based SUD and substance misuse treatment programs.

Treatment and other services to support individuals with SUDs or other substance use issues in correctional settings include (but is not limited to):

  • Cognitive-behavioral therapy, both individual or group, (see Cognitive and Behavioral Therapies).
  • Individual, group, or family counseling.
  • Self-help or peer recovery support groups.
  • Medication-Assisted Treatment (MAT) (see Pharmacological Treatment ).
  • Educational and vocational training.[87]

In addition, there are residential based treatments that include:

  • Therapeutic Communities (see Therapeutic Communities).
  • Residential Substance Abuse Treatment (RSAT) programs funded by the federal government (see Residential Correctional Treatment).
  • Residential Drug Abuse Programs (RDAP) (see Residential Correctional Treatment ).

Limitations and things to consider about SUD and substance use treatment in corrections:

  • Individual traumatic experiences and difficulty coping within a prison environment (potential post-traumatic stress disorder symptoms).
  • Co-occurring disorders (SUD or substance use in conjunction with another mental illness).
  • Breaking inmate identity and culture—treatment as a sign of “weakness.”
  • Gender-specific issues
  • Capacity to separate those in treatment from general population.
  • Quality assurance capacity to assess effectiveness of treatment.
  • Capacity and quality of treatment providers.
  • Nature of the population.
  • Length of stay and estimated time of release.[88]

Goals:

  • Decrease substance use.
  • Increase connection and engagement in aftercare services upon release from jail or prison.
  • Decrease risk for overdose.
  • Decrease recidivism (re-arrest, re-conviction, and re-incarceration).

Eligibility: Individuals in corrections with SUDs. Eligibility varies greatly between correctional facilities (jails and prisons). Some examples of assessments by correctional staff or clinicians to identify appropriate individuals include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Research findings: Overall, incarceration-based treatment research indicates significant reductions[93] in drug use and drug-related crime post-release.[94]

Overall, incarceration-based cognitive-behavioral therapy outcomes indicated

  • reduce recidivism (re-arrest, re-conviction, and re-incarceration);[95] and
  • reduce substance use and relapse.[96]

Research also suggests the importance of MAT programs within correctional institutions for those transitioning from jail or prison into the community—as it can help

  • reduce recidivism;
  • increase offender engagement in treatment; and
  • reduce risk for relapse and/or overdose.[97]

Examples in the field: IMPACT program-Cook County Jail, Second Chance Act funded programs for reentry, recidivism, and individuals with SUD and mental health issues (as well as co-occurring disorders).

Additional program examples:

Reasoning and Rehabilitation
Thinking for a Change
Moral Reconation Therapy (MRT)
Motivational Enhancement Therapy (MET)Motivational Interviewing (MI)Contingency Management programs (CM)
Trauma-informed substance use disorder treatment such as: TARGET, Seeking Safety, and TAMAR
Matrix Model
Voucher-Based Reinforcement (VBR) and Prize-Based (PB) CM
Aggression Replacement Training (ART)

Read More

Drug-addicted offenders and treatment needs in Illinois
What works? Short-term, in-custody treatment programs

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

RESEARCH UPDATE--PHARMACOLOGICAL METHODS: MEDICATION-ASSISTED TREATMENT

New research indicates patient success in the use of extended-release naltrexone (Vivitrol®) for medication-assisted treatment. While buprenorphine and methadone remain the gold standard for treatment of opioid use disorders (OUDs), naltrexone appears to have a place in treating OUDs with some success.[98]

In a 2017 study, researchers employed a 24-week, randomized, controlled clinical trial at eight U.S. community-based inpatient services and followed up with participants as outpatients. A total of 570 participants with an OUD were randomly assigned to use Vivitrol® (n=283) or Suboxone® (n=287).

Researchers found that while both medications can be effective for treating OUDs, it was substantially more difficult to initiate patients on Vivitrol® due to the required prior detoxification period of at least three days (though this varies by individual) and opioid-negative urine screen. Full detoxification is not necessary for those inducted on Suboxone® and was not required in this study.

The study found for the 570 who agreed to take part in the study, 238 participants were assigned to take Vivitrol® and 287 participants were assigned to take Suboxone®. Researchers found:

  • Most on Suboxone successfully initiated treatment (94 percent; n=270), while those on Vivitrol® had less success, with 72 percent successfully initiating (n=204).
  • 65 percent of participants on Vivitrol® experienced relapse events, defined by four consecutive missing urine screens, compared to 57 percent of participants on Suboxone®.[99]

The study found of the 474 successfully initiated individuals to treatment using Vivitrol® (n=204) or Suboxone® (n=270):

  • Similar results were seen among the participants receiving the two types of medications on outcomes of opioid-negative screens and opioid-abstinent days.
  • Initially, those taking Vivitrol® self-reported fewer cravings; however, by 24 weeks no difference was noted between the two groups.
  • For both groups, the challenge of medication retention remained.[100]

The results of this study aligned with a 2015 Norwegian study comparing Vivitrol® and Suboxone®.[101] In that study, 159 adult opioid-dependent patients were randomly assigned to Vivitrol® (n=80) or Suboxone® (n=79) in a 12-week, randomized clinical trial. Of those, 71 ultimately received Vivitrol® as assigned and 72 were received Suboxone® as assigned.

Overall, researchers found:

  • Similar retention time on the medication between both groups.
  • No difference in opioid use and adverse event outcomes between both groups.
  • Overall, there was similar short-term abstinence from illicit drugs for both groups, including illicit use. [102]

These studies support the need for pharmacological options to treat substance use disorders when medically appropriate, including opioid use disorders. Treatment should be individualized and increased patient access is needed for all medications: methadone, buprenorphine, and naltrexone.

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  67. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  68. Welsch, W. N. (2007). A multisite evaluation of prison-based therapeutic community drug treatment. Criminal Justice and Behavior, 34(11), 1481-1498.; Mitchell, O. Wilson, D. B., & MacKenzie, D. L. (2012). The effectiveness of incarceration-based drug treatment on criminal behavior: A systematic review. The Campbell Collaboration: Systematic Reviews, 18.

  69. Prendergast, M. L., Hall, E. A., Wexler, H. K., Melnick, G., & Cao, Y. (2004). Amity prison-based therapeutic community: 5-year outcomes. Criminology & Penology, (84)1, 36-60.

  70. Welsch, W. N. (2007). A multisite evaluation of prison-based therapeutic community drug treatment. Criminal Justice and Behavior, 34(11), 1481-1498.

  71. Bureau of Justice Assistance. (2005). Residential substance abuse treatment for state prisoners (RSAT) program. Washington, DC: Office of Justice Programs, Bureau of Justice Assistance, Department of Justice. Retrieved from http://bit.ly/2rhgiYL.

  72. Bureau of Justice Assistance (2005). Program performance report: Residential Substance Abuse Treatment (RSAT) program. Washington, DC: Office of Justice Programs, Bureau of Justice Assistance, Department of Justice. Retrieved from http://bit.ly/2rhgiYL.; Miller, N. (2013). RSAT training tool: Medication Assisted Treatment (MAT) for offender populations. Washington, DC: Treatment Alternatives for Safe Communities, Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from http://bit.ly/2sbpiP2.

  73. Federal Bureau of Prisons. (2008). Report to the Congress. Washington, DC: Author. Retrieved from http://bit.ly/2rldGL8.

  74. Bureau of Justice Assistance (2005). Program performance report: Residential Substance Abuse Treatment (RSAT) program. Washington, DC: Office of Justice Programs, Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from http://bit.ly/2rhgiYL.

  75. Federal Bureau of Prisons. (n.d.) Substance abuse treatment. Washington, DC: Author. Retrieved from http://bit.ly/1OciEL8.

  76. Bureau of Justice Assistance (2005). Program performance report: Residential Substance Abuse Treatment (RSAT) program. Washington, DC: Office of Justice Programs, Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from http://bit.ly/2rhgiYL.

  77. Harrison, L. D., & Martin, S. S. (2003). Residential substance abuse treatment for state prisoners: Implementation lessons learned. Washington, DC: National Institute of Justice, Bureau of Justice Assistance, U.S. Department of Justice.

  78. Federal Bureau of Prisons. (n.d.) Substance abuse treatment. Washington, DC: Author. Retrieved from http://bit.ly/1OciEL8.

  79. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  80. Texas Christian University. (2016). TCU drug screen. Fort Worth, TX: TCU Institute of Behavioral Research. Retrieved from http://bit.ly/2qwj5jm.

  81. Northpointe Institute for Public Management, Inc. (2010, January 14). COMPAS risk & need assessment system: Selected questions posed by inquiring agencies. Retrieved from http://bit.ly/2nT8LPy.

  82. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  83. Bureau of Justice Assistance. (2016). Residential Substance Abuse Treatment (RSAT) program. Biannual Grantee Feedback Report, April-September, 2015. Washington, DC: U.S. Department of Justice. Retrieved from http://bit.ly/2r8mWlu.

  84. Boyd, C. J., Pimlott-Kubiak, S., Harrell, Z., Morales, M, Roach, J., Slayden, J., & Young, A. (2001). Program evaluation of Michigan department of corrections Residential Substance Abuse Treatment (RSAT): A descriptive assessment of prison and community-based treatment programs. Ann Arbor, MI: Substance Abuse Research Center, University of Michigan.

  85. Pelissier, B., S. Camp, G. Gaes, W. Rhodes, & W. Saylor. (n.d.) Federal prison residential drug treatment: A comparison of three-year outcomes for men and women. Washington, DC: Federal Bureau of Prisons.; What Works in Reentry Clearinghouse. (n.d.) Pellisier et a. 2000-2003 (2). Counsel of State Governments.Retrieved from http://bit.ly/2r8Dr10.

  86. Taxman, F. S., Perdoni, M. L., & Caudy, M. (2013). The plight of providing appropriate substance abuse treatment services to offenders: Modeling the gaps in service delivery. Victims & Offenders: An International Journal of Evidence-based Research, Policy, and Practice, 8(1), 70-93.; Taxman, F. S., Perdoni, M. L., & Harrison, L. D., (2007). Drug treatment services for adult offenders: The state of the state. Journal of Substance Abuse Treatment, 32(3), 239-254.

  87. Center for Substance Abuse Treatment. (2005). Substance abuse treatment for adults in the criminal justice system: 9 treatment issues specific to prisons. Treatment Improvement Protocol (TIP) Series, 44, Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Retrieved from http://bit.ly/2qxcBRr.

  88. Center for Substance Abuse Treatment. (2005). Substance abuse treatment for adults in the criminal justice system: 9 treatment issues specific to prisons. Treatment Improvement Protocol (TIP) Series, 44, Rockville, MD.: Substance Abuse and Mental Health Services Administration, U.S. Retrieved from http://bit.ly/2qxcBRr.

  89. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  90. Texas Christian University. (2016). TCU drug screen. Fort Worth, TX: TCU Institute of Behavioral Research. Retrieved from http://bit.ly/2qwj5jm.

  91. Northpointe Institute for Public Management, Inc. (2010, January 14). COMPAS risk & need assessment system: Selected questions posed by inquiring agencies. Retrieved from http://bit.ly/2nT8LPy.

  92. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

  93. Quality and capacity are important. Fidelity to “what works” to treat individuals with SUDs is vital in order to see desired outcomes.

  94. Mumola, C. J., & Karberg, J. C. (October 2004). Drug use and dependence, state and federal prisoners, 2004. Washington DC: Bureau of Justice Statistics, U.S. Department of Justice. Retrieved from http://bit.ly/2rhmbVR.; Karberg, J. C., & James, D. J. (2002). Substance dependence, abuse, and treatment of jail inmates, 2002. Washington, DC: Bureau of Justice Statistics, U.S. Department of Justice. Retrieved from http://bit.ly/2sjgoOP.

  95. Mitchell, O. Wilson, D. B., & MacKenzie, D. L. (2012). The effectiveness of incarceration-based drug treatment on criminal behavior: A systematic review. The Campbell Collaboration: Systematic Reviews, 18.

  96. Pearson, F. S., Lipton, D. S., Cleland, C. M., & Yee, D. S. (2002). The effects of behavioral/cognitive-behavioral programs on recidivism. Crime and Delinquency, 48(3), 476- 496.

  97. Taxman, F. S., Perdoni, M. L., & Caudy, M. (2013). The plight of providing appropriate substance abuse treatment services to offenders: Modeling the gaps in service delivery. Victims & Offenders: An International Journal of Evidence-based Research, Policy, and Practice, 8(1), 70-93.

  98. Lee, J. D., Nunes Jr., A. V., Novo, P., Bachrach, K., Bailey, G. L., Bhatt, S…..Rotrosen, J. (2017). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): A multicenter, open-label, randomized controlled trial. The Lancet, 50, 253-264.; Lott, D. C. (2017). Extended-release naltrexone: Good but not a panacea. The Lancet, 391, 283-284.

  99. Lee, J. D., Nunes Jr., A. V., Novo, P., Bachrach, K., Bailey, G. L., Bhatt, S…..Rotrosen, J. (2017). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): A multicenter, open-label, randomized controlled trial. Contemporary Clinical Trials, 50, 253-264.

  100. Lee, J. D., Nunes Jr., A. V., Novo, P., Bachrach, K., Bailey, G. L., Bhatt, S…..Rotrosen, J. (2017). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): A multicenter, open-label, randomized controlled trial. Contemporary Clinical Trials, 50, 253-264.

  101. Kunoe, N. l., Opheim, A., Solli, K. K., Gaulen, Z., Sharma-Haase, K., Latif, Z. E., & Tanum, L. (2016). Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX). BMC Pharmacology & Toxicology, 17, 18.; Tanum, L., Solli, K. K., Latif, Z. E., Benth, J.S., Sharma-Haase, K., Krajci, P., & Kunoe, N. (2017). Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: A randomized clinical noninferiority trial. JAMA Psychiatry, 74(12), 1197-1205.

  102. Tanum, L., Solli, K. K., Latif, Z. E., Benth, J.S., Sharma-Haase, K., Krajci, P., & Kunoe, N. (2017). Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: A randomized clinical noninferiority trial. JAMA Psychiatry, 74(12), 1197-1205.

Intercept 5: Community Corrections

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

COGNITIVE AND BEHAVIORAL THERAPIES

Description: Cognitive and behavioral therapies include those that reinforce and provide incentives for abstinence, enhancing life and coping skills surrounding situations and emotions that may trigger drug use, and help change attitudes and behaviors related to substance use. Some therapies focus more on the behavioral aspect of substance use; some focus more on the cognitive aspect of substance use. Others use both approaches, called cognitive-behavioral therapy.[1] Cognitive-behavioral therapy (CBT) is a general classification of therapeutic techniques that focus on two aspects:

  • The thought processes, attitudes, and values underlying antisocial behavior (cognitive).
  • The observable behaviors (behavioral).

Ultimately, CBT helps individuals understand how thoughts and feelings influence choices in behavior, in addition to providing behavioral alternatives. In order to help change antisocial behavior, such as substance use, CBT helps individuals identify and replace thoughts, attitudes, and beliefs that lead may to substance use.[2] Further, CBT helps individuals by teaching social and emotional skills, while also using positive and negative consequences to shape behavior. This helps provide tools for individuals to use when encountering situations that may lead to substance use or other antisocial behaviors.[3] CBT incorporates several distinct interventions that may be used alone or in combination, in an individual or group format. In particular, CBT incorporates some combination of

  • cognitive restructuring;
  • social skill building;
  • emotional regulation skills;
  • modeling and role-playing;
  • homework assignments;
  • motivational enhancement/interviewing techniques;
  • contingency management principles;
  • psychoeducation; and
  • systematic training of alternative responses to triggers (high-risk situations).[4]

Some treatment focuses more on cognitions (considered cognitive therapy), some more on behaviors (considered behavioral therapy), and some provide a balance of both (considered cognitive-behavioral therapy).[5]

Behavioral and CBT-based treatment can take several forms in the community (but is not limited to):

  • Individual, family, or group-based.
  • Residential, inpatient treatment.
  • Outpatient or intensive outpatient programs (IOP).

In addition, it is also beneficial for treatment to be supplemented with other support services:

  • Educational and vocational training.
  • Self-help or peer recovery support services.
  • Mental health services. [6]

Goals:

  • Develop and increase use of appropriate social and emotional skills.
  • Understand how thinking leads to behavior.
  • Target maladaptive thinking patterns.
  • Improve moral and critical reasoning.
  • Develop and use interpersonal skills.
  • Manage or cope with risky situations that may lead to relapse.
  • Increase self-control and impulse management.
  • Increase public safety and community safety.
  • Increase number of individuals in the workforce.
  • Increase self-efficacy and self-control.[7]

Eligibility: Ideally, eligibility should be based on a validated clinical tool or validated risk/needs assessment conducted by trained professionals. Examples of assessments facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

Program Examples:The programs below have substantial and rigorous research identifying them as effective behavioral intervention programs. This is not a comprehensive list.

Relapse Prevention (RP) is a CBT-based program that specifically and systematically trains individuals to engage in alternate responses to high-risk situations related to substance use.[12] RP incorporates the use of cognitive and behavioral strategies to reduce relapse through identification of “triggers”— individually specific high-risk situations that may precede or contribute to relapse.[13] Additional aspects of RP include

  • enhancing self-efficacy;
  • managing relapses;
  • identifying and coping with high-risk situations;
  • eliminating myths and placebo effects (countering misperceptions of use); and
  • balancing and modifying lifestyle factors.[14]

Contingency management (CM) is an incentive-based intervention with a behavioral focus that uses reinforcements to meet specific behavioral goals such as remaining clean and sober, providing negative urine screens, or completing treatment sessions.[15] Reinforcements shape or control behavior through consequences and non-drug-related reinforcers to help counter the reinforcing effects of drugs.[16] Two common types of CM programs:

• Voucher-Based Reinforcement Therapy (VBRT) which uses vouchers with differing monetary values each time an individual engages in specific positive behaviors that may be exchanged for goods or services.[17]
• Prize-Based (PB) contingency management which uses a drawing for a prize when an individual engages in positive behavior, but not all drawings will result in a tangible prize.[18]

Research findings. CBT and behavioral therapies are effective types of treatment, that generally has a moderate effect on reducing

  • substance use;
  • substance abuse; and
  • reoffending.[19]

Further, research indicates that CBT and behavioral intervention programs can be more effective than

  • abstinence-based approaches;
  • standard case management; and
  • 12-step counseling.[20]

Research also suggests that behavioral therapies with CM can result in more positive outcomes than behavioral interventions alone.[21]

In a meta-analysis, CBT showed a 26 percent reduction in recidivism for CBT program participants compared to a control group.[22] Further, CBT-based programs are effective with a variety of individuals, including those with SUDs or substance abuse/misuse.[23]

Behavioral (including CBT) programs or interventions produce the greatest effects when they adhere to the following principles:

  • Target those at higher-risk to recidivate (moderate- and high-risk) based on a validated risk/needs assessment.
  • Target criminogenic risk factors most highly associated with recidivism based on a validated risk/needs assessment.
  • Are responsive to individual needs and barriers (i.e. language, mental health, intellectual or cognitive disabilities).
  • Use well-trained professionals.
  • Maintain adherence to the program or practice components (fidelity, or using a program or practice as it is meant to be delivered based on training).[24]

Other Effective and Promising Cognitive and/or Behavioral Interventions

Thinking for a Change
Moral Reconation Therapy (MRT) Dialectical Behavior Therapy (DBT)Motivational Enhancement Therapy (MET)Motivational Interviewing (MI)Contingency Management programs (CM)
Trauma-informed substance use disorder treatment such as: TARGET, Seeking Safety, and TAMAR
Matrix Model
Multisystemic Therapy-Substance Abuse
Voucher-Based Reinforcement (VBR) and Prize-Based (PB) CM
Adolescent Community Reinforcement Approach (A-CRA)/Assertive Continuing Care (ACC)
Behavioral Couples Therapy
Aggression Replacement Training (ART)
Cognitive Interventions Program
Reasoning and Rehabilitation

Read MoreRisk-Need-Responsivity Model for offender assessment and rehabilitation
Treatment for offenders under community supervision
Integrating substance abuse treatment and criminal justice supervision
National Commission on Correctional Health Care

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

PHARMACOLOGICAL METHODS: MEDICATION-ASSISTED TREATMENT (MAT)

Description: Medication-Assisted Treatment (MAT) programs incorporate the use of medicine to treat opioid or alcohol use disorders, in conjunction with behavioral therapies or counseling to treat individuals with SUDs.[25] With regard to opioids, the use of medication alone is called opioid replacement therapy (ORT), which alone, can also be effective to treat opioid use disorders (OUDs).[26] MAT programs help with treatment retention and abstinence by decreasing withdrawal symptoms and cravings; increasing quality of life; reducing risk of HIV and hepatitis C; reducing risky behaviors associated with substance use; as well as decreasing risk for overdose.[27] MAT programs can be in the community (healthcare office, methadone maintenance clinic, primary care physicians’ office, certified opioid treatment programs (OTPs)) or correctional settings.[28] Each type of medication for MAT is Food and Drug Administration (FDA) approved and is most effective when coupled with other counseling or therapy services for SUDs; however, research also suggests benefits from medication alone without counseling.[29]

Medications to treat Opioid Use Disorders (OUDs)

Buprenporphine offers a partial opioid agonist, producing similar, but lessened, effects of opiates. To increase the safety of buprenorphine and decrease the likelihood of diversion or misuse, naloxone—an opioid receptor blocker—is added to the medication.[30] Medications include

  • Bunavail® (buccal film);
  • Suboxone® (film);
  • Zubsolv® (sublingual tablets);
  • Subutex® (transmucosal);
  • Buprenex® (intramuscular or intravenous);
  • Butrans® (transdermal patch); and
  • Probuphine® (implant).[31]

Medication is prescribed and administered by a physician trained by the Drug Enforcement Agency (DEA) and given a special license and waiver by Substance Abuse and Mental Health Services Administration (SAMHSA). The medication can be administered in an office, hospital, health department, or correctional facility.[32] Physicians can prescribe only to a limited number of patients—275—per the Federal Registrar, U.S. Department of Health and Human Services, under section 303(g)(2) of the Controlled Substances Act (CSS).[33]

Methadone uses a synthetic opioid agonist taken in pill, liquid, or water form once a day. An opioid agonist tricks the brain and body as if it were taking opiates, without adverse side effects in order to reduce physiological cravings and withdrawal symptoms. First administered and monitored by a physician, it then can be obtained through an opioid treatment program (OTP) certified by the SAMHSA.[34] Methadone can be addictive, so it must be taken as prescribed to prevent adverse effects.[35]

Naltrexone is an opioid antagonist, blocking receptors in the brain from responding to opioids (or alcohol) and comes in pill (ReVia®, Depade®) or extended-release injectable (Vivitrol®) forms.[36] Any healthcare professional that is licensed to prescribe medications can prescribe naltrexone, without additional training.[37]

However, research on the use of naltrexone for OUDs is more limited than methadone and buprenorphine, particularly regarding rigorous, generalizable, long-term evaluations. While promising, more research is needed as to long-term outcomes.[38]

Medications to treat Alcohol Use Disorders (AUDs)

In addition Naltrexone can be used for AUDs, as it mediates or blocks the opioid activity within the brain related to alcohol use (see description above in OUDs).

Disulfiram is an alcohol abuse deterrent prescription medication taken daily in tablet form (Antabuse). When combined with alcohol, it causes severe physical reactions (i.e. heart palpitations, nausea, vomiting, dizziness, flushing). It is only effective if the individual is compliant with taking the medication.[39]

Acamprosate is a prescription drug taken orally (Campral®) that helps reduce cravings and withdrawal symptoms by normalizing alcohol-related neurochemical changes in the brain.[40] It targets neurochemical systems that may be biological factors of alcohol dependence.[41]

Goals:

  • Reduce cravings and withdrawal symptoms related to substance use.
  • Reduce risk for overdose.
  • Reduce substance use and relapse.
  • Increase treatment retention.
  • Decrease illegal activity.
  • Increase positive outcomes related to health (HIV, Hepatitis C).
  • Increase abstinence rates.[42]
  • Improve patient survival.[43]

Eligibility: Individuals with opioid or alcohol use disorders may be eligible for MAT programs. Individuals should be assessed with a clinical and validated substance abuse tool that includes assessment of medical, psychiatric, and substance use history; an evaluation of family and psychosocial supports; assessment of the state’s prescription drug monitoring program for detection of unreported use of other medications; a physical exam, and testing for recent opioid use and/or other drugs.[44] Some examples of assessments using self-report answers facilitated by trained clinicians include:

For professionals in the criminal justice system, a validated risk/needs assessment can help identify if substance use is a high need area for an individual, in which it may be appropriate to refer to a clinician for further assessment. Some of these validated risk/needs assessments include:

In a medical setting, physicians can ask patients about compulsive drug or alcohol use or loss of control over drinking or drug use during the past year.[49] It is also important to consider insurance coverage related to MAT programs (specifically, for the medications) for funding purposes, or other outside funding sources including low-cost drug programs, to help supplement those who may not be covered.

Research on medications to treat OUDs

Methadone can

  • decrease heroin and other opioid use;
  • decrease use of injection;
  • decrease in crime/criminal behavior;
  • improve social functioning and physical symptoms;[50] and
  • improve maternal and fetal outcomes for women who are pregnant or breastfeeding.[51]

Buprenorphine can

  • significantly decrease in opioid use;
  • increase in overall well-being and social functioning;
  • reduce potential to contract HIV or hepatitis B or C;
  • decrease mortality;[52] and
  • decrease cravings and withdrawal symptoms.[53]

Naltrexone (extended-release injectable) for OUDs can

  • increase abstinence, and
  • increase retention in treatment.[54]

Research on medications to treat AUDs

Naltrexone for alcohol can

  • reduce drinking;
  • reduce rewarding effects of alcohol; and
  • increase days abstinent.[55]

Disulfiram (Antabuse) can

  • be more effective than a placebo for sobriety;[56]
  • have a moderate effect on short-term abstinence;[57]
  • be most effective with those who are already motivated to stop drinking;[58] and
  • be most effective with close monitoring for better outcomes.[59]

Acomprosate can

  • decrease withdrawal symptoms; and
  • increase abstinence for those already motivated.[60]

Research also suggests the importance of MAT programs within correctional institutions for those transitioning from jail or prison into the community—as it can help

  • reduce recidivism;
  • increase offender engagement and retention in treatment; and
  • reduce risk for relapse and/or overdose.[61]

Examples in the field: Visit a local health care professional for information on naltrexone, buprenorphine, and methadone maintenance. See the buprenorphine treatment physician locator, Opioid Treatment Program Directory-Illinois.

Read More

SAMHSA MAT
MAT comprehensive guide
National Commission on Correctional Health CareProgram profile: Buprenorphine Maintenance Treatment
Program profile: Methadone Maintenance Treatment
Opioid Treatment Program Directory-Illinois
SAMHSA Behavioral Health Treatment Services Locator
buprenorphine treatment physician locator
Buprenorphine Information
Methadone Information
SAMHSA Division of Pharmacologic Therapies (DPT)

For more information on validated and reliable substance use assessment tools and risk/need tools:

Center for Sentencing Initiatives Assessment Appendix
Risk and Needs Assessment in the Criminal Justice System
TCU Institute of Behavioral Research

RESEARCH UPDATE--PHARMACOLOGICAL METHODS: MEDICATION-ASSISTED TREATMENT (MAT)

New research indicates patient success in the use of extended-release naltrexone (Vivitrol®) for medication-assisted treatment. While buprenorphine and methadone remain the gold standard for treatment of opioid use disorders (OUDs), naltrexone appears to have a place in treating OUDs with some success.[62]

In a 2017 study, researchers employed a 24-week, randomized, controlled clinical trial at eight U.S. community-based inpatient services and followed up with participants as outpatients. A total of 570 participants with an OUD were randomly assigned to use Vivitrol® (n=283) or Suboxone® (n=287).

Researchers found that while both medications can be effective for treating OUDs, it was substantially more difficult to initiate patients on Vivitrol® due to the required prior detoxification period of at least three days (though this varies by individual) and opioid-negative urine screen. Full detoxification is not necessary for those inducted on Suboxone® and was not required in this study.

The study found for the 570 who agreed to take part in the study, 238 participants were assigned to take Vivitrol® and 287 participants were assigned to take Suboxone®. Researchers found:

  • Most on Suboxone successfully initiated treatment (94 percent; n=270), while those on Vivitrol® had less success, with 72 percent successfully initiating (n=204).
  • 65 percent of participants on Vivitrol® experienced relapse events, defined by four consecutive missing urine screens, compared to 57 percent of participants on Suboxone®.[63]

The study found of the 474 successfully initiated individuals to treatment using Vivitrol® (n=204) or Suboxone® (n=270):

  • Similar results were seen among the participants receiving the two types of medications on outcomes of opioid-negative screens and opioid-abstinent days.
  • Initially, those taking Vivitrol® self-reported fewer cravings; however, by 24 weeks no difference was noted between the two groups.
  • For both groups, the challenge of medication retention remained.[64]

The results of this study aligned with a 2015 Norwegian study comparing Vivitrol® and Suboxone®.[65] In that study, 159 adult opioid-dependent patients were randomly assigned to Vivitrol® (n=80) or Suboxone® (n=79) in a 12-week, randomized clinical trial. Of those, 71 ultimately received Vivitrol® as assigned and 72 were received Suboxone® as assigned.

Overall, researchers found:

  • Similar retention time on the medication between both groups.
  • No difference in opioid use and adverse event outcomes between both groups.
  • Overall, there was similar short-term abstinence from illicit drugs for both groups, including illicit use. [66]

These studies support the need for pharmacological options to treat substance use disorders when medically appropriate, including opioid use disorders. Treatment should be individualized and increased patient access is needed for all medications: methadone, buprenorphine, and naltrexone.

References

  1. While this list provides examples of evidence-informed behavioral therapies, it is not all encompassing. For information on other evidence-informed cognitive- and/or behavioral-based programs, use the national resources under additional resources at the bottom of this continuum.

  2. Van Voorhis, P., & Salisbury, E. J . (2009). Social learning models. In M. B. In P. Van Voorhis, & D. Lester (Ed.), Correctional counseling and rehabilitation. (7th ed.). New Providence, NJ.: Matthew Bender & Company, Inc., of LesixNexis Group.; Van Voorhis, P., & Lester, D. (2009). Cognitive therapies. In M. B. In P. Van Voorhis, & D. Lester (Ed.), Correctional counseling and rehabilitation. (7th ed.). New Providence, NJ.: Matthew Bender & Company, Inc., of LesixNexis Group.

  3. National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide (3rd ed.). Bethesda, MD: National Institute of Health, U.S. Department of Health and Human Services, HHS. Retrieved from http://bit.ly/2r7MW0s.

  4. McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive-behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33(3), 511-525.; National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide (3rd ed.). Bethesda, MD: National Institute of Health, U.S. Department of Health and Human Services, HHS. Retrieved from http://bit.ly/2r7MW0s.; 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. Bethesda, MD: HHS.; Van Voorhis, P., & Salisbury, E. J . (2009). Social learning models. In M. B. In P. Van Voorhis, & D. Lester (Ed.), Correctional counseling and rehabilitation. (7th ed.). New Providence, NJ.: Matthew Bender & Company, Inc., of LesixNexis Group.; Van Voorhis, P., & Lester, D. (2009). Cognitive therapies. In M. B. In P. Van Voorhis, & D. Lester (Ed.), Correctional counseling and rehabilitation. (7th ed.). New Providence, NJ.: Matthew Bender & Company, Inc., of LesixNexis Group.

  5. National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide (3rd ed.). Bethesda, MD: National Institute of Health, U.S. Department of Health and Human Services, HHS. Retrieved from http://bit.ly/2r7MW0s.; 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.

  6. Substance Abuse and Mental Health Services Administration. (2017). Behavioral health treatments and services. Rockville, MD: Author, Department of Health and Human Services. Retrieved from http://bit.ly/2lsDGyc.; Taxman, F. S., Perdoni, M. L., & Caudy, M. (2013). The plight of providing appropriate substance abuse treatment services to offenders: Modeling the gaps in service delivery. Victims & Offenders: An International Journal of Evidence-based Research, Policy, and Practice, 8(1), 70-93.

  7. National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: A research-based guide (3rd ed.). Bethesda, MD: National Institute of Health, U.S. Department of Health and Human Services, HHS. Retrieved from http://bit.ly/2r7MW0s.

  8. National Institute on Drug Abuse. (2015). Chart of evidence-based screening tools for adults and adolescents. Bethesda, MD: Author. Retrieved from http://bit.ly/1MR43oA.

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  10. Northpointe Institute for Public Management, Inc. (2010, January 14). COMPAS risk & need assessment system: Selected questions posed by inquiring agencies. Retrieved from http://bit.ly/2nT8LPy.

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