Individuals Working in the Criminal Justice System

Over the last decade, the number of defendants charged with drug offenses in the Federal courts has more than doubled.¹ In 1998, drug offenders accounted for 59 percent of the Federal prison population (up from 25 percent in 1980), as well as 21 percent of the state prison population (up from just 6 percent in 1980).² Much of this upward trend can be attributed to an emphasis on mandatory prison terms and the arrest and prosecution of drug users and street-level dealers. Up to three-fourths of parolees who leave prison begin using drugs again within three months of release,³ and the recidivism rates for these individuals are very high.

The stigma of "criminality" in society is compounded by the label of "addict." As a result, adult male and female ex-offenders face a myriad of obstacles in their journey toward productive citizenship.⁴ Stigma can be attributed largely to a lack of understanding of the nature of addiction and the recovery process. Three decades of scientific research have yielded conclusive evidence that addiction is a complex, chronic health condition, and that treatment for addiction is as successful as treatment for other chronic diseases such as diabetes, hypertension, and asthma.⁵ However, for treatment to be successful, the recovery process must also be fully understood as the ongoing and often long-term effort we now know it to be. Individuals in recovery often will require multiple episodes of treatment to achieve abstinence and become fully functional.

The good news is that a growing body of evidence has confirmed that treating offenders for their drug and alcohol problems, not just incarcerating them, saves money. In fact, it is estimated that if only 10 percent of released inmates were successful in recovery, the economic benefit in the first year alone after release would be $8.256 billion.⁶ But treatment is not only economical, it is more effective in terms of reduced use, criminal activity, and recidivism.⁷

Consider these findings:⁸

• In the 12 months following treatment, the number of offenders using any drug or those using crack, cocaine, and heroin dropped by as much as 50 percent.
  
  
• Forty-seven percent of offenders who received three stages of treatment remained drug-free 18 months following release, compared to only 16 percent of those who received no treatment.
  
  
• Seventy-seven percent of offenders who received prison-based treatment services, work release treatment services, and community-based treatment services remained arrest-free 18 months following release, compared to 46 percent of those who received no treatment.
  
  
• Offenders who received community-based services had a recidivism rate half that of those who did not receive them.
  
  
• Drug treatment was successful in reducing the number of offenders committing illegal acts by as much as 60 percent.
  
  
• The percentage of substance abuse treatment clients who reported inpatient mental health visits decreased by 28 percent 12 months after treatment.

In addition, offenders who are legally mandated to enter treatment can be just as successful as those who enter it voluntarily.⁹ In fact, coerced offenders begin treatment sooner, and participate longer than voluntary participants.¹⁰

Changing the Conversation

The U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) launched Changing the Conversation:  The National Treatment Plan Initiative to Improve Substance Abuse Treatment, which builds on recent advances in the treatment field. The report brings together the best ideas about improving treatment and identifies actions that could translate knowledge into practice.¹¹ Experts and stakeholders from around the country have participated in public hearings and panel discussions to identify five key guidelines for positive action to improve the effectiveness and availability of treatment nationwide. Individuals who work in the criminal justice system, including judges, public and private attorneys (as well as their member organizations), police, probation and parole officers, and other corrections officials or agency managers, can have a great impact in affecting change by following several key guidelines for positive action. They are:¹²

1. "No Wrong Door" to Treatment— Effective systems must ensure that an individual needing treatment will be identified and assessed and receive the treatment he or she needs, either directly or through the appropriate referral, no matter where that person enters the realm of services.

2. Commit to Quality—Effective treatment and the wise use of resources depend upon ongoing improvement in the quality of care.

3. Change Attitudes—Significant reduction in stigma and changes in attitudes will require a concerted effort based on systematic research.

4. Build Partnerships—Efforts by individuals and organizations throughout the criminal justice and treatment fields to work with each other and with other people and groups who share a desire to improve treatment will require specific encouragement and support.

In keeping with the four guidelines for positive action outlined above, here are some steps individuals who work in the criminal justice system can take to reduce the impact of addiction.

Making a Difference: What Can I Do?

1. Identify and work with community partners. The integration of effective drug and alcohol treatment for offenders within the criminal justice system requires close collaboration by individuals from many diverse backgrounds with various degrees and areas of expertise. Criminal justice professionals need to work with representatives from the treatment field, as well as from the public health and social services arenas, to develop shared goals, exchange information, and create a continuum of services and programs that will produce positive, measurable results.

2. Know the range of options and use limited resources wisely. A range of interventions currently are being used within the criminal justice system, such as pretrial or prosecutorial diversion programs, drug courts, family and civil court interventions, National TASC (Treatment Accountability for Safer Communities) programs, day reporting centers, jail and prison treatment, and post-release case management. It is important to explore all of the options and to know what will work best in your jurisdiction. Criminal justice professionals must work closely with the appropriate funding agencies, treatment providers, and other institutional representatives to ensure limited treatment resources are used most efficiently.

3. Support what works. Access to and management of "wrap-around" services is essential to the long-term recovery of offenders who have drug or alcohol problems. Housing, employment, clothing, educational or vocational training, health care, and treatment are among the essentials most parolees lack.¹³ Individuals who work within the criminal justice system need to support those services, programs, and approaches that work best. For instance, family-focused therapy is often much more successful than treatment that solely targets the individual with the drug or alcohol problem. Treatment programs and services that are gender- or culturally-responsive are much more successful than those that do not take these factors into account. Special populations, such as those which include people with co-occurring mental health issues or disabilities and individuals with varying sexual orientations, also have divergent issues that need to be addressed in their recovery.

4. Pay special attention to the needs of juveniles. Thousands of adolescents and their families are struggling with the consequences of their either budding or full-blown addictions. Young people with drug and alcohol problems face academic difficulties, declining physical and mental health, peer stigmatization and socialization problems, family dysfunction, social and economic consequences, and delinquency. Often they have experienced the addiction of parents and other family members. It is this last consequence that often brings juveniles face-to-face with the justice system. Professionals in the juvenile justice system have the opportunity to intervene with drug- and alcohol-involved youths and help them gain access to early intervention and treatment, long before the cycle of addiction and criminal activity intensifies.

Making a Difference: How Can I Focus My Efforts during Recovery Month?

September 2002 is Recovery Month. It is a time every year for all of us to join forces to focus on real solutions to the social consequences of drug and alcohol abuse and addiction. This year's theme is "Join the Voices of Recovery:  A Call to Action." Individuals who work in the criminal justice arena are critical stakeholders in the national initiative to respond more effectively to the challenges of addiction. Here are some things you can do as a criminal justice professional during the month of September, and throughout the coming year, to make a contribution:

1. Educate, train, and encourage your staff. You can foster awareness about drug and alcohol addiction, treatment, and the recovery process among members of your staff through in-service education programs. By making certain that the people with whom you work are well-informed on the issues, you enable them to do their jobs with a greater degree of understanding and effectiveness. Schedule an in-service education opportunity for your staff during the month of September. Invite outside representation from the treatment community to speak on a topic that is of particular interest to your staff and the population you serve.

2. Become a spokesperson. During Recovery Month or at any time during the year, offer to serve as a community spokesperson about drug and alcohol abuse and addiction, stigma reduction, and how to improve the effectiveness and availability of treatment programs and services in your area. Speak out on the need for treatment and community-based recovery management for individuals in the criminal justice system.

3. Write an op-ed. Recovery Month is the "news hook" you need to gain the attention of your local newspaper to express your views. Write an editorial or letter to the editor highlighting the critical need to integrate criminal justice sanctions and treatment. Discuss both the social and economic benefits of doing so. Use statistics, such as those mentioned here, and anecdotal accounts based on your own personal and professional experience.

4. Participate in public events. A number of communities nationwide will be hosting Community Forums and other events during Recovery Month to raise awareness about addiction, treatment, and recovery. If you are asked to participate, do so in any way you can. If there is no community event being held in your area, work with other stakeholders to organize one. Or, collaborate on other activities that will educate and inform the public, such as conference workshops, media events, or other special events.

You are encouraged to share your plans and activities for Recovery Month 2002 with the HHS/SAMHSA Center for Substance Abuse Treatment, your colleagues, and the general public by posting them on the official Recovery Month web site at http://www.samhsa.gov.

We would like to know about your efforts during Recovery Month. Please complete the Customer Satisfaction Form enclosed in the kit. Directions are included on the form.

For any additional Recovery Month materials visit our web site at http://www.samhsa.gov or call 1-800-729-6686.

Additional Resources

Sources

¹ Bureau of Justice Statistics, Drugs and Crime Facts. Tina L. Dorsey, Editor. Washington, DC: U.S. Department of Justice, Office of Justice Programs, August 2001.

² Federal Bureau of Prisons, Federal Bureau of Prisons Quick Facts. Washington, DC: U.S. Department of Justice, February 2000.

³ Lurigio, Arthur J. Drug treatment availability and effectiveness. Criminal Justice and Behavior, 27 (4), August 2000. Cited in: Great Lakes Addiction Technology Transfer Center, Drug Treatment for Offenders: Why It Matters. GLATTC Research Update. Chicago, IL: Jane Addams College of Social Work, Fall 2000.

⁴ Community Re-Entry for Offenders. Chicago, IL: Treatment Alternatives for Safe Communities (TASC), 2001.

⁵ Principles of Drug Addiction Treatment: A Research-Based Guide. NIH Publication No. 00-4180. Bethesda, MD: National Institutes of Health, National Institute on Drug Abuse, printed October 1999/reprinted July 2000.

⁶ Behind Bars: Substance Abuse and America's Prison Population. New York, NY: National Center on Addiction and Substance Abuse, Columbia University, January 1998.

⁷ Studies/sources include: The National Treatment Improvement Evaluation Study (NTIES): Highlights. DHHS Publication No. (SMA) 97-3156. Rockville, MD: Office of Evaluation, Scientific Analysis and Synthesis, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1997; Center for Drug and Alcohol Studies, University of Delaware, 1997; Swartz, James, Ph.D., Project IMPACT Study, 1996; and National Institute on Drug Abuse, Drug Abuse Treatment Outcome Study (DATOS), 1997.

⁸ Cited from studies mentioned above in: Substance Abuse and Crime in Illinois: What the Research Tells Us. Chicago, IL: Treatment Alternatives for Safe Communities (TASC), February 1998.

⁹ Anglin, M.D., Brecht, M.L., and Maddahian, E. Pretreatment characteristics and treatment performance of legally coerced versus voluntary methadone maintenance admissions. Criminology, 27: 537-557, 1989.

¹⁰ Anglin et al.

¹¹ Changing the Conversation: The National Treatment Plan Initiative to Improve Substance Abuse Treatment. DHHS Publication No. (SMA) 00-3480. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, November 2000.

¹² ibid.

¹³ Community Reentry for Offenders.

Educators and Schools

Children in families with adults who abuse alcohol or drugs are at higher than average risk for becoming substance abusers themselves. Strong scientific evidence now suggests that addiction tends to run in families. The implication for youth is that one in four children under the age of 18 lives in a home where alcoholism or alcohol abuse is a fact of daily life.¹

Recent findings regarding adolescent drug and alcohol use reveal that: 1) marijuana remains the most widely used illicit drug; 2) the illegal use of alcohol by minors is common; and 3) the use of drugs such as Ecstasy, steroids, and heroin (without using a needle) is rising.² In fact, by the time students complete high school, 70 percent (11.1 million) have smoked cigarettes, 81 percent (12.8 million) have drunk alcohol, 47 percent (7.4 million) have used marijuana, and 24 percent (3.8 million) have used another illicit drug.³

All of this is particularly alarming since research now strongly suggests that the earlier a child smokes, drinks, or uses drugs, the greater the likelihood of dependence on those substances.⁴

Between grade school and high school, every young person must make personal decisions about whether or not to use drugs, alcohol, or tobacco. Study after study has shown that parents play the strongest role in their children's lives when it comes to the choice to abstain from doing so. In fact, young people who live in "hands-on" households—where parents establish appropriate rules and standards of behavior and talk to their teens—are at lower risk for use than those who do not.⁵

However, the second strongest line of defense in the effort to prevent and treat drug and alcohol problems among young people comprises the Nation's schools and its educators, including teachers, administrators, guidance counselors, athletic coaches, and support staff. These individuals and the schools in which they work can exert tremendous influence when it comes to two of the key factors linked to substance use and dependence among young people—availability and perception of risk. They can support young people in need of treatment for their drug or alcohol problems, and support them in their recovery efforts—especially when it comes to reentering school after a related, and perhaps prolonged, absence. In addition, educators and school administrators can play a critical part in identifying and supporting the estimated one in four children in a typical classroom who live with some form of addiction problem at home.⁶

Changing the Conversation

The Changing the Conversation:  The National Treatment Plan Initiative to Improve Substance Abuse Treatment is being spearheaded by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) in an effort to improve the quality and availability of treatment services and programs nationwide. Dozens of expert panelists, stakeholders, and members of the general public were consulted to provide guidelines for positive action and directions for addressing the problems associated with substance abuse treatment.

Improving and expanding treatment for people with drug and alcohol problems, including adolescents and their families, is a primary goal of Changing the Conversation. Educators and school administrators who want to have an impact on attaining this goal can take action on four key guidelines for positive action:

1. "No Wrong Door" to Treatment—Educators and school administrators should play a vital role in identifying students who have drug and alcohol problems or who are living with them at home in order to serve as a source of information and support in a number of critical ways.

2. Change Attitudes—Educators and school administrators have an influence on children and how they perceive the world around them. As such, their actions, what they teach, what they say, and how they say it are extremely meaningful. Educators and school administrators can actually affect not only their students' knowledge, attitudes, and behaviors when it comes to drug and alcohol use, addiction, treatment, and recovery, but those of the surrounding community as well.

3. Build Partnerships—Educators and school administrators must view the school in which they work, as well as the community in which it operates, as a partner in the effort to reduce usage rates among young people and create positive solutions and systems of support for individuals and their families.

4. Commit to Quality—As key information and referral sources for children who may need support in coping with substance abuse in their family situations, educators, their staff, and school administrators need to establish consistent communications and collaborations with local substance abuse treatment services and programs to ensure the highest standards of quality are utilized for information dissemination, staff training, and client referral. Administrators should consider offering incentives or assistance programs for their staff to promote incorporation of established standards of practice. Efforts should include reaching out to local experts for assistance in instituting the latest "best practices" training standards.

To accomplish these objectives, there are a number of very specific steps that educators, school administrators, and school systems can take to begin making inroads on the four key guidelines for positive action mentioned above. Here are just a few for your consideration.

Making a Difference: What Can I Do?

1. Do what you do best—educate. Learn all you can about drug and alcohol use and addiction and its effects on young people and their families. Then take that knowledge and share it with others whenever and wherever you can. If you are an administrator, encourage your staff members to learn as much as they can about drug and alcohol use, addiction, treatment, and the recovery process. There are a number of organizations that can help you. (See the attached list for contact information.)

2. Do everything you can to make your school drug- and alcohol-free. Students who attend schools where substances are readily available are twice as likely to smoke, drink, or use illegal drugs as those who attend drug-free schools. This is frightening when you consider that nine and a half million high school students—60 percent—and almost five million middle school students—30 percent—attend schools where drugs are used, kept, and sold.⁷ This last fact may be disconcerting, but it's not surprising given the remarkable differences that exist between students and school personnel's perceptions of the problem. When asked if their school grounds were drug-free, 11 percent of principals and 35 percent of teachers said they were not drug-free, compared to 66 percent of students who said they were not drug-free.⁸

Make every effort to integrate drug and alcohol education and student assistance programs into your school's curriculum and culture. Plan and promote drug- and alcohol-free activities. School-sponsored, substance-free prom and after-prom (or other dance) parties have steadily gained popularity and have been quite successful.

3. Be mindful of what you say and how you say it. Years of misunderstanding, and previously, a lack of scientific data, have fostered a firmly established and negative vernacular surrounding drug and alcohol use, addiction, treatment, and recovery. As a result, public perceptions and attitudes about people with drug and alcohol problems and the challenges they face remain grounded in the outdated misperception that addiction is a moral failing rather than a chronic illness. When speaking about these individuals and issues, be mindful of the bias in the language you use. And, correct students if you overhear them using derogatory terms.

4. Don't be afraid to get involved. Many teachers, coaches, counselors, and administrators come in contact with children who live in alcohol- or drug-dependent families. As trusted and respected figures in their lives, these adults are in a unique position to offer support by providing these children with age-appropriate information, teaching them to identify and express their feelings in healthy ways, and probably more importantly, taking the time to develop a healthy adult/child relationship. Educators and school personnel are in a unique position to identify problems and intervene if necessary to ensure these students get the help they need.

As an educator or someone employed by the school system, you need to be able to recognize the signs of young people at risk for drug and alcohol use, such as poor academic performance; frequent absences; current substance use; low self-esteem; depression or anxiety; learning, conduct, or eating disorders; sensation-seeking/impulsivity; discipline problems; inaccurate or limited knowledge about the effects of substance use; and low perceptions of risk of substance use.⁹ In addition, students who live with drug and alcohol problems at home are at increased risk of developing problems of their own. If you believe a student is at risk, you may want to refer him or her to a guidance counselor, social worker, or student assistance program. If you do not think the youth will be receptive, try talking with the counselor or other resource person first to get his/her guidance on how you can best work together to intervene. There also are a number of resources to assist you in this regard, including HHS/SAMHSA/CSAT's You Can Help: A Guide for Caring Adults Working with Young People Experiencing Addiction in the Family (Publication Number: PHD 878). Order a free copy by contacting SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) at 1-800-729-6686 or 1-800-487-4889 (TDD).

5. Support students in recovery. Students who are recovering from drug and alcohol problems must have support upon their reentry to school not only from their teachers, but the entire school staff and their peers. To the degree necessary for each recovering student to feel comfortable, confidentiality about his or her problems should be maintained. In addition, the following accommodations may need to be made to ensure success:¹⁰

• Adjust schedules to allow for aftercare treatment and match student/teacher learning and teaching styles to maximize the student's self-esteem and academic success.
  
  
• Provide mentoring to ensure the student feels supported in the back-to-school transition.
  
  
• Facilitate the formation of recovery groups to facilitate healthy peer interactions.
  
  
• Periodically assess the progress of your efforts.

In addition, involve family members in the recovery process wherever possible, and keep them informed of student progress or any concerns that may arise. School-based mental health and student assistance programs that include drug- and alcohol-related services can be extremely helpful to any student who has a problem, but also to students who live with drug or alcohol problems at home.

Making a Difference: How Can I Focus My Efforts during Recovery Month?

Recovery Month is celebrated nationwide every September. The theme for 2002 is "Join the Voices of Recovery:  A Call to Action." Educators and the school administrators can use this theme to plan and undertake activities aimed at combating drug and alcohol use among students and fostering greater understanding about addiction, treatment, and recovery. Here are some ideas to consider:

1. Scrutinize your situation. If you are an administrator, set up a staff meeting in early September to take careful inventory of potential alcohol and drug problems within your school. If you are an educator or other school staff person, encourage your administrator to do so because many schools do not recognize that there is a drug and/or alcohol problem among their students. Talk with members of the student bodyeven if it's just one-on-one and in private—to get a true sense of what is going on and to gather feedback on the severity of the problem and what can be done about it.

Know some of the signs to determine if your school is at risk: tobacco, alcohol, and drugs are available at school; parents are not engaged in school; mixed or inconsistent messages about substance use are conveyed and perpetuated; there is low student attachment to the school; teachers and administrators openly smoke at school; and there are low or inconsistent expectations for student achievement and behavior.¹¹ Upon more careful scrutiny, if your school is not as drug- and alcohol-free as you once thought, there are numerous resources available to assist your school to become drug-free. (See the attached list for contact information.)

2. Join forces to educate and inform. In the months following Recovery Month, schools can reach out to community groups, health providers, and treatment and recovery support program service providers to create partnerships aimed at educating and informing students and their families about drug and alcohol use, addiction, treatment, and recovery. Hold a school assembly or grade- or class-specific discussions to talk about the physiological effects of drug and alcohol use. Invite experts in from the outside to share their expertise and firsthand experience on the front lines dealing with these issues. Encourage students to engage in conversations about the issues, and let them know where they can go for assistance if they think they or someone they love might have a problem. One resource for materials to plan such programs is the National Institute on Drug Abuse's (NIDA), NIDA Goes to School web site at www.nida.nih.gov/GoestoSchool/NIDAg2s.html.

3. Communicate with parents. Schedule evening programs during the month of September for parents, grandparents, stepparents, and foster parents to learn more about the levels of drug and alcohol use among young people. Tell them the signs to look for in children. Inform them about the prevention and treatment resources available in the community to help them, their kids, or other loved ones who may be dealing with a drug or alcohol addiction. Invite expert speakers from the community to talk with them about the issues, and make sure to include representatives from the recovery community.

Consider joining forces with other educators from your school to encourage the superintendent to write a letter to parents in your district about how pervasive the drug and alcohol problem is in your area. The letter should reinforce to parents the tremendous influence they play in keeping their kids drug- and alcohol-free. It should let parents know that your school views the effort to combat drug and alcohol use and addiction as a two-way partnership, one in which everyone must play a part if it is to be successful. The letter should mention any activities being held for parents in your school(s) during the month of September and provide information on resources in the community available to assist them.

4. Set up a community network of treatment and recovery programs and services. September is a time to make sure your school has a network in place to refer students and their family members with drug and alcohol problems to the appropriate treatment and recovery resources in your community. School administrators, educators, or other personnel who determine a student has a drug or alcohol problem should be able to readily work with community agencies to arrange for proper assessment, referral, counseling, treatment, and follow-up care.

If your school already has a network in place, you are to be congratulated. Recovery Month is a good opportunity to conduct an audit of the services and programs in your network to make sure they are still viable and that they are meeting the needs of your students and their families. If your school is not tapped into an established network of programs and services in the community, September is a great time to get started. Make it a goal for the coming year to establish a network for your school by implementing Recovery Month 2002.

5. Create and/or promote student support groups at your school. Support groups can be a key component in the life of any young person who is contending with or recovering from drug and/or alcohol addiction. Recovery support groups are valuable adjuncts to outpatient services and residential programs for teenagers during the recovery process.¹² They are also beneficial for young people who are dealing with a parent or other loved one who is addicted to alcohol or drugs. The fact that September is Recovery Month provides your school with the perfect opportunity to create and/or promote student support groups in your school or in your community and to reinforce their effectiveness in improving the lives of those who participate in them.

You are encouraged to share your plans and activities for Recovery Month 2002 with the HHS/SAMHSA Center for Substance Abuse Treatment, your colleagues, and the general public by posting them on the official Recovery Month web site at http://www.samhsa.gov.

We would like to know about your efforts during Recovery Month. Please complete the Customer Satisfaction Form enclosed in the kit. Directions are included on the form.

For any additional Recovery Month materials visit our web site at http://www.samhsa.gov or call 1-800-729-6686.

Additional Resources

Federal Agencies U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) 200 Independence Avenue, SW Washington, DC 20201 877-696-6775 (Toll-Free) www.dhhs.gov HHS, Substance Abuse and Mental Health Services Administration (SAMHSA) 5600 Fishers Lane Parklawn Building, Suite13C-05 Rockville, MD 20857 301-443-8956 www.samhsa.gov HHS, SAMHSA National Directory of Drug Abuse and Alcoholism Treatment Programs www.findtreatment.samhsa.gov HHS, SAMHSA Center for Substance Abuse Treatment 5600 Fishers Lane Rockwall II, Suite 621 Rockville, MD 20857 301-443-5052 CSAT National Helpline 800-662-HELP (800-662-4357) (Toll-Free) 800-487-4889 (TDD) (Toll-Free) 877-767-8432 (Spanish) (Toll-Free) (for confidential information on substance abuse treatment and referral) www.samhsa.gov HHS, SAMHSA Center for Mental Health Services 5600 Fishers Lane Parklawn Building, Room 17-99 Rockville, MD 20857 301-443-2792 www.samhsa.gov HHS, SAMHSA Center for Substance Abuse Prevention Youth Substance Abuse Prevention Initiative 301-443-1845 www.samhsa.gov HHS, SAMHSA National Clearinghouse for Alcohol and Drug Information P.O. Box 2345 Rockville, MD 20847-2345 800-729-6686 (Toll-Free) 800-487-4889 (TDD) (Toll-Free) 877-767-8432 (Spanish) (Toll-Free) ncadi.samhsa.gov U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) National Institutes of Health (NIH) 9000 Rochville Pike Bethesda, MD 20892 301-496-4000 www.nih.gov HHS, NIH National Institute on Alcohol Abuse and Alcoholism Keeping Kids Alcohol Free Campaign Willco Building 6000 Executive Boulevard Bethesda, MD 20892-7003 301-496-4000 www.niaaa.nih.gov HHS, NIH National Institute on Drug Abuse Office of Science Policy and Communication 6001 Executive Boulevard Room 5213 MSC 9561 Bethesda, MD 20892-9561 301-443-1124 Telefax fact sheets: 888-NIH-NIDA (Voice) (Toll-Free) or 888-TTY-NIDA (TTY) (Toll-Free) www.drugabuse.gov U.S. DEPARTMENT OF EDUCATION (ED) 400 Maryland Avenue, SW Washington, DC 20202-6123 800-872-5327 (Toll-Free) www.ed.gov ED, Safe and Drug-Free Schools 400 Maryland Avenue, SW Washington, DC 20202-6123 202-260-3954 www.ed.gov/offices/OESE/SDFS U.S. DEPARTMENT OF JUSTICE (DOJ) 950 Pennsylvania Avenue, NW Washington, DC 20530-0001 202-353-1555 www.usdoj.gov DOJ, Drug Enforcement Administration Demand Reduction Section 600 Army Navy Drive Arlington, VA 22202 202-307-7936 www.dea.gov

Other Resources Al-Anon/Alateen For Families and Friends of Alcoholics Al-Anon Family Group Headquarters, Inc. 1600 Corporate Landing Parkway Virginia Beach, VA 23454-5617 888-4AL-ANON/888-425-2666 (Toll-Free) www.al-anon.alateen.org Alcoholics Anonymous 475 Riverside Drive, 11th Floor New York, NY 10115 212-870-3400 www.aa.org American Psychological Association Policy and Advocacy in the Schools 750 1st Street, NE Washington, DC 20002-4242 800-374-2723 (Toll-Free) 202-336-6123 (TTY) www.apa.org Child Welfare League of America 440 1st Street, NW, 3rd Floor Washington, DC 20001 202-638-2952 www.cwla.org Children's Defense Fund 25 E Street, NW Washington, DC 20001 202-628-8787 www.childrensdefense.org Join Together 441 Stuart Street, 7th Floor Boston, MA 02116 617-437-1500 www.jointogether.org Latino American Youth Center 1419 Columbia Road, NW Washington, DC 20009 202-319-2225 www.layc-dc.org Mothers Against Drunk Driving 1025 Connecticut Avenue, NW, Suite 1200 Washington, DC 20036 202-974-2497 www.madd.org National Asian Pacific American Families Against Substance Abuse 340 East 2nd Street, Suite 409 Los Angeles, CA 90012 213-625-5795 www.napafasa.org National Association for Children of Alcoholics 11426 Rockville Pike, Suite 100 Rockville, MD 20852 888-55-4COAS (888-554-2627) (Toll-Free) www.nacoa.org National Association for Equal Opportunity in Higher Education 8701 Georgia Avenue, Suite 200 Silver Spring, MD 20910 301-650-2440 www.nafeo.org National Association of School Psychologists 4340 East West Highway, Suite 402 Bethesda, MD 20814 301-657-0270 www.nasponline.org National Association of Social Workers 750 1st Street NE, Suite 700 Washington, DC 20002-4241 202-408-8600 800-638-8799 (Toll-Free) www.socialworkers.org National Association of State Alcohol and Drug Abuse Directors 808 17th Street, NW, Suite 410 Washington, DC 20006 202-293-0090 www.nasadad.org National Council on Alcoholism and Drug Dependence, Inc. 20 Exchange Place, Suite 2902 New York, NY 10005 212-269-7797 800-NCA-CALL (Hope Line) (Toll-Free) www.ncadd.org National Education Association-Health Information Network 1201 16th Street, NW, Suite 521 Washington, DC 20036 202-822-7570 www.neahin.org National Latino Children's Institute 320 El Paso Street San Antonio, TX 78207 210-228-9997 www.nlci.org National PTA Drug and Alcohol Abuse Prevention Project 330 North Wabash Avenue, Suite 2100 Chicago, IL 60611-3690 800-307-4782 (Toll-Free) www.pta.org Partnership for a Drug-Free America 405 Lexington Avenue, Suite 1601 New York, NY 10174 212-922-1560 www.drugfreeamerica.org Phoenix House 164 West 74th Street New York, NY 10023 212-595-5810 www.phoenixhouse.org

Sources

¹ You Can Help Pamphlet: A Guide for Caring Adults Working with Young People Experiencing Addiction in the Family. Center for Substance Abuse Treatment, U.S. Department of Health and Human Services Publication No. (SMA) 01-3544, 2001.

² Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings 2000. NIH Publication No. 01-4923. Bethesda, MD: National Institute on Drug Abuse, National Institutes of Health, Public Health Service, U.S. Department of Health and Human Services, April 2001.

³ Malignant Neglect: Substance Abuse and America's School's. New York, NY: National Center on Addiction and Substance Abuse, Columbia University, September 2001.

⁴ Substance Abuse and the American Adolescent: A Report by the Commission on Substance Abuse Among America's Adolescents. New York, NY: National Center on Addiction and Substance Abuse, Columbia University, August 1997.

⁵ National Survey of American Attitudes on Substance Abuse VI: Teens. New York, NY: National Center on Addiction and Substance Abuse, Columbia University, February 2001.

⁶ Morey, Connie K., Ph.D. Children of alcoholics: A school-based comparative study. Journal of Drug Education, 29 (1): 63-75, 1999.

⁷ Malignant Neglect.

⁸ ibid.

⁹ ibid.

¹⁰ Codori, Mike. Aftercare for recovering students: Four follow-up methods. Student Assistance Journal, 11(4): 28-29, March/April 1999.

¹¹ Malignant Neglect.

¹² Alcohol Treatment and Adolescents. A fact sheet published by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.

Public Officials and Civic Leaders

...the policy decisions that criminalize addiction often come out of a belief that these are fiscally responsible choices. So do the health care management measures that restrict access to treatment. But it's often the stigma of addiction that help people feel justified in making these choices—and make it all seem reasonable to the voting public.¹

In 2000, an estimated 14 million Americans used illicit drugs, and 12.6 million were heavy drinkers of alcohol.^2,3 Drugs and alcohol dependence and addiction take a tremendous toll on society. In particular, state and local governments must contend with the repercussions in the form of overwhelmed social service systems; escalating social and economic costs associated with illness, injury, death, and crime; challenges to the education system; and the virtually incalculable effects on families, particularly children. Children in families affected by addiction also experience difficulties that can place increased burdens on state and local governments.⁴

In 1998, states spent $620 billion of their own funds to operate state government and provide public services such as education, Medicaid, child welfare, mental health, and highway safety. Of that amount, $81.3 billion, or more than 13 cents of every state budget dollar, was spent on shoveling up the wreckage of drug or alcohol misuse and addiction.⁵ And, for every dollar spent on drug- and/or alcohol-related problems, 95.8 cents goes to pay for the burden it puts on public programs, while just 3.7 cents goes to fund prevention, treatment, and research programs aimed at reducing the actual incidence and consequences of addiction.⁶

Today, state and local governments are at a crossroads in deciding how best to expend limited resources to deal with one of the Nation's most pressing public health problems—the misuse of and dependence on drugs and/or alcohol by millions of Americans. The good news is that an extensive body of Federally-funded research shows that, with treatment, very large decreases in drug use, drug- and alcohol-related medical visits, and criminal activity are experienced, while financial self-sufficiency improves (e.g., employment increases, and welfare receipt and homelessness decline).⁷ In addition, 30 years of advances in science have reshaped our understanding of addiction and have created an array of effective interventions. In fact, treatment for drug or alcohol addiction has proven as effective as treatment for other chronic, manageable, long-term health conditions, such as diabetes, hypertension, and asthma, so long as the treatment is" well-delivered and tailored to the needs of the particular patient."⁸ And, treatment is cost-effective. Conservative estimates are that for every $1 invested in addiction treatment, a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and losses from theft results. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1.⁹

Changing the Conversation

The U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) launched Changing the Conversation:  The National Treatment Plan Initiative to Improve Substance Abuse Treatment to ensure that quality treatment services and programs are available to all who need them. As a first step, dozens of expert panelists, stakeholders, and members of the general public were consulted in the development of five key guidelines for positive action that must be addressed if the Changing the Conversation goals are to be met. Public officials and civic leaders at all levels of government can and must play an active role in affecting change in each of the five guidelines for positive action in order for the Changing the Conversation goals to be successful. They are:¹⁰

1. "No Wrong Door" to Treatment—Effective systems must ensure that anyone needing treatment is identified and assessed and receives treatment, either directly or through appropriate referral, no matter where he or she enters the realm of services.

2. Invest for Results—The wise use of resources requires investment in treatment and services that in turn must produce desired results.

3. Commit to Quality—Effective treatment and the wise use of resources depend upon ongoing improvement in the quality of care.

4. Change Attitudes—Significant reduction in stigma and changes in attitudes will require a concerted effort based on systematic research.

5. Build Partnerships—Effective efforts by individuals and organizations throughout the treatment field to work together and with outside parties who have a stake in affecting change will require encouragement and support.

Whether you are a civic leader, local public official, state legislator, governor, or member of Congress, you are a recognized and respected leader in your community. You have a tremendous amount of credibility among your constituents when it comes to critical social issues: drug and alcohol addiction, treatment, and recovery are no exception. Whether or not our communities and the nation as a whole ultimately triumph over the scourge of addiction is largely dependent on the leadership of individuals like you. In keeping with the five guidelines for positive action highlighted by Changing the Conversation, here are some thoughts on what you can do to affect change.

Making a Difference: What Can I Do?

1. Support prevention and treatment. Effective prevention and treatment programs present the most significant opportunities to reduce the burden of drug and alcohol problems on both the public and private sectors. If young people can be kept away from drugs and alcohol during their youth, the chances are good that they will never develop a problem later in life.

Treatment is the most cost-effective intervention once addiction has taken hold. An investment in effective treatment yields long-term reduced costs, whether the patients are offenders in the criminal justice system, clients in the mental health system, parents whose children are in foster care, welfare recipients, youth in the juvenile justice system, children of individuals with drug and alcohol problems, children whose parents are involved in the criminal justice system, children of drug- or alcohol-abusing welfare recipients, pregnant women and their partners, or drug- and alcohol-involved drivers.¹¹ Support prevention and treatment services and programs to meet the needs of these populations.

2. Take steps to impact the bottom line. States and local government entities control a range of legislative, regulatory, and tax powers that can ultimately reduce the impact of addiction. Some steps to consider include: require treatment for drug and alcohol offenders who are involved in publicly funded programs; mandate treatment for those who are convicted of related traffic violations; enforce the prohibition against selling alcohol and tobacco to minors; include questions about alcohol and substance abuse and addiction on licensing examinations for teachers, health care professionals, social workers, corrections and juvenile justice staff, and court personnel in order to ascertain their knowledge about addiction issues; and dedicate taxes from tobacco and alcohol sales to prevention and treatment of alcohol and substance abuse and addiction.¹² Give some thought to how you can work to implement some of these changes in your district or community.

3. Manage for better results. Public officials and civic leaders should set targets for reducing the impact of alcohol and substance abuse and addiction on their constituents and budgets. They should work to install management practices to achieve those targets. For instance, teachers, health care workers, social services, criminal and juvenile justice staff, and court personnel should be trained to implement initial screening for alcohol and substance abuse and addiction, so that they know how and when to intervene effectively. Individuals who appear positive for alcohol and substance abuse and addiction must be fully assessed and receive timely, appropriate, and effective treatment, including relapse management. Systems must be established to measure the cost-effectiveness of prevention and treatment programs. Responsibility for managing any investments in prevention and treatment programs and services should reside with a designated individual or agency. Investment should be made for research and evaluation of cost-effective policies and programs.¹³ At first glance, this "wish list" may seem overwhelming, so take a careful look at those areas where you can begin to make improvements and then gradually work to further your ultimate goals.

4. Facilitate partnerships. Reach out to other stakeholders in your community or district who have a vested interest in joining forces to find solutions to the drug- and alcohol-related issues that most affect those you serve. Specifically, work to build bridges of understanding between the public and private sectors. Find ways for representatives from the health care, social service, criminal justice, and mental health communities to work together to identify very specific areas of concern, and work together to address those issues. As a public official or civic leader, your willingness to take a leadership position on this issue will be welcomed.

Making a Difference: How Can I Focus My Efforts during Recovery Month?

September 2002 is Recovery Month. It is a time set aside each year for all of us to discuss actions needed to reduce the impact of alcohol and substance abuse and addiction, promote the effectiveness of treatment, and better understand the recovery process. This year's theme is "Join the Voices of Recovery:  A Call to Action." As a public official or other civic leader, there are steps you can take during Recovery Month and beyond to contribute to the national effort. Here are some ideas to get you started:

1. Speak out. Be vocal about the benefits of drug and alcohol treatment during Recovery Month. Make a point to include the fact that September is Recovery Month in any public presentation you make. Highlight some of the key facts about addiction, treatment, and the recovery process that will reduce stigma and enhance understanding, acceptance, and support for individuals and their families who are dealing with these issues. If you are invited to speak at any one of dozens of Community Forums being held nationwide throughout the month, agree to participate and take advantage of the opportunity.

2. Issue a proclamation. Using the sample proclamation provided in this years Recovery Month kit as a guide, issue a proclamation recognizing September as Recovery Month and calling attention to some critical drug- and alcohol-related issues that most affect your constituents. Find out what key concerns exist within your community or district that would be most recognizable and that would prompt the greatest degree of feedback and interest. Announce that the proclamation is just a first step on the road to creating partnerships, developing goals and objectives, and creating solutions to address those concerns.

3. Talk to the media. Media is critical when it comes to drug and alcohol use, addiction, treatment, and recovery. The stigma associated with these issues is still so great that all matters of public and social policy are still adversely affected. Use Recovery Month as a "news hook" to talk to the media about addiction as a chronic health condition for which treatment can be effective. Write an op-ed or letter to the editor arguing the case for treatment as a necessary component of the criminal and juvenile justice systems. Schedule a public affairs ra