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Treatment and the Justice System: Preventing Problems and Ensuring Recovery

Picture of Pamela Rodriguez, President, Treatment Alternatives for Safe Communities

View the Webcast "Treatment and the Justice System"

Ask the Expert:  Pamela Rodriguez, MS, Executive Vice President, Treatment Alternatives for Safe Communities

1. My son is incarcerated in a prison in New York state due to his participation in a drug related crime, in which he shot two drug dealers. My son chose to get married while incarcerated, but I am having trouble getting the jail to cooperate in the processing of the legalization of his marriage license, for which my daughter in law has acquired the marriage license. I am deaf and do not know where to turn for advice and assistance in dealing with the criminal justice system. I have very limited income. Do you have any suggestions or advice?

Answer:

 So many families deal daily with the struggle of having a loved one in prison. When someone is sentenced to prison, the impact inevitably extends beyond that person to his or her family and community as well. Even in the best of circumstances, the period of incarceration can be a confusing and challenging time, particularly for those on the outside who are trying to advocate on behalf of their family member.

Although I am not an expert in the legal and prison system structures in the state of New York, I reached out to some colleagues who are. They tell me that you might be able to get free help from the Legal Aid Society’s Prisoners’ Rights Project. Here’s the link to their website: http://www.legal-aid.org/en/whatwedo/civilpractice/prisonersrightsproject.aspx . They may also be able to put you in touch with some groups or listserves in your area that provide information and support for families of individuals in prison.

2. Why does it seem like we are spending more money on drug courts and punishment verses treatment? I have worked in the field of addiction and recovery for over 20 years and am sad to see the push for more jail or drug courts. Families suffer enough when one member is addicted, now with groups like MADD, and the drug courts, we are taking much needed money and time "from" the family. Why is the very system that is to prevent or stop adding to the problems the family already faces? If the client/person has money for drug court, and all the attorney fees, why not "treatment"?

Answer:

 Ensuring that prevention, treatment, and recovery support services are available and accessible to everyone who needs them is key in addressing the disease of addiction. Identifying and interrupting drug or alcohol abuse in the early stages—before it becomes a significant health or safety concern—costs less, is easier to treat, and helps to significantly reduce the flood of individuals into more costly systems like courts, prisons, or emergency rooms.

To clarify, drug courts and other alternatives to incarceration connect addicted people to treatment and other resources in the community while also holding them accountable. For individuals whose drug use has led to arrest, these alternatives are more effective and far less disruptive to families than jail or prison. It’s important that these alternatives exist.

However, far too often, the first opportunity for some individuals to receive treatment occurs because of their involvement in the criminal justice system. What is needed is a comprehensive and balanced approach, one which incorporates innovative, clinically and culturally appropriate solutions that are available in a variety of settings—throughout communities, in schools and medical care facilities, as well as in criminal justice settings.

We have a responsibility to advocate for the treatment programs and policies we seek to see enacted. Money flows to the loud and the organized. We need to leverage our knowledge and our numbers, in assembling clear, consistent messages and education that will encourage the public support and build the legislative clout to ensure that evidence-based and cost-effective treatment solutions are put in place as part of an integrated public health approach to this disease.

3. What supports exist in the criminal justice system to help sustain recovery and reintegrate into society? How are these supports funded? Given that the criminal justice system is vastly underfunded, how does the supply of these services keep up with the demand? Is there a waiting list to provide services in the criminal justice system? What happens to these individuals on the waiting list?

Answer:

 Recovery happens in communities, and having services that support and sustain this recovery is critically important. Individuals who are returning from jail or prison face a host of difficulties that make reintegration particularly challenging—accessing housing, employment, and healthcare; reuniting with families; and rebuilding lives as contributing members of society.

Peer-support groups (for people in recovery and for those formerly incarcerated), addiction and mental health treatment, employment assistance, job skills training, family counseling, and mentoring groups all help to improve the success of this transition. Even if a person has been fortunate enough to receive treatment and other services while incarcerated, it is far more difficult for them to sustain positive results if they don’t have continuing treatment and recovery support in the community.

Of course, it’s best if individuals don’t need to leave the community in the first place. As I touched on in the previous question, broad-based efforts that focus on educating, treating, and supporting individuals before they get involved in the criminal justice system are essential. Equally important is ensuring that innovative community-based programs and services are available to intervene with drug-involved individuals at all points in the criminal justice system.

In Illinois, we are fortunate to have a comprehensive framework of programs and services that links drug-involved individuals in the criminal justice system to vital community-based treatment programs and resources. For example:

At pre-adjudication, jail diversion is a primary focus, particularly for first-time or low-level felony offenders. Programs such as the Cook County State’s Attorney’s Drug Abuse Program provide drug-involved arrestees with basic education on the criminal justice consequences of drug use and drug-motivated behaviors. Successful graduates have their charges dismissed. This program has exhibited outstanding outcomes: 80-90 percent of participants complete the program, and 83 percent of these have no arrests for drug crimes in the three years following completion. Similar programs are being considered and implemented in counties throughout the state.

Specialty courts such as mental health courts and drug courts also play an important role at the adjudication and sentencing stage. Multi-disciplinary teams comprised of judges, probation officers, police, and community treatment providers work together to intervene with individuals whose addiction or co-occurring addiction and mental health conditions cause them to cycle repeatedly in and out of courts, jails, and emergency rooms. Participants are provided with intensive clinical case management and community-based treatment and other supports to interrupt, address, and manage the addiction and/or mental illness at the root of their criminal behavior.

Community-based supervision, treatment, and other support services often are mandated as part of an individual’s sentencing. TASC-supervised probation is an example of this alternative to incarceration. Under Illinois law, certain nonviolent individuals in the court system have the right to an assessment to determine if their crime was related to a substance-use disorder. TASC conducts these assessments and provides these findings to the court. Individuals who are accepted for the program are mandated to TASC as part of their probation. TASC places individuals into treatment, monitors and adjusts services as needed, and reports progress back to the court. This enables these offenders to receive needed services and supervision as they progress in their recovery in the community.

Medication-assisted treatment is also an important development in our field. Criminal justice systems in many states, including Illinois, are exploring the potential of combining the use of prescribed medications within existing treatment and recovery structures to help individuals combat the bio-psycho-social complexities of dependence on certain drugs.

All these programs and services are funded through some combination of client fees (often based on ability to pay) and government funding (at federal, state, and local levels). For example, SAMHSA and CSAT funding has played and continues to play a major role in the development, evaluation, and replication of many of these programs and services.

Interventions such as treatment readiness groups are sometimes available to provide support, monitoring, and relapse prevention for those waiting for a treatment slot to open. However, the reality is that sometimes individuals have no other option but to wait in jail, where they may or may not be lucky enough to have access to treatment. And sometimes, an individual will choose prison instead, because it is an easier or shorter alternative.

While these programs are innovative and successful, they still only reach a fraction of the people who need them. As states and service providers work to stretch scarce funding to serve the large number of individuals in need, sometimes considerable waiting lists result. For example, it has been estimated that in Illinois, approximately 7,500 individuals are waiting for treatment at any given time.

4. How does the system track and support an individual that goes through the criminal justice system, receives treatment, becomes re-involved with the criminal justice system due to a drug or alcohol problem, and re-accesses treatment? How does the system ensure continuity of care and provide a continuum of care for that individual beyond the possible 12-month drug court program (not all people will be involved with the drug court program)? How are these funded?

Answer:

 There are a number of ways in which the monitoring and integration of services can be accomplished for individuals in the criminal justice system. Some jurisdictions utilize independent case management providers (such as TASC) to track and unite services across intersecting and diverse systems and organizational structures—connecting treatment, criminal justice, and community partners as well as other public systems such as children and family services or public aid. Others rely on probation and parole to fulfill these functions. More and more, the implementation of technology in the form of electronic client records is being pursued to consolidate large amounts of data in a way that provides quick and portable access to information.

These strategies, individually or in combination, help to access past criminal or treatment history and more effectively match treatments and support services to individual needs and strengths. They also help provide appropriate and timely application of incentives and sanctions and encourage the engagement, re-engagement, or adjustment of services up or down as required. Being able to assess and respond to important clinical information at critical junctures of vulnerability, and to reinforce skills and supports that sustain self-managed recovery maintenance is critical, not only in addressing the chronic (and sometimes relapsing) nature of addiction and the uniquely complex needs of the criminal justice client, but also in ensuring that these individuals have the best possible success following their criminal justice involvement.

Unfortunately, the current reality in most states is that many drug-involved individuals receive little to no intervention before their involvement in the criminal justice system or other costly public systems. And once involved in these systems, they may not receive the appropriate level or intensity of clinical services to help them succeed. In addition, individuals often return to communities with limited recovery support options. Together, these service gaps make it more difficult for individuals to succeed in their recovery.

To address these types of gaps, the Center for Substance Abuse Treatment has provided important leadership and funding for Recovery Oriented Systems and Recovery Community Services Programs. Initiatives such as these have contributed much in extending continuity of care beyond individual treatment episodes and criminal justice involvement.

5. Recidivism is a large problem with this population. How is the system integrated to decrease recidivism and ensure recovery?

Answer:

 The fundamental structure for reducing recidivism, I believe, is rooted in the dedicated commitment to the creation and implementation of Recovery Oriented Systems. Individuals need to get the education, intervention, and treatment they need to recover, where and when they need it.

Recovery Oriented Systems match treatment and support services to individual needs, provide an appropriate mix of incentives and sanctions, engage participants in treatment with beneficial effects that are cumulative across treatment episodes, and link individuals to support in the community. They weave multiple and diverse services into an effective and efficient continuum of care, often through the use of an independent case management provider. It’s this independent case management function that effectively ties all the systems and services together by building strong relationships across justice, treatment, and community stakeholders; mediating cultural differences and translating unique professional-speak; and advocating for the most appropriate and cost-effective combinations of care and services for the client. Such an integrated recovery-oriented approach combined with the support and backing of key leadership and the alignment toward a single coordinated objective—namely to reduce recidivism—creates the ultimate key in reversing the revolving door of drugs and crime.

This model drives the excellent results we’ve seen in the Sheridan Correctional Program* here in Illinois. We noticed substantial improvement in not only our outcomes, but in the way we work together as a Recovery Oriented System, once all the providers—e.g., housing, treatment, community mentoring, parole—stopped simply focusing only on their specific service specialty (e.g., treatment placement, job placement, housing placement) and instead began to work together as a collaborative team focused on our mutual clients’ overall success in recovery and community reintegration. We began to measure individual provider success around the broader program goal of reducing recidivism and ensuring long-term recovery.

Of course, this success didn’t come about overnight. It took commitment from the highest levels of leadership in the Illinois Department of Corrections. It took the willingness of some very enculturated systems to be open to different ways of doing things. It took everyone learning to speak a common language, or at least successfully translating language across the diverse jargon we tend to use. The role of the independent case management provider was very useful in helping move through this process, because it was that independent case management thread that wove through and ultimately strengthened the various agencies and providers, both within the correctional institution and in the community.

* In 2007, the Illinois Sheridan Correctional Center was featured in the PBS weekly news program, NOW with David Brancaccio. The documentary, Maximum Capacity, offers hopeful solutions to the problem of prison overcrowding and recidivism. To view the documentary, visit http://www.pbs.org/now/shows/322/ .

6. What services exist to prevent drug and alcohol use in prison and jails? 
 

Answer:

 There are a couple ways in which this question may be interpreted, and I will try to answer both questions.

If the question refers to the preventing the used of alcohol and drugs in jails, institutions use several measures to accomplish this. Education and self-help programs certainly help in this respect. Security checks are also widely used, and some prisons conduct random drug testing of both inmates and correctional staff.

If the question is asking about the availability of treatment within prison, we know that approximately three quarters (73 percent) of jails and prisons provide some type or combination of drug treatment or recovery support programs. The majority (63.7 percent) are providing some sort of self-help programs. Also available are detoxification (provided by 32.1 percent) and drug education programs (provided by 29.6 percent). Unfortunately, national surveys of access to treatment show that while 45-53 percent of prisoners need treatment, only 15-17 percent of them access it while behind bars.



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