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1 The 13 th International Conference on of Addictive Behaviors June 4, 215 Overview of Addiction and the Criminal Justice System: Kevin Knight, Ph.D. Associate Director Institute of Behavioral Research Texas Christian University Understanding the problem What has NOT worked What is working Changes in policy and service delivery perspective Understanding the Problem 5% of the world population between years of age report having used an illicit drug mainly a substance belonging to the cannabis, opioid, cocaine or amphetamines at least once in the previous year. Denmark 33, drug users in 21 (up from 27, in 26). Criminal justice systems are overflowing; over 33% increase in the past decade. In Denmark, drug-related crime is punishable by a fine or prison sentence up to 2 years (up to 16 years if selling dangerous or injurious substances ). Few receive addiction services; less than 15% in US and lower in most other countries. In Denmark recently, there has been a relative decrease in the number of drug users seeking treatment for opioid addiction, while there are an increasing number of users seeking treatment for addiction to cannabis and stimulants. Sources: National Institute on Drug Abuse topics/criminal justice drug abuse United Nations Office on Drugs and Crime, World Drug Report 214 (United Nations publication, Sales No. E.14.XI.7), p Get The Facts Relative Risk of Death Overdose Deaths Death Among Recent Inmates of the Washington State Corrections Compared to Other State Residents Binswanger et al. NEJM 27;356: Percent Regular Drug Abuse 7% 9% Prisoners General Population Bureau of Justice Statistics Billions of $$ Cost of Drug Abuse $181 Billion $17 Billion Associated with Drug-Related Crime ONDCP Public Safety Denmark-73 prisoners/1, residents; the US- 73/1,. Recidivism rates are high: Denmark-27%; US-52%. Public Health 95% relapse rate within 3 years after prison is typical. There are an estimated 13, intravenous drug abusers in Denmark, with 67-75% having chronic hepatitis C. Copyright TCU Institute of Behavioral Research Website: Page 1 of 5

2 What Has NOT Worked! Other Ineffective Approaches Boot Camp Intensive Supervision Generic Case Management Lengthy Incarceration Harsh Punishment The Wisdom of the Dakota Indians: When you discover you are riding a dead horse, the best strategy is to dismount. Failed Strategies of Criminal Justice Systems: 1. Use a stronger whip to get the horse moving --make sentences longer --provide more intensive supervision --instill discipline through boot camps 2. Change riders --hire a different provider to provide the same failed services --hire outside contractors to provide the same failed services 3. Appoint a committee to study the dead horse --provide additional funding/training to maintain poor services --recommend lowering standards to expand availability 4. Promote the dead horse to a supervisory position Borrowed from Ed Latessa Political and CJ Agencies Are Beginning to See That It Is Time To Dismount and Try a Different Horse What Is Working Evidence-based treatment that matches services to client needs Copyright TCU Institute of Behavioral Research Website: Page 2 of 5

3 Matching to Severity The Evidence Offender Drug Use? Low Severity High Severity Low Intensity (Education) High Intensity (Residential/ Therapeutic Community) Longer Term Aftercare (or Re-entry) Program % Reduction in Recidivism Sanctions Inappropriate 3 Appropriate Andrews, D.A An Overview of Effectiveness. Research and Clinical Principles, Department of Psychology, Carleton University. The N refers to the number of studies. Texas/New Offenses Only: 3-Year Return-to-Custody Rates (%) Black Box of : Focus on Relational Factors User Reduced Crime And Health Problems No Prison Only Prison+ Aftercare Knight, Simpson, & Hiller, 1999, The Prison Journal Likelihood Ratios for Next Stages LTR ODF 3.3* 1.3* 2.7* 3.7* 1.3* 2.5* No Relapse (Coc Wkly)? OMT Motivation (Trt Readiness) Therapeutic Involvement 2.2* 1.5* 3.2* Pretreatment Months 1-2 Retention (9+ days) 36+ days No Relapse (Op Wkly) Follow-up Year 1 LTR: Long-term Residential; ODF: Outpatient Drug Free; OMT Outpatient Methadone Copyright TCU Institute of Behavioral Research Website: Page 3 of 5

4 A Client Drawn Map Changes in Policy There is a greater international emphasis now on providing a continuum of alcohol and drug treatment services rather than just a program prison to community; Greece s KETHEA treatment services Politicians are embracing alternatives to prison for justice-involved individuals who have problems associated with alcohol and other drug use political movement called Right on Crime-- a conservative approach to criminal justice: fighting crime, supporting victims, and protecting taxpayers There is a major international focus of funding to provide treatment to those involved in the criminal justice system United Nations Office on Drug and Crime priority on treatment services within the Nigerian criminal justice system New laws are being enacted that address the decriminalization of marijuana use US States including Colorado and Washington; also Washington DC Changes in Delivery Perspective Ultimately, there is a shift in perspective underway Rather than focusing on the need to provide punishment, there is greater attention now on the need to provide services that address the problems that led to alcohol and drug use and involvement in the criminal justice system. This includes the perspective that we need to retrain and reintegrate these individuals back into society. a core philosophy of the Danish prison system Changes in Service Delivery Perspective Ultimately, there is a shift in perspective underway: --Rather than focusing on the need to provide punishment, there is greater attention on the need to provide services that address the problems that led to alcohol and drug use and involvement in the criminal justice system. --This includes the perspective that we need to retrain and reintegrate these individuals back into society a core philosophy of the Danish prison system. NIDA Research-Based Guide For Criminal Justice Populations Principles of Drug Addiction : A Research Based Guide (NIDA, 2) Copyright TCU Institute of Behavioral Research Website: Page 4 of 5

5 That s All Folks! Copyright TCU Institute of Behavioral Research Website: Page 5 of 5