Substance Abuse in Prison Populations. Charles Zaylor DO

Transcription

1 Substance Abuse in Prison Populations Charles Zaylor DO

2 Substance Abuse in prison Populations Significance of substance abuse in criminal activity. Significance of substance abuse in the criminal justice system. Intervention and treatment in the correctional setting.

3 Substance Abuse in criminal activity 68% of jail inmates reported symptoms of substance dependence or abuse. 75% of prison inmates reported symptoms of substance dependence or abuse. 86% of federal inmates met definition of Substance Involved. 50% of jail inmates were under the influence of drugs or alcohol at the time of offence.

4 Substance involved inmates Weekly illicit drug use. Met criteria for substance abuse disorder. Were under the influence of alcohol or other. drug at the time of their offence. Have a history of alcohol treatment. Incarcerated for a drug/alcohol law violation. Committed offence to get money for drugs.

5 Substance abuse in criminal activity Violent crimes accounts for 37% of Federal prison, State prison and Jail populations. 78% are substance involved. Property crimes account for 20% of Federal prison, State Prison and Jail populations. 84% are substance involved. Other crimes (supervision violations, weapons, immigration, tax law) account for 13% of Federal prison, State prison and Jail populations. 83% are substance involved.

6 Substance abuse in criminal activity Substance crimes account for 29% of Federal prison, State prison and Jail populations.

7 Criminal history of jail inmates with substance dependence or abuse On parole 14% SA and 10% not SA. On probation 36% SA and 28% not SA. Prior sentence 70% SA and 46% non SA. Violent recidivists 32% SA and 21% non SA.

8 Out patient treatment and incidence of violent and or criminal behavior. 284 consecutive drug addicted patients presented to a 12 month drug treatment program. 73% reported a history of violence (patient reported inability to control violent impulses) and or criminal behavior (have a history of being charged with a crime).

9 Out patient treatment and incidence of violent and or criminal behavior. Violence and criminal behavior was associated with a more severe profile of addiction, psychopathological symptoms and maladjustment problem measures. Those with a criminal history had the highest drop out rate. Those with a violent history had the lowest drop out rate.

10 The Criminal Personality If one conceives of the criminals alcohol and drug use as an illness, it is essential that such a view not dilute or eliminate the critical focus upon choice. If a criminal is regarded simply as afflicted by a disease then the already difficult process of change through the exercise of choice, effort and endurance is further impeded. The Criminal Personality Samuel Yochelson and Stanton E. Samenow

11 The criminal continuum Responsible Irresponsible Nonarrestable Arrestable criminal Extreme criminal

12 The criminal continuum Responsible: life style of hard work, fulfillment of obligations and consideration of others and exhibiting a pattern of being conscientious in occupational, domestic and social affairs. Nonarrestable: Life style of being generally unreliable, liars, chronically late, fail to perform obligations, excuse-offerers. They may be conscientious otherwise. This behavior does not get them arrsted.

13 The criminal continuum Arrestable criminal: They have all the thinking patterns of an extreme criminal but there crime patterns are less extensive and serious. Stealing at work, shoplifting. Have desire to violate but are deterred.

14 The criminal thinking patterns Work is for suckers. Fear of being put down. I want what I want. Exercises power through exploitation and manipulation. Rebellion.

15 Case 1 Patient seen on suicide risk status, arrested for a probation violation. Came to his random drug test intoxicated on alcohol. Angry at his PO for violating him. Angry at his wife for leaving him at the side of the road in a drunken belligerent state while he vomited into his sock.

16 The Criminal Personality Treat substance abuse. Treat criminal thinking. If you are under the influence of drug you are less likely to be under the influence of your self.

17 Substance abuse in the criminal justice system. Over 2 million people incarcerated in the United States. In 2005 $74 billion spent on incarceration, court, probation and parole for substanceinvolved adult and juvenile offenders. Cost to the non criminal justice system. 53% will be released within 5 yrs.

18 Principles of Drug Abuse Treatment in Assessment the Correctional setting Drug addiction is a brain disease that affects behavior. Recovery from addiction requires treatment followed by management of the problem over time. Treatment must last long enough to produce stable behavioral changes.

19 Principles of Drug Abuse Treatment in the Correctional setting Treatment should address motivation, problem solving and skill building for resisting drug use and criminal behavior. Monitor drug use during treatment. Use of sanctions and incentives. Continuity of care when returning to the community.

20 Health Care Services. Receiving and Diagnostic Unit in prison. Medical/Mental Health intake screen in jail. Medical sick call Mental health sick call

21 Drug Rehabilitation Program Patient commits to be in treatment. AA. Individual, group and family therapy, to address drug addiction. Anger management, parenting classes. Therapeutic community. Goals include abstinence, cessation of criminal behavior, employment. Faith based therapeutic community.

22 Medical intervention Detoxification. Treat medical consequences of substance use and co-occurring medical disorders. Don t prescribe unnecessary drugs that can be abused. Don t treat psychiatric symptoms.

23 Psychiatric intervention Treat psychiatric consequences of substance use and co-occurring psychiatric conditions. Don t treat medical conditions. 58% of inmates diagnosis will change. Keep in mind Post-Acute Withdrawal. Be aware of drug seeking behavior. Treat mental health disorders not symptoms.

24 Psychiatric Intervention At less than 18 y/o mental illness is seen as the cause of criminal behavior. Substance abuse often not addressed. When over 18 y/o mental illness is not seen as the cause of criminal behavior. Substance abuse often not addressed.

25 If they are not in a recovery program all the drugs we prescribe are just, more drugs.