Principles of Drug Addiction Treatment for Criminal Justice Populations. APNC Fall Conference Wrightsville Beach, NC October 31, 2014
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1 Principles of Drug Addiction Treatment for Criminal Justice Populations APNC Fall Conference Wrightsville Beach, NC October 31, 2014
2 Nationally 1 in 34 adults are under correctional supervision* *BJS Correctional Surveys, 2011 SA is disproportionately represented in correctional populations* 80% of parolees 80% of prison inmates 67% of probationers *Report of the Re-Entry Policy Council, CSG, 2005
3 In North Carolina 59% of SA referrals from CJS 38,133 people in NC prisons* 30,506 need substance abuse services Note: 97% will be released 103,890 people on probation, parole or postrelease in NC* 69,606 need substance abuse services * NCDOC Research & Planning, October 17, 2014 populations
4 Defining Effective (Research-Based) Treatment
5 Goals of Drug Treatment: Keeping an Eye on the Target Abstinence Functionality in Family, Work, and Community Reduced Criminal Behavior
6 Effectiveness of Treatment Those who participate in community based treatment commit fewer crimes than those that don t.* 40-60% 40-60% 40% Drug Use Crime Employment * Prendergast et al. 2002; Butzin et al 2006; Kinlock et al. 2009
7 One of NIDA s latest publications focuses on treatment for those in the criminal justice system. The following principles are discussed in detail in this publication Released in 2006 and updated in 2012
8 1. Drug addiction is a brain disease that affects behavior. Brain changes in addiction help explain continued drug abuse and relapse.
9 Relapse Rates for Drug Addiction are Similar to Other Chronic Medical Conditions 100 Percent of Patients Who Relapse to 60% 30 to 50% 50 to 70% 50 to 70% 0 Drug Dependence Type I Diabetes Hypertension Asthma Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.
10 2. Recovery from drug addiction requires effective treatment followed by management of the disorder over time. A Chronic Care Approach to Drug Treatment Screening and Brief Intervention Initial Services Sustain & Manage Recovery/Chronic Care Management Prescription for Services Clinical Practices Assessment Therapeutic Interventions Behavioral Counseling and Medications
11 Effective drug abuse treatment engages participants in a therapeutic process retains them in treatment for an appropriate length of time helps them learn to maintain abstinence Multiple episodes of treatment may be required
12 Drug Abuse Treatment Can Work No single treatment is appropriate for all individuals. Treatment needs to be readily available. Treatment must attend to multiple needs of the individual, not just drug use. Multiple courses of treatment may be required for success. Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
13 Outcome In Diabetes Pre During Post Conclusion: Treatment Successful! Treatment Research Institute
14 10 Outcome In Addiction Pre During Post (Incorrect) conclusion: Treatment NOT successful! Treatment Research Institute
15 How does a person involved in the Criminal Justice system access treatment in the community? DART/Cherry and Black Mountain Substance Abuse Treatment Center for Women - 90 day residential treatment ordered by the Court and assessed by TASC Treatment for Effective Community Supervision CBI and SA / Community Intervention Centers CBI, SA and wraparound services. Ordered by the Court or by the PPO. SA needs assessed by TASC. Community Treatment Provider upon order of the court or referral by the PPO assessed by TASC and referred to provider.
16 3. Treatment must last long enough to produce stable behavioral changes. 100 < 90 Days 90+ Days Percent Cocaine (Any Use)* UA+ Alcohol (Any Drug)* (Daily Use)* Any Jail*
17 4. Assessment is the first step in treatment. Nature/extent of drug problem Strengths: Family support Employment history Motivation Threats to recovery: Criminal behavior Mental health Physical health Family Influences Employment Homelessness HIV/AIDS
18 TASC uses the ASI-MV ( ), DSM5 ( ), and the ASAM Criteria ( asamcriteria.org/ ) Treatment Providers receiving State funding use CCA, DSM5 and the ASAM Criteria.
19 5. Matching services to needs is critical for treatment to be successful. Child Care Services Family Services Housing / Transportation Services Behavioral Therapy and Counseling Vocational Services Intake Processing / Assessment Detoxification Substance Use Monitoring Mental Health Services Treatment Plan Self-Help / Peer Support Groups Clinical and Case Management Financial Services Pharmacotherapy Continuing Care Legal Services AIDS / HIV Services Educational Services Medical Services
20 The ASAM Criteria Level of Care Utilization System - LOCUS PageName=Level_of_Care_Utilization_System_f or_psychiatric_and_addiction_services Addiction Severity Inventory treatment-planning-matrs Community Corrections Risk Needs Assessment (RNA)
21 6. Drug use during treatment should be carefully monitored. Know that lapses can occur Conduct urinalysis Provide immediate feedback Intensify treatment as needed
22 Why Screen? Provides information for clinical decision making, treatment planning Basis for assessing and providing feedback on treatment progress Undetected relapse can progress to more serious drug use Detected relapse presents opportunity for intervention, rewards and sanctions
23 Urine Drug Screens Dominion Diagnostics Millennium Laboratories Redwood Toxicology Lifeloc Technologies American Bio Medica Corp.
24 7. Treatment should target factors associated with criminal behavior. Criminal thinking Antisocial values Anger/hostility Problem solving Conflict resolution skills Attitudes toward school/work Mental health problems Family functioning Barriers to care Alcohol/drug problems
25 Here s some Cognitive-Behavioral Interventions for Substance Abuse Treatment Developed by the University of Cincinnati Corrections Institute, this curriculum is designed for individuals that are moderate to high need in the area of substance abuse and well suited for criminal justice populations. The curriculum can be delivered as a stand-alone substance abuse intervention, or incorporated into a larger program, particularly those designed for clients in the corrections system.
26 The Change Companies Interactive Journaling Adult Treatment Programs Criminal Justice Programs #criminalproducts
27 The Matrix Model for Criminal Justice Settings This treatment program provides adults in a variety of correctional settings including jails, community corrections, probation programs, drug courts, and prisons with the structure of an evidence-based treatment experience and combines education on both substance use and criminal thinking and behaviors. item=338136&sitex=10020:22372:us#proddetails
28 Motivational Interviewing a collaborative, person-centered form of guiding to elicit and strengthen motivation for change. It works with substance abuse clients. It works with substance abuse clients who happen to be involved in the criminal justice system.
29 8. Treatment planning should involve treatment and criminal justice personnel. Public Health Approach Public Safety Approach -disease -treatment -illegal behavior -punish High Attrition High Recidivism
30 Integrated Public Health-Public Safety Strategy Communitybased treatment Blends functions of criminal justice and treatment systems to optimize outcomes Close supervision Opportunity to avoid incarceration or criminal record Consequences for noncompliance are certain and immediate
31 Matters 9. ContinuityAftercare of care is essential. Delaware Correctional System 3 Years Post Work Release 100 Arrest-Free * Drug-Free * 60 * * * Martin, Butzin, Saum, & Inciardi (1999)
32 DMHDDSAS-DAC-AOC MOA
33 10. A balance of rewards and sanctions can encourage pro-social behavior and treatment progress. Sanctions" Rewards" Reinforce positive behavior Graduated Use awards (non-monetary) to recognize progress Consistent, prediction, fair Catch people doing things right Treatment not a sanction! Most likely to have desired effect the closer they follow the targeted behavior.
34 How can rewards and sanctions be used.. Rewards and sanctions are most likely to change behavior when they are certain to follow the targeted behavior, when they follow swiftly, and when they are perceived as fair. Rewarding positive behavior is more effective in producing long-term positive change than punishing negative behavior.
35 Nonmonetary rewards such as social recognition can be as effective as monetary ones. A graduated range of rewards given for meeting predetermined goals can be an effective strategy. Contingency management strategies, proven effective in community settings, use voucherbased incentives or rewards, such as bus tokens, to shape progress towards treatment goals. Contingency management is most effective when the contingent reward closely follows the behavior being monitored
36 11. Treat co-existing mental disorders in an integrated way. Attention Deficit Disorder Conduct Disorders Bipolar Disorder DRUG ABUSE Depression Post-Traumatic Stress Disorder
37 Mental health conditions often co-exist with drug abuse. When this occurs, treatment must address drug abuse, mental health issues, and criminal behavior Contingency management can improve adherence to medications Case management may be useful for linking severely mentally ill individuals with drug abuse treatment, mental health care, and community services
38 12. Medications are an important element of treatment. Methadone Naltrexone Buprenorphine
39 Medications can stabilize the brain and help return it to normal functioning. Effective medications have been developed for treating addiction to opiates/ heroin and alcohol. For patients with mental disorders, medications to treat mental health conditions can be critically important. While some jurisdictions have found ways to successfully implement medication therapy, addiction medications are underused in the treatment of drug abusers within the criminal justice system, despite evidence of their effectiveness.
40 13. Assess for risk reduction and treatment needs for HIV/AIDS and other infectious diseases. Prison-based AIDS cases are 5 times as high as in the general population. Disproportionate impact on the poor, substance abusers, and minorities.
41 Research shows that treatment for drug abuse can lessen the spread of infectious diseases by reducing high-risk behaviors like needlesharing and unprotected sex (Metzger et al. 2010). Offenders often have difficulty negotiating access to health services and adhering to complex treatment protocols following release from prison and jail.
42 Work Together Community health, drug treatment, and criminal justice agencies should work together to offer education, screening, counseling, prevention, and treatment programs for HIV/AIDS, hepatitis, and other infectious diseases to offenders returning to the community.
43 What is TASC? A model that bridges two separate systems: justice & treatment Links treatment & justice goals of reduced drug use & criminal activity Uses processes that improve treatment access, engagement & retention
44 Balancing Control & Tx One Offender One Case Plan One Team Common Goal: Safely manage high-risk, high-need offenders in the community Balances Intervention Opportunities provided thru DMHDDSAS & Supervision provided thru Community Corrections & AOC
45 Screening & Assessment Referral & Placement Care Planning, Coordination & Management Reporting Progress to Justice System
46 North Carolina TASC Network Cherokee 30 A Region 4 Carlene Wood 370 N.Louisiana Ave, Ste. E-3 Asheville, NC A Graham Clay 30A Swain 30 A Macon 30 A Region 4 Jackson 30 B Haywood 30 B Madison 24 Transylvania 29 Buncombe 28 Henderson 29 Mitchell 24 Yancey 24 Polk 29 Avery 24 McDowell 29 Rutherford 29 Region 3 Michael Gray 516 N. Trade St. Winston-Salem, NC Watauga Burke 25 A 23 Ashe Caldwell 25 A 27 B Cleveland Catawba 25 B Alleghany 23 Alexander 22 Lincoln 27 B 27 A Gaston Iredell 22 Davie 22 Rowan 19 C Cabarrus 19 A 26 A-B-C Mecklenburg TASC is organized into 4 regions which reflect the state s 4 judicial divisions, consistent with the unified court & statewide probation systems Wilkes 23 Surry 17 B Yadkin 23 Union 20 B Stokes 17 B Forsyth 21 A-B-C- & D Davidson 22 Stanly 20 B Anson 20 A Guilford 18 A-B-C-D-E 19 B Rockingham 17 A Randolph 19 B Montgomery Region 2 Andy Miller 412 West Russell Fayetteville, NC Region 3 Region 2 Moore 20 A Richmond 20 A 16 A Scotland Caswell 9 A Alamance 15 A Chatham 15 B Hoke 16 A Orange 15 B Lee 11 Robeson 16 B Person 9 Durham 14 A-B Harnett A-B-C Cumberland 9 Granville Wake 10 A-B-C-D 13 Columbus 13 Bladen 9 Vance Johnston 11 9 Franklin Sampson 4 A 9 Warren 13 Brunswick 7 A Nash Wilson 7 C 8 B Wayne Duplin 4 A Pender 5 6 A Halifax 7 B Edgecombe 8 A Greene 8 A Lenoir New Hanover 5 Region 1 Jennifer Saphara 609 Shipyard Blvd. Wilmington, NC Northampton 6 B 3 A Pitt 2 Martin 3 B Craven 4 A Jones 4 B Onslow 6 B Hertford 6 B Bertie Region 1 2 Beaufort 3 B Pamlico 3B Carteret 1 Gates 2 Washington 2 Tyrrell 2 Hyde TASC Training Institute Dale Willetts 613 Shipyard Blvd. Wilmington, NC Dare 1 North Carolina TASC
47 For More Information DALE WILLETTS NC TASC Training Institute of Coastal Horizons Center Thank You!
48 You may order publications through the National Clearinghouse for Alcohol and Drug Information at: Please don t hesitate to contact us NIDA NATIONAL INSTITUTE ON DRUG ABUSE
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