Addiction treatment or jail?

Addiction treatment or jail? This is a question that hasn’t been answered. It’s a well known fact that alcohol and other drugs play a significant role in crime and incarceration. Selling drugs is not the only connection. Many people with no criminal background do something very stupid under the influence of drugs and wind up in prison. It’s true that many crimes are committed by hardened criminals who drink for the courage to carry out the crimes, but who knows what effects long term drinking and drug use has on judgment — does drug addiction drive a significant portion of these people to crime, and is addiction treatment a better solution than jail?

When I bring up the topic of addiction treatment as a substitute for incarceration in prison, if the crime and circumstances warrant treatment, I get push back from those who say that courts have tried this and treatment doesn’t work. Most people in prison who receive “treatment” receive peer assisted addiction treatment, and I’ve witnessed these peer treatment efforts. Peer assisted treatment in prison is not really treatment, although it’s better than nothing. Only around 15% of prisoners receive professional treatment, and I have to question the quality of the treatment. Is the treatment a half-hearted effort to fulfill some request from superiors to try a new approach? Is the treatment offered by prison employees who have little training and hardly any follow-up, on-going support from superiors? I think so.

A problem this size requires a quality, effective addiction treatment approach that’s backed by a determination to achieve goals and outcomes. I venture to guess that at least 40% of prisoners with alcohol and other drug problems would respond positively to treatment and that recidivism would fall precipitously. It should be tried. As we’ve seen with what was revealed with the recent New York prison escape, the present system is only ensuring recidivism.

Sufficient leverage is critical to ensure treatment compliance, and many would require half-way house type settings, but an effective treatment that builds on what drug courts and DUI courts have already accomplished is possible.

Below is a list of treatment principles that if applied would work:

Treatment Principles: An Overview

Principles for Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide provides research-based principles of addiction treatment. The 13 principles are:

1. Drug addiction is a brain disease that affects behavior. It affects people both physically and mentally. It can alter the brain and body chemistry for months or even years after a person stops using, so relapse is often part of the recovery process. It should be treated like any other disease.

2. Recovery from drug addiction requires effective treatment, followed by management of the problem over time. Drug users cannot alter their behavior without taking care of their addiction. Treatment that starts in prison or jail must continue after release. Treatment and recovery is hard work that must continue throughout a user’s life.

3. Treatment must last long enough to produce stable behavioral change. Without the right treatment, most drug users will use again once they return to their neighborhoods, even though drugs might put them right back in prison. Treatment should last long enough (90 days or more) to help drug users learn to manage their own drug problems.

4. Assessment is the first step in treatment. Drug users need to be examined by a doctor. The doctor might prescribe medicine, and will look for other possible problems, such as depression and anxiety, or medical conditions such as hepatitis, tuberculosis, or HIV/AIDS.

5. Tailoring services to fit the needs of the individual is an important part of effective drug use treatment for criminal justice populations. Each drug user has different needs regarding addiction counseling and treatment. The best approaches take each person’s age, gender, ethnicity, culture, and needs into account.

6. Drug use during treatment should be carefully monitored. Individuals recovering from drug addiction sometimes return to drug use, called relapse. Testing for continued drug use is an important part of treatment.

7. Treatment should target factors that are associated with criminal behavior. Offenders often have patterns of behavior, attitudes, and beliefs that support a “criminal” lifestyle. Treatment that helps offenders avoid negative thinking patterns can be effective.

8. Criminal justice supervision should incorporate treatment planning for drug using offenders, and treatment providers should be aware of correctional supervision requirements. It is important that corrections personnel work with treatment providers to make sure the individual treatment plan meets the needs of both the offender and the institution.

9. Continuity of care is essential for drug users re-entering the community. People who start receiving treatment while incarcerated need to continue treatment after release.

10. A balance of rewards and sanctions encourages pro-social behavior and treatment participation. During treatment, it is important that both positive and negative behaviors are recognized.

11. Offenders with co-occurring drug use and mental health problems often require an integrated treatment management approach. Drug treatment can sometimes help people who have depression or other mental health problems. It is important that these issues are addressed in treatment programs.

12. Medications are an important part of treatment for many drug using offenders. Medicines like methadone have been shown to help reduce heroin use. Medicines for mental health issues can also be used as part of treatment.

13. Treatment planning for drug using offenders who are living in or re-entering the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, hepatitis B and C, and tuberculosis. Drug users and offenders are more likely to have infectious diseases like HIV/AIDS, hepatitis, and tuberculosis. People seeking treatment should be tested for these diseases and receive counseling on risky behaviors and seeking medical advice.