Improve Recovery Support for People in the Criminal Justice System
Substance use is common among justice-involved individuals and more than half of those In US prisons and jails meet the criteria for substance use disorders (SUDs). As the opioid epidemic unfolds, correctional institutions are looking for best practices that they can use to help handle the increased demand for substance abuse and addiction treatment including diversion, treatment/drug courts, treatment while incarcerated and re-entry services and resources
Ongoing research has suggested that substance use can be associated with poorer outcomes among individuals who have been incarcerated including those under supervision in the community due to involvement in the justice system. A 2014 Pew Trusts study has shown more imprisonment does not reduce drug related issues. This study reinforces a large body of prior research that cast doubt on the theory that tough prison terms deter drug misuse, distribution, and other drug-law violations. The evidence strongly suggests that policymakers should pursue alternative strategies that research shows work better. Many states are revising their drug penalties and focusing on prevention, treatment, and recovery to address individuals and communities with integrating evidenced based practices for treatment and recovery. Integrating informed practices that are evidenced based allows criminal justice agencies and communities to work together to save lives and decrease costs associated with criminal justice system and healthcare system involvement.
Many individuals return to communities, social networks and families and require community-based mental and/or physical health care services. Community-based behavioral health providers and systems have an essential role in serving individuals with mental and substance use disorders who are currently or formerly involved with the criminal justice system. These individuals are a part of every community and providing resources to a person with a SUD can help lead to a life in recovery as opposed to a life in long-term incarceration.
Community based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery and lives productively with dignity and respect. People who need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors or actions related to his or her untreated mental illness. Additionally, some law enforcement officers use discretion to arrest when they believe a person needs health care services that are provided in the jail. Arrest and incarceration often destabilize an individual’s life, including their housing, health care, employment, and social connectedness. Researchers have found that even brief incarceration leads to adverse consequences, including loss of employment and future employment opportunities, poorer physical and behavioral health due to breaks in health care services and treatment, loss of housing and future housing opportunities, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services they need, and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon release and reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration.
Programs to improve outcomes of those in recovery and within the criminal justice system includes community-based diversion programs, drug/treatment courts, treatment while incarcerated and re-entry resources and services.
The Substance Abuse and Mental Health Services Administration (SAMHSA) put together 8 principles to assist community-based behavioral health providers and criminal justice professionals bridge the gap and provide a strong foundation for community- based care for those with a history of involvement in the adult criminal justice system. Additionally, community guidance and FAQs were outlined by SAMSHA including understanding re-entry programs, the need for collaboration among clinical are and case management with criminal justice professionals, evidence-based practices, the risk of recidivism, pre-arrest and diversion programs, medication assisted therapy and understanding of trauma.
SAMHSA 8 Principles:
- Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.
- Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.
- Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.
- Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.
- Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.
- Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.
- Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism
- Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system.
Drug Treatment & Specialty Courts
In the late 1980s alternatives such as drug courts emerged as an innovative approach when professionals recognized the importance of treating substance use and mental health to prevent relapse and recidivism. Drug courts aim to reduce drug use relapse and criminal recidivism through a variety of services. These services include risk and needs assessment, judicial interaction, monitoring and supervision, graduated sanctions and incentives, treatment, and various rehabilitation services. Additional information regarding expanding of specialty courts may be found here. 
As of today, there are more than 3,000 drug courts across the United States. Drug courts consist of juvenile, adult, and family treatment (aimed at family parenting and reunification of families). There are also Veteran Treatment Courts aimed at working with veterans and are served by judges who understand veteran behavioral health challenges and are familiar with the Veterans Health Administration.
Overall, the drug court approach intends to reduce time in the criminal just system and provide treatment to individuals instead of punishment.
Pre-Arrest Diversion & Deflection Programs
Additional information on Expand Pre-Arrest Diversion and Deflection Programs may be found here.
Deflection is the practice by which law enforcement or other first responders (i.e., fire and EMS) connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted, or in lieu of taking no action when issues of addiction, mental health, and/or other need are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested.
Pre-arrest diversion is the practice by which law enforcement officers connect individuals who otherwise would have been eligible for criminal charges to community- based treatment and/or services in lieu of arrest, thereby diverting them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs but sometimes prosecutors or a local government agency), clients are diverted to community-based services.
Pre-arrest diversion programs should not be confused with prosecutorial diversion, which occurs after individuals have already been arrested and become involved in the justice system; in contrast, pre-arrest diversion occurs before the filing of charges.
Pre-arrest diversion programs are designed to reduce the number of persons who are arrested and placed in jail because of a mental health problem, these programs shift responsibility for rehabilitation from the criminal justice system to the mental health system.
Early diversion programs provide an alternative to arrest for individuals with substance use and/or mental health disorders, as well as for low-risk offenders, and allow these individuals to avoid the collateral consequences that result from arrest and contact with the criminal justice system. This movement is data-driven and is grounded in the belief that public safety and public health approaches must work in tandem to support vulnerable individuals with substance use disorder (SUD) and/or mental illness (MI). Instead of shifting responsibility or cost from one system actor to another, this collaborative approach creates additional tools and supports for those on the front line, appropriate treatment for eligible individuals with SUD and/or MI, and opportunities for systemic change for leaders looking for creative solutions to complicated problems.
In addition, these programs serve the best interest of the community, individual, and taxpayers. Pre-arrest diversion and deflection programs have the added benefits of:
- Breaking the costly cycle of justice system involvement for eligible individuals.
- Increasing cross-sector collaboration to create new pathways to community-based behavioral health services.
- Enhancing relations between community members and law enforcement.
- Decreasing crime, incarceration, and recidivism rates.
- Lessening the burden on justice systems.
- Improving public health and safety.
- Reducing the burden on individuals who commit non-violent, low-level offenses.
- Ensuring equal access to pre-arrest diversion regardless of race, income, or geography; and
- Saving taxpayer dollars
Sequential Intercept Model (SIM)
The SIM helps communities identify resources and gaps in services at each intercept and develop local strategic action plans. The SIM mapping process brings together leaders and different agencies and systems to work together to identify strategies to divert people with mental and substance use disorders away from the justice system into treatment.
The SIM includes:
- Intercept 0: Community Services
- Involves opportunities to divert people into local crisis care services. Resources are available without requiring people in crisis to call 911, but sometimes 911 and law enforcement are the only resources available. Connects people with treatment or services instead of arresting or charging them with a crime.
- Intercept 1: Law Enforcement
- Involves diversion performed by law enforcement and other emergency service providers who respond to people with mental and substance use disorders. Allows people to be diverted to treatment instead of being arrested or booked into jail.
- Intercept 2: Initial Court Hearings/Initial Detention
- Involves diversion to community-based treatment by jail clinicians, social workers, or court officials during jail intake, booking, or initial hearing.
- Intercept 3: Jails/Courts
- Involves diversion to community-based services through jail or court processes and programs after a person has been booked into jail. Includes services that prevent the worsening of a person’s illness during their stay in jail or prison.
- Intercept 4: Reentry
- Involves supported reentry back into the community after jail or prison to reduce further justice involve of people with mental and substance use disorders. Involves reentry coordinators, peer support staff, or community in-reach to link people with proper mental health and substance use treatment services.
- Intercept 5: Community Corrections
- Involves community-based criminal justice supervision with added supports for people with mental and substance use disorders to prevent violations or offenses that may result in another jail or prison stay.
Medication-assisted treatment (MAT)
More information on use of MAT in Correctional Facilities may be found here. 
Medication-assisted therapy is treatment utilized for drug-dependent individuals within the criminal justice populations. Currently MAT is used primarily for pregnant women to detoxify within the criminal justice system and is minimally used for reentry. There are ongoing studies surrounding MAT as well as efforts to expand the use of MAT within the current correctional infrastructure. Efforts to expand MAT include training, education, reducing stigma and increasing funding resources. Expansion of MAT within community correctional settings will also require increased collaboration with community providers in order to enhance the appropriate pharmacotherapy for individuals under community correction supervision. Concerns of correctional facilities surrounding MAT have included liability, staffing, regulation and funding. CJ-DATS is working collaboratively to increase information and linkage to community MAT for those within the criminal justice system.
Other initiatives to improve recovery support for people in the Criminal Justice system include:
- Expand Pre-Arrest Diversion and Deflection Programs
- Improve Re-entry After Incarceration for those with mental health and SUD 
Impact of Mature Drug Court
Do Drug Courts Work?
Principles of Community-based Behavioral Health Services for Justice Involved Individuals: A Research Based Guide 
Imprisonment Does Not Reduce State Drug Problems
Medication-Assisted Treatment in Criminal Justice Agencies Affiliated with the Criminal Justice-Drug Abuse Treatment Studies (CJ-DATS)
Relevant Case Studies & Evidence Based practices 
- A Way Out (Lake County, IL)
- The Hope Initiative (Nashville, NC) 
- Plymouth County Outreach (Plymouth County, MA) 
- Arlington Opiate Outreach Initiative (Arlington, MA)
- Drug Abuse Response Team (Toledo, OH) 
- Quick Response Team (Hamilton County, OH)
- Law Enforcement Assisted Diversion (King County, WA) 
- Stop, Triage, Engage, Educate and Rehabilitate (Montgomery County, MD) 
- Pre-Arrest Diversion/Adult Civil Citation (Leon County/Tallahassee, FL)
- Intervention Teams (Memphis, TN)
- Reducing Substance Abuse Disorders and Related Offending: A Continuum of Evidence-Informed Practices in the Criminal Justice System 
Impactful Federal, State, and Local Policies
The Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP), formerly the Comprehensive Opioid Abuse Program (COAP), was developed as part of the Comprehensive Addiction and Recovery Act (CARA) legislation. 
SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration and will add additional resources.
Available Tools and Resources
- Pre-arrest Diversion models- Police, Treatment and Community Collaborative (PTACC)
- National Drug Court Resource Center 
- SAFE Project Pre-Arrest Diversion Guide
- Comprehensive Opioid, Stimulant, and Substance Abuse Program
A Way Out (Lake County, IL)
“A Way Out” is a Lake County, Illinois Law Enforcement Assisted Diversion (LEAD) pilot program, designed to fast-track users to substance abuse programs and services. This program is available 24 hours a day, 7 days a week at participating police departments across Lake County and ensures no criminal charges will be sought for those that may be in possession of narcotics or paraphernalia, if assistance is sought out by the prospective program participant. “A Way Out” is a program developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, re-frame the role law enforcement plays in community safety, and unite the community. For too long, substance use has been stigmatized and dealt with as a criminal issue. Substance use is a public health problem that needs to be addressed as such. Lake County Opioid Initiative is committed to developing innovative ways to create positive change in our community as it regards substance use and mental health.
The Hope Initiative (Nashville, NC)
The HOPE Initiative was the first PAD program in the State of North Carolina. Its purpose is to assist those individuals with substance use disorder to find treatment options and to get into treatment and begin recovery. While other programs were centered on opioids, the HOPE Initiative was willing to accept any substance use disorder. Partnerships were established with the local district attorney’s office, Eastpointe (LME), UNC Nash Hospital, Coastal Plain Hospital (Detox facility), Police Assisted Addiction and Recovery Initiative (PAARI), and many others. The program allows individuals to come to the Nashville Police Department, turn over any drugs and/or paraphernalia without fear of charges, and to start their recovery process. Our first HOPE Initiative participant came to the Nashville Police Department on February 17th, 2016 and serviced 320 clients in its first 2 years. The program is funded through donations, grants, and fundraisers.
Plymouth County Outreach (Plymouth County, MA)
Plymouth County Outreach (PCO) was developed through the Public Safety, Community Coalition, and the Faith Based Subcommittees of the Plymouth County Drug Abuse Task Force. Since its inception, PCO has fostered an innovative law enforcement/non law enforcement collaboration which includes the District Attorney’s Office, The Sheriff’s Department, all 27 police departments, 5 major hospitals, recovery coaches, DCF, District Court Probation, PAARI, community as well as faith-based coalitions. The two main aspects of the program are overdose follow-up and community drop-in centers. Within 12-24 hours of an overdose, an Outreach team consisting of plainclothes officers, a licensed clinician, and/or a recovery coach will conduct a home visit of the overdose survivor. The intent of the outreach effort is to provide resources and support to those with substance use disorders and/or their families with the hope of getting people into treatment and connecting family/friends with existing resources in the county. Through the support of Project Outreach / PCO Hope, a drop-in center in various sites across Plymouth County are held each week. These centers host a growing number of health care providers who help with treatment options and train and distribute Narcan for free.
Arlington Opiate Outreach Initiative (Arlington, MA)
This community-based strategy has two major components. First is the proactive outreach to known substance users. “Arlington Opiate Outreach Initiative” involves the police department clinician reaching out to the known population of persons with substance use disorders to support them in developing a plan to ensure their survival, to facilitate the long-term process of recovery, and to avail person and their loved ones to services. Second is the Arlington Community Training & Support - Arlington “ACTS” on Addiction involves a series of community-based meetings co-facilitated by the police department’s clinician and a community substance abuse intervention expert aimed at achieving the goals stated above and with creating a supportive non-judgmental environment for substance users and their families.
Drug Abuse Response Team (Toledo, OH)
The Lucas County Sheriff’s Office developed the Drug Abuse Response Team (DART) model. Lucas County credits it with diverting more than a thousand people from the criminal-justice system and into treatment during its first 4 years. 70 % of participants successfully enter detox and treatment programs. The Ohio legislature has since approved a pilot grant program to assist other Ohio counties in implementing a DART program. As of 2018 39 grant-funded programs are in the middle of 21-month-long pilots. The Lucas County DART program now has over 20 officers from several area law enforcement agencies, including Toledo PD, the Sheriff’s Department, and the Division of Children and Families. That officer works with parents with substance use disorder whose children have been put in foster care. The officer assists the parents getting access to treatment so the family can be reunited.
Quick Response Team (Hamilton County, OH)
The Hamilton County Heroin Task Force partnered with law enforcement, fire departments and social workers to create a team that follows up with overdose victims and offers them addiction treatment. The goal is to have a first responder follow up with overdose victims within the “recovery window” 72 hours after an overdose reversal and provide a warm hand off to treatment options. Teams try to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data-collecting agency. Teams also use “predictive analysis” to track drug activity to target potential overdoses with the help of University of Cincinnati’s Institute of Crime Science. QRT has since been launched as a national model being spread nationally.
Law Enforcement Assisted Diversion (King County, WA)
Law Enforcement Assisted Diversion (LEAD) is a pre-booking diversion program developed in King County, Washington to address low-level drug and prostitution crimes in Seattle and King County. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution. By diverting eligible individuals to services, LEAD is committed to improving public safety and public order and reducing the criminal behavior of people who participate in the program. The King County LEAD program has evolved to a national model with a national support organization, the LEAD National Support Bureau, which assists departments in establishing LEAD programs.
Stop, Triage, Engage, Educate and Rehabilitate (Montgomery County, MD)
The STEER Program in Montgomery County, MD, is a pre-booking law enforcement and drug treatment and recovery linkage program that aims to provide rapid identification, deflection, and access to treatment for drug-involved individuals as an alternative to conventional arrest. Individuals are assigned a care-coordinator who focuses on rapid treatment access, retention, motivation, engagement, and completion and conducts a full clinical assessment and referral. Police Officers use a screening tool to decide whether a person is a candidate for this deflection. The risk assessment may be used by a Police Officer who is responding to a call for service or in an on-view situation. Charges can be held in abeyance while the person is seeking services. STEER operates around the core value proposition of deflection, namely ensuring the “correct” movement of citizens either into the criminal justice system or away from it and towards the human services system, and as a result:
- reducing crime
- (re) building community relations
- reducing drug use
- restoring the lives of citizens
Pre-Arrest Diversion/Adult Civil Citation (Leon County/Tallahassee, FL)
As a model pre-arrest diversion program, the Leon County/Tallahassee PAD/ACC program holds offenders accountable for their crime; but, instead of being arrested and prosecuted by the traditional criminal justice system, the person receives civil sanctions, e.g., community service, and behavioral health intervention services. The essential elements of the program, following referral by law enforcement, are the use of evidence based behavioral health intervention services to reduce the likelihood of future criminal activity and the avoidance of an arrest record for those who successfully complete the program. The decision to arrest or refer for behavioral health assessment and intervention services is best made by the law enforcement officer who is on the scene and understands the nature of the offense at the time it occurred. Since inception the Leon County/Tallahassee has had over 1300 participants. The Civil Citation model has grown throughout the State of Florida. Today the Civil Citation Network (CCN) assists communities in implementation the Civil Citation model.
Intervention Teams (Memphis, TN)
The Crisis Intervention Team (CIT) program is a community partnership working with mental health consumers and family members. Officers are part of a specialized team which can respond to a crisis at any time, and they will work with the community to resolve each situation in a manner that shows concern for the citizen’s well-being. The CIT is made up of volunteer officers from each Uniform Patrol Precinct. CIT officers are called upon to respond to crisis calls that present those officers face-to-face with complex issues relating to mental illness. CIT officers also perform their regular duty assignment as patrol officers. The Memphis Police Department has approximately 268 CIT officers who participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. Due to the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24/7 coverage.
Adult National Drug Court Best Practice Standards
Adult Drug Court best practice standards provides evidence-based practice standards set forth by subject matter experts, researchers, and policy makers.
- https://nij.ojp.gov/library/publications/impact-mature-drug-court-over-10-years-operation-recidivism-and-costs Do Drug Courts Work?