Shift from Punishment to Treatment Approach for Opioid Users

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Introductory Paragraph

Evidence shows that addiction is a treatable disease of the brain, however many individuals do not receive treatment and as a result they end up involved in the criminal justice system from illegal drug-seeking behavior.

More than half of the prison population in the United States, about 65%, is estimated to have an active substance use disorder. About 20 % who did not fully meet the criteria for a substance use disorder were under the influence of substances at the time of their arrest. Many of the individuals in prison for drug-related offenses and even those for other crimes, are not receiving treatment and have a high risk of reoffending once released. Failure to provide adequate and high-quality substance use treatment is not only detrimental to the individuals who are incarcerated but also has negative implications for their families, society, and the economy. Recent data shows a significant correlation between criminal justice involvement and substance use, highlighting the importance of identifying a different approach to the problem.

Offering treatment to individuals with a substance use disorder should be a priority according to decades of the impact treatment has on an individual’s quality of life, reduced likelihood of recidivism, and future relapse. The National Institute on Drug Abuse has increased its efforts to find solutions and support to those who work within the court system, social workers, and counselors who provide services to individuals involved in the criminal justice system due to drug use [1].

Treating those with substance use disorders and illegal behavior helps decrease substance abuse ongoing as well as provides the opportunity to reduce associated criminal tendencies. There are evidence-based strategies that play a role in transforming traditional punishment-based approaches that may be used within the criminal justice system. Moving from a punishment to treatment approach improves both public health and public safety while decreasing rates of future incarceration.[2]

Key Information

Substances use disorders are considered treatable diseases of the brain that impact one’s ability to lead healthy and normal lives. Many times, individuals using substances struggle to make logical decisions and find themselves engaging in criminal behavior because of their addiction. Treatment for these issues is available and has promising effects when administered. However, instead of receiving treatment, many individuals with a substance use disorder find themselves involved with the criminal justice system that does not adequately address their addiction and behavioral problems. By failing to not treat this population of people, society has a missed opportunity to better the lives of the individuals and improve public health and safety[3].

Once incarcerated for drug-related crimes, people with substance use disorders have an extremely high risk of using substances and reoffending once released. This has substantial impacts on the economy, the criminal justice system, and the individuals living with this substance use disorder. Not only does this cycle cost taxpayers billions each year, but it also does not adequately provide the individuals with the resources they need in order to treat their addiction and break the vicious cycle. These individuals are more likely to commit crimes at a higher rate once released from prison when compared to those who are not using substances [4]

One option that seems promising is providing drug treatment inside the prisons and jails while the offenders are incarcerated. Since the 1990’s researchers have discovered highly effective interventions that can be implemented while offenders are incarcerated and after they are released [5]. A critical component of this approach is adequate prerelease and post-release counseling and support in order to reduce detrimental impacts of individuals returning to their previous stressful home-life, environments, and negative peer influences. Lack of access to treatment upon release increases the likelihood of relapse and death due to overdose due to the changes in an individual’s tolerance after being incarcerated [6]

A critical component of this approach is adequate prerelease and post-release counseling and support in order to reduce detrimental impacts of individuals returning to their previous stressful home-life, environments, and negative peer influences. Lack of access to treatment upon release increases the likelihood of relapse and death due to overdose due to the changes in an individual’s tolerance after being incarcerated.[7]

Common treatments for substance use/Opioid addition include these proven evidence-based approaches:[8]

  • behavioral counseling
  • medication assisted treatment approach (MAT)
  • evaluation and treatment for co-occurring mental health issues such as depression and anxiety long-term follow-up to prevent relapse

Relevant Research

In 2007, the National Drug Intelligence Center estimated the cost of drug use to society was around $193 billion. The cost to treat drug use was estimated to be around $14 billion. Treating drug use also included health care costs, hospitalizations, and government specialty treatment. Despite the overwhelming evidence that drug treatment is more effective than incarceration, over 80% of prisoners who would benefit from treatment while incarcerated do not receive it [9].

Over the past 20 years, recent interventions such as therapeutic alternatives to incarceration, judicial oversight in drug courts, and jail-based drug treatment have proven to be helpful in transitioning offenders back into the community where they can address their illness and live productive lives. Further research has shown the positive impact community-based drug treatment has on criminal behavior and may result in 1.8 times better outcomes in reducing drug use and the chances of reoffending. Drug courts that combined judicial supervision and treatment in place of incarceration had half the rearrests rates than those who did not participate in said programs. Individuals who participated in prison-based drug treatment programs paired with community programs after release were 7 times more likely to continue to abstain from substances and 3 times less likely to re-offend when compared to those who did not receive treatment [10].


Other relevant research includes: Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety[11]

Impactful Federal, State, and Local Policies

American Legislative Exchange Council 2021 Report including Criminal Justice Reform including Connecticut enacted sentencing and drug-free zoning reform modeled after the ALEC model policy Resolution on Drug-Free Zones, as well as juvenile justice reform modeled after the ALEC model policy Resolution in Support of Establishing a Minimum Age of Delinquency Adjudication of at Least 10-Years-Old.[12]


In the Fall of 2020, Oregon has passed a new groundbreaking and pioneering drug law that decriminalized the possession of small amounts of illegal substances. “Measure 110” expanded funding and access to addiction treatment using tax revenue from expected savings that are a direct result of reduced arrests and incarceration. One downside to this new approach is the impact it may have on the medical community. The potential risk of overdose caused by the new law may, over time, leave the healthcare system with little to no resources in place needed to receive increased overdose patients. Nonetheless, the radical change in the way law enforcement handles possession of substances in Oregon may be a stepping stone to finding alternatives to incarceration. Many times, the only way to receive treatment for substance use treatment is by being arrested or coming into contact with the criminal justice system, having detrimental impacts on an individual’s life and ability to hold employment. Measure 110 has offered another pathway by treating possession like a traffic ticket and opening the door to treatment instead of incarceration [13].

In 2021, the Federal Government introduced the bipartisan “Residential Substance Use Disorder Treatment Act” that expanded access to substance use treatment in jails and prisons within the United States. This bill also expanded access to treatment within the communities after offenders were released. This may be a step in the right direction for one day providing treatment in place of incarceration. One major improvement is the government’s acknowledgment of how important it is to resolve addiction through the use of treatment and medication in efforts to stop the revolving door pattern associated with substance use and incarceration [14].

The Adult Drug Court Grant Program, part of The Department of Justice, provides financial assistance to states, local courts and government, and federally recognized Indian tribal governments to integrate substance abuse treatment, drug testing, incentives, and sanctions in judicially supervised settings with the intent to reduce recidivism and substance use among offenders [15].

Available Tools and Resources

Lines for Life - Oregon [16] This is a 24/7 helpline that is dedicated to preventing substance use and suicide. They provide free and confidential drug-prevention education and treatment referral services.

Addiction Recovery Center hotline- Oregon: 503-575-3769 [17] This hotline is open 24/7 and provides assessments, care planning, links to services, and connects callers with crisis care and emergency care if needed.

Promising Practices

Buffalo, New York- An innovative triage approach called Buffalo Opioid Court, reduced the risk of overdose deaths and substance use by providing funding for court staff and treatment programs such as addiction counseling and medical interventions. The court staff has the ability to deploy a Rapid Integration Team that connects individuals with immediate treatment, assessment, and access to a licensed professional counselor[18]

Clayton County, GA – The Adult Felony Drug Court Program is an 18 to 24-month program that gives nonviolent drug offenders with a substance use disorder the chance to avoid incarceration and starting over and getting help [19].

Video: Reforming Criminal Justice to Help Inmates Live a Life of Dignity, not Dependency[20]

Sources

  1. https://www.drugabuse.gov/publications/drugfacts/criminal-justice
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/#R16
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/
  4. https://drugfree.org/drug-and-alcohol-news/choosing-substance-abuse-treatment-over-prison-could-save-billions-study/
  5. https://www.apa.org/research/action/aftercare
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/
  8. https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction
  9. https://www.drugabuse.gov/publications/drugfacts/criminal-justice
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083
  12. https://alec.org/wp-content/uploads/2022/05/2021-Annual-Report_V10_WEB.pdf
  13. https://www.npr.org/2021/06/18/1007022652/oregons-pioneering-drug-decriminalization-experiment-is-now-facing-the-hard-test
  14. https://www.whitehouse.senate.gov/news/release/-cornyn-whitehouse-introduce-bill-to-fight-substance-use-in-jails-and-prisons-support-inmates-upon-release
  15. https://bja.ojp.gov/program/adult-drug-court-grant-program/overview
  16. https://www.linesforlife.org
  17. bit.ly/oha-measure110
  18. https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices
  19. https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices
  20. https://alec.org/article/video-reforming-criminal-justice-to-help-inmates-live-a-life-of-dignity-not-dependency/