DRUG ADDICTED OFFENDERS IN PRISON.   Term Paper ID:28515 Click to get this paper

Essay Subject: Extensive survey of literature on imprisoned substance abusers. Problems, treatments, need for comprehensive treatment, model programs & obstacles. Recommendations. Abstract.... More...

42 Pages / 9450 Words 38 sources, 78 Citations, APA Format $100.00 Return to List of Papers

Paper Abstract: Extensive survey of literature on imprisoned substance abusers. Problems, treatments, need for comprehensive treatment, model programs & obstacles. Recommendations. Abstract. Paper Introduction: Treatment of Drug-Addicted Offenders in Prison Abstract There are an increasing number of individuals serving time in jails and prisons for drug-related crimes. However, the majority of these individuals have never received treatment for any substance abuse problems outside of the prison system, and the majority of them are still not being served while in prison. The federal government has authorized a new push for treatment of substance abusers within the prison system. Nevertheless, there are many obstacles to effective treatment, including inadequate guidelines, standards, referral and screening procedures, and lack of information about effective programs. There are also programs that have met with success, most of Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. Thus it has been concluded that causes ofalcohol problems with Native Americans remain unclear (Garcia-Andrade,Wall, & Ehlers, 1997, pp. There are also programs that have met with success, most of which arebased on therapeutic community models. Drug treatment services injails. Residentialtreatment for women parolees following prison-based drug treatment:Treatment experiences, needs and services, outcomes. Dept. B1. Classification staff determine the initial placement, whilecorrections officers make referrals to treatment based on requests fromprogram staff and inmates. Also, through inmate's discussions with prisonofficials or other inmates, information about a substance abuse problem mayemerge. The impact ofIMPACT: An assessment of the effectiveness of a jail-based treatmentprogram. One of the newer approaches to dealing with addictions isthe use of meditation within the prison system. Small Group Research, 31(3), 275-3 4. A programwaiting list is established by treatment staff and as treatment beds becomeavailable, the list is screened by correctional officers. Some attempt to explain this problem byintroducing sociocultural factors, however, studies show that noassociations were found between expectations and family history ofalcoholism. An integrated referral and screening approach; 4. Journal of Counseling and Development, 74(6), 542-552. J. Admission to the program is based both on thescreening document and the assessment. Nevertheless,there are many obstacles to effective treatment, including inadequateguidelines, standards, referral and screening procedures, and lack ofinformation about effective programs. Peters (1992) believes national standards must be created. (2 ). The Delaware program is atherapeutic community model in which the inmates are required to returnregularly to the therapeutic community for meetings with counselors andthey are to attend a weekend retreat every three months. However, the majority of theseindividuals have never received treatment for any substance abuse problemsoutside of the prison system, and the majority of them are still not beingserved while in prison. (1997),evaluation of the effectiveness of these prison programs has fallen farbehind the implementation of various programs. M., &Harrison, L. The 12 steps are divided into three parts: acknowledgingpowerlessness and turning to a higher power (steps 1-3); focus on action(steps 4-9); and a maintenance program (steps 1 -12). Theprison and jail population has more than doubled over the last 17 years ashas the number of drug abusers found within the incarcerated population.Incarceration rates in the United states are close to 1 times more thanmost European countries. Productivity in society, past orcurrent, and social support treatment were also a predictors in outcome(Hanlon, Nurco, Bateman, & O'Grady, 1998). It reduced rearrest rates and reduced time-to-rearrest forproject participants. In Seattle, they are using vipassana meditation in theprison system. Second, a drug-addicted offender poses a danger to himself or herselfand to others. Thus, Delaware'smodel presupposed a work release center again based on the model of thetherapeutic community and fundamentally removed from the influences of thestreet and inmate culture. The firsthalf of the program includes exercise groups, counseling groups, 12-stepactivities, education, special topics and self-help groups. The outcomes seemed to improve with length of stayin the program up to 15 days. Inmates who have long jailsentences, are on psychotropic medication, or have a history of violenceare denied admission. They also mention the importance ofresearchers recognizing both manifest and latent goals, hidden agendas,institutional politics, and the importance of developing rapport withcorrectional administrators, as well as treatment staff and programparticipants. Chicago: University ofChicago Press. Unfortunately, most prison and jail drug treatment programs areinadequate, according to most standards. (1991). Leukefeld and M. Rudy, D., Johnson, B., & Kilty, K. Most referrals to the program are initiatedby the court, while other referrals come from attorneys, Cermak healthservices, social services staff, and correctional officers. 275-279). In H.Steadman (Ed.) Jail diversion for the mentally ill. In the following pages the intent is to explore thefollowing: needs for comprehensive treatment; identifying the problem;treatment readiness and engagement; treatment modalities to includetherapeutic communities, psycho-educational model, medical model,alternative therapies, and self-help groups; monitoring treatment; andafter-care. Treatment of Drug-Addicted Offenders in Prison Abstract There are an increasing number of individuals serving time in jailsand prisons for drug-related crimes. It is also been shown to increase serotonin and cortisol inthe body. Health Affairs, 15(3), 226-234. He noted that there are a number of potential sources for referralinto the system, including unsentenced inmates, inmates with histories ofsubstance abuse or mental illness, and medical, psychiatric, orpsychological exams. Certainly this is not themost traditional of practices in the United States, yet it seems to havesome potential. In the case of Griffin v. (2 ). Buprenorphine is an agonist with mildwithdrawal symptoms. Treatment Readiness and Engagement Readiness and engagement of the substance abuser is an additionalfactor which must be considered. References Anglin, M. In the first stage, clients enter anorientation dorm for 3 days where they are assessed, urine-tested, andparticipate in pretreatment and orientation groups. Field, G. J., Mickenberg, J., Maslar, M. Yet, later in their stay, they maydevelop more serious problems with either use or withdrawal, andcomprehensive assessment at that point would be appropriate. For prisons in Washington State, this may notwork as well. The working through of the 12steps with the help of a sponsor offers opportunities to re-assess thedevelopment and maintenance of substance abuse behaviors, and then find newways of coping (Anonymous, 1995, p. Farabee et al.(1999) believe that some of the more recent problems are due to the massivepush to create new substance abuse programs in the prison system. The intent is to change the whole person, eliminating thosepatterns that lead the person toward drug use and reoffending (DeLeon,1994). Inciardi et al. Science, 278(5335), 66-73. 369-376). However, studies have indicated that good drug treatment programsduring prison stays can both reduce drug use and associated criminalactivity (Anglin & Hser, 199 ). Drug courts offer a possible solution to the engagement problem.These courts evolved as an effort toward engaging defendants in substanceabuse treatment. W. The primary purpose of theprogram is to help inmates achieve sobriety, reduce the chance of relapse,and prepare offenders for return to the community. There are several important differences between the groups, includingthe fact that the second group contains only men, while the other threegroups contain both men and women. 21). Any research in thefield, including ongoing working with neurophysiological factors affectingaddiction, is important and useful. Keyindicators strategic support system. Untreated prisoners arelikely to return to the crime scene once released. Forexample, the New York State program is quite different. As opposed tosupport groups, self-help groups use an ideology for achieving change, donot use professionals, and have structured, task-oriented meetings. It seems reasonable that governments wouldseek to increase treatment programs within the prison system and that itwould be helpful to seek out the best programs for maximum results. Interestingly enough, however, the majority of drug-addictedinmates had never previously obtained drug treatment. The therapeuticcommunity can readily be extended into work release programs which are inthe same general locale. Potential clients are screened with aquestionnaire that looks at drug and alcohol history, prior treatmentexperience, and withdrawal symptoms. AA's motivated benefits. While they areestablished in their own separate setting, this is not quite the same asthe therapeutic community model. Inciardi, J. L., & Ehlers, C. Seattle Times, March 22, p. Delimitations of the Study This is not an experimental design. Inmates have claimed that this violates theirright to freedom of religion, or interferes with the separation of churchand state established by the constitution. There is ongoing trafficking in drugs and alcohol atsuch a high level that both the state and federal governments have recentlysought to address the issue by expanding substance abuse treatment withinthe prison system (Farabee et al., 1999). 3. Thewomen's program is very similar, although the women can request re-enrollment. would be saved $8.9billion (Foster, p. DeLeon, and N. This was the comparison group; (2) those who receivedprimary treatment in prison, but no secondary or tertiary treatment; (3)those who received primary and secondary treatment at the Crest workrelease center for both men and women, followed by aftercare; and, (4)those who received primary treatment in prison and secondary treatment andaftercare at Crest. Two facilities were available for inmates, one for women andone for men (Inciardi et al., 1994). (2 ). In Chicago, for example, results improved significantly withlength of time participating in the program, up to 15 days. These provide both individual and group counseling. In prison services include urine testing,counseling, workshops, seminars, 12-step programs, and parole planning.After graduating from the program and being paroled, women may enter acommunity-based program. They conducted field research inboth states, using observational methods and survey data drawn from twoquestionnaires, primarily used in the Ohio program. Foster, S. Cooper, R. Programs have tried to deal with this problem inmany ways. Treatment should extend into the prisoner's release time,connecting ex-inmates with community drug treatment centers or maintainingtheir connection to therapeutic communities formed for the transitionalphase. (1996). Identifying the Problem As Farabee et al. The numbers of inmates requiring substance abuse treatment isincreasing, however most are not receiving this type of care.Approximately 18% of prisoners receive drug treatment and since AfricanAmericans and Latinos are a large portion of the prison population, theyalso are a large part of the untreated group. These are fundamental elements in any screening and referral process.Certainly screening at intake would make sense, with intake officerslooking at the inmates history, using screening questionnaires, etc., inorder to make initial referrals for evaluation. It seems as though Rudy et al. There seems to be a problem here in applyingthis model to a prison population. Does it depend upon the availability ofaftercare in prison or in the community? These include chiropractors, naturopaths, andacupuncturists. This could include: 1. An effective model of prison-based treatment fordrug-involved offenders. However, this varied with lengthof stay in the program, with the group staying from 91-15 days rearrestedat only a 41 percent rate compared to those in the 1-3 days group who wererearrested at a 69 percent rate. They are thenfurther screened by program staff for substance abuse history, treatmenthistory, and motivation for treatment. Mosttraditional 12-step programs suggest that people newly in recovery attend ameeting every day for the first few months. Inciardi et al. Strategic solutions: The international communitycorrections association examines substance abuse. (1995). Although self-help groups have been shown to be effective, someproclaim that there is little empirical evidence to support their use.Despite this controversy, they are considered to be an important adjunct tosubstance abuse treatment for many patients. They determined that an appropriate evaluation ofeffectiveness would involve longitudinal outcomes with a large enoughsample to allow for multivariate analyses. Washington, D.C.: National Institute of Corrections. Crime and Delinquency, 43(4), 512-532. In addition, itis estimated that approximately 8 percent of state and federal inmateshave committed drug offenses, were under the influence of drugs or alcoholat the time of the crime, committed the crime to support drug use, or hadhistories of inappropriate substance use (Center on Addiction and SubstanceAbuse, 1998). Washington, D.C.: U.D. Drug abuse treatment in prisons and jails.Rockville, MD: National Institute on Drug Abuse. The Prison Journal, 78(1), 31-44. The program isvoluntary and staff screen applicants for motivation. While one might assume that a prisoner leaves behind both drugs andalcohol after entering prison, particularly in maximum security facilities,this is not the case. This, of course, is what theydid in their own analysis of the TC approach to treatment of drug-addictedoffenders in the Delaware program. The AmericanJournal of Psychiatry, 152(11), 1-31. Referral and screening for substance abusetreatment in jails. 192). U.S. Of Justice. Basically, the therapeutic community model is one in which theindividual's total environment is designed to be therapeutic. L. That still leaves the administrator with the problem of eitherlocating, or developing, appropriate standards for substance abuse referraland screening programs within the system. Substance abuse - In DSM-IV, the concept of substance abuse iscaptured under the heading of Substance Use Disorder. They are also treated by outside alcohol and drug treatmentprofessionals (Rudy et al., 1997). Koons, B. The court also found the 12-step program itselfreligiously coercive, even though the prisoner was not forced to pray orparticipate in any specific religious observance. Continuation witha 12-step group is an ongoing requirement. A more detailed look at optimal program length within the prisons.There is such a wide range of program lengths among the programs mentionedjust in this study. New York Times. Case management allows for attention to the patient's needs as well asthe monitoring of their progress. For example, prisoninmates who have five convictions are found to be seven times more likelyto be heroine addicts, as compared to first offenders (Foster, 2 , p.473). It includesapproximately 33 hours of counseling and therapy over a 26 week period.The focus is very educational, with lectures, seminars, and groupdiscussions, all focused on addiction and recovery issues. Tims, G. Treatment Obstacles There are problems involved in planning, implementing, and sustainingeffective drug treatment programs in the prison systems. Conclusions There is a significant percentage of the inmate population that isinvolved with abusing both drugs and alcohol. Studies at that timedemonstrated that acupuncture was capable of stimulating the opiod systemin the body. Naltrexone is less prefered than methadone, and tendsto be used by "white collar" opiod addicts which includes physicians,nurses, and those released from prison or on probation. ethnic groups. Special report: Drugs and jailinmates. (1997). (1996). Additionally, successful programs need strongreferral and screening procedures, good in-house treatment programs,transitional services, and some opportunities for inmates to obtaintreatment or connect with a therapeutic community after they have returnedto the outside community. (1996). Thisseems remarkably similar to self-help programs, in a way. Client outcomes from therapeutic communities. Naltrexone hasbeen clinically shown to reduce alcohol craving and result in less relapsebehaviors. Of those incarcerated, 8 % participated in crimesinvolving drug or alcohol abuse. L. This was an adjunct to the state'salcohol and drug treatment program. They are quite critical of outcome studies which doexist, noting that they have involved short time frame, limited comparisongroups, few standardized measurement instruments or multivariate models, orcontrol variables. Success forinmates receiving this type of care is reported (Inciardi et al, 1994;1997). The program is voluntary and focuses oncounseling, chalk-talks, small-group work, and 12-step meetings. (1997). Disulfiram blocks alcohol metabolism and results in anoxious by-product, however, patients tend to dislike the medication andavoid its use. Under discussion was a prison visitation programwhich involved mandated AA meetings. Corrections Today,62(2), 192-193. The authors identified six barriers to creating andimplementing successful programs based on their observations of prison-based programs. Prendergast, M. Attacking prison-based substance abuse.Behavioral Health Management, 17(6), 28-29. (1997) presented 18-month follow-up data on theDelaware model seeming to indicate good success for inmates receivingeither two-stage or three-stage treatment. (1997) made several useful suggestions about ways inwhich researchers can work with practitioners to create meaningfulresearch. Without good screening, assessment and referralprocedures, comprehensive services, and, aftercare, the programs are notlikely to succeed in their desired goals. (1994, August 2). It remains unclear exactly how this procedure works, however, itis clear that it does. Community relapse prevention strategies areconnected to effective interventions with offenders (Koons, et al., p.515). It is reported that around 115, former heroin addicts arenow being maintained by methadone use. Further, itis predicated upon the belief that substance abuse is a disorder of thewhole person, with the concomitant need to make changes in cognitions,behaviors, and feelings in order to interfere with the individual's desireto abuse drugs. The IMPACT program was a demonstration program funded by the federalgovernment. In a study comparing this subjects from thisprogram to two comparison groups, findings showed that those whoparticipated in a community residential treatment reported lower drug userates and higher levels of parole discharge (Prendergast, Wellisch, & Wong,1996). For the court, this constituted coercion of the inmate, even though hewas not actually forced to participate in the 12-step program. (1996). The problem is located in the individual,involving his or her thoughts, beliefs, attitudes, assumptions, andbehaviors. There are barriers to creating effective programs. (1998). The authors concluded that it was important to provide amultistage therapeutic community, with particular emphasis on the workrelease transitional therapeutic community. Treatment staff do not understand howprisons operate and correctional staff may be cynical about treatmentprograms, thinking them simply another con. Ofthe 1.9 million prisoners, 1.5 of them are parents, which leaves around 2.5million children at risk for the same fate. Dept. (1994). 542-543). (1997). Self-help groups offer support and education and mutualaid for a single life problem shared by all group members. This is a meditation system that has been used for years inIndian prisons, but is being tried for the first time in the United States(Foster, 1998). Most of these individualshave never received drug treatment on the outside; many of them arebeginning to have the opportunity to receive treatment for their addictionson the inside of the prison system. A., Lurigo, A. Regular attendance at AA meetings wasa precondition for the prisoners to gain extended visitation privileges.The New York Court of Appeals invalidated this program, ruling that itviolated the establishment clause of the Constitution (Conlon, 1997). Rudy et al (1997) offer primarily anecdotal evidence to support theirconclusions about these two programs. 516). Schmidt, J. O'Brien, c. A., Lockwood, D., & Hooper, R. It seems to be the model of choice for working with drug-involvedoffenders, viewed as viable by clinicians and treatment professionals.Perhaps one of the major advantages of the therapeutic community (TC) modelin a prison setting is that it isolates the drug-addicted offender from therest of the prison population. Finally, the third phase of the model, paroleand community involvement, depended upon outpatient counseling and grouptherapy. Forever Free is a substance abuse program at the CaliforniaInstitution for Women. Bureau of Justice Statistics. Washington, D.C.:National Institute of Corrections. Others believe that this population are constitutionallyunable to handle alcohol and that they have the inherited disposition todevelop alcoholism. There arenine groups that are either educational or treatment oriented; theseinclude chemical dependency education, 12-step study, relapse prevention,parenting, life skills, and a monthly meditation group. Acamprosate has been shown to increase continuous abstinence inalcohol abuse. Research points out that there are many factors that need to beacknowledged when treating this population. This program stipulates that to be effective withdrug-addicted offenders, a program must extend beyond treatment within theprison, and continue into the community. Results showed that a longer stay at therelapse prevention site was advantageous, indicating that a more lengthyrelapse prevention program can improve treatment outcomes. The basic philosophy of the TC is that drug abuse is not only adisorder of the whole person, but that the addiction is merely a symptom,not the center of the disorder. Inmates must nothave excessive bond amounts, have been convicted of violent crimes or drugtrafficking, or be deemed a security risk to be referred. Significance of the Problem The problem is a significant one for several reasons. Thus, thisseems an important area to explore. Research demonstrates that rapid accessto a substance-abuse treatment program is a critical factor for sustainingthe abuser's treatment motivation level (Mejta, Bokos, Mickenberg, Maslar,& Senay, 1997, p. Peters (1992) also reported on the Cook County Jail Project (IMPACT)screening and referral process. Self-help groups such as AA, CA, or NA include the use of the 12-stepprocess. Since most prisonersin the men's facilities go back into the population, follow-up efforts havebeen through mail surveys, with apparently lackadaisical measures andcorrespondingly low response rates. G. They were required to returnregularly for meetings with counselors and attend a weekend retreat everythree months. 66-71).Alternative Therapies Acupuncture. J., & Slomka, S. Dept. Third, a drug-addicted offender is less likely to benefit from otherprograms available in the prison system. It depends uponcounseling, therapy, and education for its success. In Ohio, the program is called the Treatment Continuity Pilot Project,and it was implemented in 1991 to serve both men and women. One model program showing goodresults, the Delaware program, has incorporated the best current knowledgeof effective drug treatment services for a prison population. The program involves petty criminals, alcoholics, and drug addicts,who participate in a program that requires them to sit silently in adarkened room for ten hours a day in meditative retreat. (1992). 2. The federal government has authorized a new pushfor treatment of substance abusers within the prison system. They receive a comprehensiveassessment that may include the Addiction Severity Index, the MAST, or theMortimer-Filkins Test. In a study tracking 326 offenders for 18 months,67% of those in this program had not been arrested, compared to 47% of asimilar group that was tracked prior to the Drug Court (Schulte, pp. Studies indicate that each yearinmates remain drug-free and productive, the U.S. The focus here, however, was not on whether or notthe individual returned to drug use. Peters (1992) provided a range of examples to show how differentprograms dealt with the referral and screening problems. 472; Hooper, 1997, p. (1994). Results showed that 21 of4 patients who received acupuncture were able to complete the drugdetoxification program, compared to one out of 4 control patients.Drinking episodes for the acupuncture group were half those of the controls(Schulte, pp. At the end of one year,118 were successful and 119 were failures; failure was based on requiring amajor corrective action during the year. The researchers indicatedthat there was an optimal treatment dose of three to five months, followedby immediate placement into a community treatment program (Swartz, et al.,1996). (1997) noted that the Department of Justicecited the Delaware model as a program for other states to make use of,indicating that its continuum seemed to support an optimal opportunity forthe prisoners. This is clearly not a place with lowlevels of social deviance, and there can be considerable variability insentencing. Of Health and HumanServices. Jainchilld, Therapeutic community: Advancesin research and application. J. The report provided data on 448 clients who hadbeen re-interviewed at the 18-month period. Wilson (Eds.) Drugs and crime. Evaluating drugtreatment programs. However, to extend the continuum further, intothe offender's residential community, may be problematic in some regions.For Chicago, this is doable. American Psychiatric Association (APA). Urine drug-testing is considered one of the mostimportant methods of monitoring the client; it is done randomly and withfrequency. Science News, 152(19),297. In terms of screening and referral, however,it is quite different from JAS. Peters and May (1992) noted thatonly 7 percent of the programs offer comprehensive services and less than 1percent of the programs offer at least 1 hours of weekly drug treatment.The drug treatment programs that are available are often minimal, withlittle visible success in prison or in terms of recidivism. Transitional services during the work release phase or parole tothe community are essential. Obviously, there are many different ways to deal with inmates duringthe earliest phases of any substance abuse treatment program. They used a multivariate outcome analysis for their evaluation, and an18-month follow-up period. Substancedependence includes the maladaptive use of a substance which leads toimpairment in three or more of the following areas, during a 12 monthperiod: Tolerance, withdrawal, use of larger amounts of substance,persistent desire or inability to control use, large amounts of time spentobtaining the substance or recovering from its use, reduced social,occupational, or recreational activities due to substance use, andsubstance use despite resulting physical or psychological problems (APA,1994). G.Leukefeld and F.M. (1997). (1998). American Indian perspectives on addiction andrecovery. P. There have not been multiple outcome criteria or longitudinaloutcome studies. A therapeutic community model seems to be effective. Collective cultural historyhas an impact on the individual, for some this may be profound, and forothers it may be minimal. On the other hand, the decision to allow an inmate accessto the program depends upon the inmate's need for treatment, assessment ofjob skills and interests, and security level/escape risk. E., & Senay, E. The focus here is on relapse prevention andcommunity reintegration. 2. There is oftenconflict between the two groups. Further Research and Policy Despite their own poor efforts at evaluating the Kentucky and Ohioprograms, Rudy et al. The barriers include (a) client identification,assessment, and referral; (b) recruitment and training of treatment staff;(c) redeployment of correctional staff; (d) overreliance on institutionalversus therapeutic sanction; (e) aftercare; and (f) coercion. Unfortunately, many of the programs under discussion in this studymake use of the AA or NA model, which involves 12 steps and a "spiritual"approach to the problem. For example,American Indian women view their children and relatives as being surroundedby the landscape and having a relationship with all of their physicalenvironment. For example, programsin both Kentucky and Ohio have similar treatment processes. (1997). Acupuncture: Where east meets west. The AmericanJournal of Psychiatry, 154(7), 983-988. For example, both the New York program, Stay Out, and the Oregonprogram, Cornerstone, which are both prison-based TC programs found thatlength of stay was directly correlated with reduced rearrest or return toprison (Field, 1992). Crime and Delinquency, 42(4), 553-573. E., Nurco, D. 473). One study found thatpatients receiving acupuncture were able to remain in treatment twice aslong as the control group (Schulte, 1996, p. Health & Social Work, 23(2), 127-135. Assignment to the first and secondgroups were based on random number. This is followed by an aftercare treatment component.Again, most JSAP referrals come from the court, up to 8 percent, with theother referrals primarily from jail medical departments, classificationofficers, or self-referral. L., Bokos, P. (2 ). The drug abuser was separatedfrom the rest of the prison population for periods up to 12-15 months.During the second phase of treatment, inmates are increasingly exposed todrugs, because work release environments are often rife with drugtrafficking and exposure to new criminal activities. Meditation. Overall, 51 percent of participants (453 total participants) wererearrested during the follow-up period. Anonymous. Bower, B. Transitional services there seemed tobe extremely important in achieving sustained sobriety and reducedrecidivism. In comparing the no-treatment, and treatment groupsin terms of aftercare, the former received about 24 days of treatmentexposure, while the latter average about 116 days of exposure. Lowery, C. These were the times when, in most programs, theywere unprotected, released into milieus that often resembled those in whichthey offended. Regarding recidivism, monitoring approaches that deal with substanceabusers in the criminal justice system, are identified as imperative.Postincarceration treatment of this group requires a treatment/surveillanceapproach. It wasmandated in order for him to receive special privileges in the extendedvisitation program. M. In the 196 s methadone was shown to be helpful for treating heroinaddiction. Lowery (1998) reports further on treatment of substance abuse for theAmerican Indian. Drug courts offer anexample of this management procedure. 28). Treatment ModalitiesTherapeutic Communities/Residential The Therapeutic Community Model. In M.Tonry and J.Q. In C. Substance abuse treatment is cost-effective because it can potentiallyreduce criminal activity around two-thirds, which is close to 1 % of theprison cell cost (Caprio, 2 , p. According to Inciardi et al. Tims (Eds.) Drug abuse treatment inprisons and jails. Studies of the 12-step programs reveal that commitment is a success factor, and it is relatedto general predicted satisfaction and subjective well-being of the patient.Clear ideology is considered to be a factor in these outcomes (Schiff &Bargal, pp. U.S. Treatment of drug abuse. Dept. 226, 232). Journal of Drug Issues, 27(2), 261-278. A placebo-controlled study by Hennepin County Medical Center inMinneapolis studied detox effects of acupuncture. The authors note that mostresearch has looked only at process and only in-prison treatment related tosuccess. Alternative medicine is being practiced by a group ofnonphysician clinicians. Programshave used court referrals, inmate referrals, jail staff referrals, andreferrals from outside social service agencies. Washington, D.C. 369-376). The program should be comprehensive. For example, Dade County, Florida instituted the DrugCourt Diversion Program, where acupuncture treatment is offered as analternative to prison. Review of inmate records; 5. Of the 33 hours of work, only 26 hours were devoted to participation in self-helpgroups, or approximately 1 hour per week. NY: ColumbiaUniversity. Journal of Drug Issues, 27(2), 329-34 . For example, the New York program which was under review by thecourts essentially asserted that the self-help aspects of their substanceabuse program were separate from the formal Alcohol and Substance AbuseProgram (ASAT). D. Journal of Counseling andDevelopment, 72(5), 514-525. While this still leaves a substantial populationrearrested, and rearrested within the first year after release, it is verydifferent from a non-treatment control group which most resembles the 1-3 days inmate group. It depends onwhose criteria you use. Finally, theafter-care treatment dorms involve those prisoners who have completed theintensive treatment phase. These groups were identified as an adjunct to the formalprogram, with ASAT staff not to supervise or chair the groups. Isthere an optimal program length? Outcome measures indicated that members of the third and fourthgroups, which did receive secondary and tertiary treatment in therapeuticcommunity, had much lower arrest-free and drug-free figures than the firsttwo groups, even when controlled for demographic, criminal and drug-historyvariables Most notable were the drug-free reports, with one-third of theclients in the third treatment group and half of the clients in the fourthgroup classified as drug-free after 18 months (Inciardi et al., 1997). For example, theycould explore program failures more deeply with open-ended interviews. A range of research-based pharmacotherapiesfor addiction. Oregon prison drug treatment programs. Traditional. Hilts, P. They noted that findings indicated that thetransitional period, and community-based period, were the most vulnerabletimes for the offenders. Practice guideline for the treatment of patientswith substance use disorders: Alcohol, cocaine, opioids. As Farabee et al.(1999) noted, many prison systems are currently developing programs inplace, but they do not spend sufficient time thinking about how to makethose programs work. The intent is to look at many of theavailable models, comparing and contrasting models in an effort to identifyimportant elements of an effective substance abuse treatment program. To look at one last program, the King County Jail Substance AbuseTreatment Program has developed two separate treatment models dealing withlow to moderate security risk prisoners. Even controlling for other risk factors, the treatmentmodel seemed to be a successful one. Some attempts have been made to show that this grouphad ALDH2 enzyme deficiency, however, other studies have shown that they donot have ALDH2 gene mutations. Journal of Mental Health Administration, 19(1), 53-8 . The program lastsfor ten days and is designed to help addicts and others engage inintrospection and self-reflection to gain insight and develop some self-discipline. (1998). Again, for most of these programs,the real goal is to reduce recidivism, with treating substance abusers ameans to that end.Psycho-educational Not all of the programs are based on the TC model, however. Clients are monitored by the judgeand a drug court case specialist. For the men, the programlasts 12 weeks, while the women's program lasts eight weeks (Rudy et al.,1997). D., Morash, M., & Bynum, T. Instead, they found anoptimal period of treatment that was actually less than the maximum periodavailable. Drug lawviolators accounted for 3 percent of the increase in the state prisonpopulation and 68 percent of the increase in the federal prison populationduring the period 198 -1995 (Department of Justice, 1997). Hanlon, T. This programinvolved three community agencies and operated in Chicago's Cook CountyJail, which has over 1 , detainees. The secondhalf adds relapse prevention work to the list. There is a distinct problem with evaluation of prison programs thatmost of the researchers mentioned. Is Nicotine addictive? Courts have cited inadequatescreening procedures as contributing factors in institutional problemsregarding inmate suicide and drug trafficking (Peters, 1992). For example, one of the mostobvious problems, and one that has been brought to court attention, ismandated AA attendance. Diagnostic andstatistical manual of mental disorders, fourth edition. Other success factors involve along-term aftercare component in which treatment follows the offender backout into the community. Prison - For this study, prison is defined to include jail, and stateor federal prison. In looking specifically at this field of study - the treatment of drug-addicted offenders in prison - there are also many opportunities foradditional research. Thus healing components are spiritual, relational, andintergenerational. (1997). Yet another program is the Jail Substance Abuse Program (JSAP). 55). For example, the drugcourt provides treatment groups and case management services. Several court cases have supportedthe right of prisoners to treatment for both medical and mental healthneeds, with substance abuse potentially falling under the rubric of mentalhealth needs (although it could easily be both). Of health and Human Services in the fall of 199 . DeLeon, G. Swartz et al.(1996) indicated, however, that it did not always work out this way inpractice because of jail overcrowding and program limitations. Vaccines for addiction are currently being explored(O'Brien, pp. Clean urine is rewarded with promotion to the next phase oftreatment (Huddleston, 1998; Logan, et al, pp. Dvoskin, J. A., & Stoflet, S. Swartz, J. (1992). Finally, this program does notexclude inmates because of limited time remaining in jail and does provideup to six months of subsidized follow-up treatment and housing in thecommunity. LAAM (levo-alpha acetyl methadyl)is also being used as an agonist. Forother inmates, the problem may be withdrawal from drugs, if they are notable to obtain drugs inside the prison, or if they decide to use their timefor that purpose. Treatment programs which incorporate any 12-stepprograms cannot be mandated for prison inmates; participation must bevoluntary. Washington, D.C.: U.S. (1994). They also would more easilyunderstand each other's problems in terms of arrest records, criminalhistory, problems obtaining work, and temptations to reoffend. In general, those receivingtreatment had lower rates of drug relapse and criminal recidivism than theno-treatment group. That showed strong support for the value of a TC continuum extendingbeyond the in-prison program. Coercion is a problem thatincludes legal issues (Farabee et al., 1999). One important guidelines is theReport of the national Task Force on Correctional Substance AbuseStrategies which was completed by the national Institute of Corrections.This document emphasized the need to assess offenders needs forsupervision, control, and services, including specific recommendations.These recommendations included: (1) identification, development, andimplementation of a standardized, comprehensive method for assessingsubstance abuse problems; (2) substance abuse assessment at the earliestpossible time and on an ongoing basis; and, (3) recording of assessmentinformation in a cumulative file for evaluative purposes (U.S. Yet, Inciardi et al.(1997) insist that the research consistently supports length of stay as adirect correlate of success in reducing both drug use and rearrest. Garcia-Andrade, C., Wall, T. Peters (1992) noted that there are actually some legal precedents forthinking that inmates have the right to receive appropriate screening andtreatment for substance abuse services. In this programreferral is through several means, including intake counselors,correctional specialists, mental health unit staff, JAS program staff, andself-referral. However, the IMPACT program did obtain results at variancewith the general research emphasizing length of stay as directly correlatedwith reduced drug use and criminal behavior. RN, 59(1 ),55-57. Since programs have used the therapeutic community model and foundsome success with it, it might be helpful to look more closely at thatmodel. Coughlin, this issue was brought to theattention of the courts. IMPACT itself was a residential drug treatment model based on amodified therapeutic community (TC) model. Legal Problems Treatment programs face legal obstacles. Native Americans have the most prevalent rates of alcohol-relateddeath for U.S. It is a highlystructured program with 21.5 hours per week of participation. In other words, those who stayed for 91-15 days were only half as likely to be rearrested as those who stayed from1-3 days (Swartz, 1996). Observation to detect evidence of withdrawal or other effects ofdrug abuse; 7. H. J. A. 17). Although statistics are not available, anecdotal evidencesuggests that individuals who completed one of the two courses madebehavioral changes, both during the jail stay and after release from it(Foster, 1998). These are the two major issues in looking at treatmentprograms for inmates. Cohen (199 ) also noted that there are legal precedents for screeninginmates for substance abuse problems in order to avoid litigation and toestablish accurate and confidential records. Inmates are screened by dorm counselors forsubstance abuse problems and motivation to seek treatment. Thefirewater myth and response to alcohol in Mission Indians. Farabee, D., Prendergast, M., Cartier, J., & Wexler, H. In the Delaware model, it was clear that a majortransition occurred during the work release phase of the individual'sinvolvement with the prison system. There are several stages inwhich residents participate. In addition,results again improved when ex-inmates were provided with further treatmentin community agencies after leaving the jail. Yetprograms can fail right from the start if there is inadequate referral andscreening processes. Rockville, MD: National Institute on DrugAbuse Research. The respondents wereclassified into four groups: (1) those who were placed in a conventionalwork release setting and received neither prison-based nor community-basedTC treatment. Statement of the Problem Prevalence For a number of reasons, the criminal justice system has seen aninflux of inmates who are serving time for drug-related crimes. Self-reports of substance use declined for one month and sixmonth levels, for those who initially felt a desire to attend the 12-stepprogram. The drug-addicted offender islikely to contribute to the recidivism rates, while treatment efforts cansignificantly reduce post-prison substance use and recidivism (Farabee etal., 1999). The same behaviors that put drug addicts in prison arelikely to be continued while the drug addict is still engaged in drug-seeking and using behaviors. Treatment staff of residential programsalso monitor the patient. This seems to immediately reduce exposureto drugs, dysfunctional behavior, violence, and other criminal activity.In itself, the community might be therapeutic simply by being separatedfrom a community that could be considered anti-therapeutic. The success of around 3 acupuncture programs led to their use byprisons and courts. Treatment and training for substance abusingprisoners: Can good public policy be good politics? M. Yet, the benefitis that individuals have already gotten to know each other in the prisonsetting and can extend that camaraderie and support to each other morereadily than strangers might be able to do. Logan, T. The Prison Journal,76(3), 253-266. Finally, they also suggested that researchers work to extendthe research design and research questions to include more basic questions,rather than simply evaluating the specific program. Washington, D.C.:Author. This program will be discussed in greaterdetail in the next section. (1999) noted, administrators in jails and prisonshave little information about developing programs for effective substanceabuse treatment. (1999).Barriers to implementing effective correctional drug treatment programs.The Prison Journal, 79(2), 15 -162. This is a descriptive study basedon a review of the literature. Another significant fact in looking atthe results is that the comparison group is not actually a no-treatmentgroup, although they did not participate in the same treatment as theothers. The program was entitled theIntegrated Multiphase Program of Assessment and Comprehensive Treatment(IMPACT). Jail-based mental health services. SubstanceAbuse, involves repeated use of alcohol or other drugs which leads toproblems, but does not include compulsive use or addiction, and stoppingthe drug does not lead to significant withdrawal symptoms(APA, 1994). Addicts seem to crave theattentive and dependable parenting that the judge provides, and this helpsto engage them in the treatment process (Huddleston, 1998, p. There is an incarceration phase, a work release phase,and a parole phase. Trends in the education andpractice of alternative medicine clinicians. Addiction, 92(11), 1467-1478. This is an anomalous result, however, conflicting with most ofthe other research dealing with length of stay. 66). A. Elementsof these national standards include: 1. Screening at an early stage of incarceration; 2. 4. Tims. A study with 93men and women, treated for substance abuse in one of two hospital-basedprograms using the 12-step approach, reported findings after three weeks oftreatment. This is a common model for inmate programs, even though itseffectiveness has not been studied very effectively. Improving substance abuse treatment access and retention using acase management approach. Mejta, C. (1997). (199 ). (1997). W., & O'Grady, K. 56-57). Peters, R. A treatment program would need to have an understandingof alcoholism and recovery with regard to healing the spirit. Of this group, 8 % are recidivists. Drug courts and jail-based treatment.Corrections Today, 6 (6), 98-1 1. Delawaretreatment program presents promising results. In the therapeutic community, most of the treatment professionals areformer substance abusers who were themselves rehabilitated using thismodel. Griffin vs. Although their purpose is to offer a cost-effectivealternative to traditional criminal case processing, their successfulstrategies can be applied to the prison population. Definition of Terms The most important terms to define are "substance abuse" and "drug-addicted". In developing a model program, then, there are a number of indicatorsof the factors that need to be involved: 1. (1998).Behind bars: Substance abuse and America's prison population. Synergetic counseling and Native AmericanIndian students. Expertand offender perceptions of program elements linked to successful outcomesfor incarcerated women. Those who did not feel motivated to use the program, returned totheir prior levels of substance use (Bower, 1997, p. The traditional Native American tends not torespond well to mainstream counseling, either group or individual, becausethey are culturally taught not to share their personal problems with others(Herring, 1996, pp. There have beenseveral problems in the process, including premature release of inmates,because of dropout or movement to a new facility. McCusker, J., Bigelow, C., Vickers-Lahti, M., Spotts, D., et al.(1997). At that point, a morecomprehensive assessment, including inmate interview would be helpful.Peters (1992) emphasis on ongoing screening is also an excellent one. One program that has gained quite abit of attention at the national level is the substance abuse treatmentprogram instituted in the prison system in the state of Delaware.Essentially that program is predicated upon the belief that in order to beeffective with drug-addicted offenders, treatment must extend beyond theprison stay and into the community with the offenders (Inciardi et al.,1994). Studies with American Indian female drug addicts,showed that a 9 -day program was not long enough to address the issuesinvolved in substance abuse (Lowery, 1998).Self-help Groups The benefits of self-help groups have been reported. Thus, theydid not focus on the contribution of any specific components, but on theoverall program effects. After-Care After-care is considered a critical element in the treatment outcomefor substance abusers. Currently acupuncture is being used for the treatment ofsubstance abuse (Cooper, & Stoflet, 1996, pp. The substance abuse field, even for those outside the prison system,does not have all the answers. Schiff, M., & Bargal, D. Nevertheless, at present,substance abuse treatment has less court support as a mandate, with somesupport as treatment for detoxification and prevention (Dvoskin, 1991). In a sample of 237 paroles assigned to this approach, treatmentincluded weekly counseling and urine monitoring. This program uses a therapeutic community (TC) model,which seems to be a popular one in the prison systems. M. The program is based ona total abstinence model and recommends participation in self-help groupsusing the 12-step approach (Conlon, 1997). This is a major part of theprogram, but a very low rate of attendance in 12-step groups. Conlon (1997) indicated that this finding by the court, and findingsin other jurisdictions, has made it more difficult for addicts to receiveeffective treatment. (1994). For example, they suggested incorporating into the researchdesign ways to determine if counseling is or is not influencing the "inmatecode" in positive and productive ways. Dept. Medications are used to treatintoxication and withdrawal states (clonidine), act as antagonistsdecreasing reinforcing effects (naltrexone), discourage substance use(disulfiram; Antabuse), work as agonist substitutes (methadone), and treatcomorbid psychiatric conditions (Anonymous, 1995, p. Residential Model. First, a drug-addicted offender in the prison system presents high potential forcorruption. A., Hooper, R. Evidence shows that acupuncture helps patientsovercome alcohol, drugs, and tobacco addiction. E. The Delaware Department of Corrections began its program during theearly 199 s, using a substance abuse treatment model that is triphasic.The three phases correspond to the phases of the inmates experience withthe prison system. Vital Speeches of theDay, 66(15), 471-473. Huddleston, C. Swartz et al (1996) noted that the realpolitiks of thesituation are such that the only programs likely to continue to receivefunding, be incorporated in other jails, are those which reduce recidivismrates. However, those only completing thefirst phase of treatment in the prison-based therapeutic community did notdo as well. M. McCusker, Bigelow, Vickers-Lahti, and Spotts (1997) compared effectsof a residential drug abuse treatment program and a relapse preventionprogram, using 742 subjects. Journal of Church and State, 39(3), 427-454. In a study of female offenders, findingsshowed that one of the important success factors of a community program wasthe supervision and services that addressed specific needs of the offender(Koons, Burrow, Morash, & Bynum, 1997, p. Drug-addicted - For the purpose of this study, drug-addicted isdefined as substance dependence as defined by the DSM-IV. The Delaware model further exemplifies the importance of after-carein a treatment program. K., Williams, K., Leukefeld, C., & Minton, L. The important thing to funders is that reducing drug use reducescrime rates and rearrest. Inciardi, J. Purpose of the Study The purpose of this study is to explore the literature related tosubstance abuse treatment in the prison system in order to learn whichprograms are most effective in helping drug-addicted offenders achieve andsustain sobriety. In looking at the effectiveness of TCs, research has indicated thatthey are most effective for those who exhibit low levels of social devianceand who remain in the treatment setting for the longest periods of time(Condelli and Hubbard, 1994). Referrals to the program are coordinatedin-house by classification officers, correctional officers, and programcounselors. Coughlin: Mandated AA meetings andthe establishment clause. There are no guarantees for any individualentering a program to obtaining long-term sobriety. 279-3 4). In examining some of the model programs, it seems clear that length ofprogram and extending treatment into the community contribute to positiveresults. E. Helping characteristics of self-help and support groups: Their contribution to participants' subjectivewell-being. As a consequence, most evaluation studies focuson this factor. Theproblem, then, arouse with the connection of 12-step participation to thespecial prison visitation program. Since overcoming drugaddiction helps inmates to become more productive and remain out of prison,the need for an adequate drug treatment program is evident (Foster, 2 ,p. Center on Addiction and Substance Abuse. Needs for Comprehensive Treatment Research demonstrates the need for comprehensive treatment. Although these are related, they are not exactly the same. 297). Some of the comparison group did obtain treatment help, with 56percent of that group actually reporting some treatment during the 18 daysafter prison release. Herring, R. Schulte, E. I. There, prisons are located in more rural environments and,upon release, prisoners are likely to go back into the cities. Although it has become clear that detoxification alone is notenough to end addiction, it remains part of the treatment process, as doseveral medications (O'Brien, 1997, p. (1997). T. They have used informalinitial screenings, followed by more comprehensive assessments. During the next stage,inmates are transferred for 9 days into one or two intensive treatmentdorms. Comprehensive services also seem to provide benefits. Self-help group characteristics include the instillation of hope, an alternativeto loneliness, support, the teaching and learning of coping methods, andthe communication of experiential knowledge (Schiff & Bargal, 2 , pp. The IMPACTprogram, too, has had problems due to unexpected release of inmates fromthe treatment dorms, primarily due to jail overcrowding. Peters, R. (1998). G., & May, R. It would behelpful to research this situation, determining if the therapeuticcommunity can be reformed at a different location, combining one or more ofthe graduating groups into a new, extended therapeutic community. Institutional problems may occur with the recruitment and training oftreatment staff and the redeployment of correctional staff. Substance Abuse Treatment In Prisons Introduction One would not automatically assume that drugs are available inprisons, which seem designed to eliminate that kind of contraband, but manyinmates still manage to gain access to them (Farabee et al., 1999). Caprio, J. Written procedures to guide the referral and screening process;and, 8. The basic treatment method is socioeducational. Foster, D. Someinmates may not be evidencing drug abuse upon intake, or may not beinterested in treatment at that point. 983-988). D. Essentially, the New York Court of Appeals (which reversed theAppellate Division) held that the 12 steps of AA amounted to a religiousexercise as a matter of law and that adherence to the AA fellowshipinvolved engagement in both religious activity and religious proselytizing(Conlon, 1997). 99; Logan,Williams, Leukefeld, & Minton, 2 , pp. (1997). Peters (1992) noted that the referral process is absolutely vital tothe success of an in-house program. A., Martin, S. Treatment Monitoring Treatment monitoring with community based supervision and urinetesting have been found to be effective in the management andrehabilitation of substance-abusing offenders. Interview with the inmate; 6. Inthis program, developed by the Washington County Health Department inHagerstown, MD, there is an in-jail program of six weeks in a 17-bedtreatment unit. Additional consideration is given for the culturallyappropriateness of treatment programs for minorities, such as NativeAmericans. If inmates do not even know about theprogram, have inadequate information about it, have negative informationabout it, and do not know how to go about obtaining services, this is aserious stumbling-block to service usage. Training of correctional and other staff involved in referral andscreening. Corrections Today, 56(1),34-47. Jail tries mental boot camp' - meditation appearsto help some inmates. Further exploration of the use of therapeutic communities thatextend outward from the prison and into the community after release.Obviously this will not be as effective in instances in which prisons arelocated in areas where prisoners do not wish to live. OfJustice, 1991). Conlon, L. Those programsthat were the most intensive, such as Delaware's program, seemed to gaingood results both in sustaining prisoner abstinence and lesseningrecidivism rates. Planned duration of residential drug abuse treatment: Efficacyversus effectiveness. In the Delaware model, the first phase of treatment involved atherapeutic community within the prison. Client monitoring is part ofthe program, throughout treatment and once released for work activities.The involvement of the judge as a parental authority figure appears to becritical to the success of the program. They may have no guidance about establishing standards forselecting inmates for such programs and little interest in them. S., Butzin, C. In Kentucky,the men's program operates for 9 days with open admission. D., & Hser, V. Adrug court process evaluation: Methodology and findings. OfJustice: Intervening with substance-abusing offenders: A framework foraction. Of Justice, Federal Bureau of Prisons. Corrections Today, 59(6), 12 -124+. Both are based on the diseasemodel of treatment, include 12-step meetings, group treatment, drugeducation, and life skills work. Inmates were encouraged to return to the work release therapeuticcommunity for reinforcement sessions. For example, theJail Addiction Services program was developed from a grant through the U.S.Dept. A., Burrow, J. This is the ideal situation. 32 ). InternationalJournal of Offender Therapy and Comparative Criminology, 44(3), 369-394. S. Still, the focus was ona higher power and a spiritual solution to a substance abuse problem. That offender has to obtain drugs from somewhere and thisundercuts the integrity of the system. (1992). It is important to have goodrelationships between the two groups and clear guidelines dealing withtherapeutic and institutional roles and sanctions (Farabee et al.). Further, evidence indicated that additionalcommunity treatment also had positive results, reducing rearrest rates evenfurther, including for those inmates with optimal IMPACT treatment time(Swartz, 1996). Thisdoes not provide enough time for these systems to do appropriate planningand evaluation. InF. Substance UseDisorder essentially involves both dependence upon and abuse of drugs whichare taken voluntarily for the purpose of their effect on the centralnervous system or to prevent or reduce withdrawal symptoms. (1996). Ongoing screening; 3. Self-help groups are distinguished from support groups.Support groups offer emotional support and information to those with acommon problem. 56-57). The response of drug abuser parolees to a combination of treatment andintensive supervision. The Alcohol andSubstance Abuse Program (ASAT) is an umbrella program operated by the NewYork State Department of Correctional Services. M. Acupuncture began to be accepted by medical authorities in the 197 s,when they discovered the endorphins of the brain. Substance abuse prevention and intervention:An expanded perspective for counselors. (1997)are feeling their way along, trying to determine what would constituteeffective research on drug treatment effectiveness.Medical Model The medical model continues to be a part of substance abusetreatment. Hooper, R. Only 24 percent ofsurveyed inmates had ever participated in a drug treatment program (Bureauof Justice Statistics, 1991). N., Batemen, R. One program in King County has merely a three-weekprogram; other programs extend well over a year. (1991). Another apparently successful program operatedwith different organizational and processing constraints. L., Wellisch, J., & Wong, M. In C. If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.