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Implementing Effective. Substance Abuse Treatment. In the Criminal Justice System. Nora D. Volkow, M.D. Director National Institute on Drug Abuse. U.S. Adult Offender Population. Corrections officials estimate 70-85% of inmates need drug treatment (GAO, 1991) 68% of jail inmates

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slide1

Implementing Effective

Substance Abuse Treatment

In the Criminal Justice System

Nora D. Volkow, M.D.

Director

National Institute on Drug Abuse

u s adult offender population
U.S. Adult Offender Population

Corrections officials

estimate 70-85% of

inmates need drug

treatment (GAO, 1991)

68% of jail inmates

report regular drug

use (BJS, 2005)

In 2007, an estimated 7.3 million adults were

involved in the criminal justice system

slide3

Share of adults under correctional control, year end 2007

Source: Pew Center on the States, March 2009.

incarceration for drug offenses disproportionately affects minority populations

1

19

4

6

15

12

11

16

58

70

65

23

Incarcerated

for Drug

Offense ***

Drug Abuse/

Population

Dependence *

Incarceration for Drug Offenses Disproportionately Affects Minority Populations

100%

80%

60%

40%

20%

0%

White

Black

Hispanic

Other

Sources: * 2002 NSDUH, DHHS, SAMHSA, 2003.

** CDC HIV/AIDS Surveillance Report 2002.

*** Prisoners in 2002, BJS Bulletin, DOJ/OJP, July 2003.

(estimated number of sentenced prisoners under State jurisdiction, 2001)

slide5

Many Offenders Have a Drug Use Disorder …

But Few Receive Treatment

Mumola & Karberg. Drug use and dependence, state and federal prisoners, 2004. BJS, 2006 (rev 07)

slide6

Without Treatment & Aftercare

Drug Use & Recidivism Rates are High

CREST Completers + Aftercare

CREST Completers + Aftercare

No Treatment

No Treatment

CREST Dropouts

CREST Dropouts

CREST Completers

CREST Completers

Delaware Work Release TC (Crest) + Aftercare

Drug-Free an Arrest-Free 3 Years After Release (N=448)

100

*

80

69

Arrest-Free

Drug-Free

*

55

60

*

35

*

29

40

28

27

*

17

20

5

0

Martin, Butzin, Saum, & Inciardi (1999), The Prison Journal

* p < .05 from Comparison

slide7

Relative Risk of Death Among Former Inmates

of the Washington State Department of Corrections

Compared to Other State Residents @ 2 Weeks Post Release

14

12

10

8

Relative Risk of Death

6

4

2

0

Liver

Overdose

CV

Homicide

Suicide

MV

Disease

Disease

Accident

Binswanger, IA et al., NEJM 356(2):157-165, 2007.

slide8

drug use/

incarceration

Landscape of Consequences

adverse life events increase

risk for substance abuse

slide9

ADDICTION IS A DISEASE OF THE BRAIN

Dopamine D2 Receptors are Lower in Addiction

DA

DA

Cocaine

DA

DA

DA

DA

DA

DA

DA

DA

DA

DA

Reward Circuits

Non-Drug Abuser

Meth

DA D2 Receptor Availability

DA

DA

DA

Alcohol

DA

DA

DA

Reward Circuits

Drug Abuser

Heroin

Adapted from Volkow et al.,

Neurobiology of Learning and

Memory 78:610-624, 2002.

control

addicted

slide10

Dominant

Subordinate

Individually

Housed

Group

Housed

50

40

30

Reinforcers (per session)

*

*

Dominant

20

10

0

S

.003

.01

.03

.1

Cocaine (mg/kg/injection)

Subordinate

Morgan, D. et al. Nature Neuroscience, 5: 169-174, 2002.

slide11

Treatment Linkage & Days Used Heroin

6 Months Post-release

Days In Treatment

Days Used Heroin

90%

85%

80%

64%

70%

57%

60%

50%

46%

35%

40%

30%

20%

11%

10%

0%

C

C

+

T

C

+

M

C = Counseling Only

C+T = Counseling & Treatment Referral

C+M = Counseling & Methadone Started in Prison

Source: Gordon, MS et al., Addiction 103:1333-1342, 2008.

slide12

Treating Addiction in the

Criminal Justice System is Cost-Effective

Cost of

Treatment

(average cost for

1 year of methadone

maintenance treatment)

Cost of

Incarceration

$4,700

$24,000

(cost of one full year

of imprisonment)

slide13

Although Treatments For Addiction Are Available,

They Are Not Being Widely Used

By Those Who Need Them

Location TX Received

In 2007 An Estimated

22.3 Million Americans

Were Dependent On or Abused

Any Illicit Drugs or Alcohol

But…Only 3.9 Million (17%)

of These Individuals

Had Received Some Type of

Treatment In the Past Year

2.2

Self Help Group

Outpatient Rehab

Inpatient Rehab

Outpatient Mental

Health Center

Hospital Inpatient

Private Doctor’s

Office

Emergency Room

Prison or Jail

1.7

1.0

0.9

0.8

0.6

0.5

0.3

0 .5 1.0 1.5 2.0 2.5

Numbers in Millions

Source: 2007 NSDUH, National Findings, SAMHSA, OAS, 2008.

slide14

Research Center

Blending Research & Practice

CJ-DATS Focus Areas

  • Understanding systems
  • Assessing offender

problems

  • Measuring progress in

treatment

  • Linking criminal justice

& drug treatment

  • Adolescent interventions
  • HIV & hepatitis risk

reduction

NIDA Criminal Justice

Drug Abuse Treatment Studies (CJ-DATS)

Research Centers & CJ Partner Sites

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