Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety

“These stimuli trigger automatic responses that frequently drive relapse, even in individuals motivated to stop taking drugs.(63) The”

“One can also predict that dysfunction in this neurocircuitry would reduce an addicted person’s motivation to abstain from drug use because alternative reinforcers (natural stimuli) arecomparativelyweakerand negative consequences (eg, incarceration) are less salient.(62)”

“Additionally, repeated drug use also affects brain regions implicated in mood and anxiety, which could explain the high rate of addiction comorbid with dysphoria, depression, or both and the vulnerabilityof theaddictedpersontorelapsewhen exposed to social stressors.(65,66) Impairment of the neural substrates affected…”

“Failure to receive treatment on release increases the risk not only of relapse but alsoofmortality fromdrugoverdoseand other causes.(44) Infectious diseases such as HIV and hepatitis C are associated with illicit drug use and occur at higher rates in correctional populations than in the general population,(5) but trea…”

“As discussed below, these conditioned cues automatically activate the reward/ motivational neurocircuitry and can trigger an intense desire to consume drugs (craving).(13) The molecular and neurobiological adaptations resulting from chronic drug use persist for months after drug discontinuation,(14) and evidence exist…”

“Disruption of these circuits impairs the addicted person’s ability to inhibit intentional actions or to control strong emotions and desires and also increases the likelihood that the individual will have difficulties making adaptive decisions.(60,61) Addiction also decreases sensitivity in the reward and the motivatio…”

“The persistence of neurologic deficits provides support for the recognition of addiction as a chronic disease and highlights the need for the same continuity of care so important in treatment of other chronic diseases (eg, asthma, hypertension).(72) It also suggests that agonist medications such as methadone are impor…”

“Addicted individuals tend to have higher levels of temporal discounting than those who do not use drugs; ie, they tend to choose immediate, smaller rewards over future, larger rewards.(69) High temporal discounting is also associated with impulsivity—the inability to delay immediate gratification and to recognize the…”

“In addition to addressing drug use behaviors, treatment outcomes improve when antisocial and criminal behaviors are targets of clinical intervention.(76) Criminal justice professionals must develop an understanding of addiction—signs and symptoms, treatment, and relapse— and their role in facilitating recovery.”

“Continuity of treatment for released offenders with infectious disease is crucial not only for the individual’s health(51,52) but also for the health of the community.(45,53) There are many barriers to treatment for the drug-involved offender, including lack of the resources, infrastructure, and treatment staff (inclu…”

“8 times better in reducing drug use than the usual alternatives.(20) In a meta-analysis of 66 incarceration-based treatment evaluations, therapeutic community and counseling approaches were respectively 1.”

“In a recent survey of correctional programsandorganizationsacrosstheUnited States,(42) most correctional agencies reportedprovidingsometypeofdrugabuse treatment services;however, themedian percentage of offenders who had access tothoseservicesatanygiventimewaslow, usually less than 10% (TABLE 2).(42) Even if a correct…”

“Molecular and neuroimaging studies have helped illuminate how genes may affect vulnerability to addiction and how repeated use of addictive drugs causes long-lasting disruptions to the structure and function of the brain.(55) Among the genes identified to contribute to the vulnerability for addiction are those that pa…”

“Research over the last 2 decades has consistently reported the beneficial effects of treatment for the drug abuser in the criminal justice system.(16,17) These interventions include therapeutic alternatives to incarceration, treatment merged with judicial oversight in drug courts, prison- and jail-based treatments, an…”

“Research over the last 2 decades has consistently reported the beneficial effects of treatment for the drug abuser in the criminal justice system.(16,17) These interventions include therapeutic alternatives to incarceration, treatment merged with judicial oversight in drug courts, prison- and jail-based treatments, an…”

“Individuals who participated in prisonbased treatment followed by a community-based program postincarceration were 7 times more likely to be drug free and 3 times less likely to be arrested for criminal behavior than those not receiving treatment.(29,30) The benefits of medications for drug treatment were shown in a r…”

“Punishment alone is a futile and ineffective response to drug abuse,(2) failing as a public safety intervention for offenders whose criminal behavior is directly related to drug use.(81) Addiction is a chronic brain disease with a strong genetic component that in most instances requires treatment.”

“Even if a correctional institution does provide treatment, the continuity of treatment postincarceration,whichisessentialtorecovery,(16) isoften lackingwhenthedruginvolvedoffender transitions fromincarcerationtocommunitysupervision.(43)Failure to receive treatment on release increases the risk not only of relapse but…”

“enhanced sensitivity to drugs as rewards and the conditioning to associated drug cues increase the interoceptive awareness of discomfort (anxiety and tension) that occurs when the individual is exposed to drug cues and increase the desire to consume the drug.(64) Additionally, repeated drug use also affects brain regi…”

“By contrast, the average cost of methadone is $4000 per month,(37) and treatment with methadone has demonstrated effectiveness in reducing drug use and criminal activity following release.(31) Alternatives to incarceration can also defray job productivity losses and the separation from family and social support system…”

“Addiction is a chronic brain disease for which genetic factors are believed to contribute 40% to 60% of the vulnerability.(54) Repeated drug exposure in individuals who are vulnerable (because of genetics, or developmental or environmental factors) trigger neuroadaptations in the brain that result in the compulsive dr…”

“Although many of the neurobiological changes associated with repeated drug use persist for long periods after drug discontinuation,(71) research suggests that the impaired brain can regain some of the functions damaged by use of illicit drugs over time.(73) Second, neuroscience establishes a biological framework for u…”

“5 times more likely to reduce reoffending.(27) Drug courts combine judicial supervision with drug treatment as an alternative to incarceration; their graduates have rearrest rates about half those of matched comparison samples and much lower than those of drug court dropouts.”

“Evidence-based behavioral interventions include cognitive therapies that teach coping and decision-making skills, contingency management therapies that reinforce behavioral changes associated with abstinence, and motivational therapies that enhance the motivation to participate in treatment and in non– drug-related ac…”

“Many of the neurobiological changes associated with repeated drug use persist for long periods after drug discontinuation.(71) This helps explain why addicted individuals who have ceased drug use are at high risk of relapse and provides neurobiological support for the recognition of addiction as a chronic relapsing di…”

“Disruption of these circuits impairs the addicted person’s ability to inhibit intentional actions or to control strong emotions and desires and also increases the likelihood that the individual will have difficulties making adaptive decisions.(60,61) Addiction also decreases sensitivity in the reward and the motivatio…”

“The potential exists for immediate adoption of methadone maintenance for incarcerated persons with opioid addictions, but most prison systems have not been receptive to this approach.(34) Economic analyses highlight the cost-effectiveness of treating druginvolved offenders.”

“Impairment of the neural substrates affected by addiction—particularly those concerned with behavioral inhibition, control of emotions and desires, and decision-making—increase the likelihood that addicted individuals will make choices that appear impulsive.(67,68) This idea is supported by research in the emerging ar…”

“The large increase in the criminal justice population reflects in part tougher laws and penalties for drug offenses.(2) An estimated one-half of all prisoners (including some sentenced for other than drug offenses) meet the criteria for diagnosis of drug abuse or dependence (TABLE 1).”

“These include the stigma associated with being labeled an ex-offender, the need for housing and legitimate employment, stresses in reunifying with family, and multiple requirements for criminal justice supervision.(11,12) Returning to neighborhoods associated with preincarceration drug use places the addicted individu…”

“Additionally, repeated drug use also affects brain regions implicated in mood and anxiety, which could explain the high rate of addiction comorbid with dysphoria, depression, or both and the vulnerabilityof theaddictedpersontorelapsewhen exposed to social stressors.(65,66) Impairment of the neural substrates affected…”

“Among the genes identified to contribute to the vulnerability for addiction are those that participate in the neuroplastic changes associated with learning.(56) Imaging studies have identified multiple brain circuits that are disrupted in addicted persons(57); these include circuits involved in reward and motivation,…”

“These economic benefits in part reflect reductions in criminal behavior.(40,41) Access to Treatment Drug education—not drug treatment— is the most common service provided to prisoners with drug abuse or addiction problems.”

“Economic analyses highlight the cost-effectiveness of treating druginvolved offenders.(35) On average, inTable 1.”

“One dollar spent on drug courts is estimated to save approximately $4 in avoided costs of incarceration and health care,(38) and prison-based treatment saves between $2 to $6.(39) These economic benefits in part reflect reductions in criminal behavior.”

“Infectious diseases such as HIV and hepatitis C are associated with illicit drug use and occur at higher rates in correctional populations than in the general population,(5) but treatment for these conditions appears to fall short of need.(45,46) It is feasible to implement screening and treatment in correctional sett…”

“Continuity of treatment for released offenders with infectious disease is crucial not only for the individual’s health(51,52) but also for the health of the community.(45,53) There are many barriers to treatment for the drug-involved offender, including lack of the resources, infrastructure, and treatment staff (inclu…”

“Individuals who participated in prisonbased treatment followed by a community-based program postincarceration were 7 times more likely to be drug free and 3 times less likely to be arrested for criminal behavior than those not receiving treatment.(29,30) The benefits of medications for drug treatment were shown in a r…”

“It is feasible to implement screening and treatment in correctional settings for HIV(47,48) and hepatitis C.(49,50) Continuity of treatment for released offenders with infectious disease is crucial not only for the individual’s health(51,52) but also for the health of the community.”

“Over the past decade, scientific, public health, and policy efforts have been directed at improving prisoner reentry (13, 14).”

“However, as few as 15% of inmates in need of drug treatment actually receive it during incarceration (11, 17, 27).”

“A history of drug use or misuse is pervasive among prison inmates by every measure, including prior use, use at the time the offense is committed, drug abuse, and drug dependence [2-4].”