Thursday, October 12, 2006

Principles of Effective Drug Abuse Treatment

Thanks to our friends at JRSA, now at their BJS/JRSA national conference, we are pointed to an interesting recent publication by the National Institute on Drug Abuse (NIDA), Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide.

One notable feature of this publication is its emphasis on evidence-based research findings to support public policy innovation. We carry-on about that topic enough in these pages – Enough said (for now).

Let’s take a quick look at a handful of these 13 NIDA principles:

#2. Recovery from drug addiction requires effective treatment, followed by management of the problem over time.
# 3. Treatment must last long enough to produce stable behavioral changes.
# 5. Tailoring services to fit the needs of the individual is an important part of effective drug abuse treatment for criminal justice populations.
# 7. Treatment should target factors that are associated with criminal behavior.

The case for drug treatment in criminal justice settings is by now pretty obvious to most of the people that would read this post. I suspect most of us are likely to agree on several things (right?):
a) Effective treatment decreases drug use and criminal behavior, thus promoting public safety;
b) Just about every jurisdiction does some of it (but not enough to match the need) in settings such as jails, prisons, halfway houses, etc;
c) No treatment is 100% effective, or has to be to achieve cost-effective and public safety enhancing results (no justice-regarding policy is 100% effective in promoting public safety ends);
d) Treatment is not a one-size-fits-all deal; and
e) Sure, people have to want to change, but criminal justice system coercion can be an effective way to meet #3 above and keep people in the program long enough to make a difference.

And NIDA points out the economic argument in favor of greater resources to treatment services for criminal justice populations:
In 2002, it was estimated that the cost to society of drug abuse was $180.9 billion (Office of National Drug Control Policy, 2004), a substantial portion of which—$107.8 billion—is associated with drug-related crime, including criminal justice system costs and costs borne by victims of crime. The cost of treating drug abuse (including research, training, and prevention efforts) was estimated to be $15.8 billion, a fraction of these overall societal costs.

So, since we’re all in so much agreement, why don’t we do better and pursue treatment options more frequently and more consistently?

It’s expensive, and we can all bandy about cost-benefit ratios (treatment in an effective community program in lieu of prison), but it is still a substantial expense to shell out up front. It’s not just the treatment itself that is expensive. It’s making that treatment effective by following the NIDA principles:
Time in treatment (# 3 above) has to be more than a quick stop less-than-one-month program that is so common. It’s expensive to run such programs, resource-intensive etc.
Effective Assessment (# 5 above) is expensive too. Doling out cookie-cutter services to every offender that fits the profile of a “non-violent” offender (one that looks more deserving and less dangerous on the face of it) is a foolish waste of scarce resources, but it costs money to save money.
Follow-up to treatment is very important (# 2 above), and that means a steady and consistent commitment over a long time, and that’s expensive too.

It’s not very popular, and may not get a lot more popular. We run the risk of being viewed as providing services to a seemingly less deserving population. Lot’s of people have drug abuse problems that do not commit crime, a more sympathetic group. It’s a tough sell for politicians if it becomes a battle for scarce treatment resources between convicted criminals and law-abiding citizens, cost-benefit ratios and the expense of imprisonment not withstanding. There are a lot of ways we might address this problem, for example community court settings that provide services to all comers….

Having said all this, it should be said that all over the country we can point to programs that are making a difference. A lot of good people are making a difference in a lot of communities. But it’s frustratingly slow to develop.


future said...

Affordable Drug Rehabs Center are given to the people who can not afford the costly private rehabilitation clinics on very affordable price. They are generally run by government and non profit organizations.

rehabs guru said...

People can check whether they are suffering with addiction or not. There are numerous drug test used by drug addiction treatment center
. Urine test, Hair test, Saliva test, Sweat test are example of it. On the basis of test different therapies will perform.

brett said...

There are various substances used illegally for creating pleasure and increasing physical capabilities. But regular uses of these drugs make people addicted. Drug abuse treatment is necessary for patient to live long.

mjscottlanyard said...

Effectiveness of drug abuse treatment is based on the person, There are many rehabilitation that treat not only drug addicts, they also treat alcoholics.
teen alcohol treatment