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Is legally mandated treatment effective?

FREQUENTLY ASKED QUESTIONS (FAQS) About Drug Abuse Treatment for People Involved with the Criminal Justice System

Reprinted from “Principles of Drug Abuse Treatment for Criminal Justice Populations” by the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center.

5. Is legally mandated treatment effective?

Often, the criminal justice system can apply legal pressure to encourage offenders to participate in drug abuse treatment; or treatment can be mandated through a drug court or as a condition of pretrial release, probation, or parole. A large percentage of those admitted to drug abuse treatment cite legal pressure as an important reason for seeking treatment.

Most studies suggest that outcomes for those who are legally pressured to enter treatment are as good as or better than outcomes for those who entered treatment without legal pressure. Individuals under legal pressure also tend to have higher attendance rates and remain in treatment for longer periods, which can also have a positive impact on treatment outcomes.

Are all drug abusers in the criminal justice system good candidates for treatment?

FREQUENTLY ASKED QUESTIONS (FAQS) About Drug Abuse Treatment for People Involved with the Criminal Justice System.

Reprinted from “Principles of Drug Abuse Treatment for Criminal Justice Populations” by the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center.

4. Are all drug abusers in the criminal justice system good candidates for treatment?

A history of drug use does not in itself indicate the need for drug abuse treatment. Offenders who meet drug dependence criteria should be given higher priority for treatment than those who do not. Less intensive interventions, such as drug abuse education or self-help group participation, may be appropriate for those not meeting criteria for drug dependence. Services such as family- based interventions for juveniles, psychiatric treatment, or cognitive- behavioral interventions for changing “criminal thinking” may be a higher priority for some offenders, and individuals with mental health problems may require specialized services.

Low motivation to participate in treatment or to end drug abuse should not preclude access to treatment if other criteria are met. Motivational enhancement interventions may be useful in these  cases. Examples include motivational interviewing and contingency management techniques, which often provide tangible rewards in exchange for meeting program goals. Legal pressure that encourages abstinence and treatment participation may also help these individuals by improving retention and prompting longer treatment stays.

Drug abuse treatment is also effective for offenders who have a history of serious and violent crime, particularly if they receive intensive, targeted services. The economic benefits in avoided crime costs and those of crime victims (e.g., medical costs, lost earnings, and loss in quality of life) may be substantial for these high-risk offenders. Treating them requires a high degree of coordination between drug abuse treatment providers and criminal justice personnel to ensure that the prisoners receive needed treatment and other services that will help prevent criminal recidivism.

The Roles of Culture, the Justice System and Support Groups in Adolescent Drug Treatment , Part 8.

The Roles of Culture, the Justice System and Support Groups in Adolescent Drug Treatment, Part 8

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

15. What are the unique treatment needs of adolescents from different racial/ethnic backgrounds?

Treatment providers are urged to consider the unique social and environmental characteristics that may influence drug abuse and treatment for racial/ethnic minority adolescents, such as stigma, discrimination, and sparse community resources.

With the growing number of immigrant children living in the United States, issues of culture of origin, language, and acculturation are important considerations for treatment. The demand for bilingual treatment providers to work with adolescents and their families will also be increasing as the diversity of the U.S. population increases.

16. What role can the juvenile justice system play in addressing adolescent drug abuse?

Involvement in the juvenile justice system is unfortunately a reality for many substance-abusing adolescents, but it presents a valuable opportunity for intervention. Substance use treatment can be incorporated into the juvenile justice system in several ways.

These include:
• screening and assessment for drug abuse upon arrest
• initiation of treatment while awaiting trial
• access to treatment programs in the community in lieu of incarceration (e.g., juvenile treatment drug courts)
• treatment during incarceration followed by community-based treatment after release

17. What role do 12-step groups or other recovery support services play in addiction treatment for adolescents?

Adolescents may benefit from participation in self- or mutual-help groups like 12-step programs or other recovery support services, which can reinforce abstinence from drug use and other changes made during treatment, as well as support progress made toward important goals like succeeding in school and reuniting with family. Peer recovery support services and recovery high schools provide a community setting where fellow recovering adolescents can share their experiences and support each other in living a drug-free life.

It is important to note that recovery support services are not a substitute for drug abuse treatment. Also, there is sometimes a risk in support-group settings that conversation among adolescents can turn to talk extolling drug use; group leaders need to be aware of such a possibility and be ready to direct the discussion in more positive directions if necessary.

Questions about Medications to Treat Adolescent Drug Use

Questions about Medications to Treat  Adolescent Drug Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

13. Are there medications to treat adolescent substance abuse?

Several medications are approved by the FDA to treat addiction to opioids, alcohol, and nicotine in individuals 18 and older. In most cases, little research has been conducted to evaluate the safety and efficacy of these medications for adolescents; however, some health care providers do use these medications “off-label,” especially in older adolescents.

14. Do girls and boys have different treatment needs?

Adolescent girls and boys may have different developmental and social issues that may call for different treatment strategies or emphases.

For example, girls with substance use disorders may be more likely to also have mood disorders such as depression or to have experienced physical or sexual abuse.

Boys with substance use disorders are more likely to also have conduct, behavioral, and learning problems, which may be very disruptive to their school, family, or community. Treatments should take into account the higher rate of internalizing and traumatic stress disorders among adolescent girls, the higher rate of externalizing disruptive disorders and juvenile justice problems among adolescent boys, and other gender differences that may play into adolescent substance use disorders.

How effective is drug abuse treatment for criminal justice-involved individuals?

FREQUENTLY ASKED QUESTIONS (FAQS) About Drug Abuse Treatment for People Involved with the Criminal Justice System.

Reprinted from “Principles of Drug Abuse Treatment for Criminal Justice Populations” by the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center.

3. How effective is drug abuse treatment for criminal justice-involved individuals?

Treatment is an effective intervention for drug abusers, including those who are involved with the criminal justice system. However, the effectiveness of drug treatment depends on both the individual and the program, and on whether interventions and treatment services are available and appropriate for the individual’s needs.

To alter attitudes, beliefs, and behaviors that support drug use, the drug abuser must engage in a therapeutic change process, which may include medications to help prevent relapse. Longitudinal outcome studies find that those who participate in community-based drug abuse treatment programs commit fewer crimes than those who do not participate.

Questions About Medications to Treat Adolescent Drug Abuse, Part 7

Questions about Medications to Treat  Adolescent Drug Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

13. Are there medications to treat adolescent substance abuse?

Several medications are approved by the FDA to treat addiction to opioids, alcohol, and nicotine in individuals 18 and older. In most cases, little research has been conducted to evaluate the safety and efficacy of these medications for adolescents; however, some health care providers do use these medications “off-label,” especially in older adolescents.

14. Do girls and boys have different treatment needs?

Adolescent girls and boys may have different developmental and social issues that may call for different treatment strategies or emphases.

For example, girls with substance use disorders may be more likely to also have mood disorders such as depression or to have experienced physical or sexual abuse.

Boys with substance use disorders are more likely to also have conduct, behavioral, and learning problems, which may be very disruptive to their school, family, or community. Treatments should take into account the higher rate of internalizing and traumatic stress disorders among adolescent girls, the higher rate of externalizing disruptive disorders and juvenile justice problems among adolescent boys, and other gender differences that may play into adolescent substance use disorders.

Questions about Treating Adolescent Tobacco Use

Questions about Treating Adolescent Tobacco Use

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

12. Is adolescent tobacco use treated similarly to other drug use?  

YesPeople often don’t think of tobacco use as a kind of “drug abuse” that requires treatment, and motives for quitting smoking may be somewhat different than motives for quitting other drugs. But tobacco use has well-known health risks–– especially when begun in the teen years––and the highly addictive nicotine in tobacco can make treatment a necessity to help an adolescent quit. Laboratory research also suggests that nicotine may increase the rewarding and addictive effects of other drugs, making it a potential contributor to other substance use disorders.

Common treatment approaches like Cognitive Behavioral Therapy are now being used to help adolescents quit smoking (and quit using other drugs) by helping them “train their brains” so they learn to recognize and control their cravings and better deal with life stress. Other therapies like Contingency Management and Motivational Enhancement use incentives and motivation techniques to help teens reduce or stop smoking.

Tobacco use often accompanies other drug use and needs to be addressed as part of other substance use disorder treatment. In a recent survey, nearly 55 percent of current adolescent cigarette smokers (ages 12 to 17) were also illicit drug users (by comparison, only about 6 percent of those who did not smoke used any illicit drugs). Also, cigarette smoking can be an indicator of other psychiatric disorders, which can be identified through comprehensive screening by a treatment provider.

How can rewards and sanctions be used effectively with drug-involved offenders in treatment?

FREQUENTLY ASKED QUESTIONS (FAQS) About Drug Abuse Treatment for People Involved with the Criminal Justice System.

Reprinted from “Principles of Drug Abuse Treatment for Criminal Justice Populations” by the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center. 
9. How can rewards and sanctions be used effectively with drug-involved offenders in treatment?
The systematic application of behavioral management principles underlying reward and punishment can help individuals reduce their drug use and criminal behavior. Rewards and sanctions are most likely to change behavior when they are certain to follow the targeted behavior, when they follow swiftly, and when they are perceived as fair. It is important to recognize and reinforce progress toward responsible, abstinent behavior. 
Rewarding positive behavior is more effective in producing long-term positive change than punishing negative behavior. Indeed, punishment alone is an ineffective public health and safety intervention for offenders whose crime is directly related to drug use (Leukefeld et al. 2002). Nonmonetary rewards such as social recognition can be as effective as monetary ones. A graduated range of rewards given for meeting predetermined goals can be an effective strategy.
Contingency management strategies, proven effective in community settings, use voucher-based incentives or rewards, such as bus tokens, to reinforce abstinence (measured by negative drug tests) or to shape progress toward other treatment goals, such as program session attendance or compliance with medication regimens. 
Contingency management is most effective when the contingent reward closely follows the behavior being monitored. An intervention tested by CJ-DATS researchers, called “Step’n Out,” used a contingency management approach whereby criminal justice staff monitored specific behaviors (e.g., abstinence, employment searches, and counseling attendance) and rewarded individuals who met agreed-upon goals with social acknowledgement (e.g., congratulatory letter from parole supervisor) and small material incentives (e.g., partial payment for clothes for job interviews). This approach improved parolees’ attendance at integrated community parole and addiction treatment sessions, as well as increased use of treatment and individual counseling services (Friedmann et al. 2009).
Graduated sanctions, which invoke less punitive responses for early and less serious noncompliance and increasingly severe sanctions for more serious or continuing problems, can be an effective tool in conjunction with drug testing. The effective use of graduated sanctions involves consistent, predictable, and clear responses to noncompliant behavior.
Drug testing can determine when an individual is having difficulties with recovery. The first response to drug use detected through urinalysis should be a clinical one—for example, increasing treatment intensity or switching to an alternative treatment. This often requires coordination between the criminal justice staff and the treatment provider. (Note that more intensive treatment should not be considered a sanction, but rather a routine progression in health care practice when a treatment appears less effective than expected.)
Behavioral contracting can employ both rewards and sanctions. A behavioral contract is an explicit agreement between the participant and the treatment provider or criminal justice monitor (or among all three) that specifies proscribed behaviors and associated sanctions, as well as positive goals and rewards for success. Behavioral contracting can instill a sense of procedural justice because both the necessary steps toward progress and the sanctions for violating the contract are specified and understood in advance.

Why should drug abuse treatment be provided to offenders?

FREQUENTLY ASKED QUESTIONS (FAQS) About Drug Abuse Treatment for People Involved with the Criminal Justice System.

Reprinted from “Principles of Drug Abuse Treatment for Criminal Justice Populations” by the National Institute on Drug Abuse (in the Public Domain) by Thomas A. Wilson, MA, LCPC & CEO of Tom Wilson Counseling and Telehealth Center.

2. Why should drug abuse treatment be provided to offenders?

The case for treating drug abusing offenders is compelling. Drug abuse treatment improves outcomes for drug abusing offenders and has beneficial effects for public health and safety. Effective treatment decreases future drug use and drug-related criminal behavior, can improve the individual’s relationships with his or her family, and may improve prospects for employment.

In addition, it can save lives: A retrospective study of more than 30,000 Washington State inmates found that during the first 2 weeks after release, the risk of death among former inmates was more than 12 times that among other residents, with drug overdose being the leading cause.

Outcomes for substance abusing individuals can be improved when criminal justice personnel work in tandem with treatment providers on drug abuse treatment needs and supervision requirements. Treatment needs that can be assessed after arrest include substance abuse severity, mental health problems, and physical health. Defense attorneys, prosecutors, and judges need to work together during the prosecution and sentencing phases of the criminal justice process to determine suitable treatment programs that meet the offender’s needs.

Through drug courts, diversion programs, pretrial release programs that are conditional on treatment, and conditional probation with sanctions, the offender can participate in community-based drug abuse treatment while under criminal justice supervision. In some instances, the judge may recommend that the offender participate in treatment while serving jail or prison time or require it as part of continuing correctional supervision post-release.

Frequently Asked Questions about Adolescent Drug Use, Part 6

Frequently Asked Questions about Adolescent Drug Use, Part 6

Reprinted from the National Institute of Drug Abuse by Tom Wilson Counseling Center offering online substance abuse education for adults and adolescents.

12. Is adolescent tobacco use treated similarly to other drug use?  

YesPeople often don’t think of tobacco use as a kind of “drug abuse” that requires treatment, and motives for quitting smoking may be somewhat different than motives for quitting other drugs. But tobacco use has well-known health risks–– especially when begun in the teen years––and the highly addictive nicotine in tobacco can make treatment a necessity to help an adolescent quit. Laboratory research also suggests that nicotine may increase the rewarding and addictive effects of other drugs, making it a potential contributor to other substance use disorders.

Common treatment approaches like Cognitive Behavioral Therapy are now being used to help adolescents quit smoking (and quit using other drugs) by helping them “train their brains” so they learn to recognize and control their cravings and better deal with life stress. Other therapies like Contingency Managementand Motivational Enhancement use incentives and motivation techniques to help teens reduce or stop smoking.

Tobacco use often accompanies other drug use and needs to be addressed as part of other substance use disorder treatment. In a recent survey, nearly 55 percent of current adolescent cigarette smokers (ages 12 to 17) were also illicit drug users (by comparison, only about 6 percent of those who did not smoke used any illicit drugs). Also, cigarette smoking can be an indicator of other psychiatric disorders, which can be identified through comprehensive screening by a treatment provider.