Drug Experts Urge Better Prison Treatment

CHICAGO (AP) -- In its first report aimed at improving how the criminal justice system deals with drug addicts, the National Institute on Drug Abuse offered 13 guidelines Monday for what works - and what fails.

The key is understanding that drug addiction is a brain disease that affects behavior, and that it requires carefully monitored, personalized treatment, including access to medication such as methadone after the drug offender is released into society, the institute said.

"What does not work? Putting a person who is addicted to drugs in jail for five or 10 years and thinking that will cure him with no treatment," said Dr. Nora Volkow, director of the anti-drug abuse agency. "The likelihood of that person relapsing is very high."

The guidelines urge a mix of traditionally liberal and conservative approaches.

The institute argues that prisons and court-ordered treatment programs don't use methadone and other addiction medications enough. At the same time, the guidelines support pressuring offenders into treatment as a condition of probation and advocate urine testing during treatment to track and prevent relapses.

"The criminal justice system offers an extraordinary opportunity to help people with drug problems," Volkow said.

Every $1 spent on drug treatment programs also saves the nation an estimated $4 in crime costs, she said. The annual estimated cost to the U.S. for drug crimes is $107 billion.

Maia Szalavitz, a drug policy expert not involved with the report, said the guidelines are excellent. Methadone is rarely used in the criminal justice system despite evidence that it helps people addicted to opioids such as heroin, she said.

She faulted the system's current reliance on 12-step programs modeled after Alcoholics Anonymous, which she said works for some people but not everyone.

"If these guidelines help addicts in the justice system to get more sensitive and appropriate care, they will be highly useful," said Szalavitz, a senior fellow at the media watchdog group Statistical Assessment Service. "But if systems are not put in place to ensure that the system rewards treatment excellence and drops harmful and ineffective methods, they won't do much."

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The National Institute on Drug Abuse issued research-based guidelines for drug treatment in the criminal justice system on Monday.

1. Drug addiction is a brain disease that affects behavior.

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.

4. Assessment is the first step in treatment.

5. Tailoring services to fit the needs of the individual is an important part of effective drug abuse treatment for criminal justice populations.

6. Drug use during treatment should be carefully monitored.

7. Treatment should target factors that are associated with criminal behavior.

8. Criminal justice supervision should incorporate treatment planning for drug abusing offenders, and treatment providers should be aware of correctional supervision requirements.

9. Continuity of care is essential for drug abusers re-entering the community.

10. A balance of rewards and sanctions encourages prosocial behavior and treatment participation.

11. Offenders with co-occurring drug abuse and mental health problems often require an integrated treatment approach.

12. Medications are an important part of treatment for many drug abusing offenders.

13. Treatment planning for drug abusing offenders re-entering the community should include strategies to prevent and treat medical conditions such as HIV/AIDS, hepatitis and tuberculosis.

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Source: "Principles of Drug Abuse Treatment for Criminal Justice Populations," National Institute on Drug Abuse.