View source for Shift from Punishment to Treatment Approach

= Introductory Paragraph =

The United States has the highest incarceration rate in the world. <ref>https://medicalxpress.com/news/2021-02-incarceration-strongly-linked-premature-death.html</ref> There is substantial evidence that shows how detrimental it is to overcrowd jails and prisons and to turn a blind eye to the revolving door effect that happens when individuals are incarcerated without adequate support to change behaviors. Although evidence shows that addiction is a treatable disease of the brain, many people never receive treatment. As a result too many end up involved in the criminal justice system from illegal drug-seeking behavior. Recent data shows a significant correlation between criminal justice involvement and substance use. This highlights the importance of identifying a different approach to the problem and the need to shift from a punishment to a treatment approach. 

More than half of the prison population in the United States, about 65%, is estimated to have an active substance use disorder. <ref>https://nida.nih.gov/publications/drugfacts/criminal-justice</ref> About 20% who did not fully meet the criteria for a substance use disorder were under the influence of substances at the time of their arrest. <ref>https://nida.nih.gov/publications/drugfacts/criminal-justice</ref> Many of the individuals in prison who need treatment are not receiving it. Thus, they have a high risk of reoffending once released. Treatment has impacts that can last for decades -- on an individual’s quality of life, reduced likelihood of recidivism, and future relapse. Failure to provide adequate and high-quality substance use treatment is not only detrimental to the individuals who are incarcerated but also has negative implications for their families, society, and the economy. 

It should be a priority to offer treatment to individuals within the criminal justice system who have a substance use disorder. The National Institute on Drug Abuse has increased its efforts to find solutions. It supports social workers, counselors, and others who work within the court system to provide services to individuals involved in the criminal justice system due to drug use. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> This helps both to decrease substance abuse and to reduce crime. There are evidence-based strategies that play a role in transforming traditional punishment-based approaches which may be used within the criminal justice system. Moving from a punishment to treatment approach improves both public health and public safety while decreasing rates of future incarceration. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/#R16</ref>

= Key Information =

Ongoing research has suggested that substance use can be associated with poorer outcomes among individuals who have been incarcerated, including those under supervision in the community. A study by Pew Trusts study shows that more imprisonment does not reduce drug related issues. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/03/more-imprisonment-does-not-reduce-state-drug-problems?hd&utm_campaign=2018-03-14+PNN&utm_medium=email&utm_source=Pew</ref> This study reinforces a large body of research that casts doubt on the theory that tough prison terms deter drug misuse, distribution, and other drug-law violations. The evidence strongly suggests that policymakers should pursue alternative strategies which the research shows work better. There have been two major avenues that have proven successful in shifting a from a punishment to treatment approach. The first is through by-passing incarceration with therapeutic alternatives. The second is through increasing treatment options inside jails and prisons.

'''Therapeutic alternatives''' to incarceration, such as judicial oversight in drug courts, has proven to be helpful in transitioning offenders back into the community where they can address their illness and live productive lives. Further research has shown the positive impact community-based drug treatment has on criminal behavior and may result in 1.8 times better outcomes in reducing drug use and the chances of reoffending. Drug courts that combined judicial supervision and treatment in place of incarceration had half the rearrests rates than those who did not participate in said programs. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>.

'''Treatment services''' for people within the criminal justice system, gives society an opportunity to better the lives of the individuals and to improve public health and safety. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref> Without treatment, individuals are more likely to commit crimes at a higher rate once released from prison when compared to those who are not using substances. <ref>https://drugfree.org/drug-and-alcohol-news/choosing-substance-abuse-treatment-over-prison-could-save-billions-study/</ref> The provision of drug treatment inside the prisons and jails while the offenders are incarcerated has shown promise. Since the 1990’s researchers have discovered highly effective interventions that can be implemented while offenders are incarcerated and after they are released. <ref>https://www.apa.org/research/action/aftercare</ref> A critical component of this approach is adequate pre-release and post-release counseling and support. This reduces detrimental impacts of individuals returning to a stressful home-life or environments with negative peer influences. Lack of access to treatment upon release increases the likelihood of relapse. The risk of overdose is amplified due to the changes in an individual’s tolerance after being incarcerated, leading to a higher probability of death. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref> Common treatments include the following proven evidence-based approaches: <ref>https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction</ref>

*behavioral counseling
*medication assisted treatment (MAT)
*evaluation and treatment for co-occurring mental health issues such as depression and anxiety 
*long-term follow-up to prevent relapse

= Relevant Research =

*'''The National Drug Intelligence Center (NDIC)''' estimated the cost of illicit drug use to society was $193 billion. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> This is in addition to the $249 billion, estimated by the Office of the Surgeon General, in costs associated with alcohol misuse. <ref>https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html</ref> The NDIC estimated the cost to treat drug use at $14 billion -- including healthcare costs, hospitalizations, and government specialty treatment. 

*'''NIDA''' reports that over 80% of prisoners who would benefit from treatment while incarcerated do not receive it -- despite the overwhelming evidence that drug treatment is more effective than incarceration. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> 

*'''This article''' is titled "Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety." It summarizes relevant  findings in neuroscience and evidence-based principles of addiction treatment that could help improve public heath and reduce criminal behavior. The authors report that individuals who participated in prison-based drug treatment programs paired with community programs after release were 7 times more likely to continue to abstain from substances and 3 times less likely to re-offend when compared to those who did not receive treatment. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>

= Impactful Federal, State, and Local Policies =

*'''The Residential Substance Use Disorder Treatment Act''' of 2021 expanded access to substance use treatment in jails and prisons within the United States. This bill also expanded access to treatment within the communities after offenders were released. This was a step in the right direction for providing treatment in place of incarceration. One major advance was the government’s acknowledgment of how important it is to stop the "revolving door" pattern associated with substance use and incarceration through the use of treatment and medication. <ref>https://www.whitehouse.senate.gov/news/release/-cornyn-whitehouse-introduce-bill-to-fight-substance-use-in-jails-and-prisons-support-inmates-upon-release</ref>  

*'''The Adult Drug Court Grant Program''' is managed by the Department of Justice. It provides financial assistance to states, local courts and government, and federally recognized Indian tribal governments to integrate substance abuse treatment, drug testing, incentives, and sanctions in judicially supervised settings with the intent to reduce recidivism and substance use among offenders. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/overview</ref>

*'''Connecticut''' enacted sentencing and drug-free zoning reform based on two models promoted by the American Legislative Exchange Council (ALEC). In its 2021 Report, ALEC has a policy section titled "Criminal Justice Reform" which references ALEC resolutions, supporting drug free zones and a minimum age of 10 for delinquency adjudication. <ref>https://alec.org/wp-content/uploads/2022/05/2021-Annual-Report_V10_WEB.pdf</ref>

*'''Oregon''' passed a groundbreaking drug law in 2020 that decriminalized the possession of small amounts of illegal substances. “Measure 110” expanded funding and access to addiction treatment. It uses tax revenue from expected savings resulting from reduced arrests and incarceration. One downside to this new approach is the impact it may have on the medical community, potentially stressing resources to handle and increase in overdose patients. Nonetheless, the radical change in the way law enforcement handles possession of substances is supportive to finding alternatives to incarceration. Many times, the only way to receive treatment for substance use treatment is by being arrested or coming into contact with the criminal justice system. This has detrimental impacts on an individual’s life and ability to hold employment. Measure 110 has offered another pathway by treating possession like a traffic ticket and opening the door to treatment instead of incarceration.  <ref>https://www.npr.org/2021/06/18/1007022652/oregons-pioneering-drug-decriminalization-experiment-is-now-facing-the-hard-test</ref>

= Available Tools and Resources =

'''The US Department of Justice''' has published "Criminal Conduct & Substance Abuse Treatment: Strategies for Self-Improvement and Change Pathways to Responsible Living." <ref>https://www.ojp.gov/ncjrs/virtual-library/abstracts/criminal-conduct-substance-abuse-treatment-strategies-self</ref> 

'''BJA''' manages the Residential Substance Abuse Treatment Program (RSAT) which offers training and technical assistance to county and states <ref>https://www.rsat-tta.com/</ref> and "Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Government Officials, Jail Administrators, Correctional Officers, and Health Care Professionals." <ref>https://www.cossup.org/Content/Documents/JailResources/Guidelines_for_Managing_Substance_Withdrawal_in_Jails_6-6-23_508.pdf</ref> 

'''The National Institute of Corrections''' provides training for correctional professionals. One of these is Residential Substance Abuse Training (RSAT). <ref> https://nicic.gov/training</ref>

'''Oregon.''' Two hotlines provide support:
* "Lines for Life" is a 24/7 helpline that is dedicated to preventing substance use and suicide. They provide free and confidential drug-prevention education and treatment referral services. <ref>https://www.linesforlife.org</ref>

*Addiction Recovery Center is also open 24/7. It provides assessments, care planning, links to services, and connects callers with crisis care and emergency care if needed. <ref>https://www.oregon.gov/oha/HSD/AMH/Pages/Measure110.aspx</ref>

= Promising Practices =

'''Georgia.''' The Adult Felony Drug Court Program in Clayton County is an 18-to-24-month program that gives nonviolent drug offenders with a substance use disorder the chance to avoid incarceration.  <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices</ref>.

'''Massachusetts.''' This video titled "Reforming Criminal Justice to Help Inmates Live a Life of Dignity, not Dependency" highlights a positive case study associated with fostering musical talent in a Worcester prison. <ref>https://alec.org/article/video-reforming-criminal-justice-to-help-inmates-live-a-life-of-dignity-not-dependency/</ref>

'''New York.''' An innovative triage approach called Buffalo Opioid Court, reduced the risk of overdose deaths and substance use by providing funding for court staff and treatment programs such as addiction counseling and medical interventions. The court staff has the ability to deploy a Rapid Integration Team that connects individuals with immediate treatment, assessment, and access to a licensed professional counselor. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices</ref>

= Sources =