National Institute on Drug Abuse
`
`Principles of Drug Abuse
`Treatment for Criminal
`Justice Populations | A Research-Based Guide
`
`National Institutes of Health
`U.S. Department of Health
`and Human Services
`
`Page 1 of 40
`
`ALKERMES EXHIBIT 2006
`Amneal Pharmaceuticals LLC v. Alkermes Pharma Ireland Limited
`IPR2018-00943
`
`

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`PRINCIPLES OF
`DRUG ABUSE
`TREATMENT FOR
`CRIMINAL JUSTICE
`POPULATIONS
`1. Drug addiction is a brain disease that affects
`
`behavior. Drug addiction has well-recognized cognitive, behavioral,
`and physiological characteristics that contribute to continued use of
`drugs despite the harmful consequences. Scientists have also found
`that chronic drug abuse alters the brain’s anatomy and chemistry and
`that these changes can last for months or years after the individual
`has stopped using drugs. This transformation may help explain why
`addicted persons are at a high risk of relapse to drug abuse even
`after long periods of abstinence and why they persist in seeking drugs
`despite the consequences.
`
`2. Recovery from drug addiction requires
`
`effective treatment, followed by management of the
`problem over time. Drug addiction is a serious problem that
`can be treated and managed throughout its course. Effective drug
`abuse treatment engages participants in a therapeutic process, retains
`them in treatment for an appropriate length of time, and helps them
`learn to maintain abstinence. Multiple episodes of treatment may be
`required. Outcomes for drug abusing offenders in the community can
`be improved by monitoring drug use and by encouraging continued
`participation in treatment.
`
`3. Treatment must last long enough to produce
`
`stable behavioral changes. In treatment, the drug abuser
`is taught to break old patterns of thinking and behaving and to learn
`new skills for avoiding drug use and criminal behavior. Individuals with
`severe drug problems and co-occurring disorders typically need longer
`treatment (e.g., a minimum of 3 months) and more comprehensive
`services. Early in treatment, the drug abuser begins a therapeutic
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`PRINCIPLES
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`process of change. In later stages, he or she addresses other
`problems related to drug abuse and learns how to manage them as
`well.
`
`4. Assessment is the (cid:191)rst step in treatment.
`
`A history of drug or alcohol use may suggest the need to conduct a
`comprehensive assessment to determine the nature and extent of
`an individual’s drug problems, establish whether problems exist in
`other areas that may affect recovery, and enable the formulation of
`an appropriate treatment plan. Personality disorders and other mental
`health problems are prevalent in offender populations; therefore,
`comprehensive assessments should include mental health evaluations
`with treatment planning for these problems.
`
`5. Tailoring services to (cid:191)t the needs of the
`
`individual is an important part of effective drug
`abuse treatment for criminal justice populations.
`Individuals differ in terms of age, gender, ethnicity and culture,
`problem severity, recovery stage, and level of supervision needed.
`Individuals also respond differently to different treatment approaches
`and treatment providers. In general, drug treatment should address
`issues of motivation, problemsolving, and skill-building for resisting
`drug use and criminal behavior. Lessons aimed at supplanting
`drug use and criminal activities with constructive activities and
`at understanding the consequences of one’s behavior are also
`important to include. Tailored treatment interventions can facilitate
`the development of healthy interpersonal relationships and improve
`the participant’s ability to interact with family, peers, and others in
`the community.
`
`6. Drug use during treatment should be carefully
`
`monitored. Individuals trying to recover from drug addiction may
`experience a relapse, or return to drug use. Triggers for drug relapse
`are varied; common ones include mental stress and associations with
`peers and social situations linked to drug use. An undetected relapse
`can progress to serious drug abuse, but detected use can present
`
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`opportunities for therapeutic intervention. Monitoring drug use through
`urinalysis or other objective methods, as part of treatment or criminal
`justice supervision, provides a basis for assessing and providing
`feedback on the participant’s treatment progress. It also provides
`opportunities to intervene to change unconstructive behavior—
`determining rewards and sanctions to facilitate change,
`and modifying treatment plans according to progress.
`
`7. Treatment should target factors that are
`
`associated with criminal behavior. “Criminal thinking” is
`a combination of attitudes and beliefs that support a criminal lifestyle
`and criminal behavior, such as feeling entitled to have things one’s
`own way, feeling that one’s criminal behavior is justi(cid:191)ed, failing to
`accept responsibility for one’s actions, and consistently failing to
`anticipate or appreciate the consequences of one’s behavior. This
`pattern of thinking often contributes to drug use and criminal behavior.
`Treatment that provides speci(cid:191)c cognitive skills training to help
`individuals recognize errors in judgment that lead to drug abuse and
`criminal behavior may improve outcomes.
`
`8. Criminal justice supervision should incorporate
`
`treatment planning for drug abusing offenders, and
`treatment providers should be aware of correctional
`supervision requirements. The coordination of drug abuse
`treatment with correctional planning can encourage participation in
`drug abuse treatment and can help treatment providers incorporate
`correctional requirements as treatment goals. Treatment providers
`should collaborate with criminal justice staff to evaluate each
`individual’s treatment plan and ensure that it meets correctional
`supervision requirements, as well as that person’s changing needs,
`which may include housing and child care; medical, psychiatric, and
`social support services; and vocational and employment assistance.
`For offenders with drug abuse problems, planning should incorporate
`the transition to community-based treatment and links to appropriate
`post-release services to improve the success of drug treatment
`and re-entry. Abstinence requirements may necessitate a rapid
`clinical response, such as more counseling, targeted intervention,
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`PRINCIPLES
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`or increased medication, to prevent relapse. Ongoing coordination
`between treatment providers and courts or parole and probation
`of(cid:191)cers is important in addressing the complex needs of these
`re-entering individuals.
`
`9. Continuity of care is essential for drug abusers
`
`re-entering the community. Offenders who complete prison-
`based treatment and continue with treatment in the community have
`the best outcomes. Continuing drug abuse treatment helps the
`recently released offender deal with problems that become relevant
`after release, such as learning to handle situations that could lead
`to relapse, learning how to live drug-free in the community, and
`developing a drug-free peer support network. Treatment in prison or
`jail can begin a process of therapeutic change, resulting in reduced
`drug use and criminal behavior post-incarceration. Continuing drug
`treatment in the community is essential to sustaining these gains.
`
`10. A balance of rewards and sanctions
`
`encourages pro-social behavior and treatment
`participation. When providing correctional supervision of
`individuals participating in drug abuse treatment, it is important
`to reinforce positive behavior. Nonmonetary “social reinforcers,”
`such as recognition for progress or sincere effort, can be effective,
`as can graduated sanctions that are consistent, predictable, and
`clear responses to noncompliant behavior. Generally, less punitive
`responses are used for early and less serious noncompliance,
`with increasingly severe sanctions issuing from continued problem
`behavior. Rewards and sanctions are most likely to have the desired
`effect when they are perceived as fair and when they swiftly follow the
`targeted behavior.
`
`11. Offenders with co-occurring drug abuse and
`
`mental health problems often require an integrated
`treatment approach. High rates of mental health problems are
`found both in offender populations and in those with substance abuse
`problems. Drug abuse treatment can sometimes address depression,
`anxiety, and other mental health problems. Personality, cognitive,
`
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`and other serious mental disorders can be dif(cid:191)cult to treat and may
`disrupt drug treatment. The presence of co-occurring disorders may
`require an integrated approach that combines drug abuse treatment
`with psychiatric treatment, including the use of medication. Individuals
`with either a substance abuse or mental health problem should be
`assessed for the presence of the other.
`
`12. Medications are an important part of
`
`treatment for many drug abusing offenders.
`Medicines such as methadone, buprenorphine, and extended-release
`naltrexone have been shown to reduce heroin use and should be
`made available to individuals who could bene(cid:191)t from them. Effective
`use of medications can also be instrumental in enabling people
`with co-occurring mental health problems to function successfully
`in society. Behavioral strategies can increase adherence to
`medication regimens.
`
`13. Treatment planning for drug abusing
`
`offenders who are living in or re-entering the
`community should include strategies to prevent
`and treat serious, chronic medical conditions, such
`as HIV/AIDS, hepatitis B and C, and tuberculosis.
`The rates of infectious diseases, such as hepatitis, tuberculosis, and
`HIV/AIDS, are higher in drug abusers, incarcerated offenders, and
`offenders under community supervision than in the general population.
`Infectious diseases affect not just the offender, but also the criminal
`justice system and the wider community. Consistent with Federal
`and State laws, drug-involved offenders should be offered testing for
`infectious diseases and receive counseling on their health status and
`on ways to modify risk behaviors. Probation and parole of(cid:191)cers who
`monitor offenders with serious medical conditions should link them
`with appropriate health care services, encourage compliance with
`medical treatment, and re-establish their eligibility for public health
`services (e.g., Medicaid, county health departments) before release
`from prison or jail.
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`CONTENTS
`
`PRINCIPLES OF DRUG ABUSE TREATMENT
`FOR CRIMINAL JUSTICE POPULATIONS ....... 1
`PREFACE............................................................ 9
`ACKNOWLEDGMENTS ................................... 11
`INTRODUCTION ............................................... 12
`FREQUENTLY ASKED QUESTIONS (FAQS) .. 15
`1. Why do people involved in the criminal
`justice system continue abusing drugs? ....................................15
`2. Why should drug abuse treatment
`be provided to offenders? ...........................................................16
`3. How effective is drug abuse treatment
`for criminal justice-involved individuals? ....................................17
`4. Are all drug abusers in the criminal justice
`system good candidates for treatment? .....................................17
`5. Is legally mandated treatment effective?....................................18
`6. Are relapse risk factors different in
`offender populations? How should drug
`abuse treatment deal with these risk factors? ...........................19
`7. What treatment and other health services
`should be provided to drug abusers involved
`with the criminal justice system? ................................................20
`
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`8. How long should drug abuse treatment last for
`individuals involved in the criminal justice system? ...................20
`9. How can rewards and sanctions be used effectively
`with drug-involved offenders in treatment? ................................21
`10. What is the role of medications in
`treating substance abusing offenders? ......................................23
`11. How can the criminal justice and drug abuse
`treatment systems reduce the spread of HIV/AIDS,
`hepatitis, and other infectious diseases among
`drug abusing offenders? .............................................................25
`12. What works for offenders with co-occurring
`substance abuse and mental disorders? ...................................26
`13. Is providing drug abuse treatment to
`offenders worth the (cid:191)nancial investment? ..................................26
`14. What are the unique treatment needs of
`women in the criminal justice system? .......................................28
`15. What are the unique treatment needs of
`juveniles in the criminal justice system? ....................................29
`RESOURCES .................................................... 32
`REFERENCES .................................................. 34
`
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`PREFACE
`
`From the time it was established
`in 1974, the National Institute
`on Drug Abuse (NIDA) has
`supported research on drug
`abuse treatment for people
`involved with the criminal justice
`system.
`
`Findings show unequivocally that providing comprehensive drug
`abuse treatment to criminal offenders works, reducing both drug
`abuse and criminal recidivism. The substantial prison population in
`the United States is attributable in large part to drug-related offenses
`and is accompanied by high rates of recidivism. As such,
`it is a matter of public health and safety to make drug abuse
`treatment a key component of the criminal justice system. Indeed,
`addressing the treatment needs of substance abusing offenders
`is critical to reducing overall crime and other drug-related societal
`burdens, such as lost job productivity and family disintegration.
`Scienti(cid:191)c research shows that drug abuse treatment can work
`even when an individual enters it under legal mandate. However,
`only a small percentage of those who need treatment actually
`receive it, and often the treatment provided is inadequate. To be
`effective, treatment must begin in prison and be sustained after
`
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`PREFACE
`
`release through participation in community treatment programs. By
`engaging in a continuing therapeutic process, individuals can learn
`how to avoid relapse and withdraw from a life of crime.
`As re(cid:192)ected in our collaborative Criminal Justice(cid:177)Drug Abuse
`Treatment Studies (CJ(cid:177)DATS) Initiative, NIDA is committed to
`working across organizational boundaries to improve substance
`abuse treatment services. Multiple studies from different scienti(cid:191)c
`disciplines have helped us understand the basic neurobiology of
`addiction, along with what constitutes effective treatment. Now
`we are at the point where the implementation of evidence-based
`treatment principles is called for within the criminal justice system to
`improve public health and public safety by reducing both drug use
`and crime.
`This booklet—a complement to NIDA’s Principles of Drug Addiction
`Treatment: A Research-Based Guide—is intended to describe the
`treatment principles and research (cid:191)ndings that have particular
`relevance to the criminal justice community and to treatment
`professionals working with drug abusing offenders. It is divided into
`three main sections: (1) research (cid:191)ndings on addicted offenders
`distilled into 13 essential principles (see pages 1(cid:177)5), (2) a series of
`frequently asked questions (FAQs) about drug abuse treatment for
`those involved with the criminal justice system, and (3) a resource
`section that provides Web sites for additional information. This
`booklet and other resources on drug abuse and the criminal justice
`system are available on NIDA’s Web site at http://www.drugabuse.
`gov/drugpages/cj.html.
`With the release of this landmark publication’s revised edition, we
`are optimistic that correctional agencies have begun to understand
`how drug treatment programs are helping achieve public health and
`safety goals for the Nation.
`
`Nora D. Volkow, M.D.
`Director
`National Institute on Drug Abuse
`
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`ACKNOWLEDGMENTS
`
`This publication was written by Bennett W. Fletcher, Ph.D.,
`Redonna (cid:46). Chandler, Ph.D., and the Of(cid:191)ce of Science Policy and
`Communications, National Institute on Drug Abuse.
`This publication is in the public domain and may be used or
`reproduced in its entirety without permission from NIDA or the authors.
`Citation of the source is appreciated.
`The U.S. Government does not endorse or favor any speci(cid:191)c
`commercial product or company. Trade, proprietary, or company
`names appearing in this publication are used only because they are
`considered essential in the context of the studies described here.
`
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`INTRODUCTION
`
`The connection between
`drug abuse and crime is well
`known.
`
`Drug abuse is implicated in at least three types of drug-
`related offenses: (1) offenses de(cid:191)ned by drug possession or
`sales, (2) offenses directly related to drug abuse (e.g., stealing
`to get money for drugs), and (3) offenses related to a lifestyle
`that predisposes the drug abuser to engage in illegal activity, for
`example, through association with other offenders or with illicit
`markets. Individuals who use illicit drugs are more likely to commit
`crimes, and it is common for many offenses, including violent crimes,
`to be committed by individuals who had used drugs or alcohol prior
`to committing the crime, or who were using at the time of the offense.
`According to 2012 statistics from the Department of Justice’s
`(DOJ’s) Bureau of Justice Statistics (BJS), the total correctional
`population is 6,937,600, with 4,794,000 individuals on probation or
`under parole supervision, and drug law violations accounting for the
`most common type of criminal offense (Glaze and Herberman 2013).
`In a survey of State and Federal prisoners, BJS estimated that about
`half of the prisoners met Diagnostic and Statistical Manual for Mental
`Disorders (DSM) criteria for drug abuse or dependence, and yet
`fewer than 20 percent who needed treatment received it (Chandler
`et al. 2009; Mumola and Karberg 2006). Of those surveyed, 14.8
`percent of State and 17.4 percent of Federal prisoners reported
`having received drug treatment since admission (Mumola and
`Karberg 2006).
`
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`Treatment offers
`the best alternative
`for interrupting the
`drug abuse/criminal
`justice cycle.
`
`Juvenile justice systems also report high levels of drug abuse.
`In 2008, approximately 10 percent of the estimated 2.1 million
`juvenile arrests were for drug abuse or underage drinking violations
`(Puzzanchera 2009). As many as two-thirds of detained juveniles
`may have a substance use disorder (SUD); female juveniles who
`enter the system generally have higher SUD rates than males
`(McClelland et al. 2004a).
`Although the past several decades
`have witnessed an increased interest
`in providing substance abuse
`treatment services for criminal
`justice offenders, only a small
`percentage of offenders has access
`to adequate services, especially in jails
`and community correctional facilities
`(Taxman et al. 2007; Sabol et al. 2010). Not
`only is there a gap in the availability of these services for offenders,
`but often there are few choices in the types of services provided.
`Treatment that is of insuf(cid:191)cient quality and intensity or that is not
`well suited to the needs of offenders may not yield meaningful
`reductions in drug use and recidivism. Untreated substance abusing
`offenders are more likely than treated offenders to relapse to drug
`abuse and return to criminal behavior. This can lead to re-arrest
`and re-incarceration, jeopardizing public health and public safety
`and taxing criminal justice system resources. Treatment is the most
`effective course for interrupting the drug abuse/criminal justice cycle
`for offenders with drug abuse problems.
`Drug abuse treatment can be incorporated into criminal justice
`settings in a variety of ways. Examples include treatment in prison
`followed by community-based treatment after release; drug courts
`that blend judicial monitoring and sanctions with treatment by
`imposing treatment as a condition of probation; and treatment under
`parole or probation supervision. Drug abuse treatment can bene(cid:191)t
`from the cross-agency coordination and collaboration of criminal
`justice professionals, substance abuse treatment providers, and
`other social service agencies. By working together, the criminal
`justice and treatment systems can optimize resources to bene(cid:191)t the
`health, safety, and well-being of the individuals and communities
`they serve.
`
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`14
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`FREQUENTLY ASKED
`QUESTIONS (FAQS)
`
`1. Why do people involved in the criminal
`
`Normal
`
`Cocaine Abuser
`(100 days of
`abstinence)
`
`justice system continue abusing drugs?
`The answer to this perplexing question spans basic neurobiological,
`psychological, social, and environmental factors. The repeated use of
`addictive drugs eventually changes how the brain functions. Resulting
`brain changes, which accompany the transition from voluntary to
`compulsive drug use, affect the brain’s natural inhibition and reward
`centers, causing the
`Addictive drugs cause
`addicted person to
`long-lasting changes in the brain
`use drugs in spite of
`the adverse health,
`social, and legal
`consequences (Baler
`and Volkow 2006;
`Volkow et al. 2010;
`and Chandler et
`al. 2009). Craving
`for drugs may be
`triggered by contact
`with the people,
`places, and things
`associated with prior
`drug use, as well as
`by stress. Forced
`abstinence (when it occurs) is not treatment, and it does not cure
`addiction. Abstinent individuals must still learn how to avoid relapse,
`including those who may have been abstinent for a long period of time
`while incarcerated.
`
`Cocaine Abuser
`(10 days of
`abstinence)
`
`PET scans showing glucose metabolism in healthy
`(normal) and cocaine-addicted brains. Even after 100
`days of abstinence, glucose metabolism has not returned
`to normal levels.
`
`Source: Volkow et al., 1992, 1993.
`
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`FREQUENTLY ASKED QUESTIONS
`
`Potential risk factors for released offenders include pressures
`from peers and family members to return to drug use and a criminal
`lifestyle. Tensions of daily life—violent associates, few opportunities
`for legitimate employment, lack of safe housing, and even the need
`to comply with correctional supervision conditions—can also create
`stressful situations that can precipitate a relapse to drug use.
`Research on how the brain is affected by drug abuse promises
`to teach us much more about the mechanics of drug-induced brain
`changes and their relationship to addiction. Research also reveals
`that with effective drug abuse treatment, individuals can overcome
`persistent drug effects and lead healthy, productive lives.
`
`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 bene(cid:191)cial 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 (cid:191)rst 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 (Binswanger et
`al. 2007).
`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
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`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.
`
`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 (cid:191)nd
`that those who participate in community-based drug abuse treatment
`programs commit fewer crimes than those who do not participate
`(Prendergast et al. 2002; Butzin et al. 2006; and Kinlock et al. 2009).
`
`Outcomes can be
`improved when criminal
`justice personnel work
`in tandem with treatment
`providers.
`
`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 (see FAQ Nos. 6 and 12).
`
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`FREQUENTLY ASKED QUESTIONS
`
`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 bene(cid:191)ts 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.
`
`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.
`
`Legal pressure can
`increase treatment
`attendance and
`improve retention.
`
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`Returning to environments
`associated with drug use
`may trigger cravings and
`cause a relapse.
`
`6. Are relapse risk factors different in
`
`offender populations? How should drug abuse
`treatment deal with these risk factors?
`Often, drug abusing offenders have problems in other areas.
`Examples include family dif(cid:191)culties, limited social skills, educational
`and employment problems, mental health disorders, infectious
`diseases, and other medical issues. Treatment should take these
`problems into account, because they can increase the risk of drug
`relapse and criminal recidivism if left unaddressed.
`Stress is often a contributing factor
`to relapse, and offenders who are
`re-entering society face many
`challenges and stressors,
`including reuniting with family
`members, securing housing, and
`complying with criminal justice
`supervision requirements. Even
`the many daily decisions that most
`people face can be stressful for those
`recently released from a highly controlled prison environment.
`Other threats to recovery include a loss of support from family or
`friends, which incarcerated people may experience. Drug abusers
`returning to the community may also encounter people from their
`lives who are still involved in drugs or crime and be enticed to resume
`a criminal and drug using lifestyle. Returning to environments or
`activities associated with prior drug use may trigger strong cravings
`and cause a relapse. A coordinated approach by treatment and
`criminal justice staff provides the best way to detect and intervene with
`these and other threats to recovery. In any case, treatment is needed
`to provide the skills necessary to avoid or cope with situations that
`could lead to relapse.
`Treatment staff should identify the offender’s unique relapse risk
`factors and periodically re-assess and modify the treatment plan
`as needed. Generally, continuing or re-emerging drug use during
`treatment requires a clinical response—either increasing the amount
`or level of treatment, or changing the treatment intervention.
`
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`FREQUENTLY ASKED QUESTIONS
`
`7. What treatment and other health services
`
`should be provided to drug abusers involved
`with the criminal justice system?
`One of the goals of treatment planning is to match evidence-based
`interventions to individual needs at each stage of drug treatment. Over
`time, various combinations of treatment services may be required.
`Evidence-based interventions include cognitive-behavioral therapy to
`help participants learn positive social and coping skills, contingency
`management approaches to reinforce positive behavioral change, and
`motivational enhancement to increase treatment engagement and
`retention. In those addicted to opioid drugs, agonist/partial agonist
`medications can also help normalize brain function, and antagonist
`medications can facilitate abstinence. For juvenile offenders,
`treatments that involve the family and other aspects of the drug
`abuser’s environment have established ef(cid:191)cacy.
`Drug abuse treatment plans for incarcerated offenders can facilitate
`successful re-entry into the community by incorporating relevant
`transition plans and services. Drug abusers often have mental and
`physical health, family counseling, parenting, educational, and
`vocational needs, so medical, psychological, and social services are
`often crucial components of successful treatment. Case management
`approaches can be used to provide assistance in obtaining and
`integrating drug abuse treatment with community services.
`
`8. How long should drug abuse treatment last for
`
`individuals involved in the criminal justice system?
`While individuals progress through drug abuse treatment at
`different rates, one of the most reliable (cid:191)ndings in treatment
`research is that lasting reductions in criminal activity and drug
`abuse are related to length of t