Chapter III (continued)
3. Breaking
the Cycle of Drugs and Crime
Drug-dependent
individuals are responsible for a disproportionate percentage of
our nation's violent and income-generating crimes like robbery,
burglary, or theft. According to ADAM data, between one-half and
three-quarters of all arrestees tested in the thirty-five cities
around the country had drugs in their system at the time of arrest.
About half of those charged with violent or income-generating crimes
test positive for more than one drug. In 1997, a third of state
prisoners and about one in five federal inmates said they had committed
the offenses that led to incarceration while under the influence
of drugs. Nineteen percent of state inmates and 16 percent of federal
inmates said they committed their current offense to obtain money
for drugs (up from 17 percent and 10 percent, respectively, in 1991).38
The
nation's incarcerated population is now more than 1.8 million. According
to 1998 data (the latest data available), almost 60 percent of inmates
in federal prison are sentenced for drug offenses, up from 52.3
percent in 1990.39
Time served for these offenses more than doubled between 1986 and
1997, rising from 20.4 months to 42.5 months. In the same period,
overall time served nearly doubled, mostly due to increased penalties
for drug, weapon, and immigration offenses. Increases for violent
crime (9 percent) and property crime (1 percent) were modest by
comparison. State prisons are also experiencing significant growth
in the population of drug offenders: 21 percent of state prisoners
in 1997 were incarcerated for drug law violations. Between 1990
and 1997, the number of drug offenders in state prison grew by 77,000.
amount
of drugs consumed, the size of illegal drug markets, the number
of dealers, and the incidence of drug-related crime and violence.
The corrections and treatment professions must join in common purpose
to break the tragic cycle of drugs and crime by reducing drug consumption
and recidivism among individuals in the criminal justice system.
We should accelerate the expansion of programs that offer alternatives
to imprisonment for non-violent drug offenders. Treatment must be
made more available for drug-dependent inmates and those on probation
or parole. Finally, adequate transitional programs should support
inmates following release. The end result will be fewer addicts
and drug users, less demand for drugs, reduced drug trafficking,
decreased drug-related crime and violence, safer and healthier communities,
and fewer people behind bars. The criminal justice system has already
made much progress in providing treatment for offenders in correctional
settings and the community, but these programs can be expanded Many
juvenile and adult offenders who abuse or are dependent on drugs
and alcohol also have co-occurring mental disorders and primary
health care needs. For example, approximately thirteen percent of
the prison population has both a serious mental illness and a co-occurring
substance abuse disorder, and many others have or are at risk for
HIV/AIDS and other infectious diseases. To be maximally effective,
treatment must address these co-occurring health conditions, must
be appropriate to the age and gender of the offender, and must be
appropriate to the offender's race and ethnic heritage. When appropriate,
treatment should also involve the offender's family. The children
of substance abusing offenders are at higher risk for substance
abuse and criminal behavior themselves. Therefore, treatment which
involves the offender's family can help to break the intergenerational
cycle of substance abuse and crime.
Substance
Abuse Treatment for Incarcerated Offenders
Both
state and federal agencies have established substance-abuse treatment
programs in correctional institutions. Incarcerating offenders without
treating underlying substance abuse simply defers the time when
addicts return to the streets and start harming themselves and the
larger society. As a crime-control measure alone, drug treatment
for criminally active addicts is strikingly cost-effective. It offers
the potential of reducing crime by two-thirds at about half the
cost of incarceration alone.
According
to the Federal Bureau of Prisons (BOP), the number of federal inmates
receiving residential substance-abuse treatment increased from 1,236
in 1991 to 10,816 in 1999.40
BOP provides drug treatment for inmates prior to release. The number
of federal institutions offering residential treatment has grown
from thirty-two to forty-four since 1994. In 1998 nearly 34,000
inmates participated in all types of BOP treatment services. A joint
BOP/NIDA study of these programs resulted in an interim report addressing
the first six months after release from custody. This period is
significant because recidivism is generally highest within the first
year after prison. The study found that the treated population was
73 percent less likely to be re-arrested and 44 percent less likely
to use drugs than a comparison group that received no treatment.41
The
Corrections Program Office of the U.S. Department of Justice funded
118 state projects for substance-abuse treatment through Residential
Substance Abuse Treatment (RSAT) for State Prisoners grants. One
example of these projects is Delaware's in-prison program, which
has offered institutional and transitional drug treatment since
the late 1980s. The population that participated in both institutional
and transitional treatment programs was 69 percent arrest-free and
35 percent drug-free three years after release from custody, compared
to 29 percent and 5 percent, respectively, for the non-treated group.42
The
Drug-Free Prison Zone Demonstration Project
This
initiative is being conducted jointly by ONDCP, the National Institute
of Corrections, and BOP to reduce the availability of drugs in prisons.
The program combines policy, testing, technology, treatment, and
training — including a program of regular inmate drug testing,
the use of advanced technologies (e.g., ion spectrometry) for detection
of drugs entering facilities, and the training of correctional officers
and other institutional staff.
Detection
technology contributed to a recent evaluation of Pennsylvania's
comprehensive drug interdiction program. The results showed that
drug use went down 64 percent, drug finds decreased by 41 percent,
assaults on staff were reduced by 57 percent, assaults on other
inmates dropped 70 percent, and the number of weapons seized declined
by 65 percent. Similarly, at the Federal Correctional Institution
in Tucson and the Metropolitan Detention Center in Los Angeles,
detection technology produced a reduction in the rate of serious
drug-related inmate misconduct (introduction, use, or possession
of drugs) by 86 percent and 58 percent, respectively.
Twenty-eight
BOP facilities are gathering information on visitor screening, inmate
drug-testing, and five types of inmate misconduct. Eight states
(Alabama, Arizona, California, Florida, Kansas, Maryland, New Jersey,
and New York) began participating in January 1999 and are employing
a variety of education, training, interdiction, and treatment measures.
The initiative is being independently evaluated, and interim findings
from BOP are expected by mid-2000 and from the states by the end
of 2000.
Operating
Standards for Prison-Based Therapeutic Communities (TCs)
The
field-testing of operating standards was conducted by Therapeutic
Communities of America (TCA) with ONDCP support. The resulting document
was made available in December 1999. This groundbreaking contribution
brings a new level of discipline to practitioner discussions of
drug treatment. A comprehensive set of operating standards for prison-based
TCs — over 120 across eleven program domains — has now
been validated in operational prison settings. In its present form,
the standards provide a blueprint for state and local leaders, and
they will eventually be put into a format appropriate for use by
national accrediting organizations. In the interim, continuing leadership
by TCA and other professional groups will be needed to provide guidance
for the application of emerging standards and manuals.
Substance-Abuse
Treatment Provided with Community Supervision
In
1996, states and localities spent over $27 billion in corrections,
of which $21 billion was used for prison operations alone. The average
annual cost per inmate was $20,142, ranging from a low of $8,000
to a high of $37,800. For the federal system, the annual cost per
inmate was $23,500. By comparison, probation and parole costs in
1997 ranged from $1,110 per year for regular supervision to $3,470
for intensive supervision, and $3,630 for electronic supervision.
Cost variation is explained primarily by caseload. The average caseload
for regular probation was 175, and sixty-nine for regular parole.
Average caseloads for intensive supervision probation and parole
were thirty-four and twenty-nine, respectively; electronic supervision
was twenty and eighteen.
Using
the Federal Bureau of Prisons as a representative program, the annual
cost of residential and transitional treatment and services was
estimated at $3,000 per inmate. Generally accepted estimates of
annual treatment costs per person in the community are: regular
outpatient, $1,800; intensive outpatient, $2,500; short-term residential,
$4,400; and long-term residential, $6,800. Combining the most expensive
community supervision with the most expensive treatment yields an
estimated average cost of $10,430 per person per year compared to
$20,142 for incarceration alone, and $23,142 for incarceration combined
with treatment and transitional services. Drug courts, TASC, BTC,
and Zero-Tolerance have all helped make community supervision and
treatment more effective.
Criminal
Justice Treatment Networks
CSAT's
Criminal/Juvenile Justice Treatment Networks (CJTN) project, a five-year
systems integration initiative launched in FY95, continued its fifth
year of federal funding in FY99. The networks have developed an
integrated system of intake, supervision, and treatment across justice
agencies for adult and juvenile offenders in eight metropolitan
jurisdictions. In this past year, the networks expanded services
and partnerships. In FY 1999, SAMHSA/CSAT published Strategies
for Integrating Substance Abuse Treatment and Juvenile Justice Systems:
A Practice Guide, which describes the range of substance-abuse
treatment services provided in juvenile justice settings.
Drug
Courts
Drug
courts divert drug offenders out of jails or prisons and refer them
to community treatment. Drug courts seek to reduce drug use and
associated criminal behavior by retaining drug-involved offenders
in treatment. Defendants who complete the program either have their
charges dismissed (in a diversion or pre-sentence model) or probation
sentences reduced (in a post-sentence model). Title V of the Violent
Crime Control and Law Enforcement Act of 1994 (P.L. 103-322) authorizes
the Attorney General to make grants to state and local governments
to establish drug courts. In October 1999, 416 drug courts were
operating nationwide, including eighty-one juvenile, eleven tribal,
ten family, and seven combined drug courts. Two hundred and seventy-nine
were in planning stages, up from a dozen in 1994.43
Drug
courts have been an important step forward in diverting non-violent
offenders with drug problems into treatment and other community
resources, leaving the criminal justice system to address violent
acts. One hundred and seventy-five thousand people have entered
drug courts since their inception, and 122,000 graduated or remained
active participants. A review of thirty evaluations involving twenty-four
drug courts found that these facilities keep felony offenders in
treatment or other structured services at roughly double the retention
rate of community drug programs. Drug courts provide closer supervision
than other treatment programs and substantially reduce drug use
and criminal behavior among participants.44
CSAT,
in collaboration with OJP's Drug Court Program Office, the National
College of Juvenile and Family Court Judges, and the National Association
of Drug Court Professionals is piloting three Family Drug Courts
projects in which alcohol and other drug treatment, combined with
intervention and support services for children and families, are
integrated into the legal processing of the family's case. In some
jurisdictions there is coordination between the criminal courts
and the civil Family Drug Court. Family Drug Courts should be able
to help states comply with the Adoption and Safe Families Adoption
Act of 1997, P.L. 105-89. Family Drug Courts will substantially
reduce the time taken for final disposition of abuse and neglect
cases and will increase the percentage of family reunifications.
Treatment
Accountability for Safer Communities (TASC)
Created
in the early 1970s and originally named Treatment Alternatives to
Street Crime, TASC has demonstrated that the coercive power of the
criminal justice system can be used to get individuals into treatment
and manage their behavior without undue risk to communities. Through
TASC, some drug offenders are diverted out of the criminal justice
system into community-based supervision. Others receive treatment
as part of probation, and still others are placed in transitional
services as they leave an institutional program. TASC monitors client
progress and compliance — including expectations for abstinence,
employment, and improved personal and social functioning —
and reports results to the referring criminal-justice agency.45
Breaking
the Cycle (BTC)
BTC
encompasses the integrated application of testing, assessment, referral,
supervision, treatment and rehabilitation, routine progress reports
to maintain judicial oversight, graduated sanctions for noncompliance,
relapse-prevention and skill-building, and structured transition
back into the mainstream community. Since its inception in Birmingham,
Alabama in June 1997, 8,385 assessments have been conducted with
felony offenders to ascertain treatment needs; 2,395 offenders are
currently active within the BTC Program. Over 72,000 drug tests
were performed on offenders. Some 6,600 treatment referrals were
made at the point of assessment. A bond was implemented requiring
felony offenders to report to TASC within forty-eight hours for
assessment and urinalysis. The period of time that elapsed between
a BTC offender's entry into the system and his/her TASC assessment
dropped from twenty-four days in December 1997 to four days in August
1999. Disposition alternatives, including deferred and expedited
dockets, have been established. These sentencing options were designed
to utilize BTC compliance information to qualify defendants for
early dispositions. By diverting these cases prior to the grand
jury, circuit court docket space is available for jail cases. This
"rocket docket" allowed Birmingham to postpone construction of a
new jail pending full review of needs.
According
to results of the 1998 Arrestee Drug Abuse Monitoring Program, 67.1
percent of male offenders tested positive for drug use at the time
of arrest. By contrast, only 23 percent of BTC offenders tested
positive during routine random urinalysis after intervention occurred.
Retention rates exceeded 70 percent, and the re-arrest rate remained
in the single digits. A Policy and Advisory Oversight Committee
composed of criminal justice representatives proactively identified
systemic barriers and made substantial steps to develop solutions,
including the development of a management information system to
automate the assessment, offender tracking, and drug testing conducted
by TASC.
Birmingham's
success led to the expansion of the demonstration to three additional
sites for adult offenders in Jacksonville, Florida and Tacoma, Washington
and for juvenile offenders in Eugene, Oregon. These sites are now
beginning implementation.
Zero
Tolerance Drug Supervision Initiative
This
Presidential initiative proposes comprehensive drug supervision
to reduce drug use and recidivism among offenders. The federal government
will help states and localities implement tough new systems to drug-test,
treat, and sanction prisoners, parolees, and probationers. This
initiative will ensure that states fully implement the comprehensive
plans to drug-test prisoners and parolees as required by law. Results
must be submitted to the Justice Department. This initiative also
supports efforts by states like Maryland and Connecticut to begin
drug-testing probationers on a regular basis.
Initiatives
Currently Underway
Over
the past two years, ONDCP has joined with DOJ and HHS to lay the
foundation for systemic collaboration between justice and public
health. Working together, these federal agencies have documented
the state-of-the-science at the March 1998 consensus meeting of
scholars, clinicians, and other practitioners and then proceeded
on two fronts:
