Igor Koutsenok, MD, MS Assistant Professor of Psychiatry, UCSD, Director, Center for Criminality & Addiction Research, Training & Application (CCARTA) Treatment of Substance Treatment of Substance Involved Offenders in Involved Offenders in Criminal Justice Settings Criminal Justice Settings – – Challenges & Outcomes Challenges & Outcomes
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Igor Koutsenok, MD, MS Assistant Professor of Psychiatry, UCSD, Director, Center for Criminality & Addiction Research, Training & Application (CCARTA)
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Igor Koutsenok, MD, MSAssistant Professor of Psychiatry, UCSD,
Director,Center for Criminality & Addiction Research, Training & Application
(CCARTA)
Treatment of Substance Treatment of Substance Involved Offenders in Criminal Involved Offenders in Criminal
Let’s start with some bad Let’s start with some bad newsnews
California StatisticsCalifornia Statistics
172,785 in prison (1986: 39,373)172,785 in prison (1986: 39,373) Cost – $38 000 per inmateCost – $38 000 per inmate 117,136 on parole (1986: 19,780)117,136 on parole (1986: 19,780) Cost - $12 000 per paroleeCost - $12 000 per parolee 77% of males and 83% of females 77% of males and 83% of females
incarcerated in California have drug incarcerated in California have drug and alcohol problems.and alcohol problems.
Nationwide costNationwide costColumbia University Report, March Columbia University Report, March
20052005
$ 30 billion states spent on adult $ 30 billion states spent on adult corrections (incarceration, corrections (incarceration, probation, parole)probation, parole)
$24.1 billion of it was on substance $24.1 billion of it was on substance involved offendersinvolved offenders
During the 1980s and 1990s, the number of incarcerated women tripled, while the number of men doubled.
80% of these women have substance abuse problems.
On Women…On Women…
“What Works,” Dr. Rudy J. Cypser, CURE-NY, 2000
Some Other Sad FactsSome Other Sad Facts Over 2 million inmates inhabited U.S. Over 2 million inmates inhabited U.S.
jails & prisonsjails & prisons They are parents of 3.4 million childrenThey are parents of 3.4 million children 2 in 3 convicts have been tested 2 in 3 convicts have been tested
positive for drugs at time of arrest.positive for drugs at time of arrest. 2 in 3 inmates have verified drug 2 in 3 inmates have verified drug
histories, histories, BUT…BUT…
Under 15 % receive systematic Under 15 % receive systematic treatmenttreatment
Recidivism Recidivism Within 12 months after release from Within 12 months after release from
custody 70- 75% of substance involved custody 70- 75% of substance involved offenders are back to institutionsoffenders are back to institutions
It is clear that criminal-justice It is clear that criminal-justice sanctions by themselves do not reduce sanctions by themselves do not reduce recidivism in this populationrecidivism in this population
Prisons do manage behaviors, but do Prisons do manage behaviors, but do not shape behaviorsnot shape behaviors
Policies for Drug OffendersPolicies for Drug Offenders
Diversion Incarceration
Probation w/o verdict(Prop 36)
Drug Courts
Intermediatesanctions
Policies for Drug OffendersPolicies for Drug Offenders
Diversion Incarceration
Probation w/o verdict(Prop 36)
Drug Courts
Intermediatesanctions
Public Safety
Public Safety RisksRisks
Policies for Drug OffendersPolicies for Drug Offenders
Diversion Incarceration
Probation w/o verdict(Prop 36)
Drug Courts
Intermediatesanctions
$$$$$$ Costs $$$$$$$$
$$$$$$ Costs $$$$$$$$
$$
Public Safety Risks
Public Safety Risks
Policies for Drug OffendersPolicies for Drug Offenders
Diversion Incarceration
Probation w/o verdict(Prop 36)
Drug Courts
Intermediatesanctions
Over-Over-reliancereliance
PrisonPrison
Criminal Recidivism in 3 YearsCriminal Recidivism in 3 Years 68% re-arrested68% re-arrested 47% convicted47% convicted 50% re-incarcerated50% re-incarcerated
Relapse to Drug Use in 3 YearsRelapse to Drug Use in 3 Years 95% relapse95% relapse
Marlow D., Treatment Research Institute, 2006
Policies for Drug OffendersPolicies for Drug Offenders
Diversion Incarceration
Probation w/o verdict(Prop 36)
Drug Courts
Intermediatesanctions
Policies for Drug OffendersPolicies for Drug Offenders
Diversion Incarceration
Probation w/o verdict(Prop 36)
Drug Courts
Intermediatesanctions
Over-Over-reliancereliance
Referral to TreatmentReferral to Treatment
50% - 67% don’t show for intake50% - 67% don’t show for intake 40% - 80% drop out in 3 months40% - 80% drop out in 3 months 90% drop out in 12 months90% drop out in 12 months 70% of probationers and parolees 70% of probationers and parolees
drop out within 2 - 6 monthsdrop out within 2 - 6 months
Attrition
D. Marlow D. & T.McLellan, TRI, 2004
Time for some better Time for some better newsnews
What will happen if we
What will happen if we
combine incarceration
combine incarceration
and treatment?
and treatment?
From the work of From the work of Douglas B. Marlowe, J.D., Ph.D.Douglas B. Marlowe, J.D., Ph.D.
Types of Substance Types of Substance Involved OffendersInvolved Offenders
Criminogenic Criminogenic RisksRisks Age during rehabilitation < 25 yearsAge during rehabilitation < 25 years Criminal onset < 16 yearsCriminal onset < 16 years Prior rehabilitation failuresPrior rehabilitation failures History of violenceHistory of violence Antisocial Personality DisorderAntisocial Personality Disorder Psychopathy Psychopathy Familial history of crimeFamilial history of crime Criminal associationsCriminal associations
Criminogenic Criminogenic NeedsNeeds
Drug Dependence or AddictionDrug Dependence or Addiction
Criminogenic Criminogenic NeedsNeeds
Drug Dependence or AddictionDrug Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Criminogenic Criminogenic NeedsNeeds
Drug Dependence or AddictionDrug Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
} Abstinence is a distal goal
Criminogenic Criminogenic NeedsNeeds
Drug Dependence or AddictionDrug Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Drug Abuse or MisuseDrug Abuse or Misuse
} Abstinence is a distal goal
Criminogenic Criminogenic NeedsNeeds
Drug Dependence or AddictionDrug Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Drug Abuse or MisuseDrug Abuse or Misuse
} Abstinence is a distal goal
Abstinence is a proximal goal}
Criminogenic Criminogenic NeedsNeeds
Drug Dependence or AddictionDrug Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms
Drug Dependence or AddictionDrug Dependence or Addiction1.1. Binge patternBinge pattern2.2. Cravings or compulsionsCravings or compulsions3.3. Withdrawal symptomsWithdrawal symptoms