Benefits and costs of substance abuse treatment programs for state prison inmates: results from a lifetime simulation model

Reflecting drug use patterns and criminal justice policies throughout the 1990s and 2000s, prisons hold a disproportionate number of society's drug abusers. Approximately 50% of state prisoners meet the criteria for a diagnosis of drug abuse or dependence, but only 10% receive medically based drug treatment. Because of the link between substance abuse and crime, treating substance abusing and dependent state prisoners while incarcerated has the potential to yield substantial economic benefits. In this paper, we simulate the lifetime costs and benefits of improving prison-based substance abuse treatment and post-release aftercare for a cohort of state prisoners. Our model captures the dynamics of substance abuse as a chronic disease; estimates the benefits of substance abuse treatment over individuals' lifetimes; and tracks the costs of crime and criminal justice costs related to policing, adjudication, and incarceration. We estimate net societal benefits and cost savings to the criminal justice system of the current treatment system and five policy scenarios. We find that four of the five policy scenarios provide positive net societal benefits and cost savings to the criminal justice system relative to the current treatment system. Our study demonstrates the societal gains to improving the drug treatment system for state prisoners.     

Pathways to criminalization for street-involved youth who use illicit substances

Illicit drug use and homelessness among street-involved young people remain community and public health concerns, in part because of their association with ‘public disorder’, as well as increased encounters between youth, police, the criminal justice system, and the associated health-related harms. In the public imagination, illicit drug use, homelessness, and police encounters (including incarceration) are often understood as problems rooted in individual biographies. In general, there has been a lack of attention to the larger historical, institutional, and social-spatial contexts that converge across time, to increase young people’s risk of coming into contact with police and the criminal justice system. Drawing from a longitudinal ethnography with street-involved young people who use illicit drugs in Vancouver, Canada, we highlight two qualitative case studies that illustrate some of the ‘pathways’ to criminalization among this population. Specifically, these case studies reflect the complex linkages between child apprehension, foster care, homelessness, illicit substance use, and incarceration (juvenile detention and prison) across time. Our findings highlight the role of state interventions in perpetuating the marginalization that occurs across young people’s lives, in ways that increase their vulnerability to police and criminal justice encounters.     

The Causal Impact of Childhood-Limited Maltreatment and Adolescent Maltreatment on Early Adult Adjustment

PurposeWe use full-matching propensity score models to test whether developmentally specific measures of maltreatment, in particular childhood-limited maltreatment versus adolescent maltreatment, are causally related to involvement in crime, substance use, health-risking sex behaviors, and internalizing problems during early adulthood.MethodsOur design includes 907 participants (72% male) in the Rochester Youth Development Study, a community sample followed from age 14 to age 31 with 14 assessments, including complete maltreatment histories from Child Protective Services records.ResultsAfter balancing the data sets, childhood-limited maltreatment is significantly related to drug use, problem drug use, depressive symptoms, and suicidal thoughts. Maltreatment during adolescence has a significant effect on a broader range of outcomes: official arrest or incarceration, self-reported criminal offending, violent crime, alcohol use, problem alcohol use, drug use, problem drug use, risky sex behaviors, self-reported sexually transmitted disease diagnosis, and suicidal thoughts.ConclusionsThe causal effect of childhood-limited maltreatment is focused on internalizing problems, whereas adolescent maltreatment has a stronger and more pervasive effect on later adjustment. Increased vigilance by mandated reporters, especially for adolescent victims of maltreatment, along with provision of appropriate services, may prevent a wide range of subsequent adjustment problems.     

Offender Diversion Into Substance Use Disorder Treatment: The Economic Impact of California’s Proposition 36

Objectives. We determined the costs and savings attributable to the California Substance Abuse and Crime Prevention Act (SACPA), which mandated probation or continued parole with substance abuse treatment in lieu of incarceration for adult offenders convicted of nonviolent drug offenses and probation and parole violators.Methods. We used individually linked, population-level administrative data to define intervention and control cohorts of offenders meeting SACPA eligibility criteria. Using multivariate difference-in-differences analysis, we estimated the effect of SACPA implementation on the total and domain-specific costs to state and county governments, controlling for fixed individual and county characteristics and changes in crime at the county level.Results. The additional costs of treatment were more than offset by savings in other domains, primarily in the costs of incarceration. We estimated the statewide policy effect as an adjusted savings of $2317 (95% confidence interval = $1905, $2730) per offender over a 30-month postconviction period. SACPA implementation resulted in greater incremental cost savings for Blacks and Hispanics, who had markedly higher rates of conviction and incarceration.Conclusions. The monetary benefits to government exceeded the additional costs of SACPA implementation and provision of treatment.The overall societal costs of substance use disorders (SUDs) have in recent years reached disproportionate levels across the nation. The White House Office of National Drug Control Policy1 estimated annual societal costs of $180.9 billion in 2002 and noted that these costs have increased at a higher rate than the US gross domestic product over the past 10 years (5.3% per year vs 5.1% per year). The largest- and fastest-growing cost components were, not surprisingly, those for criminal justice activities, particularly increased spending on law enforcement and adjudication, as well as for incarceration for drug offenses and income-generating crimes. The annual federal budget allocated to combat SUDs for the 2011 fiscal year was $15.5 billion,2 with more than $7.6 billion for domestic law enforcement and interdiction. By comparison, $1.7 billion was allocated for prevention programs and $3.9 billion for treatment services.Public policies regarding criminal justice interventions with drug-using offenders have largely been driven by the acknowledged association between drug use and crime. The research literature has consistently reported that SUDs intensify rates of criminal activity, especially among dependent individuals.3–8 The importance of treating offenders with an SUD is further illustrated by the fact that both severity of drug use and recidivism rates decline during and after treatment.9,10 Consequently, a reduction or cessation of drug use has been targeted as a direct method of reducing drug-related crime and enforcement and as an indirect method of reducing other adverse social consequences associated with drug use.11–13A popular criminal justice approach to dealing with drug-using offenders has been the drug court movement, although these programs can target only a relatively few offenders. A recent systematic review14 determined the impact of adult drug courts in the United States. The nonexperimental and quasi-experimental literatures have indicated that drug courts successfully reduce future criminal behavior and future substance use, at least in the short term, versus traditional adjudication. However, none of the 3 randomized studies identified showed a consistent effect on rearrest rates for drug-involved offenders participating in drug court rather than typical adjudication. The 2 studies examining reconviction and reincarceration, however, demonstrated reduced rates for the drug court group versus those typically adjudicated. A review of California drug courts in particular found that drug court participants’ rearrest rates were reduced by 11% to 14%, with the largest reduction in rearrest rates found among individuals graduating from their treatment programs.15 Research has also been conducted to determine the economic impact of drug courts in the United States and internationally.16–18 Yet many methodological and analytical concerns have been raised in the evaluation of drug courts given the selectivity of participants and other concerns,19 although comprehensive economic analyses are available in the peer-reviewed literature that display reliable cost savings for drug courts.17,20,21In parallel with the national drug court movement, federal, state, and local jurisdictions have experimented with various diversion strategies for drug-involved offenders. One of the most extensive and recent of these was prompted by public dissatisfaction with existing California enforcement policy, which led advocates to propose Proposition 36 in the November 2000 state election, subsequently passed by citizens and enacted into California law as the Substance Abuse and Crime Prevention Act of 2000 (SACPA).22 SACPA represented a major shift in criminal justice policy whereby adults convicted of nonviolent drug offenses who meet SACPA eligibility criteria can be sentenced to probation with SUD treatment instead of incarceration or probation without treatment, regardless of treatment motivation level or other indicators of program suitability. The law was modeled after historical and concurrent offender diversion efforts, including the Treatment Alternatives to Street Crime programs, drug courts, and other diversion efforts and attempted to implement a program more broadly applicable than any previously implemented, in part by removing motivation and suitability criteria for participation.23,24 SACPA eligibility criteria include a requirement of no previous or concurrent serious or violent felonies, physical injury misdemeanors, or concurrent nondrug charges.25The law was written to also allow offenders on probation or parole who commit nonviolent drug offenses or who violate drug-related conditions of community supervision to elect community-based treatment. Incarceration of offenders for program noncompliance is prohibited in most cases, and SACPA provides as many as 3 opportunities for most offenders (2 for parolees) to reenter treatment without incarceration despite initial violations (e.g., stemming from failures to report to treatment or court appointments, subsequent drug-related arrests, or other acts of program noncompliance). In essence, SACPA became a statewide policy that changed the course of criminal justice processing for all eligible offenders and service entities involved, including the courts, district attorneys and public defenders, probation and parole officers, and SUD treatment providers.SACPA required an annual budget of $120 million for the first 5 years, spent primarily on expansion of treatment services. Subsequently, funding authority reverted to the state legislature, which reduced targeted funding for SACPA beginning in fiscal year 2008–2009 and terminated funding indefinitely in 2009–2010. Given the large financial investment and the substantial impact the law has had on SUD treatment in California, determining the economic impact of SACPA implementation, taking into account both the costs of treatment and program administration and the potentially off-setting changes in the costs of health resource utilization, criminal recidivism, and incarceration, is important. We took advantage of individually linked state-level data on criminal justice, corrections, publicly funded health resource utilization, and SUD treatment to determine the economic impact of California’s implementation of the SACPA program.     

Disparities in Criminal Court Referrals to Drug Treatment and Prison for Minority Men

Objectives. We investigated the extent to which racial/ethnic disparities in prison and diversion to drug treatment were explained by current arrest and criminal history characteristics among drug-involved offenders, and whether those disparities decreased after California’s Proposition 36, which mandated first- and second-time nonviolent drug offenders drug treatment instead of prison.Methods. We analyzed administrative data on approximately 170 000 drug-involved arrests in California between 1995 and 2005. We examined odds ratios from logistic regressions for prison and diversion across racial/ethnic groups before and after Proposition 36.Results. We found significant disparities in prison and diversion for Blacks and Hispanics relative to Whites. These disparities decreased after controlling for current arrest and criminal history characteristics for Blacks. Proposition 36 was also associated with a reduction in disparities, but more so for Hispanics than Blacks.Conclusions. Disparities in prison and diversion to drug treatment among drug-involved offenders affect hundreds of thousands of citizens and might reinforce imbalances in criminal justice and health outcomes. Our study indicated that standardized criminal justice policies that improved access to drug treatment might contribute to alleviating some share of these disparities.The prison population in the United States increased nearly 5-fold between 1980 and 2009.1 This growth has had a disparate impact on minorities. An estimated 38% of state and federal prison inmates in 2009 were Black—a staggering share when we consider that Blacks comprise only 13% of the US population.2 By age 30 years, approximately 21% of Black males will serve a prison sentence compared with only 2.5% of White males.3 The lifetime probability of spending time in prison is now greater for young Black males than the probability of attending college.4 It has been demonstrated that this disparity is at least partially a product of the “War on Drugs” and sentencing policies that require longer mandatory minimum stays in prison for low-level, drug-related offenses and offenses committed while under the influence of drugs or alcohol.4–6Given the increased focus on drug-related crimes spurred by the War on Drugs, it is not surprising that drug offenders now constitute the largest share of new commitments to prison and that the criminal justice system has become the largest source of referrals to drug treatment. Criminal justice referrals accounted for 37% of drug treatment admissions in 2008.7 Despite substantial evidence that minorities are overrepresented in the drug arrestee population, they remain a relatively large share of prison commitments and a relatively small share of criminal justice referrals to treatment. Hispanics and Blacks contributed to roughly 60% of prison admissions2 in 2006 compared with only 35% of drug and alcohol treatment admissions.7 Disparities in criminal justice referrals to drug treatment potentially affect access to treatment of hundreds of thousands of individuals arrested for drug offenses each year. If racial/ethnic disparities exist in incarceration and diversion rates, then these disparities are likely to reinforce current imbalances in the criminal justice system and impose substantial economic costs on minorities, such as the loss of future employment opportunities and poor health outcomes.8Previous empirical efforts using aggregate data to explain disparities in incarceration rates among Blacks focused on differential involvement at the arrest stage. Some of the most widely cited studies were those conducted by Blumstein.9,10 Blumstein used aggregate US data to determine whether differential incarceration rates could be explained by differential arrest rates. For 3 different years between 1974 and 1991, Blumstein found that 76% to 86% of the difference in national imprisonment rates between Blacks and Whites could be explained by differential criminal involvement at the arrest stage. However, when the analysis focused exclusively on drug offenders, only about 50% of the disparity was explained. Crutchfield et al.11 argued that aggregating national data likely missed significant differences across states and counties. Austin and Allen,12 for example, found that only 26% of disparities in drug-related incarcerations in Pennsylvania were because of differences in arrest rates. Others also contended that the results were very different for individual states.13Although these aggregate-level analyses found that the majority of the disparity in incarceration rates among drug offenders could not be explained by differential arrest rates, other potential explanations were also put forward. Individual factors, such as more serious criminal offense charges associated with the current arrest or more serious criminal histories, could increase the probability of incarceration and make individuals less eligible for drug treatment in lieu of incarceration. Alternatively, contextual factors might also play a role. Minorities are more likely to live in high-crime urban areas with a greater allocation of law enforcement resources, which might make them more prone to apprehension for drug possession crimes.14 Furthermore, courts located in urban areas might be more likely to incarcerate a drug offender because of greater caseloads, limited treatment capacity, or a greater reliance among judges on mandatory penalties that more directly affect minorities.15There were a number of important limitations with the previous aggregate studies of disparities among drug-involved offenders. Few aggregate studies of racial disparities in criminal justice outcomes for drug-involved offenders differentiated the severity of the drug offenses in the current arrest, such as whether minorities were more likely than Whites to commit felony offenses that are prison-eligible. These studies also provided no information on the criminal history of arrestees. More serious criminal histories could also contribute to disparities in incarceration rates. A meta-analysis of individual-level analyses showed that the size of the observed disparity declined significantly after controlling for offense severity, other case characteristics, and previous criminal record.16 Another limitation was that the aggregate studies relied on arrest and incarceration data from different sources, making it unclear what share of the incarcerations originated in the arrest population versus other sources, like revocations from parole or probation violations. Finally, few studies examined White–Hispanic disparities.17 For policymakers, it is clearly important to document whether Hispanics experience similar disparities as Blacks. By ignoring ethnic differences, previous research often included Hispanics as Whites in their comparisons, thereby potentially masking important differences.18Using a sample of males arrested for drug offenses in California, we investigated whether there were racial/ethnic disparities in the rate of incarceration and the rate of diversion to drug treatment. The study relied on administrative records that tracked the same individuals from their arrest to corresponding criminal court disposition. We examined whether observed disparities remained after statistically controlling for similar current arrest, criminal history, and demographic characteristics. We also examined whether these disparities were affected by changes in the sentencing regime that occurred in July 2001 with the implementation of California’s Proposition 36 (Prop36). Prop36 represents a potentially critical change in the sentencing regime. The proposition mandated that individuals with less than 3 previous drug convictions and no violent convictions be offered drug treatment in lieu of incarceration. The mandate was well funded during our analysis period, with approximately $120 million dollars annually from 2001 to 2005.19     

Examining the Temporal Relationship Between Criminal Justice Involvement and Sexual Risk Behaviors among Drug-Involved Men

Although criminal justice involvement has repeatedly been associated with human immunodeficiency virus (HIV)/sexually transmitted infection prevalence and sexual risk behaviors, few studies have examined whether arrest or incarceration uniquely contributes to sexually risky behavior. We examined the temporal relationship between criminal justice involvement and subsequent sexual HIV risk among men in methadone maintenance treatment in New York City. A random sample of 356 men was interviewed at baseline (time 1), 6-month (time 2), and 12-month (time 3) follow-ups. Propensity score matching, negative binomial, and multiple logistic regression were used to isolate and test the effect of time 2 arrest and incarceration on time 3 sexual risk behaviors. Incidence of time 2 criminal justice involvement was 20.1% for arrest and 9.4% for incarceration in the prior 6 months. Men who were arrested at time 2 demonstrated increased number (adjusted incidence rate ratio [IRR] = 1.62; 95% confidence intervals [CI] = 1.11, 2.37) and proportion (IRR = 1.36; 95% CI = 1.07, 1.72) of unprotected vaginal sex acts at time 3. Men incarcerated at time 2 displayed increased number (IRR = 2.07; 95% CI = 1.23, 3.48) and proportion (IRR = 1.45; 95% CI = 1.06, 1.99) of unprotected vaginal sex acts at time 3. Within this sample of drug-involved men, arrest and incarceration are temporally associated with and may uniquely impact successive sexual risk-taking. Findings underscore the importance of HIV prevention interventions among individuals with low-intensity criminal justice involvement. Developing prevention efforts aimed at short-term incarceration, community reentry, and alternatives to incarceration settings will address a large and under-researched segment of the criminal justice population. Alternative approaches to current criminal justice policy may result in public health benefits.     

Impact of Court-Mandated Substance Abuse Treatment on Clinical Decision Making

California’s Proposition 36 offers nonviolent drug offenders community-based treatment as an alternative to incarceration or probation without treatment. The study objective was to examine how substance abuse treatment providers perceive the impact of Proposition 36 on their clinical decision making. Program surveys were completed by 115 treatment programs in five California counties to assess the impact of the law on clinical decision making, and five focus groups were conducted with 37 treatment providers to better understand their perspectives. Compared to residential programs, outpatient programs reported that the policy impacted them to a greater extent in terms of drug testing, reporting to criminal justice personnel, and determining client discharge. Providers in the focus groups particularly highlighted their changing roles in assessing clients’ treatment needs and determining the best routes of care for them. The findings indicate that alternate strategies for determining treatment placement and continuing care should be developed.     

Psychiatric distress in incarcerated women with recent cocaine and alcohol abuse.

PURPOSE: Women frequently abuse cocaine and alcohol before incarceration. Research indicates that women in criminal justice settings also suffer high rates of psychiatric distress. This study aimed to determine how preincarceration abuse of alcohol and cocaine affected current psychiatric distress among female jail detainees held for 10-14 days. METHODS: A probability sample of women in a large urban jail (n = 469) were assessed for use of alcohol and cocaine during the 6 months before incarceration and for their current psychiatric distress. They were grouped based on their level of alcohol consumption and cocaine use: high cocaine/high alcohol; high cocaine/low alcohol; low cocaine/high alcohol; and low cocaine/low alcohol. Profile analysis was used to examine the relation of psychiatric distress, as measured by the Brief Symptom Inventory, to levels of recent alcohol and cocaine use. RESULTS: Psychiatric distress is highest (and similar) among women in the high cocaine groups, regardless of alcohol use, and psychiatric distress is lowest among those who used both substances infrequently. Characteristics of psychiatric distress differed based on level of alcohol use, but only when cocaine use was low. High alcohol and cocaine use alone and together also predict the likelihood of psychiatric distress reaching a diagnosable level of severity. CONCLUSIONS: High cocaine, alcohol, or combined use is related to higher levels of psychiatric distress among incarcerated women in this jail. Women should be screened at the time of incarceration, and women who have alcohol and other drug problems should receive treatment that includes mental health services.     

Crime, drugs and distress: patterns of drug use and harm among criminally involved injecting drug users in Australia

Objective: Explore demographic characteristics, patterns of drug use and psychological distress among regular injecting drug users (IDUs) in Australia, as a function of recent criminal activity.
Methods: Structured, face-to-face interviews with 909 regular IDUs recruited from every capital city in Australia, between June and August 2007, as part of the annual Illicit Drug Reporting System (IDRS). Criminal activity in the past month was assessed using the Opiate Treatment Index (OTI); psychological distress was assessed using the Kessler psychological distress scale (K10).
Results: Forty-three per cent of IDUs reported recent (past month) criminal activity. Those who had committed crime recently were younger, exhibited riskier patterns of drug use, reported more drug-related problems and were more likely to exhibit significant psychological distress. In a multivariate model the most important correlates of recent criminal activity were use of more than three drug types recently (OR=2.66, 95% CI 1.96-3.61), initiation to injecting before age 18 (OR=1.93, 95% CI 1.42-2.61) and daily drug injection (OR=1.55, 95% CI 1.13-2.13).
Conclusions and Implications: Criminal activity among regular IDUs in Australia is not restricted to a particular demographic group, and is a marker for riskier patterns of drug use, greater drug-related harm and psychological distress. Contact between IDUs and the criminal justice system provides opportunities for the delivery of targeted harm reduction messages, and for screening and diversion into appropriate treatment services.     

Criminally violent victimisation in schizophrenia spectrum disorders: the relationship to symptoms and substance abuse

ABSTRACT: BACKGROUND: Violent victimisation among people with major mental illness is well-documented but the risk factors for criminal violent victimisation are not well understood. To examine the relationship between symptoms and substance abuse and criminal victimisation in male patients with schizophrenia. METHODS: We examined the relationship between illness-related variables, indices of substance abuse and previous history of violence in a sample of 23 male criminally violently victimized and 69 non-criminally violently victimized male patients with DSM-IV-TR diagnoses of schizophrenia and schizoaffective disorder that were resident in the community and in contact with public mental health services in Victoria Australia. Data on criminal victimisation was acquired from the police database. RESULTS: Demographic, a history of violence or illness-related variables did not distinguish between those had been the victim of a violent crime and those who had not. Our data indicated that drug abuse was a key factor in distinguishing between the groups, but the age of onset of substance abuse was not a significant factor. Scores on measures of drug abuse were modest predictors of criminal victimisation status in our Receiver Operator Characteristic analyses. CONCLUSION: Overall, our findings suggest that substance abuse (particularly drug abuse) is a key predictor of violent victimisation based on criminal statistics. The latter has implications for mental health professions involved in the care planning and community management of patients with major mental illness and work points to the importance of substance abuse treatment in the prevention of victimisation as well as violence perpetration.     

Incarceration and High-Risk Sex Partnerships among Men in the United States

Incarceration is associated with multiple and concurrent partnerships, which are determinants of sexually transmitted infections (STI), including HIV. The associations between incarceration and high-risk sex partnerships may exist, in part, because incarceration disrupts stable sex partnerships, some of which are protective against high-risk sex partnerships. When investigating STI/HIV risk among those with incarceration histories, it is important to consider the potential role of drug use as a factor contributing to sexual risk behavior. First, incarceration’s influence on sexual risk taking may be further heightened by drug-related effects on sexual behavior. Second, drug users may have fewer economic and social resources to manage the disruption of incarceration than nonusers of drugs, leaving this group particularly vulnerable to the disruptive effects of incarceration on sexual risk behavior. Using the 2002 National Survey of Family Growth, we conducted multivariable analyses to estimate associations between incarceration in the past 12 months and engagement in multiple partnerships, concurrent partnerships, and unprotected sex in the past 12 months, stratified by status of illicit drug use (defined as use of cocaine, crack, or injection drugs in the past 12 months), among adult men in the US. Illicit drug users were much more likely than nonusers of illicit drugs to have had concurrent partnerships (16% and 6%), multiple partnerships (45% and 18%), and unprotected sex (32% and 19%). Analyses adjusting for age, race, educational attainment, poverty status, marital status, cohabitation status, and age at first sex indicated that incarceration was associated with concurrent partnerships among nonusers of illicit drugs (adjusted prevalence ratio (aPR) 1.55, 95% confidence interval (CI) 1.06–2.22) and illicit drug users (aPR 2.14, 95% CI 1.07–4.29). While incarceration was also associated with multiple partnerships and unprotected sex among nonusers of illicit drugs (multiple partnerships: aPR 1.66, 95% CI 1.43–1.93; unprotected sex: aPR 1.99, 95% CI 1.45–2.72), incarceration was not associated with these behaviors among illicit drug users (multiple partnerships: aPR 1.03, 95% CI 0.79–1.35; unprotected sex: aPR 0.73, 95% CI 0.41–1.31); among illicit drug users, multiple partnerships and unprotected sex were common irrespective of incarceration history. These findings support the need for correctional facility- and community-based STI/HIV prevention efforts including STI/HIV education, testing, and care for current and former prisoners with and without drug use histories. Men with both illicit drug use and incarceration histories may experience particular vulnerability to STI/HIV, as a result of having disproportionate levels of concurrent partnerships and high levels of unprotected sex. We hypothesize that incarceration works in tandem with drug use and other adverse social and economic factors to increase sexual risk behavior. To establish whether incarceration is causally associated with high-risk sex partnerships and acquisition of STI/HIV, a longitudinal study that accurately measures incarceration, STI/HIV, and illicit drug use should be conducted to disentangle the specific effects of each variable of interest on risk behavior and STI/HIV acquisition.     

Housing Experiences among Opioid-Dependent,Criminal Justice-Involved Individuals in Washington,D.C.

Residential mobility and type of housing contributes to an individual’s likelihood and frequency of drug/alcohol use and committing criminal offenses. Little research has focused simultaneously on the influence of housing status on the use of drugs and criminal behavior. The present study examines how residential mobility (transitions in housing) and recent housing stability (prior 30 days) correlates with self-reported criminal activity and drug/alcohol use among a sample of 504 addicted, treatment-seeking opioid users with a history of criminal justice involvement. Findings suggest that those with a greater number of housing transitions were considerably less likely to self-report criminal activity, and criminal involvement was highest among those who were chronically homeless. Residential mobility was unassociated with days of drug and alcohol use; however, residing in regulated housing (halfway houses and homeless shelters) was associated with a decreased frequency of substance use. The finding that residing at sober-living housing facilities with regulations governing behavior (regulated housing) was associated with a lower likelihood of illicit substance use may suggest that regulated housing settings may influence behavior. Further research in this area should explore how social networks and other related variables moderate the effects of housing type and mobility on crime and substance use.     

Restorative justice: Its potential

For the sake of argument let us assume an imperfect criminal justice system, creaking under the strain of volume of work, level of crime and limited resources. The term Restorative Justice is rapidly gaining currency in many sectors of our community at present. Simultaneously as interest grows, we wonder whether it is a notion, a concept, a philosophy or a different way of restoring our criminal system. It has been described as all of these: in essence it is all of these and more. It can offer our society a different paradigm of crime and society's response to it, and has even been suggested as a replacement for our existing system, (Zehr and Umbreit, 1982).     

Treatment at the front end of the criminal justice continuum: the association between arrest and admission into specialty substance abuse treatment

Background  

To reduce criminal recidivism and drug use, it has been proposed that the substance abuse treatment delivery system cut across different components of the criminal justice continuum. Arrest, at the front end of this continuum, may represent a critical moment to motivate people with substance use disorders (SUD) to seek treatment but is often over looked as an intervention point. We used data from the 2002 National Survey on Drug Use and Health (NSDUH) to compare treatment need and recent treatment admission for participants with no criminal justice (CJ) involvement in the past year, past-year arrest, and CJ supervision (i.e., probation or parole status).     

Treating the drug-abusing offender

The association between drug abuse treatment and criminal justice control is examined in this article. A framework is presented for mental health administrators and policy-makers to examine and appreciate the use of authority derived from the criminal justice system for drug abusers involved in community treatment. In addition, an overview of relevant literature is provided to encapsulate the literature related to the drug-abusing criminal offender which is most useful for mental health administrators and policy-makers.     

Neighborhood Incarceration Rate and Asthma Prevalence in New York City: A Multilevel Approach

Objectives. We examined the association between neighborhood incarceration rate and asthma prevalence and morbidity among New York City adults.Methods. We used multilevel modeling techniques and data from the New York City Community Health Survey (2004) to analyze the association between neighborhood incarceration rate and asthma prevalence, adjusting for individual-level sociodemographic, behavioral, and environmental characteristics. We examined interactions between neighborhood incarceration rate, respondent incarceration history, and race/ethnicity.Results. The mean neighborhood rate of incarceration was 5.4% (range = 2.1%–12.8%). Neighborhood incarceration rate was associated with individual-level asthma prevalence (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.03, 1.10) in unadjusted models but not after adjustment for sociodemographic characteristics (OR = 1.01; 95% CI = 0.98, 1.04). This association did not differ according to respondent race/ethnicity.Conclusions. Among New York City adults, the association between neighborhood incarceration rate and asthma prevalence is explained by the sociodemographic composition of neighborhoods and disparities in asthma prevalence at the individual level. Public health practitioners should further engage with criminal justice professionals and correctional health care providers to target asthma outreach efforts toward both correctional facilities and neighborhoods with high rates of incarceration.In the United States, asthma disproportionately affects non-White individuals living in urban areas and living in poverty.1 Because low socioeconomic status (SES) and racial/ethnic minority group status are closely intertwined with residence in an inner-city environment, characteristics of these inner-city neighborhoods have received much attention in the effort to explain patterns of asthma prevalence and morbidity.2,3 Epidemiological studies have highlighted the influence of poor housing, which may increase exposure to indoor allergens such as rat droppings4; greater likelihood of tobacco smoke exposure5; and overcrowding, which may predispose people to viral respiratory illness.2Because features of the physical environment do not completely explain observed patterns in asthma prevalence, features of the social environment have emerged as important asthma risk factors.6 Observational studies have demonstrated the association between asthma, psychological stress, and exposure to violent neighborhoods.7–9 For example, exposure to violence may influence an individual’s impulse control and risk-taking behavior, resulting in the adoption of coping behaviors, such as smoking, a known trigger for asthma.8–10 Psychological stress may be further compounded by the presence of overburdened or absent social supports and a perceived lack of control over one’s self or environment.6,11 Neighborhood-level constructs such as social capital and social cohesion have been linked to important health outcomes and may have an impact on asthma prevalence.12A natural but overlooked extension of this work is the potential impact of the criminal justice system on communities. Incarceration has a disproportionate impact on poor communities of color and has been linked to increased rates of asthma at the level of the individual.13–15 In addition to the effects on the individuals directly involved with the criminal justice system, neighborhood incarceration rates may play a role in shaping the social environment and thereby affect asthma prevalence. Exposure to high rates of neighborhood violence and crime often accompany exposure to incarceration. Recidivism and the risks of community reentry may further exacerbate this exposure.16 Incarceration has been shown to lead to long-term psychological stress for those affected17,18 and holds significant consequences for their families, creating further stress by removing social supports and weakening families.19 Individuals released from prison face legal barriers to employment, housing, public entitlements, and educational opportunities and various restrictions on political and social rights,20,21 further diminishing the social capital of their communities.Therefore, we sought to examine the association between neighborhood-level incarceration rates and several individual-level asthma outcomes. We hypothesized that increased neighborhood incarceration rates would be associated with increased asthma prevalence. Additionally, we proposed that increased neighborhood incarceration rates would be associated with increased asthma morbidity. We specifically examined factors potentially correlated with both neighborhood incarceration rate and asthma prevalence, such as SES, smoking, and poor housing conditions.     

Do cultural and linguistic competence matter in Latinos' completion of mandated substance abuse treatment?

ABSTRACT: BACKGROUND: Increasing evidence suggests that culturally and linguistically responsive programs may improve substance abuse treatment outcomes among Latinos. However, little is known about whether individual practices or culturally and linguistically responsive contexts support efforts by first-time Latino clients to successfully complete mandated treatment. METHODS: We analyzed client and program data from publicly funded treatment programs contracted through the criminal justice system in California. A sample of 5,150 first-time Latino clients nested within 48 treatment programs was analyzed using multilevel logistic regressions. RESULTS: Outpatient treatment, homelessness, and a high frequency of drug use at intake were associated with decreased odds of treatment completion among Latinos. Programs that routinely offered a culturally and linguistically responsive practice---namely, Spanish-language translation---were associated with increased odds of completion of mandated treatment. CONCLUSIONS: These preliminary findings suggest that concrete practices such as offering Spanish translation improve treatment adherence within a population that is at high risk of treatment dropout.     

Health as a mediator of change in the trajectory of young people in contact with the criminal justice system

Health care services in Juvenile Detention Centres have historically been provided by the criminal justice system. These health services have focused on assessment and treatment of presenting health problems and have been hampered by the lack of clinical algorithms and standardised protocols expected of health run services. There is now comprehensive information on the health needs and prevalence of ill health, both physical and mental, for the population of adolescents in contact with the criminal justice system. This information has led to a greater understanding of the causative relationship between disadvantage, trauma, ill health and behaviour judged to be criminal as well an understanding of the need for a population health approach to underpin intervention. Young people in contact with the criminal justice system in New South Wales were found to come from disadvantaged backgrounds, have significant physical and mental health problems as well as increased risk behaviours and their associated health sequelae. This prevalence data can be used to plan service delivery and shape a model of delivery. Paradoxically incarceration offers an opportunity to target high prevalence health presentations and to screen for emerging physical and mental health problems. The potential to ameliorate life long conditions that impact on personal quality of life, and personal and system economic costs are of importance. There is the potential for some health interventions, such as mental illness and drug and alcohol to have an impact on the trajectory and lethality of recidivist behaviour. More research is required to examine health interventions with the potential to positively impact on long-term health outcomes as well as re-offending.     

Health Care Reform,Behavioral Health,and the Criminal Justice Population

The 2010 Patient Protection and Affordable Care Act (ACA) has a number of important features for individuals who are involved with the criminal justice system. Among the most important changes is the expansion of Medicaid to more adults. The current study estimates that 10% of the total Medicaid expansion could include individuals who have experienced recent incarceration. The ACA also emphasizes the importance of mental health and substance abuse benefits, potentially changing the landscape of behavioral health treatment providers willing to serve criminal justice populations. Finally, it seeks to promote coordinated care delivery. New care delivery and appropriate funding models are needed to address the behavioral health and other chronic conditions experienced by those in criminal justice and to coordinate care within the complex structure of the justice system itself.