The challenges of integrating drug treatment into the criminal justice process.

• Author: Belenko, Steven
• Position: Statistical Data Included

1. INTRODUCTION

   The enforcement of anti-drug laws and the consequences of drug abuse and addiction have impacted the nation's criminal justice system in profound ways over the past twenty-five years.(1) Police departments and other law enforcement agencies have paid increasing attention to drug crimes, legislatures have passed more and more punitive laws against the use and sale of illegal drugs, and access to treatment has been limited for those subpopulations of drug users who are most likely to be targeted by the criminal justice system for drug-related offenses. As a result, burgeoning numbers of drug offenders have flooded jails and prisons, and court and probation caseloads have mushroomed.(2) Beginning in the 1980s, many urban police departments expanded their antidrug enforcement activities, from trying to penetrate drug-dealing organizations and arrest large-scale traffickers to targeting lower-level street dealers with undercover police officers.(3) Police departments have increasingly placed officers on the beat in a significant expansion of community policing. Most states in recent years also have legislated stiffer consequences for drug law violations.(4)

   Between 1980 and 1998, the number of arrests nationwide increased by 40%, from 10,441,000 to 14,528,300.(5) One of the largest increases in arrest rates has been for violation of laws prohibiting drug sales, distribution, and possession--up 168% during this time period, from 580,900 to 1,559,100.(6) Between 1980 and 1998, arrests for drug law violations grew at four times the rate of increase for violent felonies (up 42%) and arrests for property crimes decreased by 3%.(7) Although arrests for driving under the influence (DUI) did not increase between 1980 and 1998, there were over 1.4 million DUI arrests in 1998, more than 9% of all arrests in the United States.(8)

   Between 1980 and 1998, the number of inmates in the United States more than tripled from 501,886 to more than 1,825,000.(9) The state prison population increased by 299% (from 295,819 to 1,178,978 inmates).(10) The federal prison population increased by 417% (from 23,779 to 123,041 inmates), while local jail inmates increased by 225% (from 182,288 to 592,462).(11)

2. DRUG-INVOLVED OFFENDERS

   Drug use is the norm among those arrested and held for arraignment. Among samples of adults arrested in Manhattan during 1998,(12) 77% of males tested positive for any illegal drug, as did 82% of females.(13) A little less than half (47%) of males and 67% of females were positive for cocaine, and 16% of males and 22% of females tested positive for opiates.(14)

   Nationally, 65% tested positive for any illegal drug, including 38% positive for cocaine and 8% for opiates;(15) 15% of arrestees had injected drugs at some time in their lives.(16) In addition, 11% of arrestees in 1997 reported ever having been dependent on crack, 4% on cocaine, and 5% on heroin.(17) Overall, 79% of arrestees are "drug-involved," meaning they tested positive for an illegal drug, had used illegal drugs recently, had histories of drug dependence or treatment, or were in need of treatment at the time of their arrest.(18)

   Data from national surveys also demonstrate substantial drug involvement with illegal drugs among offenders sentenced to probation. In a 1995 national survey of a random sample of offenders on probation, 14% of probationers were under the influence of drugs at the time of the offense,(19) and 47% were under the influence of drugs or alcohol.(20) In addition, 43% of probationers had histories of regular illegal drug use,(21) 31% had ever used cocaine,(22) and 12% had used opiates or heroin?

   Data on prison and jail inmates also paint a dramatic picture. Nationally, in 1997, 83% of state prison inmates were substance-involved.(24) They violated drug or alcohol laws, were under the influence at the time of their offense, they committed their crime to get money for drugs, have a history of regular illegal drug use, or a history of alcohol treatment.(25) For state inmates in 1997, this includes 70% who have used an illegal drug weekly or more often for a period of at least one month,(26) 34% who were under the influence of drugs or alcohol at the time of their offense,(27) 17% who committed their crime to get money to buy drugs,(28) and 65% who had a history of treatment for drug and alcohol problems.(29)

   The percentage of state prison inmates sentenced for a drug law violation increased from 6% in 1980 to 23% in 1996.(30) For jail inmates the comparable increase was from 9% in 1983 to 24% in 1996.(31)

3. RELATIVELY FEW OFFENDERS RECEIVE TREATMENT

   Despite abundant research demonstrating that drug treatment can significantly reduce drug use and related criminal activity,(32) access to treatment appears to be quite limited for criminal offenders relative to their need.(33)

   For example, according to the 1997 national Arrestee Drug Abuse Monitoring Program (ADAM) data, 38% of arrestees had ever used cocaine, but only 6% had ever received treatment for cocaine.(34) Similarly, 36% had used crack, and 10% had received treatment for crack; 16% had ever used heroin, and 5% had received treatment for heroin.(35) Overall, 24% reported that they were in need of treatment for abuse of at least one illegal drug.(36)

   Similarly, a relatively small percentage of offenders are engaged in substance abuse treatment while on probation.(37) In the 1995 national probationer survey, only 25% of those who had ever used drugs received treatment while on their current probation.(38) A minority of recent drug users received treatment: 42% of those who had used drugs in the month before the offense had received treatment while on probation.(39) Only 18% of probationers who had ever used drugs regularly were currently in a treatment program at the time of the survey.(40)

   Finally, relatively few prison and jail inmates receive substance abuse treatment. Although an estimated 75% of state prison inmates are in need of substance abuse treatment, fewer than 20% actually receive such treatment.(41) Most of this treatment tends to be short-term and non-intensive.

   The lack of treatment opportunity for offenders has important implications. Although some offenders can overcome their drug problems without treatment and are able to obtain treatment on their own, or age out of drug abuse, most have difficulty escaping from the cycle of drug abuse and crime without formal interventions imposed by the criminal justice system. Offenders tend to be from poor, minority communities that largely feed the criminal justice system and have limited resources or lack health insurance with which to access treatment on their own.(42)

   Another problem is that aside from a few specialized programs,(43) the drug abuse problems of offenders are rarely assessed until sentencing. Probation and corrections may screen and assess offenders for substance abuse problems, and judges may order treatment as a condition of probation, but few actually receive such treatment. Fewer receive the long-term treatment and access to other services that this population tends to need. In particular, the special treatment needs of women offenders and members of minority groups are not often addressed.

4. INTERVENTION POINTS FOR CRIMINAL JUSTICE-BASED TREATMENT(44)

   The original mechanism for integrating treatment into the criminal justice process was commitment to secure treatment facilities, which began to be adopted more widely in several states in the early 1960s. Sometimes known as "civil commitment" (because addicts could also be committed to a secure treatment facility voluntarily or through civil justice proceedings), it had its origins in the late 1920s, when Congress created two federal "narcotic farms," established in Lexington, Kentucky and Fort Worth, Texas.(45) Under this commitment model, drug addicts or abusers were sent to a secure treatment facility, often for a number of years, either in lieu of incarceration or for simply being addicted to drugs.(46) In addition, civil commitment was used to divert arrestees from the criminal justice system into treatment, although the amount of time these offenders had to remain in secure treatment facilities could exceed the amount of time they would have spent in jail or prison had they been convicted and sentenced under the original criminal offense.(47)

   Most studies of the outcomes for addicts treated at the Lexington or Fort Worth treatment hospitals found discouraging results. Relapse rates were quite high, and few patients treated at these farms appeared to achieve long-term abstinence.(48) Follow-up studies showed that one-third to one-half of those admitted to the program were found not suitable for treatment, and that attrition rates were high.(49) When treatment was combined with compulsory aftercare, civil commitment patients did somewhat better than those in voluntary treatment; however, only about one-third of those committed remained after the six-month treatment period and entered aftercare.(50) By the early 1970s, both facilities had been converted to Federal prisons.

   The results of two of the first state civil commitment programs (California Civil Addict Program [CAP] and the New York State Narcotics Addiction Control Commission) were mixed.(51) A follow-up study of California CAP admissions from the early 1960s showed somewhat reduced daily narcotic use, lower rearrest and self-reported crime rates, and higher rates of employment for those completing treatment compared to those admitted to CAP but discharged prior to outpatient treatment.(52) Successful participants used narcotics daily 31% of the time during follow-up compared to 48% for the comparison group of discharged clients.(53) Researchers noted that the most effective aspects of the program appeared to be close community supervision coupled with regular testing for drugs, and a long parole-type follow-up of five to ten years.(54)

   The New York State Civil...