Moderator:
Laurie Robinson, Assistant Attorney General
Office of Justice Programs
U.S. Department of Justice
Washington, D.C.
Speakers:
Honorable Janet Reno,
Attorney General
U.S. Department of Justice
Washington, D.C.
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General Barry McCaffrey, Director
Office of National Drug Control Policy
Washington, D.C.
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Honorable Donna Shalala, Secretary
U.S. Department of Health and Human Services
Washington, D.C.
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Summary of Proceedings
In a rare joint appearance, three Presidential Cabinet officials joined in calling for a multidisciplinary, collaborative approach to addressing the problems of substance abuse and criminal behavior. Attorney General Janet Reno, Secretary of Health and Human Services Donna Shalala, and General Barry McCaffrey, Director of the Office of National Drug Control Policy, argued that our ability to end the intergenerational cycle of addiction and violence in the United States depends on adoption of such a systems approach.
We must treat crime and drug use as interrelated problems instead of regarding them as isolated behaviors. Attorney General Reno said, "We must learn to bring the disciplines together."
"We can't hope to prevent substance abuse among young people—in their schools, in their homes, and on their streets—unless we treat addiction behind bars," said Secretary Shalala.
And, General McCaffrey noted, "At the community level, we need to bring together judges, police, doctors, ministers, and business [leaders]."
Janet Reno, Attorney General
U.S. Department of Justice
The Justice Department promotes a three-part strategy to reduce substance abuse and criminal activity: prevention, intervention, and enforcement. For maximum effectiveness, agencies and communities need to use a systems approach and cooperate and collaborate at every point in the process, from planning to implementation to project evaluation.
- Prevention efforts must start early and be comprehensive. Cross-agency programs can be developed for young people at risk for substance abuse to provide positive alternatives to drug-related organizations. These programs need to bring together community leaders from different sectors, including educators, social workers, parks and recreation personnel, and law enforcement staff.
- Intervention requires cooperation from the very beginning. For example, if a mother fails to respond when a school calls about a truant child, a community team should be ready to respond. The team would include a police officer, a counselor, and a nurse to help the family deal with substance abuse and/or other problems. Similarly, a case of domestic violence in a hospital emergency room should trigger a substance abuse intervention.
- Enforcement must be smart. After creating a common database, for example, state, federal, and local authorities can hire expert analysts to find patterns in drug use and identify the major drug organizations for law enforcement.
Reno cited the success of the nation's drug courts, which place first-time drug offenders in compulsory treatment and supervision instead of jail. Now celebrating their 10th anniversary, the country's 200 drug courts have become an effective alternative to overcrowded jails.
The court system is overwhelmed with unmanageable caseloads, she said. These courts generally do not have adequate treatment and sentencing alternatives, and generally do not have the resources to address protracted substance abuse problems. As a result, substance-abusing offenders, especially those charged with possessing small amounts of drugs, often receive no treatment and are sent back into the same situations that helped generate their criminal activity.
Reno spoke of the carrot-and-stick approach used by drug courts, reentry courts, and other related programs. With the carrot of a positive future and reduced sentences, and the stick of enforcement, we can reduce drug abuse and criminal activity and save communities money, she said. These carrots can include:
- job training while in prison;
- job placement at the time of release;
- training in life skills;
- promoting contact with the community and the inmate's children, and ensuring child support is paid;
- drug treatment follow-up and aftercare;
- advocates who will support the inmate's cause in court.
The stick of judicial supervision, with regular reporting, drug testing, and the threat of incarceration helps make the carrots effective. "If you test positive, you're going [back] to prison," said Reno.
"We have an opportunity to stem the tide of drugs and stop the culture of violence. We can end this epidemic and give kids a future," Reno said.
Donna Shalala, Secretary
U.S. Department of Health and Human Services
The public health and criminal justice systems must collaborate to get prisoners the treatment they need. "It's not easy, but strong medicine never is," Shalala said. In the past, corrections systems focused on custody, care, and security, while public health advocates promoted health in the larger community. Today, the U.S. Department of Health and Human Services is committed to a comprehensive systems approach, and to working more closely with the criminal justice system.
The vast majority of inmates have substance abuse problems, Shalala noted. Many of these inmates also have communicable diseases, including tuberculosis, hepatitis, and HIV/AIDS, and many both abuse drugs and suffer from mental illness. However, inmates' overwhelming public health needs challenge corrections and public health agencies, and only a very small percentage of those needing treatment receive it during their incarceration.
Nonetheless, prisons and jails offer unparalleled treatment opportunities. "We need to take advantage of the fact that prisoners have no choice but to show up for treatment," said Shalala. Citing a recently released study done in Delaware, Shalala noted that offenders who completed 12 to15 months of drug treatment while in prison and 6 months of treatment after their release were twice as likely to be drug free as their counterparts after 18 months. If left untreated, substance abuse problems will continue after these individuals are released from prison, threatening the well-being of both the former inmates and the community as a whole.
Current Health and Human Services Department systems approach initiatives include helping design new models of care for correctional systems through the Centers for Disease Control's Health Resources Administration for National Corrections. The Department also has invested in the Center for Substance Abuse Treatment's family drug court program and gave $8 million to criminal and juvenile justice treatment networks last fiscal year. Increasing funding for mental illness and substance abuse treatment to prisoners will reduce costs in the long run, Shalala said. However, she noted that, by law, only a limited amount of the Department's block grants can be spent on treatment within the corrections system. Funds for these programs will be needed from other sources as well.
In stressing the need for multidisciplinary approaches, Shalala also focused on the situation of several million children at high risk for substance abuse and criminal behavior, who need more help than any one agency can provide. "We must break this cycle with leadership from all," she said. The nearly 2 million inmates currently in U.S. prisons and jails have 2.5 million children. These children are at a higher risk for abusing drugs and more likely to commit crimes than their peers. Every day judges and law enforcement officials see the children of past offenders entering the vicious cycle of substance abuse and crime. "Treatment and testing with sanctions are not just a public health priority, but a matter of public safety," said Shalala.
General Barry McCaffrey, Director
Office of National Drug Control Policy
In each of the next 5 years, 550,000 prisoners are going to be released back into communities, where two-thirds will probably fall back into the same cycle of drugs and crime.
McCaffrey emphasized that a collaborative, systems approach is essential in responding to treatment needs and that this approach is based on scientific research findings. "We have the intellectual basis to proceed," he said. Currently the Office of National Drug Control Policy is distributing the National Institute on Drug Abuse pamphlet Principles of Drug Addiction Treatment, which presents summaries of peer-reviewed studies of cross-agency substance abuse programs. Legislators, city council members, and all other public policymakers need to have information about methods that work as described in these and other credible research studies.
The Office of National Drug Control Policy is working with other agencies on three types of solutions to the related problems of substance abuse and criminal activity:
- "Front-end" solutions such as the nation's 600 existing and planned drug courts, which intervene with drug users just entering the justice system;
- Working within prison systems, including training prison personnel on substance abuse, selecting employees with substance abuse expertise, and maintaining data on prisoners' substance abuse;
- Reentry courts for released inmates, to supervise and ease the transition back into the community.
The office also is attempting to get funding to capture state-by-state substance abuse statistics and to merge databases from 70 cities across the country. High on its agenda is increasing public officials' awareness of both inmates' substance abuse and the high cost of diverting resources to imprison 2 million Americans.
McCaffrey noted that the federal government is implementing systems-approach programs in the federal corrections system. He challenged states and communities to do the same. The systems approach requires cooperation at all levels with judges, police, doctors, ministers, and business leaders, but it also demands vigorous law enforcement. "Addicts want to keep using drugs, but minimize the consequences," said McCaffrey. Strict enforcement ensures that the consequences will be significant and inescapable.
Hundreds of thousands of people are working nationwide to stop substance abuse, noted McCaffrey. Their efforts need to be acknowledged and applauded. However, the work cannot be accomplished by the efforts of these "heroic people" alone. If we are to solve the problems of substance abuse and criminal activity, these efforts need to be reflected in multidisciplinary programs and supported by additional funding.
Last Updated: March 4, 2002
