Clinical Professor of Psychiatry
University of California
San Diego, California
Jeremy Travis, Director
National Institute of Justice
Office of Justice Programs
U.S. Department of Justice
Alan Leshner, Director
National Institute on Drug Abuse
U.S. Department of Health and Human Services
Summary of Proceedings
This session provided an overview of the biology of drug addiction and effective, research-based treatment approaches to working with substance-abusing criminal offenders. Specific public policy implications of these research findings also were discussed. Moderator David Deitch of the University of California at San Diego noted that it is important to understand the "disease of drug taking" and to recognize that drug use, mental illness, and criminal activity often are co-occurring diseases.
Effective strategies to deal with the problems of drug abuse must be "as complex as the problem itself," said Alan Leshner, Director of the U.S. Department of Health and Human Services' National Institute of Drug Abuse (NIDA). Success will be found only when public safety and public health professionals use science and not ideology as the foundation of those strategies. Today's approach to the related problems of substance abuse and criminal behavior represents a "dramatic shift" in
philosophyto a new blending of public safety and public health.
A fundamental question is why people take drugs at all. Leshner noted that cocaine, methamphetamines, nicotine, marijuana, and other substances change brain chemistry. In particular, these drugs spike brain levels of dopamine, the chemical responsible for feelings of pleasure. Thus, people use drugs for two reasons. For some "novelty seekers," drugs induce a sense of "feeling good." For addicts, drugs provide a way for people to "self-medicate, because they feel miserable." Whatever the motivation, Leshner said, people use drugs to "modify their perceptions, mood, emotional state."
Prolonged drug use fundamentally and permanently changes the brain's chemistry, resulting in restlessness, unhappiness, depression, bad moods, cognitive abnormalities, and paranoia. Some people who begin as "voluntary drug users" over time move to a state of "compulsive, uncontrollable drug using." Illustrating with slides, Leshner compared the brain chemistry of non-drug users with that of long-term users. Changes in brain chemistry of users, which persist even after drug use ceases, tell us that, in essence, drug addiction is a brain disease. However, he cautioned, to understand all the dynamics involved in addiction, we need to recognize that "addiction is a brain disease shaped by behavior and social context."
Effective treatment for this disease does not take just one form, he said, but instead incorporates broad programs made up of many different elements that must be tailored to meet individual needs. A tremendous amount of information exists about the fundamental principles underlying successful treatment and about which treatment modalities work best. NIDA has published a booklet, Principles of Drug Addiction Treatment, which is the first government-produced research-based guide to drug addiction treatment (available at http://www.drugabuse.gov).
Successful substance abuse treatment needs to incorporate three basic principles:
- Drug addiction is the "quintessential" bio-behavioral disorder and, therefore, effective treatments need to attend to all aspects of the disorderbiological, behavioral, and social.
- Treatment does not need to be voluntary. The most important determinant of successful treatment is its duration.
- Successful treatment should be defined as restoration of an individual to positive functioning in his/her family, work, and community.
Leshner cited one research study that found that 3.5 years after leaving a correctional facility, only 31 percent of those who had drug abuse treatment returned to the correctional system, compared with 70 percent of those who were not in treatment. Similarly, over this same period, 81 percent of those who had treatment remained drug free, while 38 percent of those who did not have treatment went back to using drugs. Leshner concluded that treatment had resulted in a "phenomenal reduction" in recidivism. "It is foolish not to treat addicted criminals while you have them under your controlor they will be back," he said.
Jeremy Travis, Director of the National Institute of Justice (NIJ), argued that public policy decisions should be based on the knowledge obtained from sound research studies. Both public health and criminal justice professionals and public policymakers have become more open to recognizing and responding to the link between substance abuse and criminal behavior. This change in understanding has been possible because of improved research and changes in the cultures of our treatment and justice systems that have encouraged new ways of thinking.
Cautioning against overgeneralizing from any particular research finding, Travis said many studies of substance abuse and crime offer direction for a "fundamental rethinking of our current practices" and for new public policy initiatives. He outlined five basic public policy provisions or implications that he asserted follow from current research findings:
- The link between criminal behavior and drug abuse has been demonstrated in studies conducted by NIJ and others. These studies indicate that between 50 and 75 percent of all adults who are arrested have drugs in their system at the time of arrest. The range of rates for juveniles is similar, at 40 to 70 percent. Studies also indicate that the criminally involved population consumes a very large fraction of all drugs in the country. Thus, according to Travis, by reducing the use of drugs by criminal offenders, we can decrease the overall demand for drugs and, by extension, reduce the levels of illegal drug production.
- Criminal offenders who complete treatment programs have been shown to be less likely to use drugs and to commit other crimes than comparable individuals who do not participate in treatment. Thus, Travis concluded that we need to support a policy initiative for treatment opportunities within the criminal justice system as a cost-effective opportunity to reduce crime and drug use.
- Studies indicate that mandatory treatment works and that sometimes it works better than voluntary treatment. However, Travis contended that the system might "encourage the exercise of free will," through the use of "carrot and stick" or "management contingency" approaches. He indicated that such encouragement may be an essential part of the successful treatment for some individuals.
- The length of time in treatment, in both residential and community programs, correlates highly with a reduction in criminal activity and drug use. Participants need to remain in treatment for 90 days or more.
- Treatment under postrelease supervision is essential in realizing the success of treatment that starts in prison. A study in Delaware found that individuals who participated in substance abuse treatment in prison, followed by supervised aftercare, were more likely to remain drug free and arrest free for up to 18 months after release. Thus, Travis contended, postrelease supervision and aftercare services are needed to help offenders successfully integrate back into their communities. He suggested increasing the number and scope of programs such as transitional work-release projects, halfway houses, and day reporting centers.
Travis re-emphasized the need to develop comprehensive, research-based public policy initiatives and programs that take into account the "whole person." We need to increase the time and effort spent with offenders, beginning while they are incarcerated, to help them create positive links with the communities they are about to reenter. Connections need to be made to jobs, mental health services, support systems, faith-based institutions, positive peer support groups, and other community resources.
Last Updated: March 4, 2002