Overview of Jail Substance Abuse Treatment

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Overview of Jail Substance Abuse Treatment
Addiction Medicine - State of the Art 2001 New
and Emerging Roles for Clinicians, California
Society of Addiction Medicine, October 18, 2001,
Marina del Rey, California Roger H. Peters,
Ph.D., University of South Florida, Louis de la
Parte Florida Mental Health Institute, Department
of Mental Health Law and Policy, Tampa, Florida
[phone] peters_at_mirage.fmhi.usf.edu
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Scope of Substance Abuse Treatment in Jails

• 25 of inmates ever received substance abuse
  treatment in custody settings
• 4 received substance abuse treatment during
  current stay in jail
• 1.4 received counseling services during
  current stay in jail
• (Bureau of Justice Statistics, 2000)

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Scope of Substance Abuse Treatment in Jails

• 43 of jails report substance abuse treatment
  programs
• - 74 of jails gt 1,000 inmates
• - 34 of jails lt 50 inmates
• 64 of jails report self-help programs
• Only 12 provide combination of SA treatment,
  self-help, and drug education
• (Bureau of Justice Statistics, 2000)

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Type of Treatment Services Available in Jails - I

• Individual counseling (77)
• Group counseling (64)
• Assessment (64)
• Self-help groups (AA/NA 60)
• (Bureau of Justice Statistics, 2000)

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Type of Treatment Services Available in Jails -
II

• Drug education (43)
• Drug testing (42)
• Detoxification (28)
• Family counseling (19)
• (Bureau of Justice Statistics, 2000)

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Treatment Services Available in Metropolitan
Jails - I

• HIV education/prevention (100)
• Individual counseling (100)
• Relapse prevention services (100)
• Education/GED (94)
• Parenting skills (94)
• 12-step groups (94)
• (Peters Matthews, in press)

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Treatment Services Available in Metropolitan
Jails - II

• Modifying criminal thinking (82)
• Domestic violence treatment (77)
• Vocational/job training (65)
• Dual diagnosis treatment (47)
• (Peters Matthews, in press)

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Treatment Services Available in Metropolitan
Jails - III

• Acupuncture (18)
• Anger Management 18)
• Medically supervised detoxification (18)
• Family therapy (12)
• Sexual trauma treatment 12)
• (Peters Matthews, in press)
• HIV education/prevention (100)
• Individual counseling (100)
• Relapse prevention services (100
• Education/GED (94)
• Parenting skills (94)
• 12-step groups (94)
• Modifying criminal thinking (82)

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Legal Standards for Substance Abuse Treatment in
Jails - I

• No constitutional right to substance abuse
  treatment (Marshall v. U.S., 1974)
• Deliberate indifference to serious medical
  needs is exception
• - Withdrawal or other life- threatening symptoms
• - Screening

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Legal Standards for Substance Abuse Treatment in
Jails - II

• Continuation on methadone is not
  required
• AA/NA groups cant be required as condition of
  favorable classification, release, or
  institutional privileges

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Outcomes of Jail Substance Abuse Treatment

• Lower rates of follow-up arrest vs. untreated
  comparisons and program dropouts (5-25
  difference)
• Longer duration to rearrest, fewer arrests
  during follow-up
• Reduced rates of relapse, lower levels of
  depression, fewer disciplinary infractions
• Cost savings 150k - 1.4 million per year
• (Peters Matthews, in press)

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Effects of Duration of Jail Treatment

• Recidivism rates in TCs inversely related to
  duration of treatment, up to a point
• Optimal duration of TC treatment is 46-150 days
  
• Some positive effects from short-term programs
  of moderate-high intensity
• (Peters Matthews, in press)

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Outcomes of Post-Custody Treatment Services

• Aftercare recipients have 50 lower rates of
  follow-up arrest vs. non-recipients
• Linkage with either residential or outpatient
  treatment leads to lower rates of follow-up
  arrest
• Half of in-jail treatment participants are
  involved in follow-up treatment, vs. 6 of
  untreated inmates
• (Peters Matthews, in press)

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Features of Jail Substance Abuse Treatment
Programs - I

• Therapeutic communities
• Isolated treatment units
• Assessment
• Program phases

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Phases of Jail Substance Abuse Treatment Programs

• I. Assessment, intake, orientation, motivational
  enhancement, and medical detoxification
• II. Skill-building, psychoeducational activities,
  12-step groups
• III. Relapse prevention, transition planning, and
  community linkage

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Features of Jail Substance Abuse Treatment
Programs - II

• Restructuring criminal thinking errors
• Specialized mental health services
• Transition and reentry services

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Community Linkage and Reentry Services

• Reentry planning
• Linkage with community services
• Case management and use of boundary spanners
• Post-booking diversion programs

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Treatment of Co-occurring Disorders in Custody
Settings - I

• Highly structured therapeutic approach
• Destigmatize mental illness
• Focus on symptom management vs. cure

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Treatment of Co-occurring Disorders in Custody
Settings - II

• Education regarding individual diagnoses and
  interactive effects of disorders
• Basic life management and problem-solving
  skills

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Group Treatment Manual for Co-occurring
Disorders - I

• Adapted from Dartmouth/NH Psychiatric Research
  Center family educational handouts
• Manualized group treatment approach, includes 8
  sessions
• Developed and refined through consensus process
• Implemented in jail treatment and other
  community-based offender treatment settings

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Group Treatment Manual for Co-occurring
Disorders - II

• Theme running throughout is that mental and
  substance use disorders are interactive and
  affect each other
• Manual designed for implementation within
  substance abuse treatment settings
• Focus on most severe Axis I mental disorders
  commonly found among offenders with co-occurring
  disorders
• Major Depression
• Bipolar Disorder
• Schizophrenia/Schizoaffective Disorder

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Group Treatment Manual for Co-occurring
Disorders - III

• Overview of Curriculum
• Module 1 Connection Between Substance Use and
  Mental Health Disorders
• Module 2 What is Major Depression?
• Module 3 What is Bipolar Disorder?
• Module 4 What are Anxiety Disorders?
• Module 5 What are Schizophrenia and
  Schizoaffective Disorder?
• Module 6 Substance Use Motives and Consequences
  
• Module 7 Principles of Integrated Treatment
• Module 8 Relapse Prevention

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Group Treatment Manual for Co-occurring
Disorders - IV

• Curriculum Format Clinical modules
• Overview
• Symptoms
• Connection between mental disorder and substance
  abuse
• Case Story
• Self-assessment exercise
• Treatment approaches (medications, psychotherapy,
  support groups)