Epidemics in the Justice System: Alcohol and Rural Courts

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Epidemics in the Justice System Alcohol and
Rural Courts

• Linda L. Chezem, JD
• Purdue University
• Indiana Alcohol Research Center at
• Indiana University School of Medicine

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Public Health

• United States 2001
• Alcohol Harmful Effects

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Alcohol Attributable Death
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Past-Year DSM-IV Alcohol Dependence Among
12-to-17 Year-Olds by Sex, Race-Ethnicity and
Urbanicity
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Past-Year Binge Drinkers Among 12-to-17 Year-Olds
by Sex, Race-Ethnicity and Urbanicity
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Past-Year Drinkers Among 12-to-17 Year-Olds by
Sex, Race-Ethnicity and Urbanicity
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Public Health Core Functions

• Assessment
• Surveillance (how many alcohol related cases in
  the courts?)
• Detection of alcohol use in underage or other at
  risk population
• Policy Development
• Inform, educate, and empower people about alcohol
  in the justice system and the health issues
• Mobilize community partnerships and action to
  identify and solve health problems (e.g.,
  convening and facilitating community groups to
  promote health about alcohol).

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Assurance (about alcohol and health)

• Enforce alcohol laws and regulations that protect
  health and ensure safety.
• Evaluate effectiveness, accessibility, and
  quality of personal and population-based health
  services (e.g., continuous evaluation of public
  alcohol health programs).
• Research for new insights and innovative
  solutions to alcohol problems (e.g., links with
  academic institutions and capacity for
  epidemiologic and economic analyses). 
• Evaluate impact of alcohol response in the
  justice system

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First Step

• Articulate the public health impact of alcohol.
• Determine the impact of alcohol in the community.
• Seek to better understand the public health role
  of courts when alcohol is involved.

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Justice System

• More than 20,000 Courts in US have jurisdiction
  over alcohol related cases.
• Fewer than 2000 drug courts in US

Civil
Civil
Criminal
Dissolutions
Juvenile
Probate
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Rural Courts

• Cannot stand alone
• "The life of the law has not been logic it has
  been experience." Oliver Wendell Holmes from The
  Common Law, 1881
• Research that applies to rural communities is
  essential
• Utilize
• Help set agenda

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All courts are alcohol courts.

• Courts are the RURAL Community Agents for
  INTERVENTION AND TREATMENT.
• Should people have to go to court for alcohol
  health services?
• Do rural populations have geographical and
  economic access to honest EVIDENCE BASED
  TREATMENT?

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Can Drug Courts Go Country ?

• Debatable (approximately 1700 courts)
• GAO report
• Only as good as the treatment provider?
• Not easily transportable
• Limited number of judges
• Extremely limited justice resources
• Evidence based assessment and treatment services
• Community dynamics

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Alcohol fuels the justice system.

• Alcohol
• Alcohol plus other drugs
• Alcohol plus mental illness
• All of the above add up to an overwhelming
  impact on justice.

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What Research is Rural?

• Not enough studies are conducted in rural
  communities.
• Federal research dollars and foundation grants do
  not adequately include rural targets.
• Rural and non urban communities are invisible in
  much research.
• CAN community based urban research apply to
  rural?

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Alcohol Law

• Enforcing Underage Drinking Laws
• Prosecution of under 21 for possession or
  consumption of alcohol.
• Under 18 go to juvenile court.
• Over 21 go to adult court.

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Underage Drinking

• Alcohol is the most commonly used drug by
  children and adolescents.
• Teens who use alcohol and drugs are more likely
  to be involved in violent behaviors.
• Is the violence connection true for rural
  children and adolescents?

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Supporting Research

• NESARC Data.
• Teenagers who begin drinking before age 15 have
  four times the risk of developing alcohol
  dependence later in life.
• Adolescents with histories of extensive alcohol
  use have noticeable changes in brain function
  that impair learning, memory, and problem
  solving smaller hippocampal volume.

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EUDL What Works?

• Law is to prevent youthful consumption.
• Office of Juvenile Justice and Delinquency
  Prevention program.
• 360,000 to each state and discretionary grants of
  1 million.
• Required to have justice system participate in
  community coalition

• Research Response
• NIAAA is evaluating the EUDL program in rural
  communities of 7 states to determine the
  effectiveness of programs.
• The National Evaluation Excluded communities of
  under 50,000.

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Why Do We Need Research?

• Difficult to enforce
• Uneven
• Lack of police resources
• Legal process is expensive
• Results can be harsh

• Community programs have limited resources.
• Communities have limited attention spans.

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Rural Research Needed

• What prevention programs can be effective in
  rural settings?
• Who needs intervention and treatment in rural
  communities?
• How can service delivery be economically
  accessible?
• What are barriers to research?
• Can methodologies be developed to compensate for
  small numbers?

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Fetal Alcohol

• Law and policy not supported by research.
• Punitive laws used to prevent mother from
  drinking may be more harmful.
• Laws are unenforceable.
• Research about rural and small town attitudes
  indicates need for more studies.

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Rural Questions about FASD

• Purpose This 2-part study examines gender
  differences in attitudes and perceived barriers
  to intervention in a large community sample of
  persons living in rural and small-town
  environments in Kentucky (n 3,346). The study
  also examines rural/small-town prenatal service
  providers' perceptions of barriers to assessment
  and intervention with pregnant substance abusers
  (n 138).
• Findings Overall results of the community sample
  suggest that neither males nor females were
  knowledgeable about the harmful effects of
  alcohol use during pregnancy. Results also
  indicate substantial gender differences in
  alcohol attitudes, knowledge, and perceived
  barriers. Further, prenatal care providers
  identified several barriers in assessment and
  treatment of pregnant women with alcohol use
  problems in rural and small-town communities,
  including lack of knowledge and comfort with
  assessment as well as a lack of available and
  accessible treatment for referrals.

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Cite

• Rural and small-town attitudes about alcohol use
  during pregnancy A community and provider sample
• Logan TK, Walker R, Nagle L, Lewis J, Wiesenhahn
  D
• JOURNAL OF RURAL HEALTH 19 (4) 497-505 FAL 2003
• Abstract
• Context While there has been considerable
  research on prenatal alcohol use, there have been
  limited studies focused on women in rural and
  small-town environments.
• Purpose This 2-part study examines gender
  differences in attitudes and perceived barriers
  to intervention in a large community sample of
  persons living in rural and small-town
  environments in Kentucky (n 3,346). The study
  also examines rural/small-town prenatal service
  providers' perceptions of barriers to assessment
  and intervention with pregnant substance abusers
  (n 138).
• Methods Surveys were administered to a
  convenience sample of employees and customers
  from 16 rural and small-town community outlets.
  There were 1503 males (45) and 1843 females
  (55) ranging in age from under 18 years old to
  over 66 years old. Surveys also were mailed to
  prenatal providers in county health departments
  of the 13-county study area, with 138 of 149
  responding.
• Findings Overall results of the community sample
  suggest that neither males nor females were
  knowledgeable about the harmful effects of
  alcohol use during pregnancy. Results also
  indicate substantial gender differences in
  alcohol attitudes, knowledge, and perceived
  barriers. Further, prenatal care providers
  identified several barriers in assessment and
  treatment of pregnant women with alcohol use
  problems in rural and small-town communities,
  including lack of knowledge and comfort with
  assessment as well as a lack of available and
  accessible treatment for referrals.
• KeyWords PlusLOW-BIRTH-WEIGHT, SUBSTANCE-ABUSE,
  DRINKING, LIFE, RISK, CONSEQUENCES, PREVENTION,
  BEHAVIOR, CHILDREN, GROWTH
• Addresses
• Logan TK, Univ Kentucky, Ctr Drug Alcohol Res,
  Dept Behav Sci, 1151 Red Mile Rd,Suite 1-A,
  Lexington, KY 40504 USA
• Univ Kentucky, Ctr Drug Alcohol Res, Dept Behav
  Sci, Lexington, KY 40504 USA
• Bluegrass Reg Mental Hlth Mental Retardat Board
  I, Lexington, KY USA

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NCJFCJ

• SPRING 2004 VOLUME 55 NO. 2
• FETAL ALCOHOL SPECTRUM DISORDERS (FASD) AND THE
  ROLE OF FAMILY COURT JUDGES IN IMPROVING OUTCOMES
  FOR CHILDREN AND FAMILIES
• by Diane V. Malbin
• Abstract Fetal Alcohol Spectrum Disorder (FASD)
  is a physical disability that is 95 under
  diagnosed and 40 times over-represented in
  juvenile justice.

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My Suggestions

• DEMAND research that is relevant and applicable
  to the rural communities.
• Consider the appropriate role of the courts
  around alcohol abuse and dependence and the
  unique circumstances of the rural courts.
• Promote a better understanding of rural alcohol
  issues as systemic public health concerns.

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Alcohol use disorders are an epidemic that the
justice system cannot prevent nor cure.

• .

But the community can