Evidence-Based Models

Evidence-Based Models for Substance Abuse Treatment in the Criminal Justice System The United States currently incarcerates a higher percentage of its citizens than any other industrialized nation in the world. A majority of Americans who are incarcerated were taking drugs or drinking alcohol, or both, during the commission of their crimes, or were actively engaged in substance-abusing behaviors that resulted in their involvement with the criminal justice system.

The costs that are associated with incarcerating these millions of convicts each year are staggering, making the need for cost-effective interventions that can help divert substance-abusing nonviolent offenders from the penal system into other, less expensive community-based alternatives. Likewise, from a strictly pragmatic perspective, treating existing substance abuse among prison populations using methods with proven efficacy just makes good business sense. To this end, this paper compares and contrasts two evidence-based substance abuse treatment models that have demonstrated efficacy in the criminal justice system.

A discussion concerning how this model best fits in a given agency with respect to economic, human resource, therapist expertise, and other relevant factors is followed by a summary of the research and important findings in the conclusion. Review and Discussion Today, there are almost eight million Americans in various correctional systems, and these populations have inordinately high rates of chronic medical and mental health issues, infections, sexually transmitted diseases, as well as substantial substance abuse disorders (Gondles, 2010).

According to Grella, Hser, Teruya and Evans (2005), there has been a growing consensus among healthcare providers in recent years concerning the need to improve the quality and provide for better accountability by using evidence-based treatment interventions for substance abuse problems. In this regard, Gondles emphasizes that the criminal justice system has "a responsibility to society and to offenders to continue developing and evaluating efficient, effective, and cost-conscience methods of delivering valid, evidence-based treatment and programs" (2010, p. 6).

In addition, Gondles suggests that, "We also have a legal, ethical and moral obligation to return offenders to the community in a reasonable state of health to facilitate their successful reentry" (2010, p. 6). Some salient examples of efforts by the healthcare community to develop such guidelines include: 1. The principles of drug abuse treatment developed by the National Institute on Drug Abuse (NIDA) identify a core set of empirically based interventions that can be used to guide clinical practice (Grella et al., 2005, p. 469). 2.

Likewise, Hon (2003) reports that, "The active ingredients of effective treatment for alcohol problems have been distilled from several generations of research into the treatment of alcohol abuse and dependence" (2003, p. 2). 3. Finally, findings from treatment effectiveness research have provided the foundation for a set of clinical practice guidelines, including the American Society of Addiction Medicine's Principles of Addiction Medicine (Grella et al., 2005, p. 470).

Clearly, then, the use of evidence-based treatment regimens for substance abusing populations in general and prison populations in particular represents a timely and valuable enterprise, and two such evidence-based treatment regimens that have demonstrated efficacy with substance-abusing behaviors, ancillary pharmacological support and monitoring programs, are described further below. Ancillary Pharmacological Support Clinical studies have shown time and again that treatment regimens for substance abuse are more effective when used in conjunction with pharmacological support.

These are especially important issues with respect to prison populations where the transition back into society may require ongoing treatment and monitoring. Prison populations in particular can benefit from treatment programs using medications such as methadone for alcoholism and buprenorphine for heroin addiction (Principles of Drug Abuse Treatment for Criminal Justice Populations, 2011). According to Byrne, Lander and Ferris (2009), "Buprenorphine/naloxone is an evidence-based pharmacological treatment that offers a new and different option for treatment of opioid dependence.

This medication blocks the effects of other opioids and is difficult to abuse" (p. 54). In addition, the National Institute on Drug Abuse emphasizes that, "Effective use of medications can also be instrumental in enabling people with co-occurring mental health problems to function successfully in society. Behavioral strategies can increase adherence to medication regimens" (Principles of Drug Abuse Treatment for Criminal Justice Populations, 2011, para. 2).

This evidence-based treatment regimen is well suited for the purposes of this author's agency where budgets have been slashed and the need for cost-effective treatments has become highly pronounced. Both methadone and buprenorphine/naloxone have proven efficacy in the general population and there is a growing body of evidence concerning their effectiveness in prison populations as well (Byrne et al., 2009). Moreover, these drugs are inexpensive and widely available (Byrne et al., 2009).

It should be noted, though, that there are clinical guidelines concerning the use of these drugs that may require specialized training for the agency's current in-house clinical staff to ensure appropriate oversight because the majority of these offenders are referred to community-based healthcare resources for these services. The need to ensure appropriate oversight of pharmacological treatments also extends to monitor substance-abuse offenders following their release into the community, and these issues are discussed further below.

Monitoring Programs The National Institute on Drug Abuse reports that one of the most important features of any intervention for substance abusers in prison populations is to ensure a mechanism is in place to monitor the effectiveness of any protocol on an ongoing basis through drug testing to identify opportunities for improvement and areas that require specific focus. The Institute also stresses that there is no "magic bullet" available for treating substance-abusing offenders, and successful outcomes require ongoing monitoring to ensure offenders remain drug and alcohol free.

The high levels of recidivism that have been experienced in recent years with this population indicates that this is an especially important area that demands active participation by the law enforcement community in partnership with community-based resources as well as the offenders themselves (of course). In this regard, The National Institute.