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Drug addiction is a brain disease that affects behavior.
Drug addiction has well-recognized cognitive, behavioral, and physiological characteristics that contribute to continued use of drugs despite the harmful consequences. Scientists have also found that chronic drug abuse alters the brain’s anatomy and chemistry and that these changes can last for months or years after the individual has stopped using drugs. This transformation may help explain why addicted persons are at a high risk of relapse to drug abuse even after long periods of abstinence and why they persist in seeking drugs despite the consequences.
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Recovery from drug addiction requires effective treatment, followed by management of the problem over time.
Drug addiction is a serious
problem that can be treated and managed throughout its course.
Effective drug abuse treatment engages participants in a therapeutic
process, retains them in treatment for an appropriate length of time,
and helps them learn to maintain abstinence. Multiple episodes of
treatment may be required. Outcomes for drug abusing offenders
in the community can be improved by monitoring drug use and by
encouraging continued participation in treatment.
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Treatment must last long enough to produce stable behavioral changes.
In treatment, the drug abuser
is taught to break old patterns of thinking and behaving and to learn
new skills for avoiding drug use and criminal behavior. Individuals
with severe drug problems and co-occurring disorders typically
need longer treatment (e.g., a minimum of 3 months) and more comprehensive services. Early in treatment, the drug abuser begins
a therapeutic process of change. In later stages, he or she addresses
other problems related to drug abuse and learns how to manage them
as well.
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Assessment is the first step in treatment.
A history of drug or alcohol use may suggest the need to conduct a
comprehensive assessment to determine the nature and extent of
an individual’s drug problems, establish whether problems exist in
other areas that may affect recovery, and enable the formulation of an
appropriate treatment plan. Personality disorders and other mental
health problems are prevalent in offender populations; therefore,
comprehensive assessments should include mental health evaluations
with treatment planning for these problems.
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Tailoring services to fit the needs of the individual is an important part of effective drug abuse treatment for criminal justice populations.
Individuals differ in terms of age, gender, ethnicity and culture,
problem severity, recovery stage, and level of supervision needed.
Individuals also respond differently to different treatment approaches
and treatment providers. In general, drug treatment should address
issues of motivation, problemsolving, and skill-building for resisting
drug use and criminal behavior. Lessons aimed at supplanting
drug use and criminal activities with constructive activities and
at understanding the consequences of one’s behavior are also
important to include. Tailored treatment interventions can facilitate
the development of healthy interpersonal relationships and improve
the participant’s ability to interact with family, peers, and others in
the community.
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Drug use during treatment should be carefully monitored.
Individuals trying to recover from drug addiction may
experience a relapse, or return to drug use. Triggers for drug relapse
are varied; common ones include mental stress and associations with
peers and social situations linked to drug use. An undetected relapse
can progress to serious drug abuse, but detected use can present
opportunities for therapeutic intervention. Monitoring drug use
through urinalysis or other objective methods, as part of treatment
or criminal justice supervision, provides a basis for assessing
and providing feedback on the participant’s treatment progress.
It also provides opportunities to intervene to change unconstructive
behavior—determining rewards and sanctions to facilitate change,
and modifying treatment plans according to progress.
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Treatment should target factors that are associated with criminal behavior.
“Criminal thinking”
is a combination of attitudes and beliefs that support a criminal
lifestyle and criminal behavior, such as feeling entitled to have things
one’s own way, feeling that one’s criminal behavior is justified, failing
to accept responsibility for one’s actions, and consistently failing to
anticipate or appreciate the consequences of one’s behavior. This
pattern of thinking often contributes to drug use and criminal behavior.
Treatment that provides specific cognitive skills training to help
individuals recognize errors in judgment that lead to drug abuse and
criminal behavior may improve outcomes.
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Criminal justice supervision should incorporate treatment planning for drug abusing offenders, and treatment providers should be aware of correctional supervision requirements.
The coordination of drug abuse treatment with correctional planning
can encourage participation in drug abuse treatment and can help
treatment providers incorporate correctional requirements as
treatment goals. Treatment providers should collaborate with criminal
justice staff to evaluate each individual’s treatment plan and ensure
that it meets correctional supervision requirements, as well as that
person’s changing needs, which may include housing and child care;
medical, psychiatric, and social support services; and vocational and
employment assistance. For offenders with drug abuse problems,
planning should incorporate the transition to community-based
treatment and links to appropriate post-release services to improve
the success of drug treatment and re-entry. Abstinence requirements may necessitate a rapid clinical response, such as more counseling,
targeted intervention, or increased medication, to prevent relapse.
Ongoing coordination between treatment providers and courts or
parole and probation officers is important in addressing the complex
needs of these re-entering individuals.
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Continuity of care is essential for drug abusers re-entering the community.
Offenders who
complete prison-based treatment and continue with treatment in the
community have the best outcomes. Continuing drug abuse treatment
helps the recently released offender deal with problems that become
relevant after release, such as learning to handle situations that could
lead to relapse, learning how to live drug-free in the community, and
developing a drug-free peer support network. Treatment in prison or
jail can begin a process of therapeutic change, resulting in reduced
drug use and criminal behavior post-incarceration. Continuing drug
treatment in the community is essential to sustaining these gains.
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A balance of rewards and sanctions encourages prosocial behavior and treatment participation.
When providing correctional supervision of
individuals participating in drug abuse treatment, it is important
to reinforce positive behavior. Nonmonetary “social reinforcers,”
such as recognition for progress or sincere effort, can be effective,
as can graduated sanctions that are consistent, predictable, and
clear responses to noncompliant behavior. Generally, less punitive
responses are used for early and less serious noncompliance,
with increasingly severe sanctions issuing from continued problem
behavior. Rewards and sanctions are most likely to have the desired
effect when they are perceived as fair and when they swiftly follow the
targeted behavior.
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Offenders with co-occurring drug abuse and mental health problems often require an integrated treatment approach.
High rates of mental
health problems are found both in offender populations and in those
with substance abuse problems. Drug abuse treatment can sometimes
address depression, anxiety, and other mental health problems.
Personality, cognitive, and other serious mental disorders can be
difficult to treat and may disrupt drug treatment. The presence of
co-occurring disorders may require an integrated approach that
combines drug abuse treatment with psychiatric treatment, including
the use of medication. Individuals with either a substance abuse
or mental health problem should be assessed for the presence of
the other.
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Medications are an important part of treatment for many drug abusing offenders.
Medicines such as methadone, buprenorphine, and extended-release
naltrexone have been shown to reduce heroin use and should be
made available to individuals who could benefit from them. 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.
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Treatment planning for drug abusing offenders who are living in or re-entering the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, hepatitis B and C, and tuberculosis.
The rates of infectious diseases, such as hepatitis, tuberculosis,
and HIV/AIDS, are higher in drug abusers, incarcerated offenders,
and offenders under community supervision than in the general
population. Infectious diseases affect not just the offender, but also
the criminal justice system and the wider community. Consistent with
Federal and State laws, drug-involved offenders should be offered
testing for infectious diseases and receive counseling on their health
status and on ways to modify risk behaviors. Probation and parole
officers who monitor offenders with serious medical conditions
should link them with appropriate health care services, encourage
compliance with medical treatment, and re-establish their eligibility
for public health services (e.g., Medicaid, county health departments)
before release from prison or jail.