August 13, 2009

Substance Abuse Treatment Admissions Referred by the Criminal Justice System

In 2007, the criminal justice system was the largest single source of referrals to the substance abuse treatment system, comprising 37 percent of all admissions in the Treatment Episode Data Set (TEDS) (approximately 670,500 of the 1.8 million admissions). Moreover, the majority of these referrals were from parole and probation offices (44 percent of criminal justice admissions where detailed criminal justice source information is known). Understanding the impact of these admissions on the treatment system is critical for program planners and policy makers at all levels of government. Using TEDS, this report examines substance abuse treatment admissions referred by the criminal justice system and compares their characteristics with admissions referred by other sources.

In 2007, criminal justice system referral admissions and all other referral admissions showed little or no difference for some demographic characteristics but were more sharply differentiated for others. The racial/ethnic composition of both groups were similar with about three fifths of admissions non-Hispanic White (60 and 59 percent, respectively) and about a fifth non-Hispanic Black (19 and 22 percent, respectively); in addition, similar percentages of both groups were Hispanic (15 and 14 percent, respectively) (Table 1). When criminal justice system referral admissions were examined by gender, male admissions outnumbered female admissions at a ratio of 3 to 1.

While criminal justice system referral admissions were more likely than all other referral admissions to be younger than 25, the impact of this source of referrals was most pronounced among the youngest treatment admissions, those younger than 18. In fact, 10 percent of criminal justice referrals were for admissions younger than age 18 compared with 6 percent of other referrals for the same age group.

Limiting consideration to admissions aged 25 or older (i.e., those most likely to be in the workforce), criminal justice system referral admissions were more likely than all other referral admissions to be employed either full or part-time at admission (42 vs. 22 percent) and less likely to not be in the labor force (26 vs. 42 percent).

Five primary substances of abuse accounted for 96 percent of all substance abuse treatment admissions in 2007: alcohol, opiates (including heroin and prescription painkillers), marijuana, cocaine, and methamphetamine. Criminal justice system referral admissions were more likely than all other referral admissions to report primary alcohol abuse, primary marijuana abuse, and primary methamphetamine abuse and less likely to report primary opiate abuse (Figure 1). The high rate of criminal justice system referral admissions younger than 18 years old may have contributed significantly to the high rate of admissions with marijuana as a primary substance of abuse.

Criminal justice system referral admissions were more likely than all other referral admissions to report entering treatment for the first time (51 vs. 40 percent). Conversely, admissions referred by the criminal justice system were less likely than all other referral admissions to have had five or more treatment episodes (6 vs. 15 percent).

Since completing treatment and transferring to another level of care are both important predictors of longer term positive treatment outcomes, it is important to note that criminal justice system referral admissions were slightly more likely than all other referral admissions to complete treatment in 2007 (49 vs. 46 percent) and about equally likely to be transferred to another level of care (13 vs. 14 percent) (Figure 2). It is also important to note that criminal justice system referrals were less likely than all other referral admissions to drop out of treatment (22 vs. 27 percent). Taken together, 62 percent of discharges referred to treatment by the criminal justice system completed treatment or transferred to further treatment.

The proportion of substance abuse treatment admissions referred by the criminal justice system increased from 33 percent in 1992 to 37 percent in 2007 (Figure 3). Trends in referrals among admissions younger than 18 followed a different pattern, with the proportion of treatment admissions referred by the criminal justice system increasing sharply between 1995 and 2001 (from 40 to 50 percent) and then leveling off.

To some extent, TEDS data reflect trends in the use and abuse of alcohol and various illicit substances as individuals with specific primary substances are admitted to treatment. In this case, from 1992 to 2007 admissions referred by the criminal justice system show marked stability in the proportions admitted for primary abuse of alcohol, cocaine, or opiates but also a marked upswing in the proportions admitted for primary marijuana abuse (from 48 to 56 percent) or primary methamphetamine abuse (from 37 to 57 percent) (Figure 4).

Individuals may be referred to substance abuse treatment through the criminal justice system either as part of a diversionary program before formal adjudication or as part of a formal sentencing program. Treatment providers whose admissions derive from the criminal justice system need to understand the ancillary needs of these admissions and ensure that their programs are prepared to offer appropriate assistance. Similarly, both public policy makers and funders need to ensure that, as the proportion of such referrals grows, adequate resources are available to meet the needs of referrals from the criminal justice system.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies (August 13, 2009). The TEDS Report: Substance Abuse Treatment Admissions Referred by the Criminal Justice System. Rockville, MD.

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