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cont. from
• Short-Term Residential Programs
provide intensive but relatively brief residential treatment based on a modified
12-step approach. These programs were originally designed to treat alcohol
problems, but during the cocaine epidemic of the mid-1980's, many began to treat
illicit drug abuse and addiction. The original residential treatment model
consisted of a 3 to 6 week hospital-based inpatient treatment phase followed by
extended outpatient therapy and participation in a self-help group, such as
Alcoholics Anonymous. Reduced health care coverage for substance abuse treatment
has resulted in a diminished number of these programs, and the average length of
stay under managed care review is much shorter than in early programs.
Further Reading:
Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M.
Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study
(DATOS). Psychology of Addictive Behaviors 11(4): 291-298, 1998.
Miller, M.M. Traditional approaches to the treatment of addiction. In: Graham
A.W. and Schultz T.K., eds. Principles of Addiction Medicine, 2nd ed.
Washington, D.C.: American Society of Addiction Medicine, 1998.
• Medical
Detoxification is a process whereby individuals are systematically withdrawn
from addicting drugs in an inpatient or outpatient setting, typically under the
care of a physician. Detoxification is sometimes called a distinct treatment
modality but is more appropriately considered a precursor of treatment, because
it is designed to treat the acute physiological effects of stopping drug use.
Medications are available for detoxification from
opiates, nicotine,
benzodiazepines, alcohol, barbiturates, and other sedatives. In some cases,
particularly for the last three types of drugs, detoxification may be a medical
necessity, and untreated withdrawal may be medically dangerous or even fatal.
| Detoxification is a precursor of treatment. |
Detoxification is not designed to address the psychological, social, and
behavioral problems associated with addiction and therefore does not typically
produce lasting behavioral changes necessary for recovery. Detoxification is
most useful when it incorporates formal processes of assessment and referral to
subsequent drug addiction treatment.
Further Reading:
Kleber, H.D. Outpatient detoxification from opiates. Primary Psychiatry 1:
42-52, 1996.
Treating Criminal Justice-Involved Drug Abusers
and Addicts
Research has shown that combining criminal justice sanctions with drug
treatment can be effective in decreasing drug use and related crime. Individuals
under legal coercion tend to stay in treatment for a longer period of time and
do as well as or better than others not under legal pressure. Often,
drug
abusers come into contact with the criminal justice system earlier than other
health or social systems, and intervention by the criminal justice system to
engage the individual in treatment may help interrupt and shorten a career of
drug use. Treatment for the criminal justice-involved drug abuser or
drug addict
may be delivered prior to, during, after, or in lieu of incarceration.
| Combining criminal justice sanctions with drug treatment can be
effective in decreasing drug use and related crime. |
• Prison-Based
Treatment Programs
Offenders with drug disorders may encounter a number of treatment options while
incarcerated, including didactic drug education classes, self-help programs, and
treatment based on therapeutic community or residential milieu therapy models.
The TC model has been studied extensively and can be quite effective in reducing
drug use and recidivism to criminal behavior. Those in treatment should be
segregated from the general prison population, so that the "prison culture" does
not overwhelm progress toward recovery. As might be expected, treatment gains
can be lost if inmates are returned to the general prison population after
treatment. Research shows that relapse to drug use and recidivism to crime are
significantly lower if the drug offender continues treatment after returning to
the community.
• Community-Based
Treatment for Criminal Justice Populations
A number of criminal justice alternatives to incarceration have been tried with
offenders who have drug disorders, including limited diversion programs,
pretrial release conditional on entry into treatment, and conditional probation
with sanctions. The drug court is a promising approach. Drug courts mandate and
arrange for drug addiction treatment, actively monitor progress in treatment,
and arrange for other services to drug-involved offenders. Federal support for
planning, implementation, and enhancement of drug courts is provided under the
U.S. Department of Justice Drug Courts Program Office.
As a well-studied example, the Treatment Accountability and Safer Communities
(TASC) program provides an alternative to incarceration by addressing the
multiple needs of drug-addicted offenders in a community-based setting. TASC
programs typically include counseling, medical care, parenting instruction,
family counseling, school and job training, and legal and employment services.
The key features of TASC include (1) coordination of criminal justice and drug
treatment; (2) early identification, assessment, and referral of drug-involved
offenders; (3) monitoring offenders through drug testing; and (4) use of legal
sanctions as inducements to remain in treatment.
Further Reading:
Anglin, M.D. and Hser, Y. Treatment of drug abuse. In: Tonry M. and Wilson
J.Q., eds. Drugs and crime. Chicago: University of Chicago Press, 1990, pp.
393-460.
Hiller, M.L.; Knight, K.; Broome, K.M.; and Simpson, D.D. Compulsory
community-based substance abuse treatment and the mentally ill criminal
offender. The Prison Journal 76(2), 180-191, 1996.
Hubbard, R.L.; Collins, J.J.; Rachal, J.V.; and Cavanaugh, E.R. The criminal
justice client in drug abuse treatment. In Leukefeld C.G. and Tims F.M., eds.
Compulsory treatment of drug abuse: Research and clinical practice [NIDA
Research Monograph 86]. Washington, DC: U.S. Government Printing Office, 1998.
Inciardi, J.A.; Martin, S.S.; Butzin, C.A.; Hooper, R.M.; and Harrison, L.D.
An effective model of prison-based treatment for drug-involved offenders.
Journal of Drug Issues 27 (2): 261-278, 1997.
Wexler, H.K. The success of therapeutic communities for substance abusers in
American prisons. Journal of Psychoactive Drugs 27(1): 57-66, 1997.
Wexler, H.K. Therapeutic communities in American prisons. In Cullen, E.;
Jones, L.; and Woodward R., eds. Therapeutic Communities in American Prisons.
New York: Wiley and Sons, 1997.
Wexler, H.K.; Falkin, G.P.; and Lipton, D.S. (1990). Outcome evaluation of a
prison therapeutic community for substance abuse treatment. Criminal Justice and
Behavior 17(1): 71-92, 1990.
continue: Scientifically Based
Approaches to Drug Addiction Treatment .
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