Percent of u.s. residents ever going to prison during their lifetime, born in 1974, 1991, and 200
How Could Naltrexone Be Implemented as a Condition of Release? Symposium on the Ethics of Treatment and Research in Criminal Justice Populations January 4, 2005 Faye S. Taxman, Ph.D. George Mason University [email protected] Probationers/Parolees
• 4.1 million adults on probation & 600K+ on
• ~45% of probationers have drug tx orders, 17% receive treatment
• 1.8 million probationers/parolees do not meet conditions and likely to be violated--violations account for 30 to 80% new prison intakes
• One-third are arrested while on probation/parole while on supervision Decline in Successful Completion Substance Abusers By Type of Ethnicity/Race or CJ Status American Indian Pacific Islander Hispanic Probationers Parolees Per Capita Rate of Abuse Probationers/Parolees are estimated to consumers of 50 to 60 percent of opiates What Has Been Tried: CJ Interventions?
• Intensive Supervision
• Boot Camp
• Case Management
• Drug Courts
• Tx with Sanctions (e.g. Break the Cycle, Seamless System, etc.)
• In-Prison Tx (TC) with Aftercare What Have We Learned About Supervision?
• 25 Studies (some multi-site) • No difference--caseload size or intensive
– Referral/Brokerage Emphasis– Modify conditions with no theoretical
– Emphasize control conditions– Enforce conditions, not manage behavior
• Wavering Mission (law enforcement vs.
The State of Supervision Services: Implementation Issues Socio-Political Environment for Supervision
• Slap on the wrist• “Opportunity/free ride”• Offender is responsible for meeting
• Supervision agencies generally have a
Offenders are believed to able to control their
State of Probation/Parole Services
• Run by Executive Agencies, often with DOCs
• Ratio of Staff to Offenders, ranging from 70 to
• Volume drives the supervision practices• Supervision staff are “para professionals”—not
• Few agencies have clinical staff to provide
Limited Tools Available to Monitor Offender Behavior
• Predominately relies on Offender Self-Reporting for
– Curfews– Area Restrictions– Contacts– Standard Conditions (10+)– Fines/Fees– Tx, Community Service & Other Interventions
• Infrequent Use of Objective Based Tools
– Drug Testing (delay to obtain results, lack of sanctions)– Electronic Monitoring (lack of standards, privatized, fee-
The State of Supervision Services: Defining Conditions Criminal Conduct is due to…
• Sociological Causes
– Peer associations – Community disorder – Low social controls – Substance abuse
• Less acceptable rationales
– Biopsychology conditions – Deficits Moral Failings tend to dominate the perspective of criminal conduct, defines punishment options
• Sociopolitical norms: tx, fines, fees, controls, offender “self-help” activities
• Legal concerns about coercion
• External controls to deter specific behaviors (e.g. curfews, drug testing, etc.)
• Self-help orientation (e.g. low cost, address moral failings, less demanding on staff, etc.) Limited use of pharmacological related conditions due to…
• Politicization of judicial appointments
• Reputation/Experience with Methadone
• Acceptance by African American community
• Issues raised with sex offenders and depo-provera In the community, offenders are responsible for payment for services (e.g., medications,medical care, etc.) Offender-Related Issues Regarding Conditions
• Offender must agree to conditions, volunteer if it involves liberty restrictions
• If given choice, 35% prefer incarceration
• The risk of negative consequences (e.g. technical violations) outweigh benefits of tx
• Limited assistance to offenders to obtain/reinforce conditions System-Related Issues Regarding Conditions
• Most conditions are the result of Offense- Based approaches
• Judges/Parole Boards generally do not use trained clinicians to Assess BEHAVIORS
• Inadequate definition of “drug-involved”: abuse vs. dependency issues
• Failure to use techniques to “shape” behavior, focus on punishment only
• Failure to triage based on public safety risk Impact of use of Improper Conditions on Offender Outcomes re 40% w Ar ith 20% W % 10% Supervision depends on TX to determine Services
Roman, et al., Treatment Innovations in Publicly Funded Substance Abuse Treatment Centers: A Preliminary Report from the Field: Presentation at
CTN Steering Committee Meeting, 2002. Overcoming the Hurdles to Using Naltrexone in Supervision Core Features
• Value Clarification about Naltrexone and conditions
• Role Clarifications—judges/parole board, supervision staff, offender
• Intervention framework that emphasizes adherence to medication schedule
• Behavioral Management Approaches Select a tx provider that uses Naltrexone Recognize Naltrexone as the priority condition by the parole board/judge Emphasize CM concepts geared around compliance with incentives for use of medication Empower Supervision Staff with the authority in the CM protocol to provide swift, certain reinforcers that focus on equity and fairness Minimize negative consequences for conditions that do not involve public safety risks Establish medication compliance schedule that tx provider and p/p agree upon Identify high risk addicts for the experiment (triage, focus on dependent addicts) Colocate supervision staff at the tx clinic with medical staff Include CBT as a method to learn compliance management techniques Provide for offender daily attendance to acquire medication during early period Provide offender with role in self-management
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Overcoming the Hurdles to Using