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
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]
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
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
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
• 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
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%
% 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
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

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

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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