New Tools Identify Substance Use Treatment Needs in Criminal Justice System
People in prisons and jails are four times more likely to
have a substance use disorder than the general public, yet services for
this population are sorely lacking, according to experts at George Mason
University. They have developed several screening tools designed to
improve substance use treatment in the criminal justice system.
Both treatment and justice agencies would benefit from screening for
criminal justice risk, as well as substance use disorders, according to
Faye Taxman, PhD, of the university’s Center for Advancing Correctional Excellence!
(ACE!) program in Fairfax, Virginia. “More than 30 percent of offenders
could benefit from residential treatment, but less than 5 percent in
prison, jail or community corrections have access to such services,” she
says.
Taxman spoke recently about substance abuse treatment and the
criminal justice system at the American Academy of Addiction Psychiatry
annual meeting.
The Risk-Needs-Responsibility (RNR) Simulation Tools
developed by the ACE! team focus on both individuals as well as systems
as a whole. One tool developed by Taxman and her colleagues looks at a
person’s history of involvement in the system—age of first arrest,
number of times a person was arrested, incarcerated, on probation and
rearrested—to assess how likely it is that the person will return to the
system. Taxman notes this risk assessment is clinically relevant, since
it signifies the intensity and structure of services needed.
“People who score moderate to high-risk also tend to have more
behavioral health problems and patterns,” Taxman says. “They tend to
have more risky behaviors and more entrenched substance abuse and mental
health problems.” The tool allows practitioners to recommend
appropriate substance use treatment programs for individual prisoners,
based on their specific needs.
The ACE! team also has recently launched an online tool for
clinicians working with the criminal justice system to assess whether
their substance abuse treatment program meets the need of prisoners.
“The RNR tools help clinicians evaluate their own programs, and shows
them how to strengthen them,” notes Taxman. Currently, the available
services for offenders in the community are often not consistent with
the risks and needs of offenders, she says. The tool takes into account
the level of substance use disorders and mental health needs of the
population. There is a minimal cost to store data in the RNR tool,
depending on the size of the organization.
The RNR model asks how restrictive the setting is (such as prison or a
halfway house), how often drug testing is done, what treatment consists
of, whether other issues are addressed (such as anger management,
domestic violence or employment services), what the rewards and
punishments are for treatment successes and failures, the level of staff
training and how closely the treatment manual is followed.
Faye Taxman, PhD
Taxman says when criminal justice agencies know what the risks and
needs of their populations are, they are better able to identify
available programs that are appropriate for their clients. The RNR
Simulation Tool has a strategic planning capability to help systems
identify gaps in services based on offender needs. The tool allows users
to enter the characteristics of the offender population, and estimate
how many would need each level of treatment. If the user enters
information about what programs are available, the tool will identify
where there is adequate programming available, and where gaps exist.
“Clinicians in the substance abuse field often don’t want to talk to
patients about their criminal justice involvement, as though it’s not
relevant to their medical problems,” Taxman observes. “But we’ve found
it’s very relevant to providing the best care for them. If substance use
agencies screened for criminal risk, they could better serve the
population overall and reduce risk of recidivism and relapse.”
