Substance Use Disorder (SUD) and Justice-Involved Populations

ByCHESS Health

Data from the National Institute on Drug Abuse estimates that 65 percent of the United States prison population has an active substance-abuse disorder (SUD), pointing to that fact that treatment and recovery from SUD should be a foundational consideration in how the justice system operates. In order to address both the crisis of substance use and criminal recidivism, we must expand access to recovery tools for people within the justice system.

Diversion Programs

Diversion programs help individuals with mental health issues and substance use disorder enter treatment programs as an alternative to incarceration.

Several successful models exist for linking justice-involved people with treatment options. The most basic form of intervention is a screening that is implemented shortly after arrest. Taking the nature of the crime into account, the individual may be offered one of three outcomes during the pretrial period: The first outcome is a treatment referral, the second is entry into a community treatment center under supervision conditions, and the third is a treatment sentencing that serves as an alternative to an incarceration sentence. If an individual successfully complies with treatment, charges may be dismissed or reduced. These initiatives have shown positive outcomes among participants completing the programs.

Local justice systems are increasingly using technology to link individuals with community support and treatment during both post-arrest and post-release periods. For example, the state of North Carolina was awarded $10.6M to fund 18 grantees to create jail-based pre-arrest diversion and re-entry programs.

The Critical Role of Treatment for SUD within Justice Systems

Providing comprehensive substance use treatment to criminal offenders during incarceration is effective for reducing both drug use and repeat crimes once the individual reenters the community. There’s a cascading effect when an individual is given recovery tools while incarcerated: Treatment during incarceration plays a critical role in reducing crime-related and drug-related societal burdens related to family disintegration, job productivity, and recidivism – and also results in changing individuals’ attitudes and behaviors surrounding drug use.

The National Institute on Drug Abuse’s data is clear about what works. In order for SUD treatment to be effective:

  • Treatment must begin during incarceration.
  • Once started, treatment must be sustained after release through community treatment programs.
  • A continuing therapeutic process providing resources for preventing return-to-use must be offered.

While we know what’s needed to create success stories, the fact remains that only a small percentage of people in need of treatment while incarcerated actually receive it. What’s more, those who do receive treatment rarely receive what can be considered adequate treatment. For instance, a recent report published by the National Academy of Sciences shares that only 5% of people with opioid use disorder in jail and prison settings receive medication treatment. Unfortunately, most prison medical directors admit to being unaware of the benefits of using medication-based treatments to treat OUD.

A successful approach to addressing SUD within the justice system should offer access to all of the proven treatment methods, including:

  • Behavioral and cognitive therapies that help to modify a patient’s drug-related behaviors and expectations with a goal of effectively managing stress and triggers.
  • Medication-based therapies.
  • Wrap-around services provided after release. These services traditionally assist people released from the criminal justice system with housing and employment.
  • Overdose education.
Re-Entry Programs

Re-entry programs are essential for helping previously incarcerated individuals transition back into the community. 

Continuity of care is especially important during the re-entry period, as the risk of overdose increases more than 100-fold in the two weeks after release.  Unfortunately, many previously incarcerated patients discontinue medication used to treat SUD after release. (For example, studies show that 61-75% of pregnant women who initiated MOUD treatment while in jail or prison discontinue medication post-partum). Some states, such as Pennsylvania, are exploring programs that require Medicaid managed care organizations to contract with the same providers as the Department of Corrections, so that medication-assisted treatment (MAT) can be continued upon re-entry.

In addition, SAMHSA has designated peer support as a “promising program” for the treatment of SUD for justice-involved individuals, pointing to additional support that can be provided to individuals upon re-entry.

Adequate Access to Recovery Tools Is Also a Public Safety Matter

“The large number of individuals with substance use disorders involved in the nation’s criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health,” according to a 2013 paper on treating substance use disorders in the criminal justice system. In addition to discussions of the cost, morality, and viability of inserting access to recovery into the workings of the justice system, it’s important to note that many of the crimes leading to arrest today would not happen without drug-related motivations.

Among the millions of people who enter the United States criminal justice system each year, a majority are using drugs at the time of arrest. In fact, cocaine, methamphetamine, and other commonly used stimulants have psychopharmacological effects that can increase a person’s likelihood of engaging in violent crime. Immediate invention upon entering the justice system for the first time may be one of the most important measures for preventing crime that local courts and law enforcement have at their disposal.

Following an initial entry into the criminal justice system, drug use drastically increases the likelihood of continued criminal involvement. In fact, rates of relapse and recidivism are highest among drug-involved people: 68% of drug offenders are rearrested within three years of release from prison. We can no longer overlook treatment as a core factor in increasing public health and safety.

Bridging the Gap in Local Treatment Using Digital Solutions: Case Study Highlighting the Use of Technology for SUD

Technology to promote ongoing SUD recovery can help expand outreach when resources are already spread thin. Several court systems and correctional bodies have tackled resource shortages that make providing recovery resources to justice-involved individuals difficult using technology.

Marietta Municipal Court

As part of a partnership with the Addiction Policy Forum and Foundation for Opioid Response Efforts (FORE), the Marietta Municipal Court expanded telehealth support for justice-involved substance use disorder (SUD) patients. The program began as a pilot serving 29 individuals with SUD during the pandemic. Support was provided through the Connections App, including cognitive behavioral therapy, as well as direct engagement for the highest-risk clients and weekly forums/support groups.

Participants in Marietta Municipal Court’s pilot reported significant improvements in sleep, work, school, and volunteering participation. They also experienced increased confidence in their recovery. Finally, participants reported that the program resulted in more time spent around supportive people.

The Bottom Line

Data points gathered from state and federal agencies for the past five decades draw an undeniable line between substance use and incarceration. While the default approach to handling offenders has been punitive in the past, the justice system is now realizing that treating SUD at its root can help to improve lives by reducing violent crime, restoring communities, and empowering people to enter/sustain recovery. Technology can fill in the budgeting and “manpower” gaps that have made quality, comprehensive recovery resources unattainable for many justice-involved people.

At CHESS Health, we proudly collaborate with health plans, state agencies, local governments, public-sector organizations, and individual providers to get our apps and technology into the hands of individuals struggling with SUD. If you’re interested in learning more about the science-backed, life-saving technology that has already been used by agencies and municipalities around the country, contact CHESS Health today.

Resources

1. https://nida.nih.gov/publications/drugfacts/criminal-justice. “Criminal Justice Drugfacts.” National Institutes of Health, U.S. Department of Health and Human Services, 8 Sept. 2022, https://nida.nih.gov/publications/drugfacts/criminal-justice.

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859122/. “Home – PMC – NCBI.” National Center for Biotechnology Information, U.S. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/.

3. https://nap.nationalacademies.org/catalog/25310/medications-for-opioid-use-disorder-save-lives. Sciences, Contributor(s): National Academies of. “Medications for Opioid Use Disorder Save Lives.” The National Academies Press, 20 Mar. 2019, https://nap.nationalacademies.org/catalog/25310/medications-for-opioid-use-disorder-save-lives.

4. https://www.chess.health/case-studies/marietta-municipal-court/. CHESS Health. “Marietta Municipal Court.” CHESS Health, 15 Dec. 2022, https://www.chess.health/case-studies/marietta-municipal-court/.