Wednesday, February 8, 2006
Mr. Chairman and Members of the Committee:
Thank you for inviting the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health (NIH), an agency of the Department of Health and Human Services (HHS), to participate in this important hearing. As the world's largest supporter of research on drug abuse and addiction, we have learned much about the importance of drug treatment in helping people recover from this devastating disease. Our work extends to all segments of society, including the criminal justice system, where our research shows the pivotal role that drug treatment can play in breaking the vicious cycle of drug abuse and criminal behavior—particularly during the vulnerable period of re-entry into the community. In that regard, securing drug treatment for criminal offenders with drug problems extends beyond the individual to become an issue of public health and safety. I am pleased to be here today to present an overview of what the science has taught us about drug abuse treatment and to highlight effective treatment approaches, targeting intervention opportunities presented by the criminal justice system.
Nearly 7 million adults are involved in the criminal justice system in some way, with more than half of the nearly 2.3 million persons incarcerated having used drugs regularly before their incarceration. However, fewer than 18 percent of these incarcerated offenders received drug treatment either during or after their incarceration.
Among juveniles, too, the problem is serious and growing. In 2002, approximately 1.6 million youth were involved in the juvenile justice system, with 60 percent of boys and nearly half of detained girls testing positive for drug use.
This is the overwhelming reality—but the Administration is proactively working to change it. At NIDA. efforts to integrate evidence-based interventions into practice—in this case drug treatment—reflect a major tenet of our mission. NIDA’s research serves to inform important Administration programs such as the Access to Recovery program of HHS’s Substance Abuse and Mental Health Services Administration and the Prisoner Re-entry Program, led by the Department of Labor in partnership with the Departments of Justice and Housing and Urban Development. To achieve this aim, our rich criminal justice research portfolio seeks first to understand justice and treatment systems, and then to improve current practice by developing and testing new intervention models.
One old concept has been proven false, for we now know that “forced abstinence” from drug use during incarceration, if abstinence occurs, does NOT alleviate addiction. Research shows that effective treatment of addiction—a chronic, relapsing disease of the brain, characterized by compulsive behavior—requires addressing underlying issues and causes. Because drug addiction compromises the circuits involved in processing punishment and reward and in exerting control over one’s actions, the addicted person will compulsively seek drugs despite the threat of severe punishment (e.g., incarceration, loss of child custody), at the expense of natural rewards, such as that from family and friends, and even when they consciously do not want to do it. Comprehensive drug abuse treatment therefore offers the best alternative for interrupting the vicious drug use–criminal justice cycle once a person gets caught up in it.
Why Treatment Should be Provided to Offenders with Drug Disorders
Treatment Works! NIDA’s research findings show unequivocally that drug treatment works and that this is true even for individuals who enter treatment under legal mandate. Interestingly, their outcomes are as favorable as those who enter treatment voluntarily. For example, there is evidence that drug courts—by offering offenders the alternative of community-based treatment instead of incarceration—are promising in reducing criminal behavior and substance abuse.
Effective drug abuse treatment for this population progresses along a continuum that begins in prison and is sustained after release through participation in community treatment programs. Stress is a major risk factor for relapse to drug use and must be taken into account when a substance abuser is making the difficult transition back into society. Therefore, developing a continuum of care is essential to get the best results from drug treatment. To illustrate, in a Delaware Work Release study sponsored by NIDA, those who participated in prison-based treatment followed by aftercare were seven times more likely to be drug free after 3 years than those who received no treatment. Moreover, nearly 70 percent of those in the comprehensive drug treatment group remained arrest-free after 3 years—compared to only 30 percent in the no-treatment group. Studies in California and Texas report similar findings. Drug abuse treatment is an effective intervention for many offenders with substance abuse problems because it can help change attitudes, beliefs, and behavior with regard both to drug use and criminality.
What Constitutes Effective Drug Abuse Treatment?
The following are some specific aspects of drug abuse treatment that should inform customized treatment strategies.
Adolescents and the Juvenile Justice System
The Family-Based Model. Effective treatment of juvenile substance abusers often requires a family-based treatment model that targets family functioning and involvement. Evidence-based interventions supported by NIDA research have shown that these therapies decrease substance abuse and delinquent behavior and are significantly more effective than standard therapies (e.g., peer group therapy) in reducing risk, promoting protective factors, and reducing substance use over the course of treatment.
Family-based models can also help heal the severed bonds between parents and their minor children following incarceration. Sadly, 80 percent of women in state prisons have substance abuse problems, and two-thirds of incarcerated women have minor children. When the bond between a mother and child is broken due to forced separation, a tremendous amount of stress is created, frequently with devastating effects on the child. And because stress can turn the cycle of substance abuse and criminal justice system involvement, these children are placed at increased risk of having substance abuse problems themselves. It is therefore critical to pay attention to the entire family unit and to strive to break this destructive cycle. Through our research on family-based treatment models, NIDA is helping to aid this effort to heal broken bonds and increase family stability.
Disparities Among the African American Population
To address these disparities, NIDA is encouraging research that focuses on the nexus of drug abuse, HIV/AIDS, and criminal justice involvement among African Americans to understand the risk factors and pathways between drug abuse and criminal justice involvement, to determine the extent to which criminal justice involvement and HIV/AIDS risk are interlinked or compounded by drug abuse and addiction, and to develop culturally sensitive prevention and treatment programs for drug abuse and HIV/AIDS.
Continuing to Find Solutions through Research and Collaboration
NIDA research efforts are informing systems everywhere, helping to bridge the gaps between what we know works and what is actually taking place in communities. This includes an initiative to educate judges on the science of drug addiction and treatment to help them better understand and consider the consequences of drug use on the brain and behavior. Reaching out to judges, working with drug courts, optimizing our use of data, and sponsoring a range of research—all are aimed at improving drug abuse services and outcomes for criminal justice populations. Outreach to pivotal members of society helps to educate them about substance abuse disorders and to bring about a more integrated and compassionate system that addresses the reality of co-occurring diseases and other drug abuse consequences.
Thank you for allowing me to share this information with you. I will be happy to answer any questions you may have.
Last Revised: February 9, 2006