Addressing Drug Abuse in the Justice Context: The Promise and the Challenge

Dear Colleagues:

I am very honored to be with you this morning and to share the platform with Alan Leshner, my friend and colleague. He and I have recognized the important relationships between the research agendas of our two institutes and have made progress toward a new chapter of collaboration between NIDA and NIJ. It is certainly consistent with the theme of this conference that both of us are speaking to you today - with NIDA's focus on drug abuse, the effectiveness of treatment, and the impact of drugs on the brain, and our focus on crime and criminal justice issues and the role of justice institutions in enhancing public safety, it is fitting that we share a panel at a conference that explores the potential for viewing the criminal and juvenile justice systems as opportunities to intervene in the lives of substance abusers to reduce overall drug use and crime.

I would also like to commend Gen. Barry McCaffrey and Assistant Attorney General Laurie Robinson for convening this historic national assembly. In my view, it is highly significant that, in the last month of this century and the last year of this Administration, the Director of the Office of National Drug Control Policy, joined by the leadership of the Departments of Justice and Health and Human Services, has convened this remarkable coalition of public servants representing every state in the nation, and reflecting a variety of disciplines, to define and embrace the challenge of reducing substance abuse through interventions that are based in the processes of our system of justice.

A decade ago, this national assembly would not have been possible. The research base was not strong enough to give us the confidence that this strategy would make sense; we were not yet comfortable with the notion that the criminal and juvenile justice systems were appropriate points for comprehensive intervention initiatives; we lacked the political will to focus this type of attention on the offender population. Now, the times have changed and we can detect a remarkable consensus emerging that we are on the right track and that we can make the changes necessary to implement the new vision that is the topic of this assembly.

My task this morning is two fold - first, to summarize some relevant research findings that provide the foundation for this new vision, and second, to set forth some challenges that stand before us as we move forward.

I hasten to say that, notwithstanding the strong research base for this vision, research neither provides all the answers nor addresses all the questions. Changes in the cultures of our justice and treatment systems, changes in our understanding of our professional roles, changes in our willingness to risk new ways of thinking are not based on the latest research literature. Yet, even with this important reservation, I think we can be reasonably confident of five research based propositions that provide the foundation for this policy initiative.

First, we know with a high degree of certainty that there is a strong nexus between criminal behavior and drug abuse. Without joining the age-old debate about the causal relationship between criminal behavior and drug using behavior -- in other words, which is the chicken and which is the egg - we do know from our ongoing surveys that individuals involved in the criminal and juvenile justice systems are also highly involved in drug use. With remarkable consistency over the past decade, in varied communities around the country, we find that between half and three quarters of adult individuals arrested and charged with crimes have drugs in their system when arrested. Looking at juveniles separately, the rate is only slightly different, ranging from 40% to 69%.

We also know that the criminally involved population of drug users consumes a disproportionate fraction of the drugs consumed throughout the country. By one estimate, as much as half of the heroin and cocaine consumed in America is consumed by people who have been arrested in the past year. The implications of this finding for our national drug policy are clear and are reflected in the annual drug strategies of this Administration - namely, if we can reduce the drug consumption rate of the drug users who come into contact with the criminal justice system, we can reduce overall demand, and by extension reduce our levels of importation and production of illegal drugs.

Second, we know that treatment works, by which we mean that individuals who participate in treatment programs are less likely to use drugs after completion of those programs than comparable individuals who did not participate in such programs. And we know that, with this reduction in drug use we also see reductions in criminal behavior. So, we can say that treatment works and can endorse the phrase that Gen. McCaffrey uses to such great effect, "If you hate crime, you should love treatment."

Allow me quickly to add some caveats. Saying that treatment works is not the same as saying that the only way to get off drugs is through participation in a treatment program. Nor is it the same as saying that all program participants realize this benefit. Nor is it the same as saying that every treatment program is equally successful, nor that all treatment programs are successful. Certainly it is not the same as saying that treatment programs, even if made universally available, represent the panacea for our nation's drug problems.

On the first set of qualifications, we have a lot more research to conduct that will answer questions about naturally occurring desistance patterns, about treatment matching, and about the comparative effectiveness of different interventions. And we have a lot more to learn about the complex decisions that result in treatment being provided - both the decisions of the individual drug user to enter treatment and the decisions of criminal justice and program staff to offer treatment.

We also need to guard against the understandable tendency to take the results from promising innovations - whether therapeutic communities in prison or drug courts as diversion programs - and generalize from those research findings, even those conducted with rigorous research designs, to make broad statements about the potential impact of treatment for this population. Yet, even with these qualifications, we have a sufficient knowledge base, in my view, to support a policy initiative that views the justice system as presenting a cost - efficient opportunity to offer treatment that will significantly reduce drug use and crime.

Third, we know that coerced treatment works, and sometimes works better than totally voluntary treatment. Of course, treatment must on some level be voluntary - participation must be based on the free will of the client. But we are seeing that the criminal justice system can play an important role in encouraging that free will. Attorney General Reno refers to this role as the offering of "carrots and sticks", or, to use a more technical term, the "management of contingencies". There is a very solid research basis for believing that the management of these contingencies is not only consistent with effective treatment but may, for some drug users, be the essential ingredient in successful treatment.

The implications of this research consensus for our criminal and juvenile justice systems are profound - what do judges, probation officers, prosecutors and defense attorneys know about contingency management? How many of us understand the phenomenon of relapse? Our traditional legalistic models of deterrence - deterrence being the closest parallel we have in the legal context to the concept of contingency management - assume that the threat of pain envisioned by the criminal sanction, even if delivered months and years after a crime has occurred, through a highly unpredictable system based on an arrest, prosecution and sentence, is effective in keeping people on the right side of the law. In this new model of contingency management, the criminal justice system has to learn a new way of thinking -- we have to learn how to deliver both encouragements and sanctions, consistently and quickly, with increasing or decreasing severity depending on the progress in treatment. Drug courts are providing us with important experience in this retooling of legal processes to encourage sobriety and prevent relapse, but we have only begun to integrate this new way of thinking into our operational principles.

Fourth, we know that the length of time in treatment is correlated with successful treatment. According to the research literature, drug use for individuals who participated in either long - term residential or outpatient programs showed reductions in criminal activity and drug use, especially for those who have been in treatment for at least 90 days. This research also shows that the presence of criminal justice supervision increased the likelihood that the individual would stay beyond the 90 day mark.

So, we need to tailor our criminal justice supervision to these insights - to work hard to keep offenders in treatment for at least that period, but also to accept the risks associated with terminating criminal justice supervision of the treatment when it is no longer warranted. There may well be times when criminal justice goals and treatment goals conflict and these conflicts need to be examined carefully in light of this new paradigm. For example, in contemplating a judicial system that for good reasons values efficiency in case processing, is it appropriate to ask judges (and prosecutors and defense counsel) to keep cases on the calendar long enough to ensure successful completion of treatment? If we are serious about this symbiosis between treatment and justice processes, we need to pay attention to these issues.

Fifth, we know that treatment under post - release supervision is essential to successful treatment in prison. According to the evaluation of the Delaware Key - Crest program, and other similar programs, those prisoners who participated in the transitional work release program after in-prison drug treatment were more than twice as likely to remain drug free and were one-third more likely to remain arrest free eighteen months after release.

In my view, these findings have profound implications for public policy and should move us toward a fundamental rethinking of our current practices for managing the reentry of prisoners into communities around the country. Allow me to take a few moments to expand upon this thought. This year, about half a million individuals will be released from state prisons. This does not include federal prisoners, nor people being released from local jails. Half a million people - considering that twenty years ago we only had slightly more than 300,000 people in state prisons, the fact that we are releasing half a million each year is nothing short of breathtaking. This development should not surprise us -- it is the natural and predictable consequence of our increased use of imprisonment. When we send them away, they all come back.

What is particularly disconcerting, however, is that over the same period we have significantly reduced our capacity to manage the processes of reentry. We have diminished our ability to increase the likelihood that these offenders are reintegrated into society, do not violate the law, and become productive members of their families and communities in many states. We have abolished parole, reduced the time under post - release supervision by enacting truth in sentencing statutes, cut back on parole funding so that caseloads are higher than ever, and skimped on in-prison programs that traditionally prepared prisoners for the world of work and social responsibility. Perhaps even more shocking than the statistic that half a million prisoners will be released this year is the new data revealing that nearly a quarter of them will be released with absolutely no supervision - they have maxed out. These one hundred thousand people will move from prison cells to street corners with no criminal justice agency even nominally responsible for that transition. Certainly more troubling is that some of the prisoners who have maxed out have done so because they presented behavior problems while in prison - forfeiting good time and other privileges. Finally, although we do not have the data yet, we can be certain that some small number of them have moved directly from maximum security detention on one day, with the greatest loss of liberty, to a new life amongst us the next day with no restrictions on their liberty whatsoever.

How does this relate to the research finding that post-release supervision reduces the rate of return to drug use and return to criminal behavior? In my view, the research literature on programs like Key Crest points the way to a new policy focus on the processes of reentry. If we want to find a way to decrease the public risk posed by prisoners being released to the community, we will increase, not decrease, the level of post-release supervision. We will increase, not abolish, the role of half - way houses and day reporting centers. We will require that prisoners spend the last year before release in an intensive effort to create links between the offender and the world he is about to reenter. These are the successful ingredients and structures of Key Crest and other in prison programs that create a continuum of supervision, treatment and accountability.

Fortunately, there are a number of new initiatives that seize upon these lessons and present the potential for a fundamental rethinking of the reentry process. Attorney General Reno and Assistant Attorney General Laurie Robinson have issued a call for concept papers for reentry courts that would act much as drug courts do, but at the point of release from prison rather than at the point of arrest. The enthusiasm for this new idea has been very exciting and we hope to have a number of demonstration projects underway early in the year 2000. The Corrections Program Office, the Community Oriented Policing Services Office and the National Institute of Justice are working with eight states to develop Reentry Partnerships in which state correctional officials, local police agencies, and community leaders at the neighborhood level will work with identified returning prisoners to create support networks and accountability systems so that the chances for successful reintegration are enhanced.

The attendees at this conference represent the best hope that we can embrace this challenge in the near future. Recognizing that as many as 80% of prisoners have a history of drug abuse, but only 13% of them participate in drug treatment programs while in prison, you should ask why your state in not providing in - prison drug treatment to nearly all prisoners within a year of release. Recognizing that only a small fraction of prisoners who DID participate in drug treatment while in prison continued in treatment when released, you should ask why your state does not, at a minimum, provide treatment and supervision to those prisoners when they are released.

But the challenge is broader than a challenge to provide drug treatment to drug involved prisoners both inside and outside of prison. We should not view the entire world through the lens of drug abuse. The challenge is to recognize that even the best drug treatment is not enough - we should link all returning prisoners, those with and those without histories of drug abuse, to jobs, mental health services, faith institutions, positive peer groups and other forms of informal social control. The challenge is to reduce their levels of reoffending, reduce their rates of return to prison for parole violations, increase their contributions to their communities. This is not the responsibility of one agency called parole, or even the entire criminal and juvenile justice system, this is the responsibility of all of us.

Allow me to leave you with this final observation. One of our country's greatest assets is our spirit of innovation. President Clinton uses this wonderful phrase: that for every problem America faces, some community somewhere is trying with some success to solve it. Over the past several years we have witnessed a stunning decline in crime rates - attributable in large part to good problem solving efforts at the local level involving police, probation, community activists, school officials and others coming together to enhance the level of safety in their communities.

We need to have the same spirit of innovation and determination about reducing drug use. We need local measurement systems to assess the levels of drug use - yardsticks really -- just as we have local measures of crime rates. I am pleased that NIJ and NIDA, through the ADAM program and the Community Epidemiological Working Group, are developing those measures. We need offices of local drug control policy just as we have an Office of National Drug Control Policy to coordinate those efforts. And, with the new local measurement systems that we are developing, we need those local offices to be as willing as has been the national office to keep track of progress at the local level and set goals for reducing the community's level of drug use. If each community in the country were to take this challenge seriously, it would soon discover that much of it drug using population can be found in its juvenile and criminal courts. With the solid research that now informs our efforts, we have a road map that may not show us the entire route to our goal, but certainly tells us the direction we must be headed. With the commitment evidenced in this room, it is clear that we are ready to begin that journey.