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I am very honored that you invited me to address your conference this morning. I have developed a very high regard for NASADAD, and for the work that you do throughout the country. You represent, in my view, a critical perspective on the issues that concern us at the National Institute of Justice -- the issues of crime and the administration of justice -- and I think it fair to say that all of us in the criminal justice professions -- researchers and practitioners alike -- are just now coming to realize the importance of the contributions that you can make. So I am pleased to be here this morning to talk a bit about the common issues we face -- the role of treatment for substance abuse in the context of the criminal justice system.
I hope to make two observations this morning -- neither of them is particularly novel to this audience -- but I think they represent important historical trends that, if captured and directed, can create important changes in this country's policy debate on substance abuse and crime. The first observation is that we are witnessing a new interdisciplinary partnership between our professions. In many ways, from the research communities to the worlds of practice, we are seeing the perspectives of public health and public safety brought together to create new knowledge and innovative practice. The second observation is that we are witnessing a localization of the public discussion about crime and, perhaps to a lesser extent, about substance abuse. Communities -- and the governmental agencies that serve them -- are increasingly taking ownership of the problems that are facing them, including prominently the problems of crime, safety, and community well-being. The thought I would like to leave with you it that these two historical developments, if we grab hold of them, can become powerful allies in our common goal of developing a more rational public policy regarding substance abuse and ameliorating its harmful effects on our communities.
The Public Safety - Public Health Partnership
I think that we are witnessing a new public willingness to support substance abuse treatment. You may disagree with this proposition -- and I certainly recognize that you fight uphill battles every day -- sometimes losing battles -- to secure adequate funding for treatment services. Certainly a closer examination of the history of congressional support for treatment programs does not support my optimistic assertion that there is a new willingness to support treatment. So let me quickly modify my assertion to a narrower proposition -- that at least we are seeing an increased level of support for treatment for criminal justice populations and that this change in attitudes bodes well for the future. Allow me to catalogue some evidence of this shift -- much of which was discussed yesterday in the presentation by Associate Attorney General Ray Fisher.
Later this week, in Washington, there will be the annual conference of the National Association of Drug Court Professionals. When I first came to the Department of Justice four years ago, I found it somewhat puzzling that there was an entity called the National Association of Drug Court Professionals. Didn't they know that treatment was not in vogue? That the public mood favored punishment, not intervention? Hadn't they been following the dispiriting debate over midnight basketball? Well, from a small acorn planted in the soil of Dade County Florida where the first drug court was inaugurated barely a decade ago, hundreds of mighty oaks have now grown. They expect close to two thousand attendees at the conference this week. The funding for drug courts has grown every year in Congress to the point that drug courts have now been established in 275 jurisdictions. The demand is strong and the pace of innovation is fast. The most effective advocates for drug courts, in my view, excluding those articulate and inspirational graduates of treatment programs, are judges -- these are highly credible criminal justice officials, respected in their communities, who attest to the power of this intervention, who speak convincingly about the inadequacies of traditional criminal justice processing, who speak knowledgeably about the efficacy of treatment, who can speak sympathetically about the challenges of relapse and the need to balance treatment with criminal justice supervision.
A second example. In March of this year, the Justice Department announced that 49 states, the District of Columbia and eligible territories are receiving more than $59.3 million under the Residential Substance Abuse Treatment program (RSAT) to continue implementing drug intervention and treatment programs in state and local prisons and jails. I think it noteworthy that the United States Congress has provided such strong support for treatment. Again, the demand is strong, and the innovations being supported by this funding are quite impressive.
This support for treatment in the criminal justice context is of course not limited to federal funding. Within the past few months, to take a few examples, the State of Pennsylvania opened a new correctional facility devoted to drug treatment, the State of Connecticut enacted legislation to offer early release to some inmates on the condition that they enter treatment and submit to frequent drug testing, and the State of Maryland has adopted a statewide program of "coerced abstinence" and "seamless services" for offenders under probation and parole supervision. Something important is happening at the intersection between the treatment and criminal justice systems.
Why is this happening? Many explanations are possible. I have an admittedly self-serving view as to why this shift in public policy is underway. I think that the research findings that treatment is effective are irrefutable and are providing a solid, objective basis for a new policy that merges a public health approach with a public safety approach. For the audience attending this conference, there is no need for a long recitation of the research literature on the effectiveness of drug treatment. You are well aware of the RAND corporation study, for example, that found that drug treatment is the most cost-effective drug control intervention. You know the study of CALDATA -- a comprehensive review of drug and alcohol treatment programs in California, that concluded that for every dollar invested in drug treatment, taxpayers saved seven dollars.
I would, however, like to call your attention to a critical element of the research literature -- namely, that criminal justice supervision can serve as a booster to enhance the effectiveness of treatment. At NIJ, we published a report by Doug Lipton at National Development and Research Institutes summarizing the findings from a number of highly rigorous studies that examined the effectiveness of prison-based therapeutic communities. These studies found that the treatment was effective -- but more importantly, in my view, they found that the continuation of treatment under conditions of post release helped maintain the positive effects. Take the findings from the Delaware Key-Crest program, for example, research conducted by Jim Inciardi. Graduates of the in-prison program who participated in a transitional work release program were more than twice as likely to remain drug free, and one third more likely to remain arrest -free, than those who were released directly to the community.1
Similarly, the results of the DATOS study funded by NIDA -- the Drug Abuse Treatment Outcomes Study -- demonstrate the booster effects of criminal justice supervision. That study, under the leadership of Dwayne Simpson, found that both long-term residential and outpatient drug treatment programs lead to significant decreases in illegal activity and reductions in drug use. Importantly, however, the DATOS study also found that a key factor in successful outcomes was the length of stay in the treatment programs -- those who stayed at least 90 days were more likely to succeed -- and that the presence of criminal justice supervision increased the likelihood that the individual would stay beyond the 90 day mark.2
So, I think that these research findings about the effectiveness of treatment in the context of criminal justice supervision are providing an empirical base for increases in treatment funding. This conclusion is captured in General McCaffrey's succinct phrase -- "if you don't like crime, you'll love treatment." Even more important, however, is the accelerated pace of innovation at the intersection of the two systems we represent -- the treatment system and the criminal justice system. The drug court approach is now being adapted to child abuse and neglect proceedings in some pioneering court projects so that drug-involved mothers are maintained in treatment programs while decisions regarding the placement of their children are deferred. In addition to the drug court and RSAT programs I mentioned, a number of very interesting system-wide reforms are being supported. At CSAT, there is continuing support for the criminal justice treatment networks that are attempting to reach under served populations of women and juveniles. At NIJ, we are implementing, with support from ONDCP, the Breaking the Cycle research demonstration program in Birmingham, working with Birmingham TASC, where we are asking what would happen if every drug involved offender arrested in a single jurisdiction were offered appropriate treatment and interventions throughout the pendency of the criminal case. In the next three months, we will be announcing replications of the Birmingham program in two adult sites and later in two juvenile sites. Finally, in the federal courts, Operation Drug TEST is introducing a system of universal testing, sanctions and treatment in 25 federal districts.
At the National Institute of Justice, we see our role as keeping abreast of these rapid changes in progressive practice to learn from these efforts to reduce drug use and improve public safety. We have sponsored evaluations of drug courts in the District of Columbia, Portland OR, Las Vegas, Kansas City and Pensacola. Within the next month we will award a research grant to look at the next generation of drug courts in fourteen additional jurisdictions -- Tuscaloosa, AL; Riverside, CA; Tampa, FL; Atlanta, GA; Kankakee, IL; Omaha, NE; San Juan, PR; Richmond, VA; Spokane; WA; Birmingham, AL; Sacramento, CA; Santa Barbara, CA; Chicago, IL and Brooklyn, NY.
We have funded a national evaluation of the federal Drug TEST program and the RSAT program -- as well as local evaluations of the RSAT programs in Florida, Delaware, California, New Mexico, Michigan, Wisconsin and Maryland. I urge you to learn about these evaluations and apply the lessons from these studies to the policy discussions in your communities. The larger lesson to draw from this era of innovation is that public support for treatment for these populations is growing, and, with encouragement, can be accelerated.
Local Problems, Local Solutions
The second development that my colleagues and I have been observing is the localization of the discussion about crime. In many ways, the development of robust community policing practices is yielding this result. As police officers are assigned to neighborhood beats and expected to meet with community residents to learn from them about the problems of crime and safety facing that community, the discussion inevitably takes on a very concrete, spatial dimension. This change in policing practice is now being supported by increased use of crime mapping software which literally displays crime in geographic context. The net result is that criminal events that would otherwise not be seen as related are now placed in a neighborhood setting. Concerns about drug dealing on specific street corners, or vacant lots that attract rowdy youth, or apartments that are frequent locations for domestic violence calls are now brought forcefully to the attention of police and community alike. And, in an important corollary, accountability for results can be established, both within the police department and on behalf of a specific community.
At NIJ we have developed a phrase to capture this insight -- we say that "all crime is local" -- and we are increasingly coming to realize that there is a parallel observation regarding the drug abuse phenomenon that concerns the NASADAD membership: that all drug problems are local. Even though there are clearly international aspects to the Nation's drug problem -- I do not want to be understood to minimize the importance of international interdiction efforts -- and even though it is important to track national level trends in drug use -- the Household Survey is a highly valuable yardstick -- I want to impress upon you the enormous variation in our drug problem when we look at it from the ground up.
Allow me to draw some examples from NIJ's Arrestee Drug Abuse Monitoring (ADAM) program, formerly the Drug Use Forecasting (DUF) program. In San Diego, about as many individuals arrested and tested for drugs test positive for methamphetamine as for cocaine; yet in New York City, methamphetamine does not register on the scale. In Baltimore, 37% of male arrestees and 48% of female arrestees test positive for opiates, while forty miles away in Washington, only 9% of male arrestees and 6% of female arrestees test positive for opiates. The drug problem in these four cities is clearly not the same drug problem. Although we talk about our national drug problem, we in fact have very different drug problems at the local level.
I gather that there is also a strong community movement against drug abuse, paralleling the community movement we are seeing against crime. The success of the Community Anti-Drug Coalition of America is a testimonial to that movement. The Fight Back program, the Safety Now program, and other national organizations dedicated to community organizing on the drug issue demonstrate the strength of this movement. Even the DARE program can be understood in this context -- even though its effectiveness at reducing drug abuse has yet to be proven, the fact that it has penetrated over two thirds of this country's school districts is a strong statement about community insistence that their police and schools do something about the drug problem.
The question we face now, I believe, is how to take the observation that there are many drug problems in our many communities, harness that to the emerging community level problem solving activities on both crime and drug issues, marry that energy to our emerging research knowledge, and create a set of new strategies that actually reduce drug use block by block, neighborhood by neighborhood, community by community.
At NIJ, we think that our new ADAM program can be an important tool in the community's toolbox. You may recall that we have taken the former DUF program and retooled it to become the ADAM program. We have added 12 sites to the original 23 sites and hope, with Congressional support, to expand ADAM to over 75 sites over the next three years. When the expansion is completed, every city over 200,000 in population will have an ADAM program that will allow that city to know, in a close to real time way, about changes in the drug use patterns within the criminal justice population in that city. We will expect each of those sites to conduct a quarter of data collection outside the city in rural, suburban or tribal settings, so that our picture of drug use reflects all kinds of American communities.
I would like to call your attention to two new features in the ADAM program that should make it useful to you in your work. First, we have asked each site to create a Local Coordinating Council consisting of criminal justice, public health and treatment representatives to make effective use of the data that are produced. Although ADAM is a national research platform, we believe very strongly that its greatest value is to the local community. We are encouraging -- and will be funding -- the design of research projects that are of interest to the local practitioners. For example, if you are interested in knowing whether arrestees are participating in treatment programs, then you need only ask your local ADAM site to add appropriate questions to the survey instrument. If you are interested in HIV prevalence, you can find the answers quickly. I know that a number of you have already begun working with the ADAM team in your states, but I want to encourage you to take advantage of this opportunity. Allow me to name the 23 original sites and the 12 expansion sites so you can make those connections -- the original sites are Manhattan, NY; Philadelphia, PA; Washington, D.C.; Ft. Lauderdale, FL; Miami, FL; Cleveland, OH; Atlanta, GA; Detroit, MI; Indianapolis, IN; Birmingham, AL; New Orleans, LA; Chicago, IL; Omaha, NE; St. Louis, MO; Dallas, TX; Houston, TX; San Antonio, TX; Denver, CO; Phoenix, AZ; Los Angeles, CA; San Diego, CA; San Jose; CA and Portland, OR.
This year's expansion sites are Anchorage, AK; Spokane, WA; Seattle, WA; Sacramento, CA; Las Vegas, NV; Salt Lake City, UT; Tucson, AZ; Albuquerque, NM; Laredo, TX; Oklahoma City, OK; Minneapolis, MN and Des Moines, IA.
The second feature of ADAM that should be of interest to you is that we are working with our federal colleagues in NIDA, NIAAA, CDC, CSAT and ONDCP to add questions that will enhance our understanding, at the national level, of the nexus between criminal behavior, substance abuse and public health indicators. We hope to gather information on treatment needs, barriers to treatment, treatment history, alcohol use, mental health status, prevalence of sexually transmitted diseases and HIV, access to health care, and other variables. These data will add to our knowledge base so that we can increase public understanding of the connections between crime and indicators of community well being.
The Challenge: To Develop a Research-Based, Locally-Defined Action Agenda
I think the challenge we face is to harness the energy of these two developments -- the growth of innovation that has come from a dialogue between treatment and criminal justice perspectives, and the emergence of local problem definition and problem solving efforts -- and create a new action agenda at the local level. If we test these ideas at the local level, we should find that we can give communities new tools to target community resources -- including treatment resources -- so that drug use can be reduced. If we believe that knowledge is power, then the emerging research knowledge about the effectiveness of treatment -- particularly the effectiveness of treatment of criminal justice populations in reducing criminal behavior -- should be a powerful tool for new policies and programs. If we believe that local communities can be effective advocates for solving the problems that confront them -- and we can give them the tools to identify problems and measure progress -- then they will ultimately be our strongest allies in demanding more effective responses to the problems of substance abuse.
So I urge you to continue to find partnership between the treatment and criminal justice communities, to embrace the problem of crime as well as the problem of substance abuse, to insist upon research and data at the local level, and to find common cause with the local community groups, including, as Nelba Chavez rightly pointed out, consumers of treatment services and their families, that represent untapped resources.
I thank you again for the invitation to speak with you this morning and welcome the opportunity to work with the NASADAD membership on these and other challenges in the months and years ahead.
- Lipton, Douglas S. "The Effectiveness of Treatment for Drug Abusers Under Criminal Justice Supervision." November 1995. National Institute of Justice: Research Report. US Department of Justice, Office of Justice Programs, National Institute of Justice, Washington, DC.
- Findings from the Drug Abuse Treatment Outcome study presented April 7, 1997. Rockville, MD. National Institute on Drug Abuse.