Results from a Rhode Island Hospital study indicate benefits among many drug users.

PROVIDENCE, R.I. — A study from Rhode Island Hospital has found that collaborative behavioral management may be effective in reducing substance abuse among convicted marijuana users who are paroled. The findings have important implications for the management of a substantial proportion of the U.S. community correctional population. The study is published in Addiction and is available online in advance of print. Report by Eurek Alert.

In the U.S., over 700,000 inmates leave prisons each year and over two-thirds of those inmates have a drug problem. The return of these inmates to the community is a critical issue for public health and safety. Relapse following release contributes to the re-arrest of more than two-thirds of parolees and re-incarceration of over half of inmates in the three years after release. While treatment can reduce relapse, drug-involved ex-inmates give limited priority to addiction treatment. Surveillance with the threat of sanction by parole officers is the traditional method of following parolees, yet many ex-offenders fall into the same pattern and are arrested again.

Knowing that contingency management can be an effective treatment for drug abuse and addiction, researchers at Rhode Island Hospital and nationwide, led by Peter D. Friedmann, M.D., performed a clinical trial called “Step ‘n Out” to determine whether collaborative behavioral management would be effective in reducing substance abuse, crime and re-arrest among drug-involved parolees. This study was funded by the National Institute on Drug Abuse of the National Institutes of Health.

Friedmann, a physician and an addiction health services researcher at Rhode Island Hospital, explains, “Because of the so-called War on Drugs, an unprecedented number of people have been put in prison for drug use and the great majority of them return to the community. Community reentry is a difficult period – having a criminal record makes it hard to get a job and you usually return to the same environment you came from with the same people and temptations. Thus, a large proportion of drug-involved ex-offenders return to drugs and crime.”

Addiction treatment during the transition period can reduce relapse, but competing priorities such as the need for housing and finding work often limit ex-offenders willingness to participate in treatment. Parole and probation are supposed to encourage treatment and prevent a return drugs and crime, but they are poorly designed to do so. Probation and parole are based on supervision and punishment for bad behavior. For example, if a parolee tests positive for drugs, he/she might be returned to jail.

Behavioral theory holds that effective reinforcers or punishments must be both immediate (close in time to the behavior) and reliable (happen every time the behavior happens). “Any parent knows that punishment alone is not the optimal way to motivate behavior – it is best to have both carrots and sticks,” Friedmann says. “The problem is that punishment is neither immediate nor reliable — in part because of due process, but also because surveillance is imperfect and offenders have a disincentive to get caught. Conversely, drug use produces both immediate and reliable reinforcement, where a user gets a good feeling with every use.”

Friedmann explains, “The everyday reinforcers of daily life such as a good job and good family life can’t compete – they are delayed and not guaranteed.” Thus, behavioral theory explains what we see – the reentry period is extremely challenging and many ex-offenders end up returning to drugs and crime.”

Through the Step’n Out study, the researchers developed a system of “bridge reinforcement” to provide incentives for good behavior. Weekly over 12 weeks, officers, treatment counselors and clients worked together to agree on a behavioral contract in which there were three target behaviors. If the client met the behaviors then they were rewarded through a system of points that led to positive social reinforcers or material reinforcers like gift cards. A computer program helped track and manage the points and reinforcers. The motto of the study was “Catching People Doing Things Right” because the clients now had a reason to report their successes and the parole officers to recognize them. This intervention was studied in a randomized clinical trial in six parole offices in five states.

The Step ‘n Out trial reported that collaborative behavioral management worked to reduce primary drug use among “non-hard drug” users, primarily marijuana. Since marijuana users comprise a large proportion of individuals arrested for drug use, this study suggests that this behavioral approach to community corrections might reduce drug use and ultimately reincarceration. The findings, however, could not demonstrate benefit among parolees who preferred stimulants or opiates.

Friedmann notes, “Since the majority of drug violation arrests in the U.S. are for marijuana, these findings have important implications for the management of a substantial proportion of parolees. The study shows that an intervention grounded in behavioral science is feasible and effective in real-world correctional settings.”

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Friedmann’s principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. He also has an academic appointment at The Warren Alpert Medical School of Brown University. He is also a physician with University Medicine Foundation http://www.umfmed.org/ and the Providence Veterans Affairs Medical Center. Other researchers involved in the study with Friedmann include Traci C. Green, Faye S. Taxman, Magdalena Harrington, Anne G. Rhodes, Elizabeth Katz, Daniel O’Connell, Steven S. Martin, Linda K. Frisman, Mark Litt, William Burdon, Jennifer G. Clarke and Bennett W. Fletcher for the Step ‘n Out Research Group of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS).

CJ-DATS is funded through a cooperative agreement from the National Institute on Drug Abuse, National Institutes of Health (NIDA/NIH), with support from the Center for Substance Abuse Treatment; the Centers for Disease Control and Prevention; the National Institution on Alcohol Abuse and Alcoholism (all part of the U.S. Department of Health and Human Services) and from the Bureau of Justice Assistance of the U.S. Department of Justice.

Tammy Drug Treatment & Diversion, Probation and Parole, Rhode Island

Judge William Sessions, who was nominated Monday to be chairman of the U.S. Sentencing Commission, hopes to continue reforming federal sentencing guidelines to address prison overcrowding.  From the Rutland Herald:

“We’re at a particular point in history where prisons are incredibly overcrowded,” Sessions said. “We’re also at a particular point in time in which there’s a potential for real change.”

Sessions is the chief judge of the U.S. District Court for Vermont and has been a federal judge in Vermont since 1995. He was nominated by President Barack Obama, but will still need to be confirmed by the Senate, a process that he said can be highly political.   Sessions, who made national headlines in 2002 when he declared the death penalty unconstitutional, is currently a vice chairman of the commission, which sets sentencing policy for the United States and advises Congress and the executive branch on crime policy.

Options other than standard incarceration should be used more to address prison overcrowding, Sessions said. That includes drug treatment courts, placement in home confinement or community confinement, and split sentences in which part of a sentence is served in prison and part is served in the community.

Sessions also hopes to make rehabilitation a higher priority in federal sentences.   “For the last 15 years there’s been little interest in rehabilitation,” Sessions said.   Instead, punishment has been the priority.   “A person commits a crime, and they get X,” he said. “We’re going back to, ‘How do we get these people rehabilitated so when they get out of prison, they’re not a danger?’”

There is a great deal more background in the full article.

vericatrajkova Drug Treatment & Diversion, Overcrowding, Re-Entry, Sentencing

Members of the New Jersey administration appeared this week before the State Senate Budget Committee.  The NJ DOC was no exception, as reported by NJ.com.

Department of Corrections Commissioner George Hayman told the committee: “We are living through an era when each expenditure must be scrutinized and every efficiency realized.”

New Jersey’s inmate population continues to drop — from 22,908 in 2007 to a projected 21,715 next year — but the annual cost of housing inmates continues to rise, to $38,500 per inmate. Prisons remain over capacity, with 5,563 more inmates than the facilities were designed for.

The department is doing everything from buying milk and cereal in bulk to closing a prison, Riverfront State Prison in Camden, this year to save money, Hayman said.

Sen. Shirley Turner (D-Mercer County), asked about drug treatment and rehabilitation programs, which she said could help reduce the number of former convicts returning to prison.  Hayman said they were doing the best they could with limited resources.  “We treat as many as we can treat,” he said.

vericatrajkova Drug Treatment & Diversion, Economic Issues, New Jersey

Criminals are using the lack of rehabilitation in South Australian jails to win less jail time.

In the past 12 months, evidence of the lack of rehabilitation has been considered by judges when:

• Releasing a multiple child sex offender from indefinite detention partly because a lack of resources had delayed rehabilitation.
• Overturning the indefinite detention of a rapist, partly because it was “unfair” he was denied rehabilitation reserved for those soon to be released.
• Fixing a non-parole period for a drug user, commenting he could access better rehabilitation in the community.
• Suspending the sentence of a man convicted of assault, commenting this would allow him to access community rehabilitation.
• Lowering a non-parole period for a sex offender, commenting prison could set back his recovery.

Chair of the Law Society’s Criminal Law Committee George Mancini said the trend was increasing because of a State Government policy of longer sentences. “It is an aspect of overcrowding, of longer terms of imprisonment and not spending sufficient resources on rehabilitation,” he said.  A spokesman for Prisons Minister Tom Koutsantonis defended the Government’s record on rehabilitation.  “Prior to 2005, there was no sex offender treatment in SA prisons at all,” the spokesman said.

A number of the recent decisions have been made on the advice of Dr Raeside, a consulting psychiatrist to the Department of Correctional Services, who has been praised by judges for his professionalism and is highly critical of rehabilitation in the state’s jails.

“I figure if we are going to lock more people up for longer (whether one agrees with that policy or not) then we ought to do something for them whilst they are there to reduce the chances of them re-offending and make the community safer when they get out,” he said.

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The Kentucky Parole Board granted parole to significantly more prisoners in the past two months than last year, but officials say it’s not because they are trying to save the cash-strapped state money, according to the Louisville Courier-Journal.

The parole rate climbed to 69 percent in February and 58 percent in March, compared with 48 percent and 52 percent in the same months last year.  The parole rate for all of the last fiscal year was 47 percent.

Parole Board Chairwoman Caroline Mudd cited two factors for the jump: more substance-abuse treatment opportunities for parolees, and a study the board received in January that found the length of inmate sentencing isn’t related to their odds of re-offending. “I will tell you that as Parole Board members we read the papers, we listen to the evening news, we understand that there is a budget crunch going on,” Mudd said. “However, that (revenue shortfall) is not what drives our decisions” …

But some prosecutors and victim advocates aren’t convinced. “Felons are being freed faster, either because of the budget or a new hug-a-thug philosophy in Frankfort,” Kenton County Commonwealth’s Attorney Rob Sanders said. “Either way, public safety suffers” … Of the 814 individuals paroled in February, 8 percent were violent criminals incarcerated for rape, murder and sexual offenses.  And Jo Ann Phillips, executive director of Kentuckians’ Voice for Crime Victims, argues that one paroled violent or sex offender is too many. “They can let out every single check bouncer, joy rider and marijuana possessor that they wanted to,” she said. “It’s the rapists, murderers and pedophiles that should concern all citizens” …

The legislature allocated $4.5 million for substance-abuse treatment programs in prisons and jails this fiscal year, and $5 million next fiscal year, he said. Such programs began in the 2005-06 fiscal year with a $500,000 appropriation.  Mudd noted that the board has begun granting parole to more inmates who agree to remain incarcerated for six to nine months while undergoing substance-abuse treatment. “I think if we can give them the tools, then perhaps they are less likely to re-offend as a result,” she said.

vericatrajkova Drug Treatment & Diversion, Kentucky, Probation and Parole

The Nevada Senate’s top Democrat told lawmakers Monday that a new program for low-risk parole violators and drug and alcohol offenders would reduce the state’s prison population and save millions of dollars in taxpayer money. Report from Mercury News.

Senate Majority Leader Steven Horsford told Finance Committee members that SB398 would create a two-year pilot program of “intermediate sanction” centers for low-risk probation violators as well as people whose crimes are linked to alcohol or drug addictions.  Life skill and rehabilitative programs would be offered to about 400 participants a year, who would stay an average of six months.  Horsford said the program could save the state more than $34 million over the next five years. “Clearly there is a new and more innovative approach we can take that would ensure public safety and require the offender to go through their sentence, but also do it in a way that doesn’t cost the state what we’re spending now,” Horsford said.

The program would use existing facilities and wouldn’t require new beds. Horsford added that program participants wouldn’t mix with other inmates and that a little more than half of the beds would be concentrated in southern Nevada.  Drug and alcohol treatment programs for Willden told lawmakers an additional $2.2 million per year would be required to provide such programs, at a ratio of one staff person for every 27 inmates. The centers would be provided through the Department of Health and Human Services, who would work with community service providers, DHH director Mike Willden said.

Bernie Curtis, chief of the Division of Parole and Probation, spoke in support of the bill, saying, “It’s not going to cost us anything in parole and probation, frankly, to use these intermediate sanctions. We think it’s a good start for a program that is needed in this state.”

vericatrajkova Community Corrections, Drug Treatment & Diversion, Nevada, Probation and Parole

In January, a consultant told Lancaster County PA prison officials it would cost $169 million to build a new prison.  Next week, the same consultant will discuss the financial wisdom of abandoning the current prison entirely if a new prison is built.   Yet officials say that when it comes to dealing with the county’s prison overcrowding problem, they’ll be passing out thinking caps long before they break out any shovels.  Reported by LancasterOnline.

At next Thursday’s prison board meeting, L. Robert Kimball & Associates will outline for the board how much cheaper it would be to operate one big, new prison than to run the current prison and a scaled-down prison to be built somewhere else.  A January report prepared Kimball detailed the shortcomings of the circa-1851 prison at 625 E. King St., which  has a design capacity for 658 beds, but today is home to 1,143 prisoners.  That report discussed the projected need in 2025 for 2,114 prison beds, then laid out several scenarios to build a new prison. The most ambitious plan was for a new, 2,158-bed facility that would cost  $169.42 million to build, an amount roughly equal to the cost of the downtown hotel/convention center.  Yet most prison board members say the are now focused on how to save money, not how to spend it on a new prison …

“We’re just not going to build ourselves out of this problem right now when there’s other things we could be doing before we get to that point,” said County Commissioner Scott Martin.   Martin, who chairs the seven-member prison board, said streamlining some court operations and setting up a day-reporting center are among the options that would free up space at the East King Street prison, delaying the need for a new jail …

Among the improvements, [District Attorney Craig] Stedman said, would be to streamline the court’s scheduling system to get people to trial quicker, thereby cutting down on the number of prisoners who are waiting for a trial date.   In 2006, the Kimball report said the average stay in the county prison was 71 days, while adding that every day knocked off that average could reduce the daily prison population by 16 prisoners.  And since about 80 percent of prisoners in the county prison that year were awaiting trial, getting them through the court system quicker could free up a lot of space …

Commissioner Craig Lehman also highlighted the benefits of a day reporting center, which could be set up apart from the prison and include drug testing and job training services.  With such a center here, probation officers could send violators there instead of simply adding them to an already overcrowded prison, local officials say.

vericatrajkova Court Delays, Drug Treatment & Diversion, Economic Issues, Overcrowding, PA Lancaster County, Pennsylvania, Pre-Trial, Prison and Jail Construction

There are not many winners in the new New York State budget, but the fiscal plan will make it easier for some prison inmates to be released early for medical, merit and other factors.  This report from the Buffalo News.

The relaxed standards, contained deep within the 2009 state budget, go beyond the much-publicized reforms to the Rockefeller-era drug laws that Gov. David A. Paterson and lawmakers pushed to include in the fiscal plan over the objections of many district attorneys.  The provisions will, according to supporters, encourage more humane treatment of a select number of inmates while, in some cases, making prisons safer. The efforts will also save money and, eventually, help in the years ahead to close expensive facilities that are seeing fewer inmates.

But critics insist that some of  the new standards are open to wide interpretation that will result in the release of still-dangerous inmates.  “It’s a wholesale change in the policies that have led to the most significant drop in the violent crime rate of any state in the nation,” said State Sen. Michael F. Nozzolio, a Finger Lakes Republican who until January had served for years as chairman of the Senate’s Crime Victims, Crime and Correction Committee. “These issues, taken together, will ensure more violent criminals are out on the streets, and that’s going to create tremendous pressur e for law enforcement. It will make our cities less safe,” Nozzolio said.

The major sentencing change involves the Rockefeller drug laws, eliminating mandatory minimum sentences for some drug violations and providing judges with more discretion to steer some individuals to treatment instead of prison … The new budget adopted last week [also] permits some inmates to be released on medical parole if approved by a physician and the state Parole Board, a plan originally proposed by Paterson in December. It is the first major change to medical parole laws since 1992, when terminally ill inmates were first allowed to leave prison early. It also recognizes the prison system’s increasingly aging population; the number of inmates older than 55 has risen from 1,500 to more than 3,600 in the last decade … The Paterson administration estimates that 45 individuals now in prison could be released this year. They estimate $2 million in savings this year from the early releases …

The new budget also includes an expansion of the merit-time program that permits early release of eligible inmates, including violent felons. It allows the release of such inmates six months before the completion of their minimum sentence. Not eligible are those convicted of first-degree murder or sex crimes.   The new merit-time effort takes into consideration whether an inmate participated in no less than two years of college programming while in prison and other efforts to reduce recidivism rates, such as enrollment in a state-approved apprenticeship program. Credit can also be given for working as an inmate hospice aide. The inmate’s prison behavior, and even whether they filed a “frivolous” civil lawsuit while in prison, are also considered as factors for the credit.

There is a great deal more detail and background in the Buffalo News article.

vericatrajkova Drug Treatment & Diversion, Early Release, Economic Issues, New York, Sentencing

In answer to criticism of State treatment for addicts in New York’s prison system, Commissioner Brian Fischer wrote the following letter to the New York Times:

The myth that addiction goes untreated in prison is just that: a myth.   Last year 90 percent of all inmates with identified substance abuse needs who were released for the first time had received addiction treatment in New York’s state prisons.  Every day nearly 10,000 inmates receive in-prison substance abuse treatment from qualified, professional staff members. Last year alone, 34,300 inmates participated.

We offer traditional treatment programs, as well as specialized treatment for sex offenders and mentally ill inmates. We offer intensive, minimum-six-month structured residential treatment. More than two-thirds of inmates who complete the program stay out of prison for at least two years. Diversion to community-based treatment, as Gov. David A. Paterson supports, is an appropriate response to the issue of addiction. But treatment within prison remains vital for those who are nonetheless incarcerated.

vericatrajkova Drug Treatment & Diversion, New York

The state-of-the-art jail facility in Hubbard County has enough beds to hold 116 prisoners.  But on a recent day there are only 34.  A situation faced by many jails across the State.  This report from the Minneapolis-St Paul Star Tribune.

When the facility was built in 2006, there were high hopes it would draw overflow prisoners from around the region, and help Hubbard County make some money from its neighbors.   But that isn’t happening. The overcrowding from just a few years ago disappeared.  In fact, Minnesota Department of Correction figures show the number of prisoners in county jails is down 3.5 percent …

In Hubbard County, some officials say without that outside revenue, it would actually be cheaper for them to shut the jail down and send their inmates elsewhere. Hubbard County Commissioner and former County Attorney Greg Larson said that’s unlikely to happen.  Still, he and others wonder what’s going on … “One of the things that was not foreseen was a downturn in business. The numbers I see from the courts indicate the courts are less busy than they were a few years ago,” Larson said. “There is less of a workload, and other counties are experiencing the same thing” …

There’s lots of speculation as to why jail populations are down.   Some say the state has a better handle on the meth problem that plagued communities a few years ago. Others wonder if perhaps it’s due to an aging population. The children of baby boomers are growing beyond the age when they’re most likely to commit crimes.

In Crow Wing County, the story is the same.   The county has a jail facility with 286 beds, but more than a third of them are empty. Daily populations are about 50 inmates less than when the jail opened two years ago.    The number of prisoners Crow Wing County houses for the state has also dropped, and so has their revenue.  Jail administrator Jerry Negen said one reason for the decrease in inmates is that the courts are increasingly finding alternatives to jail time for law breakers. There’s a big push for more specialized programs that reduce jail time in favor of more treatment and court supervision.   “They’ve got 30 plus people in our drug court right now that are doing well, so there’s 30 people out of custody that they report to drug court,” Negen said. “We also have in Crow Wing County DWI court… So there’s another 15 to 20 on that. So there’s where our numbers went, we believe.”

vericatrajkova Drug Treatment & Diversion, MN Crow Wing County