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Offender treatment: 'You're doing it backwards.'

May 16, 2014
by Shannon Brys, Associate Editor
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Recent reports have alluded to the fact that prisons and jail systems are the new “holding tank” for mentally ill and addicted individuals. Throughout the years, professionals have created plans to solve the issue, but the cycle continues. Douglas Marlow, chief of science, law and policy at the National Association of Drug Court Professionals said, “We shouldn’t be punishing people for having a substance abuse or mental illness, we should be diverting them to treatment.”  

The three “masters” he said criminal justice policies have been chasing are: lowering costs, protecting public safety and saving lives. He explained to the audience at the 2014 National Council for Behavioral Health conference that “you are the latest victim of our understanding to the problem.”

Once the policy of sending people to prison proved to be highly expensive and had lower outcomes in terms of treatment for those who were addicted and mentally ill, the policies shifted to the complete opposite side of the spectrum, he said.

Now, officials and the public believe that if offenders are sent to treatment instead of prison, “magic will occur,” public safety will improve and money and lives will be saved. However, Marlowe explained that this won’t be the case because providers are not prepared for the large population of offenders entering the treatment system.

“Providers don’t know what the issues are and don’t understand the population. Most of their beliefs and interventions are inappropriate,” he said. Interventions must be specific to the individuals being treated.

Marlowe explained that crime will increase if providers:

  • Give the wrong intervention
  • Give too little intervention
  • Give too much intervention
  • Don’t deliver the intervention correctly

“If you don’t get it right, it’s better if you don’t do anything at all,” he told the audience in Washington D.C. “It’s a painful, difficult, extreme statement but it happens to be supported by decades and decades of research. You don’t have room to experiment with the populations that are coming your way in the next few years and building up over the next few decades.”

Interventions need to be built that will improve the emotional functioning of the individual, protect public safety and also contain or reduce costs. The trick is to balance these three areas.

The answer, Marlow said, is what the criminal justice system calls the Risk-Need-Responsivity Model. He explained that developing interventions depends on two things:

1.      The risk level in the population of the individual

2.      The need level

He explained that while many associate the word “risk” with violence and danger, what it should really mean is “prognosis.” Risk essentially means that the individual will be harder to treat. He may be more likely to drop out of treatment, fail on probation, appear back in court, and/or commit the same crime as before, Marlowe said.

“Most, if not all, treatment programs identify high-risk individuals and screen them out. Low-risk individuals are screened into the treatment programs.” he explained. “This is backwards.”

The higher the risk level or the worse the prognosis, the more intensive the supervision, accountability and services should be, he said. High risk means that the person is not going to get better on his own.

Mixing risk levels

Aside from screening individuals into the program that are high-risk, another area Marlowe touched on is mixing risk levels. His advice: Do not do it.

“If your treatment programs are not stratifying your patient populations by risk, they are engaged in malpractice,” he explained. “If they don’t do a risk assessment or receive a risk assessment from probation and keep the high-risk and low-risk populations separate, that’s like taking someone who does not have tuberculosis, and putting them in a room with lots of people who have tuberculosis. Risk is highly contagious.”

Marlowe said that by failing to stratify the populations, there will be an increase in crime. He then explained some areas that can help determine the risk-level of a person entering treatment.

Prognostic risks:

  • If current age is less than 25 years
  • Delinquent onset before the age of 16
  • Substance abuse onset before the age of 14
  • History of violence
  • Antisocial personality disorder
  • Family history of crime or addiction
  • Criminal or substance abuse associations
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Comments

Mr. Marlow has an excellent point of view. We at Addiction Blog totally agree with him on the grounds that we should send substance abusers to treatment centers and not to prisons.
Why are we not implementing a good addiction treatment program in the prisons themselves? How can we educate people across our society on strategies in choosing the right intervention? Is addiction the public service campaign of the 2010's?

This sheds light on the problem of addiction treatment as a whole. Even "experts" with the best of intentions just have it wrong. There is such a cookie cutter approach and "blame the patient" attitude if treatment isn't working. It is insane to discharge people when treatment is failing, hand them a taper script (insufficient for a successful taper) and show them the door. No responsibility for the patient, referring them to a higher level of care keeping them as a patient until they reach the higher level of care. No responsibility for a patient who the provider choose to take on, knowing that the symptoms of their condition is continued drug use! The system is broken, a lack of access to service unless you're lucky enough to have a family who can pay $15-20,000 for a month of a higher level of care. He is right, the treatment community is not ready to deal with the influx of the criminal justice population and the criminal justice system is even less prepared to treat the problem. There needs to be money pumped into an overhaul of services. Actual access to multiple levels of care to even begin to "individualize" treatment which is so crucial.

Robert Wilson, LPC, NCC, AADC