Percent of u.s. residents ever going to prison during their lifetime, born in 1974, 1991, and 200

How Could Naltrexone Be
Implemented as a Condition of
Release?
Symposium on the Ethics of Treatment and Research in
Criminal Justice Populations
January 4, 2005
Faye S. Taxman, Ph.D.
George Mason University
[email protected]
Probationers/Parolees
• 4.1 million adults on probation & 600K+ on
• ~45% of probationers have drug tx orders, 17%
receive treatment
• 1.8 million probationers/parolees do not meet
conditions and likely to be violated--violations
account for 30 to 80% new prison intakes
• One-third are arrested while on probation/parole
while on supervision
Decline in Successful Completion
Substance Abusers By Type of
Ethnicity/Race or CJ Status
American Indian
Pacific Islander
Hispanic
Probationers
Parolees
Per Capita Rate of Abuse
Probationers/Parolees are estimated to consumers of 50 to 60
percent of opiates
What Has Been Tried:
CJ Interventions?
• Intensive Supervision
• Boot Camp
• Case Management
• Drug Courts
• Tx with Sanctions (e.g. Break the Cycle,
Seamless System, etc.)
• In-Prison Tx (TC) with Aftercare
What Have We Learned About
Supervision?
• 25 Studies (some multi-site)
• No difference--caseload size or intensive
– Referral/Brokerage Emphasis– Modify conditions with no theoretical – Emphasize control conditions– Enforce conditions, not manage behavior • Wavering Mission (law enforcement vs. The State of Supervision Services:
Implementation Issues
Socio-Political Environment for
Supervision
• Slap on the wrist• “Opportunity/free ride”• Offender is responsible for meeting • Supervision agencies generally have a Offenders are believed to able to control their State of Probation/Parole Services
• Run by Executive Agencies, often with DOCs • Ratio of Staff to Offenders, ranging from 70 to • Volume drives the supervision practices• Supervision staff are “para professionals”—not • Few agencies have clinical staff to provide Limited Tools Available to
Monitor Offender Behavior
• Predominately relies on Offender Self-Reporting for – Curfews– Area Restrictions– Contacts– Standard Conditions (10+)– Fines/Fees– Tx, Community Service & Other Interventions • Infrequent Use of Objective Based Tools – Drug Testing (delay to obtain results, lack of sanctions)– Electronic Monitoring (lack of standards, privatized, fee- The State of Supervision Services:
Defining Conditions
Criminal Conduct is due to…
• Sociological Causes
– Peer associations
– Community disorder
– Low social controls
– Substance abuse
• Less acceptable rationales
– Biopsychology conditions
– Deficits
Moral Failings tend to dominate the perspective of
criminal conduct, defines punishment options
• Sociopolitical norms: tx, fines, fees, controls,
offender “self-help” activities
• Legal concerns about coercion
• External controls to deter specific behaviors
(e.g. curfews, drug testing, etc.)
• Self-help orientation (e.g. low cost, address
moral failings, less demanding on staff, etc.)
Limited use of pharmacological
related conditions due to…
• Politicization of judicial appointments
• Reputation/Experience with Methadone
• Acceptance by African American community
• Issues raised with sex offenders
and depo-provera
In the community, offenders are
responsible for payment for services
(e.g., medications,medical care, etc.)
Offender-Related Issues
Regarding Conditions
• Offender must agree to conditions, volunteer
if it involves liberty restrictions
• If given choice, 35% prefer incarceration
• The risk of negative consequences (e.g.
technical violations) outweigh benefits of tx
• Limited assistance to offenders to
obtain/reinforce conditions
System-Related Issues
Regarding Conditions
• Most conditions are the result of Offense-
Based approaches
• Judges/Parole Boards generally do not use
trained clinicians to Assess BEHAVIORS
• Inadequate definition of “drug-involved”:
abuse vs. dependency issues
• Failure to use techniques to “shape”
behavior, focus on punishment only
• Failure to triage based on public safety risk
Impact of use of Improper
Conditions on Offender Outcomes
re 40%
w Ar
ith 20%
W
% 10%
Supervision depends on TX to determine Services
Roman, et al., Treatment Innovations in Publicly Funded Substance Abuse Treatment Centers: A Preliminary Report from the Field: Presentation at CTN Steering Committee Meeting, 2002.
Overcoming the Hurdles to Using
Naltrexone in Supervision
Core Features
• Value Clarification about Naltrexone and
conditions
• Role Clarifications—judges/parole board,
supervision staff, offender
• Intervention framework that emphasizes
adherence to medication schedule
• Behavioral Management Approaches
Select a tx provider that uses Naltrexone
Recognize Naltrexone as the priority
condition by the parole board/judge
Emphasize CM concepts geared around
compliance with incentives for use of
medication
Empower Supervision Staff with the authority
in the CM protocol to provide swift, certain
reinforcers that focus on equity and fairness
Minimize negative consequences for
conditions that do not involve public safety
risks
Establish medication compliance schedule that
tx provider and p/p agree upon
Identify high risk addicts for the experiment
(triage, focus on dependent addicts)
Colocate supervision staff at the tx clinic with
medical staff
Include CBT as a method to learn compliance
management techniques
Provide for offender daily attendance to acquire
medication during early period
Provide offender with role in self-management

Source: http://www.gmuace.org/documents/presentations/2005/2005-presentations-naltrexone.pdf