“We can’t arrest our way out of this problem,” dozens of public officials and members of law enforcement are quoted as saying in recent years, referring to the opioid crisis.
“We’ve come to really understand that our largely punitive responses to people with substance use disorders is ineffective. It’s inhumane, and it’s costly,” said the director of the Office of National Drug Control Policy, Michael Botticelli, in 2016.
That same year, the Surgeon General echoed his sentiments, recommending that we “implement criminal justice reforms to transition to a less punitive and more health-focused approach.”
Even as consensus seems to be gathering around the need for a less punitive and more therapeutic approach to addiction, there are monumental questions about how to actually achieve this shift.
What does it look like on the ground?
How do you measure if it’s working?
“It is our urgent priority to advocate, teach and model therapeutic, not punitive or counterproductive, approaches to addictions,” said IRETA’s Executive Director, Dr. Peter Luongo.
He cites a number of current IRETA projects that illustrates a better way of doing things. For those of you who are wondering what a more therapeutic model looks like, here are some examples.
For the Federal Judicial Center, we help re-entry courts respond to continued or new substance use with therapeutic interventions rather than punishment. Intensifying treatment is not punitive; it is a clinically-appropriate response. So now, instead of issuing a sanction such as a “shock incarceration” or home detention, a re-entry court evaluates the treatment services, holds a case review, and determines what additional services (if any) are needed. Sometimes the decision is to stay the course.
For opioid treatment programs, we provide a two-year clinical quality improvement process that helps programs respond to continued use, or relapse, by enhancing clinical services to match the patient’s treatment need. So now, instead of dismissing a patient with a positive drug screen as not ready to change, the program reassesses the treatment plan and offers additional clinical counseling. The treatment intervention adjusts to match the patient.
For purchasers of treatment services, such as U.S. Probation and Pretrial Services, IRETA consults on how to procure treatment services that fit the needs of the patient, not simply provide funds to purchase what the treatment program offers. Forcing patients into a treatment service that doesn’t fit them is a disaster waiting to happen, so we have helped courts expand the treatment options available for probationers. For instance, addiction pharmacotherapy is now available for probationers in western Pennsylvania with opioid use disorder, whereas in the recent past only an inpatient detox followed by drug-free programming was available.
To learn more, take a look at our FY 2018 Annual Report.