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Center for Substance Abuse Treatment. Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1995. (Treatment Improvement Protocol (TIP) Series, No. 17.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System

Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System.

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Chapter 7—Coordinated Training

This chapter discusses some training needs of staff in both the criminal justice and the alcohol and other drug (AOD) abuse treatment systems with the primary focus on coordinated training. Topics that should be included in training efforts are suggested.

To effectively administer AOD treatment within the criminal justice system, staff in both systems should receive cross-training. They should become familiar with the philosophy, approach, goals, objectives, language, and boundaries of both systems. Treatment providers should understand the importance of security issues, and criminal justice personnel should understand the dynamics of AOD treatment and its potential to reduce recidivism and relapse.

Joint training should be discussed and planned at the highest policymaking levels. Establishing and overseeing training can be an important responsibility for a criminal justice and AOD treatment coordinating council. Training is necessary for personnel at every stage of the criminal justice continuum. For example, police and pretrial officials should know about available AOD treatment options for different types of addiction. Judges and prosecutors also should be familiar with the range of treatment options and how AOD treatment plans can be adapted to an offender's particular circumstances.

Issues for systems that serve criminal justice clients include the following:

  • Judges, prosecutors, and defense attorneys need to update their information about AOD community treatment programs and resources to refer defendants and offenders for treatment.
  • Counseling staff should have specialized training about the multiple needs of offenders.
  • Personnel in all parts of the criminal justice continuum should be knowledgeable about the types and benefits of AOD treatment. Examples of special target groups include States' attorneys, correctional personnel, and jail and prison administrators.
  • Training for probation and parole officials should emphasize relapse prevention and management (see Chapter 5).
  • Training in the AOD treatment system may be targeted to parole boards and to State and county legislators. Parole boards are usually autonomous, with politically appointed members. These members often have other jobs or are recently retired, and they may vary in their knowledge and expertise regarding the criminal justice system, AOD abuse, and AOD-involved offenders. Legislators need current information about both systems in order to draft effective legislation.
  • AOD treatment staff must be trained in the legal mandates and responsibilities imposed by the criminal justice system.
  • Judges must have an understanding of addiction, craving, and relapse.

Cross-Training

AOD treatment providers must understand the goals of the criminal justice system in order to develop effective AOD treatment plans for offenders and to earn support from justice personnel. AOD providers should also understand the operational responsibilities of the justice system, the importance of public safety, and the security concerns that are at the heart of criminal justice. Many AOD treatment providers may have only a layperson's familiarity with the criminal justice system; may use such terms as intermediate sanctions, diversion, and supervision interchangeably; and may not understand the important distinctions between arrest and arraignment, and parole and probation.

Just as criminal justice personnel must understand the roles of AOD treatment program personnel and the different types and levels of AOD treatment, providers must understand the different roles and functions of justice system personnel. For example, they should have knowledge about the specific responsibilities of criminal justice personnel as cases flow from arrest through trial and sentencing, as described in the Center for Substance Abuse Treatment (CSAT) Criminal Justice Treatment Planning Chart (Appendix B).

Since the late 1980s, CSAT has provided technical assistance to States seeking to establish cross-training programs. Early efforts focused on training probation officers and treatment staff. More recent efforts have focused on creating multidisciplinary teams of staff from a spectrum of the systems that collaborate to engage and retain offenders in treatment.

Many of the Treatment Improvement Protocols (TIPs) in this series can be used or adapted for use in training staff in both systems. For example, the TIP entitled Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse (TIP 10) has a chapter on identifying and treating persons with personality disorders, including antisocial personality disorder, which is a common disorder among offenders. The TIP provides materials for helping people with this disorder identify dysfunctional thinking and response patterns and work effectively in 12-step programs.

The TIP Detoxification From Alcohol and Other Drugs (in development) can be used to give staff a broad understanding of this step, which is the first in the treatment process for many persons. Intensive outpatient treatment may provide an appropriate community-based level of care for many nonviolent offenders, and the TIP Intensive Outpatient Treatment for Alcohol and Other Drug Abuse describes one approach to this level of care. The TIPs on Pregnant Substance-Abusing Women, Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases, and Treatment for HIV-Infected Alcohol and Other Drug Abusers contain material especially relevant for work with offender populations. Many persons in the justice system may have a poor understanding of treatment with methadone or LAAM, and three TIPs describe current practices in this area: State Methadone Treatment Guidelines, Matching Treatment to Patient Needs in Opioid Substitution Therapy and LAAM in the Treatment of Opiate Addiction (in development).

Four other TIPs in this series address current efforts to link the treatment and criminal justice systems and would be especially useful in training treatment staff in justice system issues. These other TIPs are TIP 7:Screening and Assessment for Alcohol and Other Drug Abuse Among Adults in the Criminal Justice System, TIP 12: Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System, TIP 23: Treatment Drug Courts; Integrating Substance Abuse Treatment with Legal Case Processing, and TIP 21: Combining Alcohol and Other Drug Abuse Treatment Services With Diversion for Juveniles in the Justice System.

Judicial Education

In order to make effective legal decisions, judges must stay informed about issues in many areas. Organizations such as the American Bar Association, the National Judicial College, the National Association of State Court Judges, the American Judicature Society, and the National Association of State Judicial Educators ensure that judges receive many kinds of information and training. Substance abuse may play a role in any case that comes before a judge -- not just drug-related offenses -- and recognizing its role can improve judicial decisionmaking. For example, settling some custody disputes requires judges to understand the dynamics of substance abuse in family systems. In making decisions about AOD-involved offenders, judges must understand the spectrum of addiction from both a medical and behavioral perspective, as well as the various types of interventions and treatments available. They should have knowledge of the dynamics of self-help groups and their role in recovery from AOD dependence. They should also receive information about the costs of treatment and various third-party payers, including private- and public-sector sources. Such basic information is the core of most AOD treatment education for judges.

In making decisions about AOD-involved offenders, judges need to understand the spectrum of addiction, from both a medical and behavioral perspective, as well as the various types of interventions and treatments available.

However, in addition, judges often need training about the extent of their authority to require offenders to participate in treatment or other types of interventions. Many judges are not aware of the extent of their authority to implement innovative sentencing alternatives. For example, in some jurisdictions judges have taken the initiative in establishing Victim Impact Panels in their communities. The panels are composed of victims of crime, such as individuals who have been injured by drunk drivers or the family members of those who have been killed. As part of an offender's sentence, a judge requires attendance at one or several of the panel's sessions. At the session, victims of crimes speak directly to offenders about how their lives have been affected.

In addition, judges may benefit from discussions with peers about the extent of judicial responsibilities and how an individual judge's beliefs about these responsibilities influence his or her decisions; many training courses and workshops offer this additional benefit of peer support. Some training courses attempt to increase judges' understanding of the difficulties that an AOD-involved offender might have in accepting help for the AOD problem. Role-playing with peers may be used in this situation. Learning to offer help in a way that motivates a person to accept help can also be a training focus.

In a few States, AOD training for judges has evolved beyond basic information. In the State of Wisconsin, for example, judges also receive training in how to recognize "functional misfits," that is, individuals who may be functioning at a high level in some environments (for example, those who have reached important positions in their profession) but not in others (for example, those who may be physically or emotionally abusive with their families). The judges are taught to look for the strategies these individuals use to hide their dysfunction. The Wisconsin judges are also trained to recognize early signs of AOD abuse problems in lawyers and other justice personnel, including other judges, and to offer help in a way that is more likely to be accepted. Professional peer support and self-help play an important role in the training.

Targeted Training

Training can target such issues as the goal of prevention, Federal confidentiality regulations, relapse prevention, infectious diseases, cultural competence, and the high levels of stress experienced by those who work with substance-abusing clients. Each of these areas is described in detail in the following sections.

Prevention

Prevention -- of AOD abuse and crime -- is a primary goal of both systems. Prevention offers communities an opportunity to stop AOD problems before they start and provides hope for effecting community change to support healthy behaviors. While there is no single definition of AOD abuse prevention, there is general agreement on the positions taken by AOD practitioners on the overall principles of prevention:

  • Alcohol use is acceptable only for those of legal age and only when the risk of adverse consequences is minimal.
  • Prescription and over-the-counter drugs are used only for the purposes for which they were intended.
  • Other abusable substances are used only for their intended purposes.
  • Illegal drugs and tobacco are not used at all.

Because AOD use plays a role in the transmission of human immunodeficiency virus (HIV) disease and a variety of other illnesses, the importance of prevention cannot be overemphasized. A key component of all prevention efforts is education. Personnel from both the AOD treatment system and the justice system should receive prevention education and training in a variety of topics. They should also learn ways to enhance the prevention messages among offender populations.

Prevention Premises

Since 1986 the Center for Substance Abuse Prevention (CSAP) has provided guidance and leadership in the Nation's prevention efforts. From its efforts, several basic prevention premises have emerged that can form the basis for sound prevention training and education (Center for Substance Abuse Prevention, 1993). These premises are

  • Prevention strategies must be comprehensively structured to reduce individual and environmental risk factors and to increase resiliency factors in high-risk populations.
  • Community involvement is a necessary component of an effective prevention strategy.
  • Prevention must be interwoven with general healthcare and social services delivery systems and it must provide a full continuum of services.
  • Prevention approaches and messages that are tailored to differing population groups are most effective.

As prevention strategies have evolved over the last 20 years, several have proved effective, especially when used in combination:

  • Information dissemination. This strategy promotes awareness and knowledge of the nature and extent of AOD abuse and addiction and the resulting effects on individuals, families, and communities. It also provides awareness of prevention policies, programs, and services. It helps set and reinforce norms (for example, drug dealers will not be tolerated in this neighborhood).
  • Prevention education. The goal of this strategy is to affect critical life and social skills, including decisionmaking, refusal skills, critical analysis (of media messages, for example), and judgment.
  • Alternatives. This strategy establishes constructive and healthy activities that do not include AOD use and encourages individuals to use alternative methods of meeting needs usually filled by the use of alcohol and other drugs.
  • Problem identification and referral. This strategy calls for identification, education, and counseling for individuals, especially youth, who are at high risk of developing AOD problems.
  • Community-based process. This strategy aims to enhance the ability of the community to provide prevention and treatment services more effectively. Activities include organizing, planning, enhancing efficiency and effectiveness of the implementation of services, collaborating with other agencies, building coalitions, and networking. Building healthy communities encourages healthy life-style choices.
  • Environmental approach. This strategy sets up or changes written and unwritten community standards, codes, and attitudes to reduce AOD problems in the community. Included in this approach are laws to restrict availability and access, price increases, and communitywide actions.
  • Topics for prevention training might include
  • Discussion of needle sharing and its effects on HIV transmission
  • High-risk sexual behaviors and their consequences
  • AIDS prevention efforts targeted to adolescents
  • Discussion of community policing and its role in prevention
  • Mobilization of community prevention efforts -- for example, to counter advertising of alcohol in inner-city neighborhoods or to close crack houses
  • Establishment of mentoring programs and recreation leagues for youth and provision of positive role models
  • Self-esteem and its role in prevention
  • Designated driver programs
  • Parents and their roles in prevention
  • Parenting skills training as a prevention tool.

CSAP has published numerous books, training guides, and curricula on prevention of AOD abuse, many of which would be suitable for use in training personnel in the AOD treatment and criminal justice systems and encouraging them to develop creative ways to prevent recidivism and reduce the offender population. A catalog that lists prevention materials available for use in training can be ordered from the National Clearinghouse for Alcohol and Drug Information (NCADI). (See phone numbers for NCADI on page v of this TIP.)

Confidentiality

Personnel in both systems need specific training in the Federal confidentiality regulations related to substance abuse and the protection of certain types of information about persons receiving treatment (42 U.S.C. §§290 dd-3 and ee-3 and 42 C.F.R. Part 2). These regulations should be thoroughly understood by staff who come into contact with the AOD-involved criminal offender. Chapter 8 of this TIP provides detailed guidelines for operating treatment programs in compliance with these regulations. The chapter could be used as a training document or reference guide for staff.

Confidentiality regulations are sometimes interpreted by criminal justice officials and some AOD treatment providers as obstructions to getting needed information. However, most AOD treatment personnel consider confidentiality a key element of the treatment system because it builds clients' trust in the treatment process. Offenders, in particular, may have a great deal of fear about entering AOD treatment and may not consider treatment if they are not assured that their confidentiality will be protected.

Specific topics that could be addressed in training about confidentiality rules include

  • The purpose of confidentiality regulations
  • The general confidentiality rule (see Chapter 8)
  • Types of consent forms and their use
  • Use of consent forms in interagency communications about the offender
  • Exceptions to the general rule (for example, duty to warn others of threats, court-ordered disclosures, reports of child abuse and neglect).

Relapse Prevention

Personnel in the criminal justice system should be educated about the fact that relapse is a normal part of the addiction and recovery process. Consequently, strict requirements such as dismissal from the AOD treatment program on the basis of one or two positive urine samples are not realistic but indicate the need for sanctions and for reassessment of the offender and the treatment plan. In 1993, CSAT published a Technical Assistance Publication on relapse, entitled Relapse Prevention and the Substance-Abusing Criminal Offender, which can be used in training staff from both systems. In addition to providing guidelines for staff, it describes specific Federal, State, and local relapse prevention programs that have operated successfully in correctional institutions and in the community.

Specific topics that should be addressed in the area of relapse prevention are

  • Why offenders are especially vulnerable to relapse, including stressors related to release from the system and psychosocial factors related to crime and AOD use
  • The recovery process and its various stages
  • The unstabilized and stabilized relapse-prone individual
  • "Stuck points" in recovery and how to get past them
  • Basic principles of relapse prevention therapy, including self-knowledge and identification of warning signs, coping skills and management of warning signs, and involvement of significant others in the relapse prevention plan
  • The timing of relapse prevention efforts, especially in advance of the release date.

Infectious Diseases

Initial and ongoing training must be provided about a range of communicable diseases, from the common cold to tuberculosis (TB) and sexually transmitted diseases (STDs) including HIV disease. Staff will benefit from understanding today's four major public health problems-substance abuse, TB, HIV and acquired immunodeficiency syndrome (AIDS), and other STDs -- and from knowing that substance abuse is the common thread linking the other health problems.

Particular attention should be paid to training staff members about transmission of HIV disease so that fears and misunderstandings will not interfere with the provision of treatment.

Specific topics that might be included in staff training about medical issues are

  • Transmission of HIV, TB, and STDs, including the role of unsafe behaviors
  • Tests for HIV, TB, and STDs and what the test results mean
  • Pre- and posttest counseling
  • Medical information about HIV disease and AIDS, an overview of the stages of disease, and treatments for various complications
  • HIV case management, including available primary care resources
  • Recognizing the common manifestations of STDs (sores, rash, discharge)
  • HIV/STDs and the law, including partner notification and confidentiality requirements.

Another TIP in this series, TIP 11: Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases, has an appendix that summarizes a curriculum developed by the Centers for Disease Control and Prevention (CDC) that has been used for the last 4 years to train outreach workers and HIV educators. The curriculum emphasizes prevention education.

CDC has prepared a variety of training and educational materials specific to TB, including a Core Curriculum on Tuberculosis, which contains material applicable to the correctional setting. A narrative text on Tuberculosis in Correctional Facilities is also available, with 67 accompanying slides, a videotape, and a wallchart on administering and interpreting the purified protein derivative (PPD) skin test for TB. Doing Time With TB, a brochure for inmates, contains five fact sheets covering exposure, the PPD skin test, TB prevention, treatment for TB, and the relationship between TB and HIV disease. CDC has also issued Control of Tuberculosis in Correctional Facilities: A Guide for Health Care Workers, which provides information on implementing CDC's guidelines on TB control and outlines recommended regimens of TB treatment. 4

Cultural Competence

Cultural competence includes the behaviors, attitudes, and policies in a system or agency or among professionals that enhance effectiveness in cross-cultural situations. Cultural competence is based on understanding and respect for differences among people and groups. It is important to recognize that culture plays a complex role in peoples' lives and in the development of AOD use problems and their treatment.

Cultural competence is based on acceptance and respect for differences between people and groups. It is important to recognize that culture plays a complex role in peoples' lives and in the development of specific AOD use problems and their treatment.

Delivering culturally competent services is a basic tenet of AOD abuse treatment that must be presented and discussed in training for both AOD abuse providers and criminal justice personnel. Practical examples of cultural competence in program development and operation should be reviewed. Staff should be trained in cultural diversity and issues specific to the cultural populations that they serve. Topics to include in training might include

  • Stereotypes and biases
  • Language and terminology and their role in perpetuating stereotypes
  • Diversity within groups (i.e., avoiding the belief that all members of a group are the same)
  • Ethnic minority groups and their diverse heritages, especially as cultural beliefs relate to AOD use and criminal activity
  • Women, including effects of AODs on women and stereotypes about women AOD abusers
  • Gay men and lesbians, including effects of intolerance on treatment seeking.

Information should also be presented about people who are economically deprived, because they represent a majority of the offender population.

Two TIPs in this series present important information on providing culturally competent treatment. TIP 12: Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System has an appendix that describes a continuum of competence; it also contains a useful self-assessment tool, the Cultural Competence Checklist. The checklist can be used as the basis for a staff discussion of these issues. In addition, TIP 6: Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases reprints two articles in Appendix C that can be used in training sessions. In one forum-type article, a variety of treatment professionals discuss personal and professional experiences with prejudice and its effect on treatment. The other article describes a self-instructional comic-book-formatted guide that has been successfully used to prevent HIV infection among African American and Hispanic American adolescents.

Staff should receive specific training in cultural diversity and issues specific to the cultural populations that they serve.

Staff Issues

Persons working with AOD abusers in the criminal justice system experience high levels of stress, especially those who work directly with clients. Some staff may suffer from burnout or even posttraumatic stress disorder. Some personnel, particularly those working in correctional facilities, also may be victims of physical or verbal abuse. Frequently, there is little staff support when abusive situations occur. As a consequence of all of these issues, staff should receive training focused on burnout and handling stressful environments.

Specific topic areas might include

  • Recognition of the signs of burnout in oneself and others
  • How burnout affects significant others
  • The role of peer support in preventing and dealing with burnout
  • The importance of institutional policy and response to staff burnout
  • Formation of groups within the institution to address sequelae of violent incidents, especially stress syndromes such as posttraumatic stress disorder
  • How to deescalate or otherwise respond to potentially violent situations
  • Stress management strategies, including relaxation techniques.

Summary

In summary, staff training needs can be immense. Currently, few staff members in either system are trained to use comprehensive and integrated approaches, to identify which approaches are appropriate for various situations and populations, and to use these approaches comfortably. For example, when working with clients who are fairly new to the criminal justice system and who do not have full-blown AOD abuse disorders, the staff should use approaches that differ from those used with offenders who have been in the criminal justice system for a long time. In the area of early intervention, staff training can help identify those at risk who may not exhibit robust signs and symptoms of AOD abuse or addiction. Staff can identify client life-style issues and behaviors associated with high risk for developing later AOD problems, even if the clients do not perceive these issues and behaviors as current concerns.

Endnote

Footnotes

1. Requests for CDC publications should be directed to the CDC's Information Service, 1600 Clifton Road N.E., Mailstop E-06, Atlanta, Georgia 30333; telephone (404) 639-1819.

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