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Position Statements
Substance Use Disorder Treatment for Adults
and Adolescents
Introduction
Scientific advances in understanding the pathophysiology of
substance use disorders and in developing effective treatments
have progressed dramatically in the past several years. The
justice system has not kept pace. Current policy has generated
for drug and alcohol offenders a revolving door of arrest,
incarceration, release to the streets untreated or undertreated,
and then rearrest and return to incarceration, resulting in a
costly, futile cycle.
The incarceration of substance use offenders has overwhelmed
many correctional facilities and hampered efforts to provide
adequate treatment. This mismatch between high treatment need
and constrained resources to meet this need undermines efforts
to address what is often the underlying cause of incarceration
and one of the reasons why resources are strained in the first
place.
This position statement addresses the need for treatment of
substance use disorder in corrections facilities. It does not
address the broader issue related to national drug policy.
Position Statement
The National Commission on Correctional Health Care advocates
the following principles for care of adults and adolescents with
substance use disorders in correctional facilities; these
principles reinforce and expand on principles articulated in
NCCHC’s standards for health services.
1. Screening
of detainees/inmates upon entry using valid instruments that are
available from a variety of sources (e.g., National Institute on
Drug Abuse; see also NCCHC standard E-02 Receiving Screening).
2. Assuring that correctional and health staff receive
appropriate training in receiving screening.
3. Formal evaluation for substance use disorder and
comorbidity, including concurrent mental health disorders, by
qualified health professionals trained and experienced in
managing comorbid disorders.
4. If ordered by a correctional physician, continuation of
prescribed medications for substance use disorders.
5. Assessment of opioid and alcohol/sedative withdrawal using
valid scales such as the Alcohol Withdrawal Assessment Scoring
Guidelines (CIWA-Ar) and the Clinical Opiate Withdrawal Scale
(COWS).
6. Evidence-based treatment such as cognitive-behavioral
treatment and medication-assisted treatment of substance
withdrawal.
7. Evidence-based behavioral and pharmacological treatment for
substance use and mental health disorders.
8. Prerelease referral for, and coordination of, treatment for
substance use and mental health disorders.
NCCHC recommends adopting the principles of drug abuse treatment
for criminal justice populations promulgated by the National
Institute on Drug Abuse of the National Institutes of Health
(2007) and endorsed by the American Society of Addiction
Medicine, including support for comprehensive reentry services
designed to minimize relapse and recidivism.
NCCHC supports high-quality research regarding best practices
related to treatment of substance use disorders in corrections.
Although a substantial evidence base exists for such treatment,
there is a high need for research to determine the best
practices for provision of treatment in different types of
correctional facilities. Such research is needed to inform
optimal treatment type, intensity, timing, and postrelease
coordination for different populations (e.g., adolescents, those
with chronic persistent mental illness, and those with different
types of substance use disorders). Research should also address
issues related to risk stratification and composition and
training of substance use disorder teams.
Adopted by the National Commission on Correctional Health
Care Board of Directors
October 10, 2010.
References
National Institute on Drug Abuse. (2007, September).
Principles of Drug Abuse Treatment for
Criminal Justice Populations (revised; NIH Publication No.
06-5316). Retrieved from
http://www.nida.nih.gov/PODAT_CJ/
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