PLNDP logo

View Image ›

Annotation

Physician Leadership on National Drug Policy: Brown University Center for Alcohol and Addiction Studies

PLNDP Action Kit Slides


PLNDP Chair,Vice-Chair, Director

View Image ›

Annotation

Lonnie R. Bristow, MD (Vice Chair), Practicing physician (Internal Medicine) in San Pablo, California. Member of the American Medical Association Board of Trustees and Executive Committee. Immediate Past President of the AMA.

David C. Lewis, MD
(Project Director), Director, Center for Alcohol and Addiction Studies, Brown University. Professor of Medicine and Community Health, Donald G. Millar Professor of Alcohol and Addiction Studies.

June E. Osborn, MD
(Chair), Sixth President of the Josiah Macy, Jr. Foundation. Former Chair of the U.S. National Commission on AIDS. Former Dean, University of Michigan, School of Public Health.


PLNDP Members

View Image ›

Annotation

PLNDP Members

Errol R. Alden, MD, Deputy Executive Director of the American Academy of Pediatrics (AAP) and Clinical Professor of Pediatrics at the University of Chicago.

Jeremiah A. Barondess, MD, President of the New York Academy of Medicine and Professor Emeritus of Clinical Medicine at the Cornell University Medical College.

Floyd E. Bloom, MD, Chair and Member of the Department of Neuropharmacology, The Scripps Research Institute, La Jolla, California. Editor, Science.

Thomas F. Boat, MD, Chair, Department of Pediatrics at the University of Cincinnati College of Medicine and Director of the Children's Hospital Research Foundation. Former Chair, American Board of Pediatrics.

Edward N. Brandt, Jr., MD, PhD, Director of the Center for Health Policy and Regents Professor of Internal Medicine and of Health Administration and Policy at the University of Oklahoma Health Sciences Center.

Lonnie R. Bristow, MD (Vice Chair), Practicing physician (Internal Medicine) in San Pablo, California. Member of the American Medical Association Board of Trustees and Executive Committee.

Christine K. Cassel, MD, Chair, Department of Geriatrics and Adult Development of Mount Sinai Medical Center, Professor of Geriatrics and Medicine. Chair-elect of the American Board of Internal Medicine.

Linda Hawes Clever, MD, Chair, Department of Occupational Health at California Pacific Medical Center. Medical Director of the Renewal Center for Healthcare Professionals of the Institute for Health and Healing.

George D. Comerci, MD, Clinical Professor of Pediatrics, University of Arizona College of Medicine. Former President of the American Academy of Pediatrics and the Ambulatory Pediatric Association.

Richard F. Corlin, MD, Speaker of the American Medical Association House of Delegates. Assistant Clinical Professor at the University of California- Los Angeles, School of Medicine.

James E. Dalen, MD, Vice-President for Health Sciences and Dean, College of Medicine at the Arizona Health Sciences Center. Editor, Archives of Internal Medicine.

Catherine D. DeAngelis, MD, Vice Dean for Academic Affairs & Faculty and Professor of Pediatrics at the Johns Hopkins University School of Medicine. Editor, Archives of Pediatrics and Adolescent Medicine.

Spencer Foreman, MD, President of Montefiore Medical Center and recent Chair of the Association of American Medical Colleges (AAMC).

Willard Gaylin, MD, Clinical Professor of Psychiatry at Columbia College of Physicians and Surgeons. Co-founder of the Hastings Center.

H. Jack Geiger, MD, Arthur C. Logan Professor and Chair, Community Health and Social Medicine, City University of NY Medical School. Contributing Editor, American Journal of Public Health.

Alfred Gellhorn, MD, Director, Aaron Diamond Foundation Post Doctoral Research Fellowships in AIDS and Drug Abuse. Former Director of Medical Affairs, NY State Department of Health.

David S. Greer, MD, Dean and Professor Emeritus of the Brown University School of Medicine and Founding Director of International Physicians for the Prevention of Nuclear War.

Howard H. Hiatt, MD, Professor of Medicine at Harvard Medical School, Senior Physician at the Brigham and Women's Hospital. Secretary of the American Academy of Arts and Sciences.

Jerome P. Kassirer, MD, Editor, New England Journal of Medicine. Former Vice Chair of the Department of Medicine at Tufts University School of Medicine and Past Chair, American Board of Internal Medicine.

David A. Kessler, MD, Dean, Yale Medical School. Former Commissioner, Food and Drug Administration (Bush and Clinton Administrations).


PLNDP Members

View Image ›

Annotation

PLNDP Members

Philip R. Lee, MD, Senior Advisor and Professor Emeritus School of Medicine, University of California- San Francisco. Former Director and Founder of the Institute for Health Policy Studies, UCSF.

David C. Lewis, MD (Project Director), Director, Center for Alcohol and Addiction Studies, Brown University. Professor of Medicine and Community Health.

George D. Lundberg, MD, Editor-in-Chief, Scientific Information and Multimedia for the AMA. Editor, Journal of the American Medical Association (JAMA).

Joseph B. Martin, MD, PhD, Dean, Harvard Medical School. Former Chancellor, University of California - San Francisco.

Antonia Novello, MD, MPH, Visiting Professor at the Johns Hopkins University School of Hygiene and Public Health. 14th Surgeon General of the U.S. Public Health Services.

Claude H. Organ, Jr., MD, Professor and Chair of the Department of Surgery, University of California, Davis-East Bay. Editor, Archives of Surgery.

June E. Osborn, MD (Chair), Sixth President of the Josiah Macy, Jr. Foundation. Former Chair of the U.S. National Commission on AIDS.

Robert G. Petersdorf, MD, Distinguished Professor of Medicine, University of Washington and Distinguished Physician, Veterans Health Administration.

P.Preston Reynolds, MD, PhD, Associate Professor of Medicine, Vice Chair, Department of Medicine, Chief, Division of General Internal Medicine, Eastern Virginia Medical School.

Frederick C. Robbins, MD, Director, Center for Adolescent Health of Case Western Reserve University. Nobel Laureate in Physiology and Medicine.

Allan Rosenfield, MD
, Dean of the School of Public Health, DeLamar Professor of Public Health and Professor of Obstetrics and Gynecology at Columbia University. Chair, NY State Department of Health AIDS Advisory Council.

Stephen C. Scheiber, MD, Executive Vice President, American Board of Psychiatry and Neurology. Adjunct Professor of Psychiatry at Northwestern University Medical School.

Seymour I. Schwartz, MD, Distinguished Alumni Professor and Chair of the Department of Surgery at the University of Rochester School of Medicine and Dentistry. President-elect and Chair of the Board of Regents of the American College of Surgeons.

Harold Sox, MD, Joseph M. Huber Professor of Medicine and Chair of the Department of Medicine at the Dartmouth Medical School.

Robert D. Sparks, MD, President and Chief Executive Officer of the California Medical Association Foundation and Senior Consultant for the W.K. Kellogg Foundation.

Louis W. Sullivan, MD, President, Morehouse School of Medicine. Founding President of the Association of Minority Health Professions Schools.

Allan Tasman, MD, Professor and Chair, Department of Psychiatry and Behavioral Sciences at the University of Louisville School of Medicine. President, American Association of Chairs of Departments of Psychiatry.

Donald D. Trunkey, MD, Chair, Department of Surgery, Oregon Health Sciences University. Former Chief of Surgery at San Francisco General Hospital.


Former Federal Government Officials

View Image ›

Annotation

A sample of a publication widely read by the medical profession, illustrating that the PLNDP's message is being conveyed.

Source: JAMA, April 15, 1998, 279(15): pp. 1149-1150


PLNDP Consensus Statement
excerpt

View Image ›


PLNDP Consensus Statement
excerpt

View Image ›


PLNDP Consensus Statement
excerpt

View Image ›


PLNDP Consensus Statement
excerpt

View Image ›


PLNDP Consensus Statement
excerpt

View Image ›


PLNDP Consensus Statement
excerpt

View Image ›


PLNDP Consensus Statement
excerpt

View Image ›


JAMA, 4/15/98 – Volume 278
Number 15

View Image ›

Annotation

A sample of a publication widely read by the medical profession, illustrating that the PLNDP's message is being conveyed.

Source: JAMA, April 15, 1998, 279(15): pp. 1149-1150


“Addiction and Addiction Treatment”
text slide

View Image ›

Annotation

Prepared by the PLNDP National Office at the Brown University Center for Alcohol and Addiction Studies Providence, Rhode Island


Lead Researchers

View Image ›

Annotation

Henrick J. Harwood is Vice President with the Lewin Group and has studied the economics and policy of alcohol and drug abuse since 1976. Previously he served in the Office of National Drug Control Policy/Executive Office of the President. He has been on staff at the Institute of Medicine/National Academy of Sciences and at the Research Triangle Institute, where he directed Economic Costs of Alcohol and Drug Abuse and Mental Illness--1980. Mr. Harwood is currently performing a new study of the costs of drug abuse for NIDA and NIAAA. He coedited the IOM report "Treating Drug Problems" and directed the economic analysis on the CALDATA study.

James W. Langenbucher, Ph.D. is a Clinical Psychologist and Associate Professor at the Center of Alcohol Studies, Rutgers University. He is a federally funded researcher with interests in psychiatric diagnosis and the application of health economics to public policy for mental health services. Dr. Langenbucher is senior author of Socioeconomic Evaluations of Addictions Treatment, the most comprehensive review of the health economics of addictions treatment available, which was published in 1993 by the White House Printing Office and distributed broadly to lawmakers and policy analysts here and abroad.

A. Thomas McLellan, Ph.D. is a Professor of Psychiatry at the University of Pennsylvania and the Senior Scientist at the PENN/VA Center for Studies of Addiction. Dr. McLellan and colleagues have developed the Addiction Severity Index (ASI) and the Treatment Services Review (TSR) and have used these evaluation instruments in over 150 studies of psychosocial therapy, pharmacotherapy, and combined interventions in the treatment of substance abuse disorders. He is interested in the measurement of treatment outcome and effectiveness and in the matching of particular types of treatment to specific types of patients.

Jeffrey C. Merrill is the Director for Economic and Policy Research of the Treatment Research Institute at the University of Pennsylvania School of Medicine. He is currently involved in a number of research projects looking at issues pertaining to substance abuse and criminal justice, welfare reform and managed care. Much of his work examines both the costs of substance abuse and the potential cost offsets that may result from prevention and treatment programs. Mr. Merrill serves as an advisor to a number of federal agencies and is the author of numerous articles as well as a book on health care reform.

Donald S. Shepard, Ph.D. is Research Professor at the Institute for Health Policy at the Heller School, Brandeis University. A health economist, his research focuses on cost-effectiveness analysis and financing of substance abuse treatment and other health services. Dr. Shepard is currently principal investigator of a multi-site NIDA study on cost-effectiveness of drug treatment and a NIAAA evaluation of the impact of managed care programs for substance abuse for Medicaid recipients in Massachusetts and Michigan. He also leads the cost and cost-effectiveness analyses in a major national study of substance treatment (the Alcohol and Drug Services Study) and in an analysis of substance abuse treatment in Connecticut prisons.


Weighing the Costs – Annual Cost per Drug Addict

View Image ›

Annotation

Weighing the Costs - Annual Cost per Drug Addict

This summary presents a perspective on the relative costs of different types of treatment and how they compare with incarceration as a means of dealing with drug dependent individuals. A range of treatment modalities is required to address the varying needs of drug dependent and abusing individuals. Costs for a given treatment modality vary from program to program. The National Treatment Improvement Evaluation Study (NTIES) has estimated unit and average costs for various treatment modalities. The NTIES study provides some uniformity in that these data are derived from CSAT (Center for Substance Abuse Treatment) funded services. Data from the Federal Bureau of Prisons provides a means of considering the costs of incarceration. Regular Outpatient Treatment NTIES estimates the average cost of regular outpatient treatment to be $1,800, based on $15 per day, for 120 days. Outpatient treatment at Level I, as defined by the ASAM (American Society of Addiction Medicine) Patient Placement Criteria, typically involves one or more group or individual sessions with up to 9 hours of service per week. Charges for one group session can be as high as $30 to $50 and typically last from one to several hours. Intensive Outpatient Treatment Intensive outpatient treatment, Level II of the ASAM criteria, ranges from 9 hours of structured services per week as seen in some evening programs to more than 20 hours for day programs. The average cost estimate of $2,500 includes six months of weekly maintenance care group sessions after completion of the intensive phase of the treatment. Methadone Maintenance The NTIES estimates a methadone maintenance cost of $13 per day for an average of 300 days, or $3,900 per person. Costs during the first year of methadone maintenance may be considerably higher due to additional assessments, closer monitoring, and group sessions that are required at the initiation of methadone treatment. Short Term Residential Treatment NTIES estimates the average costs for short term residential care to be $130 per day, for 30 days, yielding a treatment cost of about $4,000. An additional $400 for 25 weekly group sessions is added to the NTIES estimate because research has shown that six months of ongoing care yields better outcomes. Charges for short term residential treatment vary widely depending upon the nature of the clients served and the total package of services provided. Private sector treatment programs include costs of service delivery plus indirect expenses such as capitol debt retirement and typically range from $6,000 to $15,000. These programs usually include up to a year of weekly maintenance care group sessions and/or provision of any other necessary service in the event of relapse. Long Term Residential Treatment The NTIES estimates the average cost for long term residential care to be $49 per day for an average of 140 days or a total of $6,800. Incarceration The incarceration cost estimate of $25,900 is based on one of the more common cost estimation strategies. The total federal corrections budget of approximately $3.2 billion minus construction costs (about 15% of the total budget) is divided by the number of federal inmates (currently about 105,000). Daily operating costs range from just over $53 per day for low security inmates to over $71 per day for high security prisoners. According to the Federal Bureau of Prisons the average weighted operating cost for housing an inmate is $59.83 per day, for an annual cost of approximately $21,800. Capitol investments required for the construction of facilities result in amortized costs that must be added to the operating budget to account for all incarceration costs. Dividing the total budget for fiscal year 1997 by the number of inmates (a cost of over $30,000 per inmate) is inaccurate because construction costs should be spread over the functional life of the facility. The cost estimate of $25,900 which includes non-operational costs but excludes the current year's construction is a reasonable estimate of total incarceration expense.


Prevalence of Major Chronic Behavioral Health Problems

View Image ›

Annotation

Prevalence of Major Chronic Behavioral Health Problems

Large segments of the U.S. adult population have health problems with a behavioral origin or potential for control. Hypertension is prevalent among more than 20 percent of the adult population, slightly greater than the number of persons experiencing threats to their health due to sedentary lifestyle and obesity, respectively. Heart disease and diabetes affect about 15 to 20 million persons.

Alcoholism and drug addiction are experienced by about 14 and 7 million persons annually. For alcohol, on the order of 15 percent of the roughly 90 million current drinkers have problems with dependence or abuse. For drugs it appears that up to half of current users (which is somewhat over 11 million) may meet clinical criteria for abuse or dependence.

Source: National Institutes of Health (1997). Disease-Specific Estimates of Direct and Indirect Costs of Illness and NIH Update. Department of Health and Human Services.


Annual Total Deaths for Major Chronic Behavioral Health Problems

View Image ›

Annotation

Annual Total Deaths for Major Chronic Behavioral Health Problems

  • The mortality toll from heart disease, diabetes, and stroke (as well as smoking) are all much higher than the loss of life from alcohol and drug disorders. Of course, one of the palpable concerns with respect to alcohol and drug abuse is that a minority of deaths is of innocent victims (non-users of alcohol or drugs) through accidents and violence.
  • Valuable perspective is provided on this by McGinnis and Foege (1993), who found that diet and activity patterns were responsible for about 300,000 deaths per year (this cuts across heart disease, stroke, diabetes, and other disorders) versus about 400,000 from smoking, 100,000 from alcohol abuse, and 20,000 from drug abuse.
  • Heart disease and diabetes have total health expenditures many times greater than alcohol and drug disorders, while annual stroke and smoking health expenditures are only somewhat greater than alcohol and drug costs. Medically necessary health services for these other health behavior related disorders are routinely covered under private insurance as well as Medicare and Medicaid, as are health problems cause by smoking (prominently including heart disease and stroke).
  • Source: National Institutes of Health (1997). Disease-Specific Estimates of Direct and Indirect Costs of Illness and NIH Update. Department of Health and Human Services

Annual Expenditures on Major Chronic Behavioral Health Problems

View Image ›

Annotation

Annual Expenditures on Major Chronic Behavioral Health Problems

Heart disease and diabetes have total health expenditures many times greater than alcohol and drug disorders, while annual stroke and smoking health expenditures are only somewhat greater than alcohol and drug costs. Medically necessary health services for these other health behavior related disorders are routinely covered under private insurance as well as Medicare and Medicaid, as are health problems caused by smoking (prominently including heart disease and stroke).

Source: National Institutes of Health (1997). Disease-Specific Estimates of Direct and Indirect Costs of Illness and NIH Update. Department of Health and Human Services.


Productivity Losses Due to Major Chronic Behavioral Health Problems

View Image ›

Annotation

Productivity Losses Due to Major Chronic Behavioral Health Problems

Aggregate productivity losses (employment, and household productivity) from alcohol and drug disorders are very comparable to those for the other selected disorders with health behavior elements. Note that a major part of the lost productivity for alcohol abuse is associated with alcoholics "on the job", but working at impaired levels of effectiveness, while drug abuse costs are elevated primarily because about a small minority of drug addicts "drop out" of the legitimate labor market for crime careers.

Source: National Institutes of Health (1997). Disease-Specific Estimates of Direct and Indirect Costs of Illness and NIH Update. Department of Health and Human Services.


Annual Cost per Affected Person of Major Chronic Behavioral Health Problems

View Image ›


Summary of Socio-Economic Findings

View Image ›


Is Drug Dependence a Treatable Medical Illness?

View Image ›


Compliance and “Relapse” in Selected Medical Disorders

View Image ›

Annotation

Compliance and "Relapse" in Selected Medical Disorders

Source: O'Brien, C.P. and McLellan, A.T., "Myths About the Treatment of Addiction," Lancet, 347 (January 27, 1996): 237-240


Healthcare Cost Profile of Untreated Addictive Diseases

View Image ›

Annotation

Healthcare Cost Profile of Untreated Addictive Diseases

  • This graphic illustrates the escalating costs of repeated relapse episodes of untreated drug addiction. For example, data from Blose, et al shows a gradual 38% increase in the monthly costs of care of alcoholic patients over several years prior to a serious health crisis. Immediately prior to crisis, costs increased to nearly 350% of baseline levels, and then ramped up sharply to 10 times the baseline rate in the final month. If patients are stabilized, costs may decline temporarily, but will rise again prior to the next health crisis.
  • Ultimately, the patient's health care cost history will assume a serrated aspect as in this figure, alternately rising and falling between crises and remissions, with a steadily compounding floor due to aging and the accumulation of unresolved symptoms. This type of cost profile is typical of many chronic exacerbating/remitting illnesses which can only be treated palliatively.
  • However, good evidence exists that addictive illnesses can be treated at more than a palliative level. This research shows that when treatment is available, and is targeted appropriately at the addictive behavior rather than merely at the secondary health effects of that behavior, substantial benefits unfold.

Sources: Blose, J.O., Holder, H.D., "The utilization of medical care by treated alcoholics: Longitudinal Patterns by Age, Gender, and Type of Care" (1991), Journal of Substance Abuse, (3):13-27; Langenbucher, J.W., "Prescription for Health Care Costs: Resolving Addictions in the General Medical Setting" (1994), Alc Clin Exp Res, 18:1033-1036; Luce, B., Elizxhauser, A., Standards for the socioeconomic evaluation of health care services (New York: Springer-Verlag, 1990).


Value of Reduction in Crime-Related Costs vs. Costs of
Drug Treatment

View Image ›

Annotation

Value of Reduction in Crime-Related Costs vs. Costs of Drug Treatment

The ability of drug abuse treatment to reduce illegal activity has marked economic impact. One study found a reduction in crime-related costs in the year following treatment that averaged more than $19,000 per patient. This compares favorably to the cost of providing the treatment - $2,828 for methadone maintenance, $8,920 for residential treatment, and $2,908 for outpatient drug-free.

Source: Rajkumar, A.S. and French, M.T. (1997), "Drug Abuse, Crime Costs, and the Economic Benefits of Treatment," Journal of Quantitative Criminology, 13 (3): 291-323.


Number of Monthly Cocaine Users by Employment Status

View Image ›

Annotation

Number of Monthly Cocaine Users by Employment Status

Two-thirds of adults who use cocaine monthly are employed full-time.

Source: National Household Survey on Drug Abuse, Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA); Youth Risk Behavior Survey (YRBS), Conducted by the Centers for Disease Control and Prevention (CDC).


Number of Youths Who Used Cocaine in Past 30 Days by Father’s Educations

View Image ›

Annotation

Number of Youths Who Used Cocaine in Past 30 Days by Father's Educations

53% of cocaine users had fathers who went to college making children of college graduates the largest group of cocaine users.

Source: National Household Survey on Drug Abuse, Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA); Youth Risk Behavior Survey (YRBS), Conducted by the Centers for Disease Control and Prevention (CDC).


Ranking Life-Saving Interventions

View Image ›

Annotation

Ranking Life-Saving Interventions

A study by Tengs et al from Harvard School of Public Health entitled "Five Hundred Life Saving Interventions" provides a perspective in a larger health context. The authors compute the cost per year of life saved for a variety of behavioral, medical, and safety interventions. The substance abuse treatments fall in the most favorable category of the 500 interventions. All saved money and saved lives.

Source: Tengs, T.O., Adams, M.E., Pliskin, J.S., Safran, D.G., Siegel, J.E., Weinstein, M.C., Graham, J.D. (June 1995), "Five-Hundred Life-Saving Interventions and Their Cost-Effectiveness," Risk Analysis, 15(3): 369-90.


“Health Addication and the Criminal Justice System”

View Image ›

Annotation

"Health Addiction and the Criminal Justice System"

Prepared by the PLNDP National Office at the Brown University Center for Alcohol and Addiction Studies Providence, Rhode Island


Lead Researchers and Respondents

View Image ›

Annotation

Lead Researchers and Respondents

M. Douglas Anglin, Ph.D. is Director of the University of California at Los Angeles Drug Abuse Research Center and Professor in Residence of Medical Psychology in the Department of Psychiatry and Biobehavioral Sciences, at the University of California.

Steven Belenko, Ph.D. is a Senior Research Associate at The National Center on Addiction and Substance Abuse at Columbia University. Previous research and management positions were at the New York City Criminal Justice Agency, the Mayor's Criminal Justice Coordinating Council, Mathematica Policy Research, and the Vera Institute of Justice.

David Farabee, Ph.D.
has served as lead analyst for criminal justice research at the Texas Commission on Alcohol and Drug Abuse (1992-1995), Assistant Professor of Psychiatry, and Research Scientist at the University of Kentucky Center on Drug and Alcohol Research (1995-1997). He is presently study director of a five-year evaluation of the California Substance Abuse Treatment Facility (funded by the California Department of Corrections).

Kevin Knight, Ph.D. is a Research Scientist at the Institute of Behavioral Research (IBR) at Texas Christian University. His research, reported in over 30 publications, centers on evaluating corrections-based treatment effectiveness.

Douglas S. Lipton, Ph.D. is a Senior Research Fellow at National Development and Research Institutes, Inc. (NDRI) in New York City. From 1988 to 1992, he was Director of Research at NDRI (then Narcotic and Drug Research, Inc.). He has evaluated drug abuse control and treatment programs around the world for the UN, consults regularly with HM Prison Service in GB and the CSC in Ottawa, and served as expert consultant to the Partnership for a Drug Free America since its origin. He has taught at several universities and co-authored or edited 6 books and almost 200 publications.

Frank S. Pearson, Ph.D. is Project Director of the National Institute on Drug Abuse funded meta-analytical review of evaluation research on correctional treatment programs, reported from 1968 to the present. He is also Project Director on a project funded by the National Institute of Justice (NIJ).

D. Dwayne Simpson, Ph.D. is Director of the Institute of Behavioral Research (IBR) and the S.B. Sells Professor of Psychology at Texas Christian University.

Ken Winters, Ph.D. is the Director of the Center for Adolescent Substance Abuse and an Associate Professor in the Department of Psychiatry at the University of Minnesota.

Paul Gendreau, Ph.D. is Professor of Psychology and Director of the Criminal Justice Studies Centre at the Saint John Campus of the University of New Brunswick. He is also a licensed clinical psychologist.

Carol Shapiro is Director of La Bodega de la Familia, a neighborhood drug crisis center and a project of the Vera Institute of Justice. Previously, she served as a consultant to Her Majesty's Home Office in London, an Assistant Commissioner for the NYC Department of Correction, and an administrator for an applied research center at Rutgers University Graduate School of Criminal Justice.

Donald S. Shepard, Ph.D. is Research Professor at the Institute for Health Policy at the Heller School, Brandeis University. A health economist, his research focuses on cost-effectiveness analysis and financing of substance abuse treatment and other health services.

Constance Weisner, Ph.D. is Area Director for Health Services Research at the Alcohol Research Group and Adjunct Professor at the School of Public Health, University of California, Berkeley. She is on the National Advisory Council of the Center for Substance Abuse Treatment and a member of the World Health Organization's Expert Advisory Panel on Drug Dependence and Alcohol Problems


Flow of Individuals Through the Criminal Justice System
(numbers of individuals)

View Image ›

Annotation

Flow of Individuals Through the Criminal Justice System (numbers of individuals)

POLICE All arrests reported to the FBI Uniform Crime Report for Index Crimes (violent crimes, property crimes, murder, forcible rape, robbery, aggravated assault, burglary, larceny/theft, and motor vehicle theft). These data do not include misdemeanors and other felonies not listed as an Index Crime. This figure does not include juvenile arrests which are estimated to be 2,851,700 in 1996. (Snyder, H. N. (Nov. 1997). "Juvenile Arrests 1996." Washington, DC: US Department of Justice, Office of Juvenile Justice and Delinquency Prevention.)

COURTS (Bureau of Justice Statistics (1997) "Felony Sentences in the United States, 1994." Washington, DC: National Institute of Justice.) The latest available figures include all felony sentences imposed by state and federal courts.

DRUG COURTS Over 90,000 clients have entered drug court with approximately 70% graduated or still participating (63,000). (Drug Court Clearing House (1998). "Looking at a Decade of Drug Courts." Washington, DC: American University.)

PROBATION At year's end, 1997, there were a total of 32,627 adult federal offenders and 3,229,261 adult state offenders on probation status. (US Department of Justice (August, 1998). "Nation's Probation and Parole Populations Reach New High Last Year" - Advanced release. Washington, DC: National Institute of Justice, Bureau of Justice Statistics.)

PRISON At year's end, 1997, there were 112,973 federal and 1,131,581 state inmates. (Gilliard, D. K. and Beck, A. J. (August, 1998). "Prisoners in 1997." Bureau of Justice Statistics Bulletin. Washington, DC: US Department of Justice.) In addition, there were 637,379 jail inmates awaiting trial or serving sentences in mid-1997. (Gilliard, D. K. and Beck, A. J. (August, 1998). "Prisoners in 1997." Bureau of Justice Statistics Bulletin. Washington, DC: US Department of Justice.)

PAROLE At year's end, 1997, there were 58,827 adult federal offenders and 626,206 adult state offenders on parole. (US Department of Justice (August, 1998). "Nation's Probation and Parole Populations Reach New High Last Year" - Advanced release. Washington, DC: National Institute of Justice, Bureau of Justice Statistics.)


Flow of Individuals Through the Criminal Justice System
(percentages)

View Image ›

Annotation

Flow of Individuals Through the Criminal Justice System (percentages)

POLICE The estimate of problematic drug involvement among arrestees is drawn from the most recent report on ADAM (Arrestee Drug Abuse Monitoring) site program data (NIJ, 1998, "ADAM 1997 Annual Report on Adult and Juvenile Arrestees. NIJ Research Report." Washington, DC: US Department of Justice, Justice Programs Office, NCJ 171627). The 64% was calculated by obtaining an average percentage of individuals with positive urine screens, whether or not separately reported by gender. The range in reported positive rates was very wide, 38% to 80%. ADAM indicated that separately reported positive rates by gender showed a higher rate of positive urine screens among men (average = 58%, range = 54% to 80%) than women (average = 58%, range = 38% to 79%). The wide variation in positive urine screen rates can be attributed to differences in tests conducted (i.e. some substances are more likely to be positive than others), regional drug use rates vary for specific drugs, variations in reporting policies, and criteria for positive ratings.

COURTS
Drug offenses represent 31.9% of all state and federal felony convictions in 1994 (Langan, P.A. and Brown, J. M. (1997), "Felony Sentences in the United States, 1994." Bureau of Justice Statistics Bulletin. Washington, DC: US Department of Justice, Office of Justice Programs, NCJ 165149). Federal convictions are more likely to be for drug offenses (41.4%) than are State convictions (31.4%) in 1994. Drug offenses refer to both possession and trafficking charges.

DRUG COURTS Although not explicitly stated in available literature, it is reasonable to assume that all drug court participants are drug involved. While most drug court participants are substance abusers (alcohol and illicit drugs), it is also true that some participants are drug dealers who do not abuse substances.

PROBATION 46.8% of all State and Federal probationers (including DWI) reported that they were under the influence of alcohol or drugs at the time of their offense (Mumola, C.G. and Bonczar, T.P. (May 15, 1998 revision), "Substance Abuse and Treatment of Adults on Probation, 1995, Bureau of Justice Statistics Special Report." Washington, DC: Us Department of Justice, Office of Justice Programs. NCJ 166611). Non-DWI offenders who had positive urine were used to indicate the proportion of probationers with problematic substance abuse because that group is more consistent with the criminal population in other segments of the figure, the substance use was associated with a criminal justice sanction (therefor problematic) and the data were directly obtained in a survey of probationers. Further, this indicator is consistent with the self-reported 32% of the 2,064,145 individuals on probation in 1995 who used illicit drugs in the 30 days prior to committing their offense.

PRISONS The estimated 59.6% of local jail, State and Federal prison inmates (on June 30, 1997) who ever used drugs regularly is based on the ONDCP report (Office of National Drug Control Policy, March, 1998, "Drug Treatment in the Criminal Justice System." ONDCP Drug Policy Information Clearinghouse Fact Sheet. Washington, DC: Executive Office of the President, Office of National Drug Control Policy) which used 1991 reports of inmate drug usage (U.S. Department of Justice, Bureau of Justice Statistics, September, 1994. "Comparing Federal and State Prison Inmates, 1991." Washington, DC: US Department of Justice, Bureau of Justice Statistics, and BJS (1991) "Drugs and Jail Inmates, 1989" Washington, DC: US Department of Justice, Bureau of Justice Statistics) to determine substance abuse involvement of inmates in all three types of facilities in the mid-year 1997 population (U.S. Department of Justice, Bureau of Justice Statistics, January, 1998. "Prison and Jail Inmates at Midyear, 1997." Washington, DC: US Department of Justice, Bureau of Justice Statistics. It is assumed that these estimates, based on the most recently available data, are conservative, given the increases in drug related arrests and convictions from 1991-1997. Other indicators have been used by other authors. For example, ONDCP notes that the current proportion of all Federal and State inmates who have ever used drugs (60-80%) is twice the estimated drug use of the total U.S. population (35%).

PAROLE A total of 40.7% of the 1996 Federal parolees were released to the community with the special condition of drug treatment or monitoring (Adams, W.P., Roth, J.A. and Scalia, J, August, 1998, "Federal Offenders Under Community Supervision, 1987-96." Bureau of Justice Statistics Special Report. Washington,DC: US Department of Justice, Bureau of Justice Statistics). * A positive drug test does not necessarily itself indicate a cause/effect relationship between drugs and crime.


State & Federal Inmates Needing vs. Receiving Substance Abuse Treatment

View Image ›

Annotation

State & Federal Inmates Needing vs. Receiving Substance Abuse Treatment

  • By 1996, the estimated number of inmates in state and federal prisons who needed treatment had risen to 840,000, representing a steady increase since 1990
  • Less than 1 in 5 of these inmates received any form of substance abuse treatment
  • On average, states spend roughly 5% of their prison operating budgets on drug and alcohol treatment services Source: CASA, 1998

Prevalence of CJS Referrals to Community Treatment
(in DATOS)

View Image ›

Annotation

Prevalence of CJS Referrals to Community Treatment (in DATOS)

  • Nationally, 80% of admissions to publicly-supported drug treatment are in outpatient drug free (ODF) or long-term residential (LTR) programs (Ray, Henderson, Thoreson, & Toce, 1997)
  • Information from the 3rd national treatment evaluation funded by NIDA (ie, the DATOS Project) shows that over half of all admissions during 1991-93 to representative community-based LTR and ODF programs were "legally involved" (i.e., on probation, on parole, or awaiting trial)
  • Over one-third were referred to these programs by the criminal justice system (CJS) At least one of every four admissions to methadone treatment were legally involved, but the CJS does not view or use this important treatment modality as a generally acceptable referral option (only 2% were referrals from CJS)
  • Source: Ray, B., Henderson, L., Thoreson, R., and Toce, M. (February, 1997), National Admissions to Substance Abuse Treatment Services: The Treatment Episode Data Set (TEDS) 1992-1995, Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; Craddock, S.G., Rounds-Bryant, J.L., Flynn, P.M., & Hubbard, R.L. (1997), "Characteristics and Pretreatment Behaviors of Clients Entering Drug Abuse Treatment: 1969 to 1993," American Journal of Drug and Alcohol Abuse, 23: 43-59.

Historical Overview of Prison-Based Treatment Evaluations

View Image ›

Annotation

Historical Overview of Prison-Based Treatment Evaluations

  • Findings summarized by Lipton (1996) indicate the overall effectiveness of several major prison-based treatment programs that compared low and high treatment groups on a variety of recidivism criteria (with "high" treatment groups generally representing a modified therapeutic community)
  • Randomized studies are seldom feasible or allowed by correctional authorities or systems, so evaluations usually address "selection biases" by identifying no-treatment comparison samples, making statistical adjustments across outcome groups, and monitoring the stages of treatment participation
  • More recent evaluations emphasize the importance of having "aftercare" phases of treatment that follow the correctional-based residential primary care
  • Source: Lipton, D.S. (February, 1996), "Prison-Based Therapeutic Communities: Their Success With Drug-Abusing Offenders," National Institute of Justice Journal (Washington D.C.: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice), pp. 12-20

Distribution of New Admissions of Problem Drinkers in
Community Agency Systems

View Image ›

Annotation

Distribution of New Admissions of Problem Drinkers in Community Agency Systems

Data weighted for design effects, non-response, and to a common fieldwork duration so that each agency system sample is shown proportionate to its size. Problem drinking rates over a base of problem drinkers across all agency systems (Weighted N=803).

Source: Weisner, C., "The Evolving Health Services Research Agenda" (1995), Alcohol Health and Research World, 9(1): pp.71-76


Distribution of New Admissions of Weekly Drug Users in Community Agency Systems

View Image ›

Annotation

Distribution of New Admissions of Weekly Drug Users in Community Agency Systems

Data weighted for design effects, non-response, and to a common fieldwork duration so that each agency system sample is shown proportionate to its size. Weekly drug use rates over a base of weekly drug users across all agency systems (Weighted N=707).

Source: Weisner, C., Schmidt, L., "Expanding the Frame of Health Services Research in the Drug Abuse Field" (1995), Health Services Research, 30(5): 707-726.


Promising Delinquency Intervention Programs

View Image ›

Annotation

Promising Delinquency Intervention Programs

Source: Lipsey, M.W. and Wilson, D.B., "Effective Intervention for Serious Juvenile Offenders: A Synthesis of Research," in Loever, R. and Farrington, D. (Eds.), Serious and Violent Juvenile Offenders: Risk Factors and Successful Interventions (London: Sage Publications, 1998), pp. 313-344


PLNDP Contact Information

View Image ›