Form the Executive Summary:

For men and women whose struggle with substance abuse brings them into
contact with the legal system, the personal losses can be enormous: families
can break apart, health deteriorates, freedom is restricted, and far too
often, lives are lost. But this is just the beginning of the potential devastation.
Personal costs to the victims of crime are immeasurable. The effects
of every theft, burglary, and violent crime reverberate throughout the
whole community. Economic losses include the costs of arresting, processing,
and incarcerating offenders, as well as the costs of police protection,
increased insurance rates, and property losses.
Strong empirical evidence over the past few decades consistently has
shown that substance abuse treatment reduces crime. For many people in
need of alcohol and drug treatment, contact with the criminal justice system
is their first opportunity for treatment. A substance use disorder may
be recognized and diagnosed for the first time, and legal incentives to
enter substance abuse treatment sometimes motivate the individual to
begin recovery. For other offenders, arrest and incarceration are part of a
recurring cycle of drug abuse and crime. Ingrained patterns of maladaptive
coping skills, criminal values and beliefs, and a lack of job skills may
require a more intensive treatment approach, particularly among offenders
with a prolonged history of substance abuse and crime.
This TIP was developed to provide recommendations and best practice
guidelines to counselors and administrators based on the research literature
and the experience of seasoned treatment professionals. It covers the
full range of criminal justice settings and all the phases through which an
individual progresses in the criminal justice system. It addresses both clinical
and programmatic areas of treatment. The consensus panel defined
the areas highlighted below as important in efforts to achieve the treatment
objectives of recovery and a life in the community for everyone.

Screening and Assessment
A vital first step in providing substance abuse
treatment to people under criminal justice
supervision is to identify offenders in need of
treatment. In the criminal justice system,
screening often is equated with “eligibility,”
and assessment often is equated with “suitability.”
To do this effectively, the consensus panel
recommends that protocols be developed to
determine which offenders need substance
abuse treatment, assess the extent of their
treatment needs, and ensure that they receive
the treatment they need. Obtaining accurate
and reliable information during screening and
assessment can be a challenge; offenders do not
always accurately report drug or alcohol problems.
Other collateral sources of information
(e.g., drug test results, correctional records)
can be combined with self-report information
to make referral decisions. For example, in
many correctional facilities, urine tests are
used to flag the need for treatment—even when
an offender denies recent substance abuse.
Many offenders who abuse substances have co-occurring
mental disorders that can make
treatment more complex. They should therefore
be screened for other psychological or
emotional problems. Offenders who are initially
assessed as having symptoms of co-occurring
disorders should be evaluated over an extended
period of time to determine whether these
symptoms resolve in the absence of substance
use.
A significant number of offenders who abuse
substances also have histories of trauma and
physical or sexual abuse. Screening and assessment
of a history of physical and sexual abuse
should be conducted routinely, particularly in
settings that include female offenders. Staff
training is needed to develop effective interviewing
approaches related to the history of
abuse, counseling approaches for addressing
abuse and trauma issues, and in making referrals
to mental health services.