Successful Community Supervisory Programs

06/07/2017
By Donna Rogers, Editor


Substance abuse treatment for those under community supervision differs from treatment for those who are incarcerated. One reason is that access to drugs and alcohol is much easier, and the abusers also have greater influence by acquaintances and through social situations they encounter. After all there are no bars in prison (excuse the pun).
 
Further, compared with those who are locked up, probationers and parolees may be undergoing greater duress and turbulent times during their initial release into the community. Those under supervision are attempting to overcome great personal odds over and above their addictions.
 
Besides battling their deep physical cravings, securing basic needs such as food and shelter is often of paramount importance, especially for parolees attempting to reintegrate into society, underscores the publication Substance Abuse Treatment for Adults in the Criminal Justice System published by the Substance Abuse and Mental Health Services Administration (SAMHSA). It is part of the Treatment Improvement Protocol (TIP) Series (No.44) to assist criminal justice professionals manage substance abuse in all phases of the justice arena.
 
History of Substance Use
Despite differences in their situation, parolees and probationers often share a history of drug or alcohol use. It comes as no surprise to our readers that an overwhelming percentage are substance abusers. According to the above Substance Abuse Treatment report, approximately 83% of probationers can be characterized as alcohol- or drug-involved, while 74% of parolees are such involved (based on State prisoners that were to be released between 2000 and 2001).
Unarguably, drug abuse continues to be a huge problem with a high cost to society—in lost productivity, health care expenses, increased crime, and the cost of law enforcement, adjudication and incarceration. According to the Office of National Drug Control Policy, the economic cost of drug abuse in 2002 was estimated to be approximately $181 billion, with an average annual increase of 5.3%.
 
Proof of that is almost 1 million visits in 2009 to U.S. hospital Emergency Departments involved an illicit drug, either alone or in combination with other types of drugs, according to the National Institutes of Health. In addition, approximately 32 percent (658,263) of all drug abuse ED visits in 2009 involved the use of alcohol, either alone or in combination with another drug.
Research has repeatedly shown that investment in treatment is valuable and, furthermore, produces better outcomes with more cost-effectiveness than incarceration alone. The Justice Policy Institute reported that if an individual receives treatment while incarcerated, there is, on average, an estimated benefit of $1.91 to $2.69 for every $1 invested in prison programs. “Benefit” is measured for taxpayers by program costs and for crime victims by lower crime rates and less recidivism. There is also an estimated $8.87 benefit for every $1 invested in therapeutic community programs outside of prison. JPI found that other community-based substance abuse treatment programs generate $3.30, drug courts generate $2.83 and intensive supervision programs to generate $2.45 in benefits for every $1 spent (McVay D, Schiraldi V, Ziedenberg J. 2004 and Aos S, Phipps P, Barnoski R, Lieb R. 2001).
In recent years the nation has been focusing on providing a growing number of drug and alcohol treatment programs, according to the Drug Policy Alliance and the New York Academy of Medicine. Early examples include legislature and programs that divert people convicted of low-level drug offenses to treatment and other services. In one early instance, the California Substance Abuse and Crime Prevention Act of 2000 diverts people convicted of non-violent drug-related crimes to community-based treatment, education, or training and probation. A fiscal evaluation estimated that for every $1 allocated to fund SACPA, $2.50 was saved, resulting in a net savings to the state and local governments of $173.3 million per year in avoided criminal justice costs, reduced trial court costs, and reduced arrest rates of drug court participants (Carey SM, Finigan M, Crumpton D, Waller M., 2006).
 
Another such program, New York’s Kings County Drug Treatment Alternative-to-Prison (DTAP) program provides treatment as an alternative to prison for people convicted of a second time non-violent felony drug offense. Studies have found this program to produce a cost savings of $38 million for the 971 DTAP clients it has graduated at an average cost of $32,975 per client. These savings are seen in the significantly decreased recidivism rates, health care and public assistance as well as in the increased employment earnings by the individuals (Zarkin GA, Dunlap LJ, Belenko S., 2005).
 
Yet, even with overwhelming documented evidence of success, persons needing treatment still do not receive it in great proportions. According to SAMHSA’s National Survey on Drug Use and Health, 23.5 million persons aged 12 or older needed treatment for an illicit drug or alcohol abuse problem in 2009 (9.3 percent of persons aged 12 or older). Of these, only 2.6 million—11.2 percent of those who needed treatment—received it at a specialty facility.
 
Treatment Programs Sorely Needed
Work on pairing offenders with treatment programs is still sorely needed. What goes into a successful treatment program? Chapter 10 of the SAMHSA report provides an overview that covers all the basics to establishing a solid plan. First, it notes, different levels of supervision are necessary to best accommodate each probationer or parolee according to their individual circumstances. Traditional supervision, which involves some drug testing, minimal programs and reporting to supervisors, can be used when the infraction is minimal. Intermediate supervision can include increased drug testing, short jail stays, increased reporting to criminal justice staff, referral to day reporting centers, attending 12-step meetings, community service requirement, curfews, work release centers, and electronic monitoring.
For those needing extra oversight, “Intensive supervision generally involves frequent contact with supervising officers, frequent random drug testing, strict enforcement of probation or parole conditions, and community service. The level and type of supervision that are labeled intensive vary widely but usually require closer supervision and greater reporting requirements than regular probation. “Contacts can range from more than five per week to fewer than four per month. Conditions usually include having a job or attending school, and participating in treatment.”
 
The appropriate levels for each individual can be found in more detail in the report, which notes: “The level of treatment services recommended for the offender should be individualized and based on a multidimensional, diagnostically driven assessment; clinical judgment; and availability of resources in a given community.”
 
Types of treatment services consist of varied methods that are best suited to the individual. These include residential, outpatient, halfway houses, and day reporting (see sidebar page 40).
Because substance abuse is a chronic, relapsing disorder influenced by numerous interacting biological, psychological, and social factors, treatment should address a full range of services.
 
Some of these might include:
 
•          Screening and assessments—medical, psychiatric, and substance abuse
•          Detoxification
•          Medical assessment—pregnancy tests and treatment for HIV and AIDS, other sexually transmitted diseases, and tuberculosis
•          Treatment planning—medical, psychiatric, and substance abuse
•          Counseling—group, individual, family, couples
•          Substance abuse education—didactic lectures, interactive groups, videos, reading assignments, and journal-writing assignments
•          Relapse prevention services
•          Crisis intervention
•          Drug testing and monitoring
•          Self-help education and support
•          Mental health services—medications when indicated
•          Family services unrelated to substance abuse treatment
•          Assistance in managing entitlements (e.g., food stamps, veterans benefits)
•          Housing Assistance
Parolees and probationers often cannot meet their basic needs. A lack of housing for offenders under community corrections supervision is a major problem in most jurisdictions, yet stable living arrangements are crucial to treatment. Available housing often is inconvenient to jobs, public transportation routes, community social services, or other agencies and includes drug-involved family members and/or friends. Sometimes a halfway house, a “sober house,” or recovery house are better alternatives than the offender-client's home. Probation and parole officers should be required to visit and evaluate client residences promptly.
 
The Right Programs at the Right Time
Although highly important to an offender's recovery, vocational training and employment can create problems when they are mandated by the community supervision agency before the offender has been engaged in treatment. If the client has not undergone treatment, there is a high risk that money earned will be spent on drugs or alcohol. Another common result of mandating employment before treatment is that the offender may lose his or her job because of behavior related to substance abuse. Achieving and maintaining abstinence depends on structured, phased programming. Vocational training should occur before employment to enable the offender to retain a job or obtain a better one (Wexler 2001a).
Case Management, the process of linking the offender with appropriate resources, tracking his or her progress through required programs, reporting this information to supervising authorities, and monitoring court-imposed conditions when requested, is crucial to the offender’s success.
 
Case management tests the ability of the criminal justice and treatment systems to work collaboratively and is based on two types of agreement: the agreement between the client and the two systems laying out protocols and consequences of infractions, and the agreement between the two agencies, a memorandum of understanding (MOU) that defines how each will manage the caseload of offender-clients in the jurisdiction. There can be one or two case managers representing each system. If two case managers are involved, they must coordinate efforts, working to encourage a multidisciplinary response that takes advantage of a wide range of treatment and rehabilitation options.
 
Understanding Relapse
When an offender experiences relapse, it is crucial to gauge the seriousness of the “slip” to determine appropriate interventions. One positive urine test or one drink after a long abstinence should not be viewed as failure but as a signal for stepped-up treatment and closer monitoring. Because resumption of drug abuse can lead to resumption of criminal activity, graduated sanctions for relapses should be specified in the treatment plan. It is essential that personnel from both the criminal justice and treatment systems agree to the range of responses and times when certain responses are appropriate. Repeated relapses must trigger consequences based on danger to the community and the offender's treatment progress.
The rate of relapse is high among offenders, and relapse prevention training must be provided at the beginning of and throughout treatment, and stressed prior to release. Personal relapse plans along with relapse prevention skills should be part of each offender-client's treatment plan, addressing how clients can refuse drugs and identify and manage triggers for craving. When relapse occurs, clients must be helped to understand it is part of the recovery process, rather than a personal failure, so they can rededicate themselves to success. If properly handled, relapse can lead to increased motivation for recovery, strengthening an individual's knowledge of his or her limitations, the dangers of stressors, and awareness of what could be lost by leaving the treatment process.
Criminal justice decisionmakers at all levels, including judges and court personnel, should be aware that relapse is a characteristic feature of substance use disorder that must be anticipated, prevented, and addressed.
 
Sanction possibilities include:
•          House arrest
•          Assignment to halfway house
•          More frequent drug testing
•          Electronic monitoring
•          Day treatment
•          Brief jail stays
•          Assignment of community service hours
 
Probationers’ Treatment Issues & Obstacles
Those under community supervision, whether they are probationers or parolees, have common psychological issues. 
 
Shame and stigma are tremendous obstacles for offenders to overcome after an arrest or in making the transition between incarceration and the community. One effective approach to overcoming this stigma involves encouraging offender-clients to become active as volunteers in support of a community activity. Providing an opportunity for individuals to make a positive contribution to the community—to “give back”—may reduce feelings of alienation and build self-regard.
 
At the same time, self-esteem is not always a useful treatment target or goal with offenders. Feelings of shame and stigma are sometimes missing, especially in those having antisocial traits and psychopathy. Targeting self-esteem without also increasing sense of personal responsibility and empathy for others may only result in a more confident criminal. Com-munity service serves to reconnect the offender with the community and allows for retribution.
Many offenders have multiple financial responsibilities—child support, family obligations, job requirements, restitution, and treatment schedule—which can be major obstacles to successful treatment. A client burdened with overwhelming responsibilities sometimes gives up, saying, “I just couldn't handle it.” Criminal justice and treatment professionals need to plan realistic requirements for individuals under community supervision.
 
Some communities have recognized the obstacles and stress presented by competing assignments and schedules imposed on offenders, which often necessitate expensive and time-consuming travel between sites. On Maryland's Eastern Shore, Tyson's Food, a major chicken producer, has given parole officers an office on-site at the processing plant so that employees do not need to miss work to meet reporting requirements.
 
Probationers and parolees have internal barriers to treatment as a result of their path in life. These may include: a history of failure; alienation from and cynicism about the social structures and governmental agencies; a sense of hopelessness that anything can make a difference in their lives; and a culturally supported belief that treatment is for weak people.
Those working with probationers and parolees need training to address each of these barriers. It is important for professionals working with offenders under community supervision to learn that offenders often do not realize that the goal of community corrections is to prevent them from being reincarcerated.
 
Motivation for Treatment
Establishing an offender's motivation to change is an essential first step in substance abuse treatment. It cannot be skipped. Generally, clients lack focus or goals, which must be established to permit motivation. Those working with probationers and parolees need to be familiar with techniques of motivation and how to create and/or support the offender's desire to break a pattern of criminality. Without genuine motivation on the part of the offender-client, treatment problems cannot be guaranteed. Clients need to feel hope and counselors need to plan a continuum of events that can begin to generate hope. During early stages of treatment, the offender-client should be oriented toward small accomplishments.
 
Counsellor Qualities
Flexibility on the part of community corrections officials is important.
Both treatment programs and corrections agencies can work together to build opportunities for success—keeping an appointment, having a clean urine test, or completing homework—small, structured steps that clients can take with relative ease and derive confidence from as they progress. When the client completes one goal, the provider should be ready to suggest the next. Incentives can be built into the system as well. For example, the more frequent the negative drug test results, the less frequent the mandatory testing.
Treatment is impeded when counselors have a negative perception of the client's desire to change, believe there is a poor prognosis for recovery, or are reluctant to serve offenders in general. Clients easily pick up on a provider's negative attitude, which often confirms their own feelings about the futility of attempts to give up drugs. The cross-training of professionals helps build an understanding of offender-clients' needs and potential, but professionals in both systems must acknowledge that the very nature of substance abuse means that maintaining recovery is a long-term goal.
 
The kinds of changes community corrections professionals ask drug offenders to undertake are extraordinarily challenging and difficult to contemplate on a personal level.
A counselor who is a role model of courage or compassion can often be very effective in persuading clients to reevaluate their lifestyles. On the other hand, counselors should also be prepared for setbacks, lapses, and slow progress, as offenders come to terms with the extent of lifestyle change that is being asked of them.
 
Self-help groups are a crucial component in recovery; they can provide peer support and nurture positive change. As bridges between incarceration and community, they can help with crises and personal growth. Probation and parole officers often advise clients to attend well-known programs like Alcoholics Anony-mous or Narcotics Anonymous, saying, “Don't take my word. I'm not the expert. Listen to the folks who've been there.”
 
Practitioners need to remember that although self-help groups are not a substitute for counseling, they can be an important adjunct to it.
 
Both parole and probation officers need to be attuned to treatment needs, the dynamics of substance use disorders, and the changes required to maximize an offender-client's chance to succeed. Training needs to be provided to them on how to craft requirements that support a client's potential for success. Flexibility must be built into the requirements, given the complex pressures on most offenders in the community.
 
Revocations because of technical violations of probation or parole requirements are a major barrier to completion of successful treatment. Required expectations for offender behavior need to be realistic. Cross-training can be helpful in fostering a shared vision of success. Such training should have specific goals. For example, the consensus panel suggests that training for probation officers working with drug offenders could include education on what treatment is and is not. Generic models of treatment should be presented. Similarly, treatment professionals working with drug offenders should be trained on the role of parole and probation in the criminal justice system. Probation and parole are frequently the most misunderstood element of the system, considered to be “law enforcement” by treatment professionals and “social work” by law enforcement. Often the breakdowns in communication between probation, parole, and treatment professionals are the result of a lack of understanding of each other's roles.
 
Both parole and probation officers, who may have a supportive role before the client enters treatment, are likely to move into supervisory mode once treatment is underway to reduce public safety and liability risks. Zero tolerance and “three strikes” policies make it difficult for officers to overlook drug lapses and contradict knowledge that substance use disorder is a chronic disease. Relapse is not necessarily a failure. The common belief that treatment does not work is often based on the fact that most people recovering from substance use disorders relapse from time to time.
 
Increasingly, vocational training, GED programs, and job readiness training are being added to treatment. Counselors can help clients applying for employment prepare for responding to a prospective employer's questions about their past.
 
The report also contains further suggestions too many to list  for specific populations on both probation and parole that may be helpful to supervisory officers.
 
For the full report see: Substance Abuse Treatment for Adults in the Criminal Justice System, SAMHSA, 2005, at https://www.ncbi.nlm.nih. gov/books/NBK64141/