While mandatory drug treatments in the criminal justice system are a widespread practice, new research reports that many patients who receive such treatment do not believe they need it.
In an article published this month in the Journal of Urban Health, a team of researchers headed by Alana Rosenberg, a research associate at the Yale School of Medicine, evaluated the effectiveness of drug treatment accessed through the criminal justice system. The researchers found that mandatory drug treatments were seen as unnecessary by those who received them, although the treatments provided indirect benefits.
“Mandatory treatments for chronic diseases, including substance use disorders, rarely work and do more harm than good by forcing people to choose from unacceptable options,” said Robert Heimer, an epidemiology professor at the School of Public Health and co-investigator of the article. “People have to own their treatment if it’s going to work; making it mandatory prevents this from occurring.”
A series of interviews with patients conducted every six months in New Haven between 2011 and 2014 formed the basis of the researchers’ article. Many of the 45 participants who received mandatory drug treatment did not consider the programs necessary, either because they did not believe they had a drug problem or felt they had more pressing concerns than substance abuse. Nevertheless, participants in the study proved resourceful in using these treatments to reduce their involvement in the criminal justice system; prove their worthiness through rehabilitation; and access other resources, such as employment, housing and medical care.
Experts interviewed emphasized that targeted care that goes beyond drug treatment would benefit participants.
Samuel Ball, a psychiatry professor at the School of Medicine who was not involved in the research, said that it might be helpful to demonstrate to people incarcerated for selling drugs the impact their behavior has on people in their neighborhoods.
“This is an important qualitative study of the lived experiences of those in the criminal justice system mandated to receive treatment,” Ball said. “It was very impressive of [the researchers] to follow this population every six months, which is very difficult to do with this kind of population.”
Ball emphasized that it’s necessary for authorities to carefully assess a person’s drug-use problems before referring him or her to a certain type of blue cross rehab program. A long-term residential treatment program, for example, would be excessive for an individual who doesn’t have serious drug problems, he said.
It is more important to focus on preventive measures rather than deal with the symptoms of poverty, said Rosenberg, the research associate at the medical school.
She stressed the need to address poverty, especially in inner cities like New Haven, where increased economic opportunity, better education and greater access to mental health services could help lower incarceration figures. With this in mind, Rosenberg said, substance abuse should be treated as a human rights and health issue, not a criminal one.
“Even if you have an addiction problem, if you go into a residential program for 90 days and then you’re released and you’re still homeless, it’s extremely hard to maintain any kind of abstention from drugs, because you’re using drugs to cope with being homeless,” Rosenberg said. “So maybe a better intervention for people who are homeless would be to house them first or to tailor the programs to what people really needed.”
Rosenberg said that she is currently conducting a related study that explores the links between criminal justice experiences and access to stable housing and health, with a particular focus on HIV risk.
As of last month, 46.1 percent of all inmates in America were jailed because of drug offenses, according to the Federal Bureau of Prisons.
Eui Young Kim | euiyoung.kim@yale.edu