Addiction Medicine: Closing the Gap between Science and Practice

The importance of attending to co-occurring
conditions in this population is highlighted by a
study of veterans with co-occurring PTSD and
addiction who participated in addiction
treatment.* 118 This study found that receiving
treatment for PTSD during the initial year of
addiction treatment almost quadrupled
participants’ odds of being in remission from
addiction† five years later.^119

Individuals Involved in the Justice System ......................................................................

In 2006, the National Institute on Drug Abuse
(NIDA) developed evidence-based principles for
the effective treatment of individuals in the
justice system who have addiction. These
principles include providing comprehensive
assessments of the extent and severity of
offenders’ substance involvement, addressing
the presence of co-occurring conditions that
might call for specialized treatment services,
assessing treatment progress and adjusting
interventions accordingly.^120

For both juveniles and adult offenders with
addiction, the use of treatment-based alternatives
to incarceration represents an important step in
treating the disease. Drug courts, prosecutorial-
based diversion programs and intensive
treatment-based probation are some of the
approaches that have proved effective in the
justice field.^121 Services also can be provided by
professionals, using evidence based practices,
during incarceration and after release. These
initiatives provide addiction treatment, assure
collaboration between justice authorities and
treatment providers and hold the offender legally
accountable for treatment compliance.^122

• The sample was drawn from male inpatients

participating in a multisite VA program evaluation of
addiction treatment.
† Defined as having (1) abstained from all 13

substances investigated, (2) had no problems related
to alcohol or other drugs and (3) consumed 3 oz.
(88.79 ml) or less of alcohol per day on maximum
drinking days in the past month. Freedom from
problems related to substance use was reflected by a
response of “never” to each of 15 problems in the
areas of health, work, legal situation and finances.

Juvenile Offenders .....................................................................................................

Comprehensive treatment and management of

addiction in the juvenile justice population result

in decreased substance use, crime (recidivism),

homelessness and high-risk sexual behavior;

improved school performance, productivity,

employment and future earning power; and

better health and psychological adjustment.^123

For adolescents in the juvenile justice system,

screening and comprehensive assessments are

critical for identifying an adolescent’s needs and

for connecting the juvenile with effective

interventions and treatments. Comprehensive

assessments can take place at various points,

including at the first interview after referral to

juvenile court (often conducted by an intake

officer) where results may be used to refer the

adolescent to more appropriate community

health services rather than incarceration.

Assessments also may be conducted upon

admission to a pre-trial detention center to await

adjudication or upon admission to a post-

adjudication community program or correctional

facility.^124

Addiction treatment for juvenile offenders

should reflect the standards of evidence-based

care for adolescents in the general population,

with a special focus on family-based treatment

models. Effective treatment approaches include

multidimensional family therapy (MDFT),

functional family therapy (FFT) and multi-

systemic therapy (MST).^125

Adult Corrections .......................................................................................................

Treatment tailored to criminal justice

populations should ensure that treatment plans

correspond with correctional supervision

requirements as well as the medical and social

support services that the patient may need.^126

Cognitive behavioral therapy (CBT),

motivational enhancement therapy (MET) and

contingency management (CM) have been

shown to be effective treatment approaches for

inmates,^127 particularly in that they help train

patients to recognize errors in judgment that lead

to substance use and to criminal behavior,^128 and