Medication-Assisted Treatment in Drug Abuse Cases: A Path to - Episode 5
Drug-related convictions place a substantial burden on the criminal justice system and on society. The MD Magazine Peer Exchange “Medication-Assisted Treatment in Drug Abuse Cases: A Path to Success” features a panel of experts in the criminal justice field who provide insight on medication-assisted re-entry programs.
This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons, and an associate director of Surgical Intensive Care at New York-Presbyterian Hospital.
The panelists are:
Peter L. Salgo, MD: We’re talking about medication-assisted treatment in drug abuse cases, a path to success. We have a great panel here. I introduced you the first time, now it’s your turn to work for a living. Why don’t you tell the folks who you are?
Phillip Barbour: Sure. Well, again, my name’s Phillip Barbour. I’ve been at TASC for over 25 years. I’ve worked there in a number of different capacities. First, I’ve acted as a case manager—supervisor then—and a program administrator for our re-entry program for several years. You know what they say: when you get too old, you don’t do the work anymore, you go teach. Well, now I’m the master trainer at TASC, and spend most of my time training and providing technical assistance to others.
Peter L. Salgo, MD: Got it.
Joshua D. Lee, MD, PhD: I’m Joshua Lee. I’m at NYU here in New York City. And we do a lot of research on clinical applications and treatments of addiction disorders, including alcohol and opiates, where medications work pretty well. So, we do a lot of medication treatment trials with those disorders. And I have worked in the jail system in New York City for over a decade and do research there, as well, on re-entry models for drug treatment.
Jac A. Charlier, MPA: I’m Jac Charlier. I’m the director of consulting and training at the Center for Health and Justice at TASC. Let me unpack that a bit. So, TASC stands for “treatment alternatives for safe communities.” We’re headquartered in Illinois. We provide life-changing opportunities for people whose substance abuse disorders, drug use abuse and addiction, or mental health challenges put them at chronic risk for exposure to the criminal justice system. Our goal is to shrink the justice system by using behavior health, public health, and medical interventions, where appropriate, for people who are nonviolent, low risk, and who are better handled in the community than in the justice system. We’re promoting public safety while also promoting health, well-being, and recovery, since we’re talking about addiction. In the Center for Health and Justice, which is where Phil and I are in TASC, we do national consulting and training around the intersection of public health, criminal justice; where they come together. We use evidence-based practices to, as I said, shrink the justice system, improve public safety, and achieve cost savings for the taxpayers.
Jonathan Grand: And my name is Jon Grand. I’m from Advocates for Human Potential in Sudbury, Massachusetts. We’re a consulting company. We work specifically in substance abuse, mental health, homelessness, and domestic violence. We have a lot of contracts with the federal government. We carry out grants for services that they want. And, specifically in this case, we have a grant to run the residential substance abuse treatment program. We call it RSAT. Basically, it’s a program that is federally funded to county jails and state prisons that have specialized pods for people who have substance use disorders. And we go and work with the state governments, as well as with the substance abuse treatment people in those jails and prisons, to help them provide good services.
Peter L. Salgo, MD: Okay. Well, I heard the word re-entry program. Alright, so how do they work? I’m assuming these are programs that help drug-addicted people, people with drug issues, in the criminal justice system reenter society, and not relapse into either another encounter with criminal justice or with drugs. How do they work and who are the team members? What are their roles? Give me the granular thing about this. What is it?
Phillip Barbour: I think I probably am the best one to answer that question.
Peter L. Salgo, MD: Then go ahead and answer it.
Phillip Barbour: A re-entry program, the concept behind it, is that people need to transition from prisons and jails back to communities in a healthy way. And the components involved in that is a multidisciplinary approach. You have everybody that’s going to be involved in that—I don’t like to use the word offender, but in this context it’s appropriate—offender’s re-entry once they finish their jail or prison sentence.
So, the team of people includes everybody who’s worked with that individual from the departments that are inside of a prison or jail. That would include medical, psychological department treatment—if they’re going through substance abuse treatment—and anything else that would be applicable, including vocational opportunities and educational opportunities. The idea is to try to identify those criminogenic needs that this offender has, to address them appropriately, and then to do a smooth transition back to the community.
The key players in that transition are going to be somewhat of a case management approach, which is what TASC does in our program, and then also community supervision, which is going to be a pro-agent or a probation officer. We work hand in hand and collaborate with them. That way the offender doesn’t play one end against the other. And then the important other thing to understand for those who have gone through treatment and re-entry programs, when they finish up the treatment inside, it’s not done. There is an after-care component that occurs in the community, and that’s essential to their ongoing recovery.
Peter L. Salgo, MD: So, you mentioned getting off drugs in prison.
Philip Barbour: Yes.
Peter L. Salgo, MD: That implies that there is some option for the incarcerated individuals to get help in prison to come off the drugs.
Phillip Barbour: Sure.
Peter L. Salgo, MD: What are those options?
Phillip Barbour: If they want it.
Peter L. Salgo, MD: Well, if they don’t want it, they’re going to go cold turkey.
Phillip Barbour: Well, yes.
Jac A. Charlier, MPA: So, we should be clear—this is a great question, Peter, that you’re asking—like in the opening comments about what is the scope of the criminal justice system. This is one where, again, the civilians may not fully grasp what’s not happening in the criminal justice system. And what’s not happening is drug treatment; 10% to 12% of the people who go into the criminal justice system are going to receive treatment, and yet the statistics say that 50% to 80%, 55% to 85% of the people have a substance use disorder. That’s a massive mismatch. So, no one should assume that going into criminal justice means you’re going to get treatment. It’s actually very unlikely that you do receive treatment. And, then, when you do get treatment, using DSM-5 for clinical assessment, whether or not it’s clinically correct for the level of disorder is anybody’s game.