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Issue Brief

Drug Policy Reform - Overview

Goal Statement   one sentence that further defines the topic

•  To reduce the number of people suffering from substance abuse issues by examining methods other than the incarceration. 

Local/State/National Information    additional information on this topic at the local, state, national, global level

• Drug Policy Reform - USA

• Drug Policy Reform - Georgia

• Drug Policy Reform - Atlanta, Georgia

• Drug Policy Reform - South Carolina 

• Drug Policy Reform - Spartanburg, South Carolina

Policy Options / Model Programs   link to profiles of specific policies or program models, grouped by type 

• Treatment Programs / Rehabilitation for Drug Addiction

• Rehabilitation/Psychological treatment techniques that offer alternatives to incarcerating individuals:

• Behavioral Techniques^[1]: 

• 1. Cognitive Behavioral Therapy:  Designed to help patients recognize, avoid, and cope with the situations in which they are most likely to use drugs. 

• 2. Multidimensional family therapy: Developed for adolescents with drug abuse problems as well as their families—which addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning

•  3. Motivational Interviewing: Consists of asking patients what they desire for themselves, and having the patients engage in such deep reflection has been associated with massive improvement in the psychological states. 

• 4. Motivational Incentives: Positive and/or negative reinforcement.  

• Biological Techniques: 

• Drugs^[2]:

• Naltrexone and Buprenorphine: These medications have shown significant improvement in patients with Opoid addictions by blocking the receptors in the brain which Opoids would bind to and activate, and thereby help reduce or possibly eliminate the "high" that are associated with said Opioids.

•  Disulfiram: This medication can be used for a form of aversion therapy. It deactivates the enzyme that is meant to process ethanol and causes headaches, nausea, and vomiting in patients who consume alcohol, therefore making the addiction a lot less desirable. 

•  Modafinil: This drug, commonly prescribed to individuals as a treatment for narcolepsy, acts as a stimulant and aids in alertness/wakefulness. Recent studies have provided significant support to conclude that the stimulant properties of Modafinil may be also used as a treatment for cocaine dependence by alleviating some of the symptoms of acute cocaine withdrawal.  

• Bupropion: A common medication used for Attention Defecit Disorder provided some evidence in reducing cravings for cocaine use.  

• Substance Abuse Prevention
• Adverse Childhood Experiences (ACEs) have demonstrated predictive capabilities in its ability to highlight the individuals most prone to developing a substance abuse/addiction issue. 
• According to Kiani and Colleagues, findings showed that ACEs can predict both suicide (r = 0.322) and addictions; cigarette smoking (r = 0.244), alcohol consumption (r = 0.216), substance abuse (r=0.180) and street drugs (r = 0.172). ^[3]
• According to Naal and colleagues, childhood adversities are highly prevalent in a Lebanese substance use disorder population which raises the need for better screening strategies and more understanding of Adverse Childhood Experiences in this specific population.^[4]
• According to the ACEs Connection advocacy program, the method that must be followed in order to alleviate the effects of ACEs on many individuals includes increasing Behavioral healthcare, increasing early childhood learning, parent supports, youth mentors, family-centered schools, better transportation, better housing, better food, medical and dental care, as well as job training.
• Drug Courts 
• Drug courts are currently our best attempt to rehabilitate substance-involved offenders while keeping them out of prison. 
• Why are drug courts a more beneficial alternative to incarceration: 

1. Recidivism Rates: NIJ researchers found that drug courts may lower recidivism rates (re-arrests). They used data from a primarily pre-plea adult drug court in Portland, Oregon, to track 6,500 offenders who participated in the Multnomah County Drug Court between 1991 and 2001. Re-arrests were lower five years or more later compared to re-arrests for similar drug offenders within the same county. Reductions in recidivism ranged from 17 to 26 percent. ^[5]
2. Lower Costs: Compared to traditional criminal justice system processing, treatment and other investment costs averaged $1,392 lower per drug court participant. Reduced recidivism and other long-term program outcomes resulted in public savings of $6,744 on average per participant (or $12,218 if victimization costs are included).^[6]

• Why are drug courts more effective: They are based on a psycho-social view of crime as something that can be treated, and often pair medical treatment with behavioral therapy. The goals of drug courts are to:

• Reduce recidivism
• Reduce substance use
• Reduce the costs of drug-involved crimes
• Decrease prison crowding.

• Based on several retrospective and quasi-experimental studies, it appears that drug courts are accomplishing most of their goals. Graduates have lower rates of recidivism and substance use, and the treatment is far more cost effective than incarceration. Drug courts also tend to enjoy support from the communities in which they are implemented (Lowenkamp et al., 2005). 

Glossary of Terms   key words or phrases that the layperson needs to know to understand this issue  

• Cognitive Behavioral Therapy: Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions.^[7]

• Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. ^[8]

• Drug Court: Specialized court docket programs that help criminal defendants and offenders, juvenile offenders, and parents with pending child welfare cases who have alcohol and other drug dependency problems.^[9]

• Adverse Childhood Experiences: Adverse childhood experiences (ACEs) are traumatic events occurring before age 18. ACEs include all types of abuse and neglect as well as parental mental illness, substance use, divorce, incarceration, and domestic violence^[10]

• Neglect: The failure of a parent, guardian, or other caregiver to provide for a child’s basic needs. Neglect may be: physical, medical, educational, or emotional. These situations do not always mean a child is neglected. Sometimes cultural values, the standards of care in the community, and poverty may be contributing factors, indicating the family is in need of information or assistance^[11]

• Abuse: Abuse is defined as any action that intentionally harms or injures another person^[12]

• Household Dysfunction: A dysfunctional family is one in which conflict and instability are common. Parents might abuse or neglect their children, and other family members are often forced to accommodate and enable negative behavior. In some cases, dysfunctional families can be the result of addiction, codependency, or untreated mental illness.^[13]

• Mass Criminalization: The culture of mass criminalization is one in which aggressive policing and incarceration are our default tools for dealing with a wide array of social problems that can and should be solved by other means. These punitive approaches far exceed what is necessary to maintain public safety and primarily target poor people and people of color.^[14]

• Harm reduction: a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.^[15]

• Fentanyl: a synthetic (man-made) opioid 50 times more potent than heroin and 100 times more potent than morphine. There are two types of fentanyl: Pharmaceutical fentanyl is primarily prescribed to manage severe pain, such as with cancer and end-of-life palliative care. Non-pharmaceutical fentanyl is illicitly sold fentanyl, it is often mixed with heroin and/or cocaine or pressed into counterfeit pills—with or without the user’s knowledge.^[16] 

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