Drug and Alcohol Treatment Options

NATIONAL ASSOCIATION OF SENTENCING ADVOCATES
DRUG AND ALCOHOL TREATMENT OPTIONS
By Sharon Caulum
Client Service Director
Wisconsin State Public Defender

Our clients are often sent to prison to receive drug and alcohol treatment. Sentencing advocates need to be aware of treatment options in the community in order to argue persuasively that such clients can be effectively treated outside of prison. This article will describe both traditional and non-traditional drug treatment and how sentencing advocates can develop plans which include community-based treatment.
Community-based treatment may use the following methods: therapeutic interventions, support groups, detoxification/emergency treatment, pharmacologic assistance, acupuncture or homeopathic therapy. The settings for treatment are outpatient, day treatment, in-patient, residential, or therapeutic community.
Methods of Treatment
Therapeutic intervention includes individual or group counseling and psychotherapy, and treatment is usually provided by trained therapists. Most therapeutic intervention programs rely on cognitive-based therapy which addresses irrational thinking and attempts to restructure thought processes.
Support groups are usually conducted by a member of the group with the assistance of prepared materials by a national organization. The most well known support groups are Alcoholics Anonymous and Narcotics Anonymous. Most support groups are modeled on the Twelve Steps of AA and rely on faith in a "higher power" to assist in achieving goals.
Detoxification treatment is a program of planned withdrawal which may or may not include medication to assist in withdrawal. Length of detoxification depends on the substance ingested and the methods used for detoxification. Detoxification without other treatment has not been found to be effective in maintaining sobriety.
Acupuncture is gaining in popularity as a treatment for addictions. In addition to its use in community-based treatment programs, more than 500 inmates are taking acupuncture treatments around the country each day. For substance abusers, the process involves inserting three to five needles into precise points of the outer ear just beneath the skin for
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about 45 minutes while the patient sits in a chair. The needles signal neurotransmitters that release natural pain relieving endorphines which reduce cravings for drugs or alcohol and help calm the patient. Some programs use acupuncture in combination with other traditional forms of addiction treatment.
Examples of pharmacological medications which are used to treat addictions are disulfiram, methadone, and ibogaine. Disulfiram, which is more commonly known by its trade name, Antabuse, is taken daily by mouth to deter the consumption of alcohol by causing severe but temporary discomfort when combined with alcohol. Symptoms include weakness, vertigo, decrease in blood pressure, throbbing head and neck, flushing of the face, chest pain, labored breathing, nausea and vomiting. For most people, the threat of such a noxious reaction is enough to deter alcohol consumption. Disulfiram therapy is usually used in combination with a comprehensive treatment program. Calcium carbimide, marketed under the trade name Temposil, is also used as an alcohol deterrent.
Methadone is a narcotic analgesic similar in potency to morphine. Under a special license, some treatment facilities provide drug dependent persons with methadone as a substitute for heroin, morphine, or exycodone (Percodan). Initially, daily dosages of methadone are gradually increased until a stabilization dose level is achieved. Users are maintained on the stabilized dose for an extended period of time. The eventual goal of many methadone programs is to decrease the daily dosage of methadone to help the dependent person achieve a drug-free state without suffering the distress of abrupt withdrawal. For most users, methadone suppresses withdrawal symptoms and the chronic "drug hunger" for other narcotics without renewing euphoria. Nausea and vomiting are common side effects and must be endured until tolerance is developed. Constipation and physical dependence on the drug are chronic, long term side effects.
Ibogaine is a naturally-occurring hallucinogenic alkaloid which comes from the roots of a West African plant. Ibogaine has received some media attention recently for its use in controlling addiction to cocaine. Critics of its therapeutic use point out that ibogaine is a hallucinogenic which produces early effects of nausea, vomiting, sweating, weakness, dizziness, tremors, and numbness. Users then become physically relaxed and tend to lose interest completely in their surroundings. They experience long dreamlike sequences of vivid images and fantasies, dominated by specific intense colors. The duration of the hallucinogenic activity is approximately six hours.
Proponents of ibogaine's therapeutic use point to the user's decrease in intense craving for cocaine. Some users of ibogaine assert that their dependency on crack is based on their inability to control their craving. By substituting ibogaine for crack, they are able to control their crack use and are able to re-establish productive lives. Another medication used to reduce cocaine craving is Bromocriptine (Parlodel), a drug used to treat Parkinson's disease. Bromocriptine mimics the action of dopamine by stimulating dopamine receptors. This may lead to reduced craving for cocaine. Anti-depressants have also been used with some limited success to treat the craving for cocaine. Pharmacologic approaches are almost always used in conjunction with other forms of drug treatment.
Homeopathic treatment for drug and alcohol abuse is provided under the care of a homeopath physician or practitioner. Homeopathy and naturopathy medicine rely on natural treatment remedies such as herbs, along with diet and massage, to achieve chemical balance in the body. Most homeopath physicians have doctor of medicine degrees. Naturopathic physicians are not medical doctors, but have a doctorate in naturopathy. A listing of homeopath physicians is found in the yellow pages under "Homeopaths." Not all homeopath physicians treat alcohol and drug dependence.
Treatment Plans
The best treatment for one client may differ from the treatment intervention for another. The type of drug, the client's background, length of abuse, motivation for treatment, environment and social support play a part in determining the most appropriate treatment intervention.
When treatment is part of your sentencing proposal, advocates should make the treatment referral as early as possible. Sometimes, early intervention can be used as an indicator of
the client's motivation for change. In addition, if the treatment staff have some history with the client, they may provide testimony on the progress of the client's treatment at the sentencing hearing. Early referrals also help address the problem of lengthy waiting lists.
Some treatment agencies will not interview clients in the jail. Defense attorneys sometimes file a motion with the court asking that the client be released to go to an agency for an assessment interview. Another option used by sentencing advocates is to find a person who will go to the jail to provide assessment. At the sentencing hearing, the attorney provides this information which shows that if the client was assessed, he or she would likely be accepted into the treatment program.
If sentencing advocates use treatment agency personnel who are not familiar with the interview practices in the jail, they should provide the interviewer with information such as what identification to bring, whether the interview can be arranged with direct contact with the inmate, and a copy of the jail rules, including time restrictions on jail visits. It is good practice to provide the jail with written notification of the interview. Some jails require a background check of the interviewer to be completed prior to a professional contact visit.
In some cases, sentencing advocates provide probation and parole agents with information about their referrals to treatment agencies. Frequently, agents do not have the time or interest in referring clients to programs; however, they are often not opposed to others making referrals. Sentencing advocates' treatment plans are more likely to be accepted if they have joint agreement between the defense and probation agents.
In some cases, probation officers are opposed to a community-based treatment plan, and they will not facilitate the referral. In these cases, sentencing advocates should make the referral themselves if the agency will accept the client, or ask the defense attorney to bring a motion before the judge to order the probation officer to make a referral.
Funding Sources
Funding for alcohol and drug treatment comes from a variety of sources, including government, donations, insurance, private pay, and gambling revenues. Some state and federal funding for treatment is funneled through state agencies and then dispersed to the local level.
Other sources of governmental funding for treatment are Title 19 (Medicaid), veteran benefits, Treatment Alternatives to Street Crime (TASC) grants, and legislatively-mandated specific appropriations. Sentencing advocates should find out if their clients have Title 19 or veteran benefits. If they have or qualify for veteran benefits, they may refer their clients to the county veteran service office which will provide information on local services. If clients have Title 19, sentencing advocates may refer clients to private service providers, or any agency which accepted Title 19 funding.
Frequently, your Department of Corrections (or Probation Department) also has funds to purchase treatment services. When using this source of funds, the agent preparing the presentence report or the parole agent is usually required to make a formal referral. Sentencing advocates may encourage agents to make referrals for treatment by making the initial contact themselves to treatment agencies, and providing information to the agent about the feasibility of acceptance. Occasionally, staff of treatment agencies will contact the agent, and encourage the agent to make the referral.
Donations are used to augment funding for non-profit agencies such as United Way. Often, services in United Way agencies are provided on a sliding-scale fee basis. Donations, usually from the participants, are used to fund support groups.
Funds for treatment are often provided by an insurance carrier. In addition to insurance provided through employment or school, Health Maintenance Organizations (HMO) insurance may be purchased by counties for persons on general assistance. As part of the contract, some HMO's provide treatment for persons receiving general assistance.
Gambling revenues are providing new sources of income for Indiana tribes. Most tribes provide treatment for their members.
Effectiveness of Treatment
Studies conducted in the last fifteen years show that drug treatment is effective in reducing drug abuse, increasing employment, improving psychological adjustment, and decreasing crime. The most persuasive evidence of the effectiveness of treatment is found in the results of the Treatment Outcome Prospective Study (TOPS). See Robert L. Hubbard, et.al., Drug Abuse Treatment: A National Study of Effectiveness (Chapel Hill, NC: U of North Carolina Press, 1989).
TOPS studied 10,000 individuals admitted to 37 programs in 10 cities. They found that "drug abuse treatment has been notably effective in reducing drug abuse up to five years after a single treatment episode." The study also reported, "By serving as an alternative to incarceration, treatment can be particularly beneficial for drug abusers identified in jails or prisons, and it can play a central role in combating the spread of acquired immunodeficiency syndrome (AIDS) by reducing the intravenous use of heroin and other drugs." The TOPS study also found that legal pressure tended to keep people in treatment for longer periods and that this coercion did not interfere with treatment goals.
The potential for reducing criminal behavior is one of the most compelling reasons in favor of drug treatment. The TOPS study found that "three to five years after leaving treatment, the proportion of clients who were involved in predatory crimes was one-third to one-half of the pretreatment proportion."
Additional Information
For national drug information and treatment referral, call 1-800-662-HELP. The hotline can provide information on programs listed in the National Directory of Drug Abuse and Alcoholism Treatment and Prevention Programs, which includes information on profit/non-profit, Federal/State, inpatient/outpatient or residential facilities.
The Bureau of Justice Statistics publishes State Drug Resources: A National Directory, which lists governmental agencies, TASC programs, treatment centers, and electronic bulletin board information. This publication is available, free of charge, by writing Drugs & Crime Data Center and Clearinghouse, 1600 Research Blvd., Rockville, Maryland 20850, or by calling 1-800-666-3332. The Drugs and Crime Data Center and Clearinghouse will also answer requests for specific drug-related data and will perform bibliographic searches on specific topics.

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