TREAT THE ADDICT, CUT THE CRIME RATE

There was a time when the nation's crime rate was front-page news. In
the 1990s, the crime rate began to drop and we worried less. But a
preliminary report released by the FBI in June shows an increase in
robberies and violent crime in 2005. Inasmuch as drug abuse can
facilitate criminal behavior, this is a good time to take a closer
look at how the science in substance abuse has started to provide some
answers on how to solve these problems.

The crimes associated with drug abuse include sale or possession of
drugs; property crimes or prostitution to support drug habits; and
violent crimes reflecting out-of-control behavior. In fact, offender
drug use is involved in more than half of all violent crimes and in 60
to 80 percent of child abuse and neglect cases. It is estimated that
70 percent of the people in state prisons and local jails have abused
drugs regularly, compared with approximately 9 percent of the general
population.

In 2002 approximately 60 percent of male juvenile detainees and 46
percent of female detainees tested positive for drug use. The
estimated cost to society of drug abuse in 2002 was $181 billion --
$107 billion of it associated with drug-related crime.

When drug abusers enter the criminal justice system, it signals a
pivotal crisis in their lives. It also offers a unique opportunity to
institute treatment for drug abuse and addiction. Studies have
consistently shown that comprehensive drug treatment works. It not
only reduces drug use but also curtails criminal behavior and
recidivism. Moreover, for drug-abusing offenders, treatment
facilitates successful reentry into the community. This is true even
for people who enter treatment under legal mandate.

In a Delaware work-release research study sponsored by the National
Institute on Drug Abuse, those who participated in prison-based
treatment -- followed by ongoing post-release care -- were seven times
more likely to be drug-free and three times more likely to be
arrest-free after three years than those who received no treatment.
Other studies report similar findings. The Substance Abuse and Mental
Health Services Administration reports that substance-abuse treatment
cuts drug abuse in half and reduces criminal activity by as much as 80
percent.

If treatment works, then why have some communities resisted offering
comprehensive treatment programs to drug-abusing offenders? One reason
is that addiction is still often seen as something for the individual
to deal with. The other is the cost.

Science now tells us that repeated drug exposure affects the areas of
the brain that enable people to exert control over their desires and
emotions, which may explain why it is so difficult for an addict to
abstain. Drugs also affect areas of the brain responsible for the
perception of pleasure and punishment, for learning and cognition, and
for motivating our behaviors. These findings have led to the idea of
addiction as a complex disease of the brain that cannot be managed
with a stern moral lecture -- or even with a period of forced sobriety
in jail. If we understand that, we can better understand how to manage
drug-abusing offenders.

Some reject the concept of addiction as a disease on the grounds that
it removes responsibility from the addict. But in fact it gives the
addicted person the responsibility for seeking and maintaining
treatment for the disease, just as is the case for other diseases.

Some courts and communities have also resisted offering comprehensive
treatment because of fears of high costs. But recent studies show it
is actually less expensive for communities to treat drug-abusing
offenders than to let them sit in jail or prison. It is estimated that
every dollar invested in addiction treatment programs yields a return
of $4 to $7 in reduced drug-related crimes. Savings for some
outpatient programs can exceed costs by a ratio of 12 to 1.

Some criminal justice systems are working on innovative approaches to
dealing with drug-abusing offenders. In Cook County, Ill., for
example, NIDA sponsors a pilot project that trains judges on how
addiction affects the brain so they can be better prepared to place
addicted defendants in adequate treatment environments. Last month
NIDA released a report titled "Principles of Drug Abuse Treatment for
Criminal Justice Populations." These principles emphasize the need for
customized strategies that can include cognitive behavioral therapy,
medication, and consideration of other mental and physical illnesses.
Continuity of care after reentry into the community is also essential.

The ultimate goal of treatment, of course, is to help an addict stop
using drugs. As a clinician I don't remember ever meeting an addicted
person who wanted to be addicted or who expected that compulsive,
uncontrollable or even criminal behavior would emerge when he or she
started taking drugs. Providing drug-abusing offenders with
comprehensive treatment saves lives and protects communities.