Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

16. Addiction and the Law 363Dispositions after PrisonAddiction psychiatrists may work with parole boards to mandate treatment.There may be times when the psychiatrist is asked to comment to a paroleboard about an inmate who is addicted in prison or beforehand. On discharge,both inmates with SUDs and those with SUDs comorbid with psychiatric conditionsare at high risk of relapse, which may affect criminality as well. OneScottish study found that of the increased deaths after release, many were intravenousdrug users, especially those with HIV (Bird & Hutchinson, 2003). Someparole boards mandate treatment either using their own authority or by referringparolees to the mandated treatment programs (see below). Such requirementshave been accepted in the case of sex offenders but have not been successfullyutilized for addictions to this point.When asked by a court to suggest a treatment plan for the addictedoffender, it is best to offer multiple modes of treatment and surveillance. Considerresidential, groups, day treatment, medication management, and others.The period of treatment should be a minimum of 1 year. Random screens arebest done twice weekly. Attendance at required activities should be required.The clinician should reevaluate the individual on some regular basis.ALTERNATIVES AND ADJUNCTS TO, AND DIVERSIONS FROM,THE INCARCERATION/JUSTICE SYSTEMFor those with SUDs who have been or will likely become dangerous to themselvesor others, various states, counties, and federal government agencies havebeen developing ways in which to intervene. This includes “diversion” programs(such as drug courts), as well as mandated treatment laws. These institutionsmay protect the public from violence or accidents, and they may reduceexpenditure on incarceration.“Diversion” refers to institutions, practices, and laws that divert criminaloffenders who have a mental disorder or an SUD out of the standard criminaljustice system and into alternatives. There are moral and economic rationalesfor diversion, which may occur at any stage of the justice process, from arrest tosentencing. A review of the many programs can be found in a volume by theCouncil of State Governments (2002).Drug courts, one type of diversion, are special courts given the responsibilityto handle cases involving substance-abusing offenders through comprehensivesupervision, drug testing, treatment services, and immediate sanctions and incentives.These courts mandate treatment, seem to have low recidivism rates, andlead to education, cost savings, and drug-free babies. They have been shown tohave good outcomes, to save money, and to reduce criminal recidivism.