Pleading guilty or no contest to the crime of driving under the influence (DUI) in the state of Florida has statutory minimum mandatory penalties that must be imposed by the court. That means the lawmakers up in Tallahassee have decided to take away some of the discretion of the Miami-Dade, Broward and Palm Beach courts in determining what sentence to give to someone pleading to or found guilty of driving under the influence.
Note that these are minimums for a Florida DUI conviction. The court can impose more; in fact, for a DUI, the court can impose jail. However, understand that these Florida statutory minimums are required only when convicted of a DUI.

If the DUI attorney negotiates a reduction of the charge from a DUI to, say, reckless driving, then the minimum mandatory penalties do not apply. If the DUI attorney negotiates a dismissal of the case, then the penalties do not apply. If the DUI attorney wins the case at trial, then the penalties do not apply.
Below I have listed the possible penalties associated with a DUI conviction in the state of Florida.

Possible Jail Time
A standard first time DUI conviction can result in up to 180 days in the county jail. If the blood alcohol content (BAC) was over a .15, or if a minor was in the vehicle at the time of the incident, then the maximum jail time is increased to 270 days. If there was damage to another person or his property, the maximum jail time is 365 days in county jail.

A second DUI conviction is punishable by up to a year in jail. A third DUI conviction within ten years of a previous DUI can be a felony, if the prosecutor so chooses, and is punishable by up to five years in prison. A fourth or subsequent DUI conviction is also punishable by up to five years in prison.
For first-time DUI offense in Florida, the prosecution oftentimes does not seek jail time. However, when there is an accident involved, or some other aggravating conduct by the defendant, the prosecutor may seek a term of incarceration as part of the sentence for the DUI.

For a second-time DUI conviction in Florida that is within five years of a previous DUI conviction, there is a minimum 10 days required in the county jail. A third-time DUI within 10 years of a prior DUI conviction in Florida requires a minimum of 30 days in the county jail.

Fines and Court Costs
The fine for a first time DUI in Florida is between $500 and $1000. If a .15 or higher BAC is obtained, or there is a minor in the car, then the fine is between $1000 and $2000.

A second DUI conviction within 5 years of a previous prior DUI conviction will result in a fine of between $1000 and $2000. If there is a .15 or higher BAC or a minor in the car, then the fine is between $2000 and $4,000. A 3rd DUI conviction or more will result in a fine between $2000 and $5000.

Probation and Cost of Supervision
A DUI conviction will often include a probationary term of up to one year for a misdemeanor and five years for a felony. Cost of supervision while on probation is not cheap; usually $50 to $60 dollars a month during the period of probation. The other penalties of the DUI conviction, like DUI school and monetary fines, are considered conditions of the probation.

If the conditions are not completed while on probation, the probationer can be violated. If violated, the probationer could face up to the entire term of incarceration he was facing before being put on probation. For a first-time DUI, that means violating probation could result in up to 180 days in county jail.

Ignition Interlock and Impoundment
The ignition interlock is another costly condition of probation that might accompany a DUI conviction. Specifically, a first-time DUI conviction with a BAC of over .15 will result in a 6-month ignition interlock requirement. A second DUI conviction in Florida with a BAC over .15 requires 24-months of the ignition interlock device.

In Miami-Dade, Broward and Palm Beach counties, the device costs roughly $200 to install, and has a monthly service fee of between $50 to $100. Note: The interlock device is required even if you do not own a vehicle! Just the other day, a Judge in Broward stated on record that this requirement never made sense to her. A lot of judges have stated the same, but the legislature has made it statutory.

Any second or subsequent DUI conviction in Florida will result in impoundment of the vehicle, unless doing so would be a hardship to the family of the driver. Exceptions may apply if the vehicle is operated for business purposes.

Driver’s License Suspension
Even though the Florida DMV has likely already administratively suspended the license after an arrest, a DUI conviction results in a separate and distinct driver’s license suspension. On a first DUI conviction, the court will order a 6- to 12-month license suspension. A second within five years of a prior DUI conviction will result in a five-year suspension. A third DUI within 10 years of any one prior DUI is also a minimum of a five-year driver’s license suspension. A third DUI within ten years of convictions for any two prior DUI’s in Florida is a ten-year suspension. The fourth conviction is a lifetime Florida license revocation.

The driver is eligible for a hardship license immediately on a first-time DUI if the DUI school is complete. On a second DUI within 5 years of a prior conviction, the driver is eligible for a hardship license after 12 months. On a third conviction within 10 years of a prior DUI conviction, the driver is eligible for a hardship license within 12 months. On a third within ten years of two previous prior DUI convictions, the driver is eligible for a hardship license after 24 months. On a fourth DUI conviction, no possibility exists for a hardship license.

DUI School and Community Service
Every Florida DUI conviction will require DUI school. The first conviction will require completion of Level 1 DUI school. A second or subsequent DUI conviction requires multiple offender school. Any substance abuse treatment deemed appropriate must also be completed as a condition of probation. And of course, the probationer must pay for all this.

Every conviction requires 50 community service hours. These can sometimes be purchased with an additional fine paid to the court.

An Option to Convert Jail Time to Treatment Time
If you are facing mandatory jail time for any of the above DUI categories, there are cases where the jail sentence may be converted into treatment time in a residential rehab setting. Defendants will usually have to admit that they have an alcohol or drug problem and are eager to seek treatment for a substance abuse problem.

In most cases the amount of residential treatment time must be greater than the amount of jail time offered. For example, if the state is asking for 60 days’ jail time, a lawyer would normally propose a 90-day treatment plan in lieu of jail time.

The decision is strictly up to the discretion of the court with the consent of the State Attorney’s Office.

Time to Up the Standards in the Addiction Treatment World (Part II)

I felt this was a good time to follow up on my last article, Time to Up the Standards, regarding the dire straits the entire addiction treatment milieu is presently in and emphasize the necessity for increasing standards in the field.

Addressing the Issues
To summarize, I wrote about the fact that anyone can own a treatment center or a sober home. There are really no requirements, other than having the money to invest.

The vast majority of employees at treatment centers are not even college graduates and have no clinical experience. They are often hired as babysitters, called “mental health technicians,” for $10-12 per hour. The only requirement is that they have 6 months or 1 year sober themselves. These are the people charged with caring for your loved ones in treatment for the majority of hours in each day. And the treatment centers are billing the client or his family’s insurance to the tune of $30,000 to $50,000 per month for this privilege.

I also wrote about the marketers out there, getting paid to put “heads in beds.” They give themselves different titles such as “Interventionists,” “Case Managers,” “Treatment Placement Specialists,” etc., but in reality, they are people with no real clinical training or educational background who act as “body brokers.” To clarify, they are receiving monetary kickbacks for the clients they place in a certain treatment facility. This has been going on in the industry, which is scarcely regulated, for so long that some of them do not even realize that what they are doing is not only unethical – but ILLEGAL!
Making ProgressThe Sober Homes Task Force, of which I am a member, was formed in July of this year and has made great progress under the leadership of State Attorney, Dave Aronberg and Chief Asst. Al Johnson. We have made a dozen arrests so far and plenty more to come. A grand jury was convened, which was the first of its kind in Florida to examine the state’s billion-dollar substance abuse treatment industry and offer recommendations on how to improve it. The report cites deceptive marketing as a common practice that threatens to exploit a vulnerable class.

To illustrate, people looking for treatment for their disease call an 800 number, thinking they are calling a legitimate treatment center and speaking to a professional. The fact is they are usually talking to a telemarketer in a boiler room where the call has been routed. This telemarketer is going to tell the prospective client whatever they want to hear in order to ensure they come to that facility. Some will even go as far as sending the client a plane ticket to reel them in. These marketers are usually rewarded with some type of bonus for the number of clients they bring into the facility – as a straight per-client-commission would be a more obvious violation of the Stark Act, a Federal law which prohibits patient brokering. The State of Florida also has laws in the book against patient-brokering, which have gone largely unenforced in this industry due to lack of regulation and the general culture of acceptance within the field.

The grand jury report recommends the state certify marketers, force them to provide disclaimers, and criminalize deceptive marketing practices and providers. This is a start. However, we need to penetrate much deeper than just unethical marketing going on at the admission level. We need to look at the actual treatment being provided to the clients once they are enrolled, and also the Case Management services provided, which should include discharge planning. I reiterate from the last article, the need to hire qualified clinicians with educational degrees as well as clinical field experience. This does not include people whose sole qualification is that they have been in a twelve step program themselves and think that they know what they are doing.

Breaking Out of the Wild West
Listen, even though I watched every episode of Law & Order on TV and thought I had pretty good knowledge of the law, I still had to go through all those years of college and law school, then sit for – and pass – the Bar Exam. It should be even more stringent to become an Addiction Professional considering we are treating people with a medical disease. Most of the people being hired to work at addiction treatment facilities would not be hired in a traditional medical milieu. We need to more strongly regulate who can and cannot own a treatment center or a Sober Home. Even convicted felons have been running treatment centers down here in Florida, just by putting it in their wives’ names.

I believe that treatment centers should only be owned and operated by people with a medical background, or who are licensed/certified personally under the appropriate state statute. If they are going to bill insurance as medical providers, they should be required to have all the proper credentials as such. Sober Homes can be owned and operated by anyone. Up until now the municipalities have had little success in any regulation of these homes because they used the ADA (American Disabilities Act) as their shield. However, we have found other ways to hold them accountable now, such as requiring accreditation in order for them to receive any referrals from state licensed treatment facilities. More regulation is better, as these facilities have been operating like the Wild West for way too long.

The Task Force is also recommending raising industry fees to hire more regulators, making it easier for investigators to access patient records, toughening penalties for illegal patient referrals, and requiring commercial sober homes to be licensed. They have recommended fines be increased for multiple violations of the patient-brokering statute. (Violating the patient-brokering statute is a third-degree felony, punishable by a maximum of five years in prison – for each count).

It is good that the funding, which will be necessary for cleaning up this industry, will come from the appropriate place – the treatment industry itself – which is largely responsible for this mess. Of course, many of them will try to pass these costs onto their clients – but we will be watching carefully. The grand jury report concludes that the “proliferation of fraud and abuse within the substance abuse treatment and recovery residence industries requires immediate attention by the Legislature.”

The Demise of For-Profit Addiction Treatment

I will preface this article by stating that I am an addiction professional who has been working in the field, specializing in the court system, for the last 10 years. I have worked in both state/county funded and private for-profit facilities. While the addiction treatment field has always been very liberal with regards to professional training and educational requirements, it is my opinion that the entire field has deteriorated steadily over the last decade.
While addiction has certainly been confirmed as a disease by the AMA, the for-profit treatment industry has seized upon this as a license to bill insurance companies in the tens of thousands of dollars in reimbursement for their services. Putting aside all of the illegal and unethical activities engaged in by many for-profit treatment centers, I just want to focus on the ones who are doing everything legally for the purpose of this article.

Questioning the Industry Standards
Since we are dealing with a health epidemic which is classified by the AMA as a disease, doesn’t it make sense that substance abuse disorders should be held to the same standards as any other medical disease?

The majority of people employed at for-profit treatment centers are not even licensed or certified addiction professionals. However, their insurance EOB’s indicate they are billing for medical services – services which are more expensive than many customary medical procedures. Think about it – $15,000 to $30,000 per month.

Doctors in emergency room settings performing surgical procedures do not bill that much. And these doctors are actually saving lives, after having attended college and medical school for many years. While insurance does not usually pay the amount billed by treatment centers, even if they pay half of it, it is still too much considering actual medical services provided are little to nothing. The insurance companies pay these over-inflated bills from the treatment centers, but you know who really pays for it? That’s right…you and I. The insurance companies just pass the costs along to the consumers, and that’s why health insurance is so unaffordable for the majority of citizens in our country.

The only medical staff present at an average for-profit treatment center is the medical director, who is normally a psychiatrist. However, the normal procedure is for the patients to be seen perhaps once per week by an ARNP (nurse practitioner) who monitors and dispenses meds as needed. The medical director signs off on everything the nurse practitioner does. In most cases, the medical director is also serving in the same capacity for several other treatment centers. In order for a treatment center to be licensed by the state, they must only have ONE licensed person on the staff. There is no mandate for how often that one licensed person must be present at the facility or how hands-on they must be. The majority of the clinical staff at your average for-profit treatment center would not be qualified for employment in a traditional medical setting, such as a hospital. The top level clinical staff generally holds degrees in social work or mental health counseling. Many of them are not actually licensed individually, which is not mandated since they are covered under the umbrella of the treatment facility which is licensed.

Glorified Daycare Services Equal Huge Profits
The substance abuse treatment industry has become a multi-billion dollar industry – an enormous “cash cow” with very deep pockets. As a capitalist, I do not pass judgment on businesses making profits. However, the services provided should be at least somewhat congruous to the amount of dollars being billed.

If addiction is really a medical disease, then why shouldn’t addiction treatment facilities be held to the same level of professionalism and oversight as any other medical facility? A treatment center should be run with the same medical standards and supervision as a hospital. Only trained and licensed medical professionals should be able to own and/or operate a treatment center. And, insurance companies should only reimburse for medically necessary procedures such as detox (3-5 days in most cases). What occurs in the standard 30- to 60-day residential treatment facility does not – and should not – qualify as treatment. True, these facilities provide some structure and supervision, and perhaps some education to the patients, but again this should not qualify as treatment. They are billing $15-30,000 per month for what I like to refer to as glorified daycare centers.

The treatment center owners will go ballistic when they hear these facts – and deny they are making a large profit – but the truth is that most of them are spending the majority of that profit not on implementing more scientifically based treatment models, but on marketing campaigns to increase their client census. For example, it has recently come to my attention that it is the industry standard to pay marketers $150,000/year or more to place 20 or more clients in a particular facility. It may seem like a lot of money to shell out to a marketer with a GED, but if you do the math, you will see that that amount of clients could equate to close to 5 million dollars for the treatment center.

An Industry Tainted by Financial Gain
The point of the above illustration is that the financial aspect of the for-profit treatment industry has tainted it to the very core. There is no integrity in it anymore. Admissions and treatment plans are financially driven. Throughout the last decade, I have personally observed more successful outcomes from clients who went through treatment programs in the correctional system, as well as long-term treatment at community and state funded facilities.
The fact is that there is usually a waiting list to get into these underfunded community treatment facilities. The reason they are underfunded is because demand dropped due to the opening of these for-profit centers on every corner with their aggressive marketing campaigns and willingness to do whatever it takes to get the client so they can bill their insurance. If a client breaks the rules at one of these state-funded facilities, they will be shown the door, whereas at the for-profit centers, they will be much more lenient – so they can keep the client and keep on billing.

The recidivism rate is another concern. The private for-profit centers as a whole, have an abysmal success rate. It is now the norm for a client to relapse and go back to treatment five or six times. They say relapse is part of the process, but it does not have to be that way. Of course, the for-profit treatment centers are not going to cry over the repeat business relapse generates for them.

My prediction is that things are going to change regarding the whole for-profit treatment industry. In fact, it has already begun. I hear treatment center CEO’s complaining that insurance is only covering a maximum of one month of residential treatment. It’s going to be interesting to see how they react when that is cut further to two weeks, and eventually to nothing after detox. There are other options out there for no-frills treatment. For example, we are working hard and have made progress in getting the approval for funding for the creation of new community treatment programs and the reopening of old ones that had shut down years ago due to the privatization of treatment.

I am also working hard with the task force here in Palm Beach County to make sure that unethical treatment centers and sober homes are shut down and held accountable. We have made over 20 arrests so far and many more to come. Additionally, the county commission has recently approved the creation of a “Drug Czar,” which will bring more power and resources to our mission. I encourage community leaders throughout the country to take a look at what we are doing to address these problems here in Palm Beach County and use it as a road map. As far as addiction treatment, we need to put an end to the current situation and go back to grassroots community treatment.

Great Changes in the Marchman Act Effective July 1, 2016 - By Myles B. Schlam

The Florida Legislature has made it easier to get help for a loved one with changes that take effect July 1, 2016. In the past, if someone were floundering in the raging seas of drug addiction or alcoholism there was little one person could do. It took either the family or three friends to get the suffering person into treatment via the Marchman Act. Very difficult to do at times. So many times, families are in denial that there’s a problem and so often well-meaning friends are unwilling to put their names on the dotted line to help commit a friend to a addiction or alcoholism recovery treatment center, even if that friend might be in mortal danger.

The good news is that the Florida law has been changed and now one unrelated person can file.

SUMMARY OF THE CHANGES:

The law is changed so that instead of requiring three unrelated individuals to file a Marchman Act petition, one unrelated individual can now file a petition for treatment. This makes it easier to get the ball rolling for impaired individuals to receive help.
The law makes it clear that the Marchman Act includes people with a “co-occurring disorder” such as bipolar disorder or a personality disorder. This is very helpful to families when the loved one suffers with a mental illness and substance abuse is also an issue but perhaps not the prominent issue.
Another helpful change is that the new law increases the initial time for treatment to 90 days rather than the 60 days it used to provide. That extra month can be a huge option where the impaired person is really struggling.
The law makes it clearer that when the impaired individual has the resources to pay for treatment that he or she should pay or to make the necessary arrangements with his or her insurer to pay for it.
The law makes it a little more difficult to get an order for treatment when the impaired person has not previously failed at treatment. That is to say, it’s easier to get a Marchman Act order if your loved one has already failed. But don’t let that stop you, an order can still be gotten, if we can show sufficient evidence. Talk to us. We are based in Palm Beach County but are available to represent people throughout the State of Florida.

The Role of Case Management in Substance Abuse Treatment - By Myles B. Schlam

Case Management is one of the most overlooked and underestimated components of clinical Addiction treatment. Many people are not aware that in the State of Florida, an agency must be licensed by the State in order to provide Case Management services. An agency licensed for Case Management is held to all the same licensure requirements as any addiction treatment facility.

Many people have asked me, “What services does a Case Manager actually provide?” There are different types of Case Managers in the Addiction treatment milieu. There are the internal Case Managers within individual treatment centers whose duties include linkage of clients to ancillary services. There are Case Managers who work within the Drug Court system to monitor compliance of clients and out of county transfers. What most people do not know is that Case Management is considered a type of Intervention and a clinical component for substance abuse treatment. Even though most Case Managers are not licensed by the State, it is legally required to be licensed by the Florida Dept. of Children and Families to provide such services. A Case Manager must also have professional liability insurance coverage. Advocare Solutions, Inc. is unique in that we are an agency licensed in and specifically devoted to Case Management. We have developed a program which is centered around strong, intensive Case Management. After years of working in the Addiction field and in the court system, I observed that strong Case Management was severely lacking and this was a primary cause of clients “falling through the cracks”.

Our job is to ensure that clients do not fall through the cracks by ensuring that the Continuum of Care is followed – that clients have a smooth transition from one phase of treatment to the next. The best analogy I can give for my job as Case Manager is that of the head coach of a football team. Addiction clients have many “ancillary” or outside needs that must be addressed which cannot necessarily be done within the treatment center. This is where “linkage” is necessary. ASI has a large network of resources to refer our clients to for a wide range of “outside” issues. Our job is to oversee the entire process. We generally have a client on our caseload from 6 to 18 months. During that time we may place a client into detox and subsequently place that client into another facility for PHP (residential). Upon completion of PHP we may determine that a client should stay at that facility for IOP (Intensive Outpatient Treatment) if they have that component, or we may place that client into a separate IOP facility in conjunction with a sober-living facility.

In making these determinations, it is important place the clinical needs of the client first and foremost. The first step is a Screening and full bio-psycho-social Assessment performed on each new client. The Assessment is important because that is how we determine the appropriate modality and level of treatment for each client based on individual factors. As a licensed Case Management Agency, we are required to maintain a clinical chart for every client which we must keep for 7 years. We must also meet with each client for an individual session at least once per month. A Treatment Plan which is called an “Intervention Plan” must be formulated with each client containing both short and long-term goals and objectives along with Interventions to be provided by ASI. A review of the Intervention Plan must be conducted with the client every 60 days. Upon discharge, there must be a solid Discharge Plan for every client.

Another duty we take very seriously is providing quality assurance to the clients while they are in treatment. We are in frequent contact with the primary therapist and case manager at the treating facility to staff each client’s case and provide input to the treatment plan and give suggestions. We only work with treatment centers that provide quality individualized treatment and have a good teamwork approach. As Forensic Case Managers we are also in frequent communication with the courts, probation officers, prosecutor, and defense attorneys to ensure that all court requirements are met and to give status reports on clients. Serving as the liaison between the treatment facility and the courts is one of our primary responsibilities. It is important as Case Manager to always be available to all the various parties. Because I am personally in the courts 3-5 days per week, the Judges feel comfortable with the fact that I can always be reached necessary.

Our job extends to placing clients in a sober-living facility upon completion of treatment while continuing to oversee their case. We work with a network of attorneys who specialize in various areas of the law whom we call upon to represent our clients. Because Addiction is a family disease, Case Management also includes communications with the family of the client and keeping them informed and involved in the process. Clients may have other health issues that need to be addressed which would also be coordinated by the Case Manager. The client may have vocational issues, including dealing with the EAP at work or a boss who is at his wits end.   They may need assistance in utilizing the FMLA (Family Medical Leave Act). Other clients have educational issues and need direction in obtaining their GED or getting back into college after a leave. We always encourage our clients to continue with Aftercare upon completion of treatment and often provide them with one of our network therapists for follow up.

One reason it is so paramount to have an Independent Case Manager steering the ship is because there are conflicting priorities. For example , the defense attorney on board is looking at the case from the perspective of “beating the case” or doing as little time as possible…that’s his job and that is what he is trained to do. His opinion may be in complete conflict with the therapist. The therapist’s opinion may be in conflict with that of the Psychiatrist. In some cases there are spouses or family members who have their own opinions regarding course of action. As the Case Manager, our job is to be completely objective and neutral, helping the client to weigh out the pros and cons - always keeping their best interest as the primary concern. At the end of the day however, the client will have to make their own decision and we can only hope they follow our suggestions.

In sum, a strong and effective Case Manager can greatly improve a client’s chances of successful recovery. When a teamwork approach is taken and all the elements are working together, we can have a profound impact on somebody’s life. It can go from a catastrophic situation to one where the client comes out the other end with a good foundation underneath them, and a great deal of hope in their life to create something positive for themselves.
If you or a loved one have a case pending in the court system or are just seeking the best individualized treatment alternatives for Alcoholism or Drug Addiction, ASI is available for a free consultation.   Both in and out of custody evaluation are provided by appointment only.

Drug Treatment & Crime - By Myles B. Schlam

Sending drug abusers to community-based treatment programs rather than prison could help reduce crime and save the criminal justice system billions of dollars, according to a new study by researchers at RTI International and Temple University.

Nearly half of all state prisoners are drug abusers or drug dependent, but only 10 percent receive medically based drug treatment during incarceration. Untreated or inadequately treated inmates are more likely to resume using drugs when released from prison, and commit crimes at a higher rate than non-abusers.

The study, published online in November in Crime & Delinquency, found that diverting substance-abusing state prisoners to community-based treatment programs rather than prison could reduce crime rates and save the criminal justice system billions of dollars relative to current levels. The savings are driven by immediate reductions in the cost of incarceration and by subsequent reductions in the number of crimes committed by successfully-treated diverted offenders, which leads to fewer re-arrests and re-incarcerations.

“Substance abuse among offenders continues to concern policy makers because of its high prevalence and its effect on criminal behavior,” said Gary Zarkin, Ph.D., vice president of the Behavioral Health and Criminal Justice Research Division at RTI and the study's lead author. “Given the obvious burden on the criminal justice system and society caused by substance abuse within this population, diverting offenders to effective and targeted substance abuse treatment leads to less drug use, fewer crimes committed, and costs savings.”

The findings were based on a lifetime simulation model of a cohort of 1.14 million state prisoners representing the 2004 U.S. state prison population. The model accounts for substance abuse as a chronic disease, estimates the benefits of treatment over individuals’ lifetimes, and calculates the crime and criminal justice costs related to policing, trial ,sentencing, and incarceration. The researchers used the model to track the individuals’ substance abuse, criminal activity, employment and health care use until death or up to and including age 60, whichever came first. They also estimated the benefits and costs of sending 10 percent or 40 percent of drug abusers to community-based substance abuse treatment as an alternative to prison. According to the model, if just 10 percent of eligible offenders were sent to community-based treatment programs rather than prison, the criminal justice system would save $4.8 billion when compared to current practices. Diverting 40 percent of eligible offenders would save $12.9 billion.

The results clearly demonstrate how diversion from prison to community-based treatment will benefit the United States and the criminal justice system. To be more useful for policy makers, this model should be implemented on a state level, which would provide more specific data on criminal behavior, the prevalence of treatment programs and state criminal justice costs.

Drug enforcement experts say the evidence strongly supports wider use of drug courts, which seek to impose treatment regimens instead of prison sentences on repeat criminals that are dependent on illegal drugs. West Huddleston, of the Alexandria, Virginia-based National Association of Drug Court Professionals, said a convicted criminal who successfully completes a court-imposed treatment regimen is nearly 60 percent less likely to return to crime than those who go untreated.

There are more than 2,600 drug courts operating in the United States. But they reach only a fraction of drug-addicted offenders. According to Chandler, 5 million of an estimated 7 million Americans who live under criminal justice supervision would benefit from drug treatment intervention. But only 7.6 percent actually receive treatment. 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.

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. It costs the tax payers an average of $150/day to keep an inmate incarcerated.

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. Drug offenders should be referred to private court-approved treatment facilities whenever they have health insurance coverage or the ability to pay for treatment, thus shifting the cost of treatment onto the offenders and not society.

The ultimate goal of treatment, of course, is to help an addict stop using drugs. As a licensed Clinician and Criminal Justice Addiction Professional, 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.

In our experience, a criminal case can sometimes be the turning point for a substance addicted or abusing client. Our endeavor is to guide them through this process with the hopes that they will find recovery and not become recidivists in the criminal justice system. ASI is available for consultations, and both in and out-of-custody evaluations by appointment only. We are also approved to conduct court-ordered evaluations. We work together with a large network of Treatment Providers throughout Florida and the USA. Clients who suffer from a Mental Health Disorder in addition to Substance Abuse will be referred to one of our Dual Diagnosis facilities.

Is Addiction Treatment Really Effective? - By Myles B. Schlam

Drug addiction is a complex medical problem with negative consequences that can affect almost every part of a patient’s life. To be successful, a drug addiction treatment program must be ready to address these issues by not only focusing on the patient’s addictive behavior, such as drug use, but also offering solutions to ancillary problems. Many programs now offer job skills training in order to help the patient become a productive member of both his family and society at large. This aspect of drug addiction treatment is an essential part of encouraging patients to stay sober by giving them something to be sober for.

Drug addiction treatment can be found in a variety of environments, using many different behavioral and pharmacological methods. There are over 10,000 drug addiction treatment facilities in the US that offer counseling, behavioral therapy, medication, and case management to those suffering with substance abuse.

In addition to formal drug addiction treatment centers, many drug addicts can get valuable assistance in doctor’s offices and medical clinics from doctors, nurses, counselors, psychiatrists, psychologists and social workers. Drug addiction treatment can be offered in outpatient, inpatient and residential settings and, although some treatment models are typically associated with a particular treatment environment, many effective methods are flexible enough to be offered anywhere.

Since drug addiction is such a major public health issue, much of the funding for drug treatment comes from local, state and federal government budgets. Although private or employer-subsidized health insurance policies can provide coverage for addiction treatment and the resulting medical fallout, benefit caps have resulting in shorter stays or the total elimination of certain programs. Although the US Congress recently passed a mental health parity law, it does not apply to all insurers and there are significant loopholes available for corporations to use to avoid having to pay out benefits.
Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse. According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives.

People typically do more research when shopping for a new car than when seeking treatment for addiction. They search on the internet and see these beautiful resort-type facilities with beaches and palm trees promising to cure them or their loved ones of addiction. They call an 800 number and a “treatment consultant” tells them exactly what they want to hear. A recent Colombia University report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors actually suggested that such insufficient care could be considered “a form of medical malpractice”.

Contrary to the 30-day stint typical of inpatient rehab, people with serious substance abuse disorders commonly require care for months or even years. The short term fix mentality partially explains why so many people go back to their old habits. Good Case Management, as I addressed in last month’s article is severely lacking. “You don’t treat a chronic illness for four weeks and then send the patient to a support group”, said Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism in an interview. “People with a chronic for of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

While it is true that some people are helped by one intensive round of treatment, “the majority of addicts continue to need services” Dr. Willenbring said. He cites the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed. Strong and consistent Case Management is vital to ensure the continuum of care throughout the treatment process.

Before committing to a treatment program you should do your homework. The first step is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with any specific program. For any treatment center we consider placing a client in, we check on the credentials of the program’s personnel, who should have at least a master’s degree. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine. We also meet with the therapist who will treat you and ask what your treatment plan will be. It should be more than movies, lectures or three-hour classes three times a week. You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all.

Our mission at ASI is to provide quality assurance to the clients before, during and after the actual treatment. We do the research for our clients to ensure that they are placed in a treatment facility that will treat the whole person and meet all their ancillary needs as well. It is important to have an independent professional who will oversee the entire treatment episode and facilitate appropriate aftercare. Oftentimes staff at a particular treatment facility are hesitant to question tactics employed at their facility for fear of “rocking the boat” or even losing their jobs. As independent Case Managers, we will say the things that need to be said and take action when necessary without these conflicts of interest. Our primary concern is for the client to receive the very best individualized treatment for their condition. Because no one treatment facility is the right fit for everyone, we work with a wide network of treatment facilities that have various sub-specialties. If a treatment center is not providing a high level of services to our clients, we will cease to refer clients to that facility.

Unfortunately insurance companies will rarely pay for the full extent of treatment that is recommended. That is where the necessity for thinking outside the box comes into play. Many of our treatment providers have agreed to discount their rates for our clients so that they may continue in treatment once insurance benefits are exhausted. When it is not feasible to keep the client in that facility, we will use one of our community-based facilities that are either free or on a sliding scale.