ONDCP Blog

ONDCP and NIDA Voice Concerns over Vietnam's Approach to Drug Treatment

A recent Human Rights Watch report asserts that there may be over one hundred facilities in Vietnam subjecting thousands of addicted individuals to inhumane labor conditions under the pretense of providing drug treatment.  Furthermore, there are indications that the Government of Vietnam may erroneously believe that these practices comply with NIDA’s Principles of Effective Treatment. 

In a letter forwarded to Human Rights Watch earlier today, the Director of National Drug Control Policy and the Director of the National Institute on Drug Abuse (NIDA) reiterated the United States’ strong support for safe, effective, evidence-based, drug addiction treatment that is consistent with NIDA’s Principles of Effective Treatment and internationally recognized human rights.  This joint letter from NIDA and ONDCP sets the record straight.

The United States does not in any way condone the forced labor or inhumane conditions described in Human Rights Watch’s report on drug rehabilitation facilities in Vietnam.  While NIDA’s Principles of Effective Treatment include a principle stating that “treatment does not have to be voluntary to be effective,” it is not intended to provide a justification for violent or punitive coercion without access to due process or internationally recognized human rights.  This principle is based on evidence that treatment entered as a result of a criminal justice mandate to avoid imprisonment, or even within a criminal justice setting, can be successful.  It also applies to other addicted individuals who would not have entered treatment were it not for a doctor, nurse, relative or friend who took the time to present to them the serious health consequences of avoiding needed drug treatment. 

ONDCP wholeheartedly supports all of NIDA’sresearch-based Principles of Effective Treatment, which also include:

• Addiction is a complex but treatable disease that affects brain function and behavior;
• No single treatment is appropriate for everyone;
• Treatment needs to be readily available;
• Effective treatment attends to multiple needs of the individual, not just his or her drug abuse;
• Remaining in treatment for an adequate period of time is critical;
• Counseling – individual and/or group – and other behavioral therapies are the most commonly used forms of drug abuse treatment;
• Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies;
• An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs;
• Many drug-addicted individuals also have other mental disorders;
• Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse;
• Drug use during treatment must be monitored continuously, as lapses during treatment do occur; and
• Treatment programs should assess patients for the presence of HIV/ AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

NIDA and ONDCP believe that regardless of the manner in which an intervention is initiated, effective drug addiction treatment ultimately must be:  a) evidence-based; b) take advantage of the various treatment modalities available; and, c) address the multiple needs of the individual. 

The United States will continue to work to ensure that Vietnam and other countries worldwide receive this important drug treatment message loud and clear.  For more information, read the full letter.

The Health Care Innovation Challenge Wants Your Ideas

As part of the Affordable Care Act, the Health Care Innovation Challenge will award up to $1 billion in grants to fund the best projects that doctors, hospitals, and other innovators propose to deliver high-quality medical care and save money.

In a previous blog, the White House encouraged interested individuals to send innovative ideas and solutions, and submit a proposal for transforming the health care system.  This provides the substance abuse community the opportunity to join the conversation and create new innovations for the prevention, treatment and recovery fields.  In the application, proposals are encouraged to focus on high cost/high-risk groups including those populations with multiple chronic diseases and/or mental health or substance use issues, poor health status due to socio-economic and environmental factors, multiple medical conditions, high cost individuals, or the frail elderly.

Visit the website for more information and to join one of the upcoming webinars.

Obama Drug Policy: Reforming the Criminal Justice System

Ed. note: This was cross-posted from Huffington Post

Recently we had the privilege of recognizing 10 community organizers at the White House as "Champions of Change." Each of these Champions represent innovative organizations and programs working across America to reform the way we approach our nation's drug problem. Among this group of educators, physicians, social workers and people in recovery from substance use disorders, was a 25-year veteran of the Providence, R.I. police department.

As we sat in the Roosevelt Room just steps from the Oval Office, Lt. Daniel Gannon told us something many Americans might not expect from a law enforcement officer. Not every drug offender belongs in prison, he said. "Prisons are for the bad guys." For many of the others, he said, what's often needed is access to drug treatment, community services and a second chance. Lt. Gannon -- who advocates for an innovative community policing program called Drug Market Intervention -- is just one among thousands of community leaders around the country working to implement a variety of innovative, compassionate and evidenced-based drug policies at the local level.

Progressive and effective reform efforts like these could not come at a better time. More than seven million people in the United States are under the supervision of the criminal justice system. Of these, more than two million are behind bars. Making matters worse, African Americans are disproportionately incarcerated for drug offenses. In fact, African Americans have higher proportions of inmates in state prison who are drug offenders compared to whites -- about 50 percent higher. For states and localities, the cost of managing the prison population has grown significantly. Between 1988 and 2009, annual state corrections spending jumped from $12 billion to more than $50 billion.

Just as alarming is the strong connection between crime and substance use. Data shows that over half of state and federal inmates used drugs during the month preceding the offense corresponding to their sentence. And nearly a third of state prisoners and a quarter of Federal prisoners were using drugs at the time of the offense.

The complexity and scale of our drug problem requires a nationwide effort to support smart drug policies that reduce drug use and its consequences. Since day one, the Obama Administration has been engaged in an unprecedented government-wide effort to reform our nation's drug policies and restore balance to the way we deal with the drug problem. We have pursued a variety of alternatives that abandon an unproductive enforcement-only "War on Drugs" approach to drug control and acknowledge we cannot arrest our way out of the drug problem and, further, that drug addiction is a disease of the brain, not some "moral failing."

This strategy is vital because by recognizing drug addiction as a chronic and progressive disease, we can actually work to prevent and treat substance use disorders and break the cycle of drug-related crime. Simply put, it makes more sense to prevent and treat drug problems before they become chronic than simply to legalize drugs altogether or keep filling our prisons with drug offenders over and over again. Neither of these extremes are sound or humane drug policies.

Under the Obama Administration, the shift has already begun toward programs that emphasize public health over incarceration. Over the past year, the federal government spent $10.4 billion on drug prevention and treatment programs. That is more than twice the amount -- $4.3 billion -- spent on drug-related incarceration operations. And it's just the beginning:

• Last year, President Obama signed the Fair Sentencing Act into law. This important and long-overdue criminal justice reform dramatically reduced a 100-to-1 disparity between sentences for powder and crack cocaine that disproportionately affected minorities. More recently, we advocated for, and the U.S. Sentencing Commission approved, the retroactive application of these sentencing guidelines which became effective on Nov. 1.
• The Administration ardently supports the expansion of drug courts, which place non-violent drug offenders into treatment instead of prison. Today, there are over 2,600 drug courts across the nation, diverting about 120,000 people a year into treatment instead of prison. Because of this expansion, someone in America is referred to drug treatment instead of jail through drug courts on average every four minutes.
• The Administration is implementing the Second Chance Act, which passed Congress with overwhelming bipartisan support and provides resources for common sense, evidence-based approaches to reducing crime. Specifically, it provides funding for programs that improve coordination of reentry services and policies at the state, tribal, and local levels, including demonstration grants, reentry courts, family-centered programs, substance abuse treatment, employment, mentoring and other services needed to reduce recidivism and improve the transition from prison and jail to communities.
• Last year, the Department of Justice awarded $100 million to support 178 state and local reentry grants to provide a wide range of services and, in late September, awarded another $83 million to 118 new grantees.
• The Department of Justice has urged state attorney generals to review the legal collateral consequences of their state laws being placed upon ex-offenders that may burden their successful reentry into society. (State and local governments are also taking action. During their 2011 legislative sessions, more than a dozen states tackled sentencing and corrections issues.)
• The Administration has worked to make certain that local public housing authorities understand Federal law regarding the discretion housing authorities have to allow ex-offenders access to public housing. Research shows that ex-offenders who do not find stable housing in the community are more likely to recidivate than those who do. Studies have also found that the majority of people released from prison intend to return to their families, many of whom live in public or other subsidized housing. Clarifying these rules allowing ex-offenders to rejoin their families is therefore an important part of our overall criminal justice reform efforts. There are only two explicit bans on occupancy: Individuals convicted of manufacturing methamphetamine in public housing and registered sex offenders.

But more still must be done. That is why we are closely examining innovative new programs that show great promise in extending our approach to criminal justice reform and alternatives to incarceration. Here are two that are already showing solid results:

• The Drug Market Intervention program.This community-based strategy has shown tremendous promise in disrupting open air drug markets by directly engaging drug dealers, their families, and communities by creating clear and predictable sanctions, offering a range of community services including drug treatment, and improving community-police relations. Jurisdictions that have implemented this strategy have experienced decreases in drug crime and other crimes without displacement of the drug market activity into other neighborhoods.
• Hawaii's HOPE Probation program(Hawaii's Opportunity Probation with Enforcement).This program reduces probation violations by drug offenders and others at high risk of recidivism. Probationers in the program receive swift, predictable, and immediate sanctions - typically resulting in several days in jail - for each detected violation, such as detected drug use or missed appointments with a probation officer. So far, evaluation results indicate the program is highly successful at reducing drug use and crime, even among difficult populations such as meth users and domestic violence offenders.

There is no simple, straightforward fix to America's drug problem. Successfully combating this social challenge and reducing the toll substance abuse takes on our nation requires a broad approach that blends drug treatment, smart law enforcement and effective alternatives to incarceration. With these proven public health and public safety strategies, we can break the vicious cycle of drug use and crime, thereby saving countless lives and taxpayer dollars and helping to make it possible for all Americans to achieve their full potential.

Rafael Lemaitre is Associate Director for Public Affairs

Maricopa County Works to Break the Cycle of Drugs, Crime, and Incarceration

The 2011 National Drug Control Strategy recognizes that many individuals who use drugs become involved in the criminal justice system.  This is also the case in Maricopa County, Arizona.    The most recent Arizona Arrestee Reporting Information Network (AARIN) Annual Adult Report, which provides data on arrestees in Maricopa County, indicates that in the 30 days prior to arrest 56% used marijuana, methamphetamine, cocaine, or heroin. 

Many of the principles identified in the Strategy that are intended to break the drugs and crime cycle are being implemented in Maricopa County by the Maricopa County Adult Probation Department.  Below are some accomplishments and ongoing projects focused on assisting offenders.

• Evidence-Based Practices (EBP) - The department is committed to using evidence-based practices (EBP) in its supervision strategies and has translated EBP into practical approaches that probation officers can incorporate into their daily supervision practices, such as using validated risk and needs assessments and reassessments to develop probationer case plans.  Individuals with drug abuse disorders are referred to drug court or other relevant treatment programs. 
• Reentry - In January 2010, through a federal stimulus grant, the department implemented a Prison Reentry Unit, changing the way released offenders are supervised.  A key priority is ensuring these offenders report to the probation department following their release from the Arizona Department of Corrections.  In the first year, over 1200 offenders received services from the unit.  The rate of offenders failing to report to probation following release from prison dropped from 23% to 2.3% with the grant.  In addition, the rate of petitions to terminate probation and return the offender to the Department of Corrections (called “petitions to revoke”) filed in the first twelve months after release dropped from 10.1% to 4.9% with the program, and the rate of new felony arrests dropped from 13.8% to 10.8% with the program.
• Earned Time Credit (ETC) - Effective January 1, 2009, the State of Arizona implemented Earned Time Credit (ETC), providing eligible offenders the opportunity to earn 20 days of credit for every 30 days they comply with their court-ordered financial obligations, community restitution hours and are making progress towards their case plan goals.  In the short-term, it is anticipated that this legislation will reduce the length of time on probation while increasing the likelihood of successful completion of probation.  In the long term, we expect that the likelihood of recidivism will be reduced following termination from probation. 
• Probation Outcomes - While evaluations of the effectiveness of these initiatives are ongoing, we have seen positive results.  Crime reduction is a key goal in the department’s strategic plan and is measured through three main results: successful completion of probation, termination of probation and returning to the Department of Corrections, and new felony sentences.  From FY2008 to FY2011, the percentage of offenders successfully completing probation increased from 66% to 80.3%; the percentage of offenders returned to the Department of Corrections decreased from 28% to 18.4%, and the percentage of offenders with new felony sentences decreased from 8.0% to 4.9%.  How does this affect public safety? In FY2011, an additional 1,340 offenders successfully completed probation, 1,601 fewer offenders were returned to the Department of Corrections, and 885 fewer offenders were sentenced for new felony offenses.

These results are encouraging. It suggests that offenders can be effectively supervised in the community without negatively affecting public safety. And we can break the cycle of drugs, crime and incarceration.

Barbara Broderick is Chief Probation Officer at the Maricopa County Adult Probation Department