Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person’s ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.

Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.

Behavioral Treatments

Behavioral treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioral approaches.

Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as—

• Cognitive–behavioral therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
• Multidimensional family therapy, which was developed for adolescents with drug abuse problems—as well as their families—addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.
• Motivational interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
• Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.

Residential treatment programs can also be very effective, especially for those with more severe problems. For example, therapeutic communities (TCs) are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. TCs differ from other treatment approaches principally in their use of the community—treatment staff and those in recovery—as a key agent of change to influence patient attitudes, perceptions, and behaviors associated with drug use. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. TCs are now also being designed to accommodate the needs of women who are pregnant or have children. The focus of the TC is on the re-socialization of the patient to a drug-free, crime–free lifestyle.

Treatment Within the Criminal Justice System

Treatment in a criminal justice setting can succeed in preventing an offender’s return to criminal behavior, particularly when treatment continues as the person transitions back into the community. Studies show that treatment does not need to be voluntary to be effective.

Studies show that treatment can cut drug abuse in half, reduce criminal activity up to 80 percent, and reduce arrests up to 64 percent.² Based on a review of this and other scientific literature on drug abuse treatment and criminal behavior, in 2006 NIDA released Principles of Drug Abuse Treatment for Criminal Justice Populations. This publication discusses 13 principles proven through research to help criminal justice organizations tailor treatment programs to better serve their populations. In brief, these principles are:

• Drug addiction is a brain disease that affects behavior.
• Recovery from drug addiction requires effective treatment, followed by management of the problem over time.
• Treatment must last long enough to produce stable behavioral change.
• Assessment is the first step in treatment.
• Tailoring services to fit the needs of the individual is an important part of effective drug abuse treatment for criminal justice populations.
• Drug use during treatment should be carefully monitored.
• Treatment should target factors that are associated with criminal behavior.
• Criminal justice supervision should incorporate treatment planning for drug abusing offenders, and treatment providers should be aware of correctional supervision requirements.
• Continuity of care is essential for drug abusers re-entering the community.
• A balance of rewards and sanctions encourages pro-social behavior and treatment participation.
• Offenders with co-occurring drug abuse and mental health problems often require an integrated treatment approach.
• Medications are an important part of treatment for many drug abusing offenders.
• Treatment planning for drug abusing offenders who are living in or re-entering the community should include strategies to prevent and treat serious, chronic medical conditions, such as HIV/AIDS, hepatitis B and C, and tuberculosis.

Drug abuse treatment can be incorporated into criminal justice settings in a variety of ways. These include treatment as a condition of probation, drug courts that blend judicial monitoring and sanctions with treatment, treatment in prison followed by community-based treatment after discharge, and treatment under parole or probation supervision. Outcomes for substance abusing individuals can be improved by cross-agency coordination and collaboration of criminal justice professionals, substance abuse treatment providers, and other social service agencies. By working together, the criminal justice and treatment systems can optimize resources to benefit the health, safety, and well-being of individuals and the communities they serve.

For more information, see Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide at www.drugabuse.gov/DrugPages/cj.html.

1 National Institute on Drug Abuse. Principles of Drug Abuse Treatment: A Research-Based Guide. National Institutes of Health Publication No. 00-4180. U.S. Department of Health and Human Services. 1999

2 Center for Substance Abuse Treatment. The National Treatment Improvement Evaluation Study (NTIES). Substance Abuse and Mental Health Services Publication No. SMA-97-3156. 1997