The Substance Abuse and Mental Health Services Administration (SAMHSA) released a new Treatment Improvement Protocol (TIP 44) that presents clinical guidelines to help substance abuse treatment counselors who treat persons in the criminal justice system.

The TIP, Substance Abuse Treatment for Adults in the Criminal Justice System, was released by SAMHSA Administrator Charles Curie at the Treatment Accountability for Safer Communities (TASC) conference in Cleveland.

TIP 44 provides information on state-of-the-art screening, assessments, treatment services and follow-up services for individuals in a variety of criminal justice settings.

The TIP is designed for treatment counselors and clinicians working with clients who are involved in the criminal justice system under full or partial supervision; on probation; on parole; or on pretrial release. The TIP is also useful for criminal justice system personnel dealing with offenders who abuse alcohol or drugs.

"Our vision at SAMHSA is 'a life in the community for everyone.' Without a doubt, this includes the men, women, and youth whose lives have become entwined with the criminal justice system due to addiction and mental illness," said SAMHSA Administrator Charles Curie. "We have made serving people in criminal and juvenile justice systems with mental and substance use disorders a priority at SAMHSA."

Curie continued, "The goal of this new TIP is to help substance abuse treatment counselors address issues that arise from their clients' status in the criminal justice system and to aid personnel in the criminal justice system in understanding and addressing the challenges of working with offenders with substance use disorders."

The TIP recommends screening and assessment to identify offenders in need of treatment and also offenders with co-occurring mental disorders. Those who are initially assessed as having symptoms of a co-occurring mental disorder should be evaluated over an extended period of time to determine whether the symptoms resolve in the absence of substance use.

The TIP recommends that criminal justice settings provide a range of substance abuse treatment options. Counselors are advised that along with the clinical issues shared by others receiving substance abuse treatment, many offenders have problems with thinking like criminals and holding criminal values, and difficulties dealing with anger and hostility. "Their identity as criminals may need to be offset by exposure to more pro-social values and identities such as those of family member and wage earner," the TIP recommends.

Among the various criminal justice populations, variations must be recognized, the TIP points out. For instance, counselors must recognize the different stresses experienced by minority cultures; the likelihood that many women have been traumatized by physical or sexual abuse; and the differing needs of older adults, persons with disabilities and sex offenders.

TIP 44 addresses issues in various criminal justice settings. For example:

• In the pretrial setting, treatment professionals need to be careful not to coerce clients into waiving due process rights.

• Appropriate treatment options for persons in jails will depend on the expected duration of incarceration. Programs of one to three months can work on: communication, problem solving and relapse prevention, as well as some anger management techniques and encouraging participation in self-help groups. Programs from three months to one year can provide additional skills training, and vocational and educational activities, and examine criminal thinking errors.

• In-prison drug abuse treatment, followed by community-based continuing care treatment, has been credited with reducing short-term recidivism and relapse rates. Studies indicate that 9-12 months of prison treatment followed by at least three months of community treatment are needed to produce significant improvement and reductions in recidivism and relapse.

• Parolees may have difficulty meeting their basic needs when they are released and can benefit from case management services that help with housing and employment.

SAMHSA is a public health agency within the Department of Health and Human Services. The agency is responsible for improving the accountability, capacity and effectiveness of the nation's substance abuse prevention, addictions, treatment and mental health service delivery system.