Seeking Treatment within the Criminal Justice System - Research Paper Example

? Seeking Treatment within the Criminal Justice System al Affiliation In most countries, the criminal justice systems have had a lot of criticism in preventing people from committing crime or even dealing with those who have already are committed crime. A number of researches have proven that mental and substance disorders have contributed towards many people being on the wrong side of the law. It is there fore very important and crucial for the criminal justice system in every country to incorporate treatment programs and facilities to help decrease the number of criminals. There are many treatment methods that the criminal justice systems have implemented and still continue to incorporate in their systems. There have been debates on whether the criminal justice systems should use the multi-dimensional kind of treatment where there is a combination of different methods of treatment, or uni-dimensional treatment where only one method is used at a time. This paper discusses the different kinds of treatment in the criminal justice systems. Keywords: Criminal Justice System, Treatment, Multi-Dimensional, Uni-Dimensional, Co-Morbidity Introduction The criminal justice system is a set of agencies and processes that have been established by governments to control crime and impose punishments to those who violate the law. Criminal justice is a complex subject to deal with. Most nations have several systems of justice; for example, in the United States, there are different systems of criminal justice. The criminal justice system is therefore a system that ensures that the laws of different countries are enforced (Goldsmith & Israel, 2000). Drug courts have been created in some nations, such as the United States America. This is in response to the realization that there is need for increased capacity in local jails, due to the high number of criminals arrested for reasons related to drug abuse. According to Lessenger and Roper, “drug courts have been found to be effective in keeping many such offenders out of jail and prison by enhancing the effectiveness of community correction approaches” (2007, p. 143). However, despite the fact that drug courts have been beneficial in handling offenders with drug abuse problems, they have been less effective when it comes to dealing with mentally ill offenders. The criminal justice systems in many countries have most of the time received a lot of criticism, because most of the people do not have trust in them. This is because most of them fail to treat offenders, which is in fact the main reason behind the establishment of such systems. There are different methods that can be used to treat substance abusers, mentally ill criminals and other conditions in people who enter into the systems. This paper discusses multi-dimensional and uni-dimensional treatments that are effective in treating criminals within the criminal justice system. Differences between multi dimensional and uni-dimensional treatments with substance abusers Multidimensional Family Therapy treatment is commonly used to treat substance abuse in adolescents and related behavioral and mental health problems (Liddle, Rodriguez, Dakof, Kanzki &Marvel, n.d.). The method seeks to reduce symptoms and at the same time, enhance developmental functioning by changing some domains of the behavior. This kind of treatment has received the highest rating in treating adolescent drug abusers, especially the juveniles because not use a single specified method making it very effective. This treatment is based on a combination of the theoretical and clinical traditions of psychopathology and developmental psychology, family therapy, and an ecological perspective. According to Liddle, Rodriguez, Dakof, Kanzki and Marvel, “multidimensional treatment uses research derived knowledge about risk and protective factors for adolescent drug related problems as the basis for assessment an intervention” (p. 128). Multidimensional Family Therapy holds the argument that drug abuse among teenagers is as a result of a network of influences. Treatment involves the individuals and their family members at the family courts, school, or other community locations. Unlike the multidimensional treatment of drug and substance abusers, uni-dimensional treatment refers to the use of one kind of treatment for offenders. This is however not effective in completely treating criminals given that an offender may have more than one need for treatment. Rich points out that a unidimensional approach “considers treatment to be essentially psychoeducational or cognitive-behavioral have been increasingly replaced by more clinically sophisticated and complete models that recognize the wholeness and complexity of clients and their needs and the need for multidimensional treatment” (2011, p. 4-5). Should the criminal justice system use one specific method in treating drug and substance abusers or a combination of methods? Treatment within the criminal justice system is necessary in preventing an offender from going back to criminal behavior, particularly if the treatment continues even when the individual goes back to the society. Treatment does not need to be voluntary in order to be effective. In the past decades, there have been increased interests in providing voluntary treatment to offenders of substance abuse. However, only a small percentage of the criminal justice offenders get to access this treatment. Additionally, treatment which is of insufficient quality and intensity, or not well suited to the needs of the offenders will not be effective (Fletcher, Chandler and the Office of Science Policy and Communications, 2012). Treatment of substance abusers is very crucial and there is need for it to be intergrated into criminal justice, which can be done in various ways. For example, treatment in the prison and then following the offender release to the community is very important in helping the offender abstain from substance abuse. One of the goals of treatment planning is to match with the needs of the each individual abuser, because if only one treatment is applied, it might not be effective in treating the individual, but another may be effective and thus over time, various methods of treatment are required (Fletcher, Chandler and the Office of Science Policy and Communications, 2012). Evidenced based interventions in treatment of substance users include cognitive- behavioral therapy, which helps participants learn positive and social coping skills, and contingency management approaches, which boost positive changes in behavior. Additionally, there is motivational enhancement to increase treatment, engagement, and retention. Thus a combination of these treatments will definitely yield good effects in treating the abusers (Fletcher, Chandler and the Office of Science Policy and Communications, 2012). The above methods of treatment give clear evidence that the criminal justice system should apply multi-dimensional treatment, as it gives more room to prevent the perpetuation of drug and substance abuse, even when the offenders are released to the community. For the young offenders, treatments and especially where the family is involved and other aspects related to the surroundings of the drug abusers are adequate in treatment. As seen earlier, behavioral management values that determine punishments and rewards are important in substantially reducing substance abuse levels in individuals. Rewards and punishments can be used as one of the methods of treating these individuals, by changing their behavior in order to achieve a targeted behavior. Rewarding positive behavior is more effective in producing a long term positive change than punishing the individuals (Fletcher, Chandler and the Office of Science Policy and Communications, 2012). Multi-dimensional treatment, such as therapy and medication works to yield better results than medication or therapy exclusively. Medication allows the brain to function more normally and allow abusers to leave behind the life of substance abuse and crime. There are pills that have been recommended for use during therapy, so as keep the individual relaxed during therapy. Though there have been reports of its efficiency, the use of medication exclusively has received control from the criminal justice system because the individuals can still abuse the same medication (Fletcher, Chandler and the Office of Science Policy and Communications, 2012). Discuss the efficacy of treating a substance disorder individually, treating a mental health disorder individually (depression, anxiety, schizophrenia, etc.) or treating both disorders together in a program that addresses both of these concerns in the CJS Individual drug counseling has demonstrated efficacy in treatment of substance abuse such as cocaine, but it is not a hundred percent effective. Within the field of substance abuse and mental disorder treatment, several kinds of treatment have been used. There are those who prefer to deal with the problems as separate entities and at the same time deal with the individuals specifically. Substance abuse and mental disorders are concurring disorders. In other words the two occur as a result of each other. Separating the two disorders when treating an individual, does not offer any assistance. Over the years, many social institutions have been created to respond to the needs in the society. Each society has found the need to create institutions that deal with people who cause disturbances be it by theft, assault, or drunkenness. During the colonial era in America, there were very few prisons and jails and there were no mental hospitals or drug treatment facilities. From the seventies, the mentally ill often turned to substance and alcohol abuse in attempts to self-medicate, survive, and fit in (Lessenger & Roper, 2007). This is what prompted the development of a national substance treatment system. Before that Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) were the primary resources for those seeking treatment. Because of the nature of criminal justice, mental health and substance abuse systems evolved separately and staffs became specialists in one particular area. Thus these three systems were not prepared to address the issues presented by an individual with criminal behavior, mental health issues, and substance abuse disorders. Gradually, substance abuse and mental health treatment fields have learnt to integrate treatment and work with the criminal justice system (Lessenger & Roper, 2007). In a study conducted by the National Co-Morbidity survey, it was found that 51% of the people with mental disorders also had experienced , or were currently experiencing substance abuse disorders (Lessenger & Roper, 2007). According to the study, 41% to 66% of the people with a substance use disorder experienced a mental disorder. This data clearly supported the theory that many people are dually disordered. It was also discovered that, the one mental disorder had one or more co- concurring disorders. In many cases, any substance abuse increases a person’s psychiatric symptoms. But the exact extent towards their influence differs greatly among many people. It is important to note that there is a risk that comes with continued substance abuse both towards a client and the community around him. Most people with mental health disorders often turn to alcohol and drugs to help them manage their mental conditions. It is important to identify the reasons for substance use in order to offer alternate solutions to the people. Thus, these are evidences showing that, the criminal justice system should make sure that substance and mental disorders should be treated together and not as separate entities for them to be efficient (Lessenger & Roper, 2007). A comprehensive treatment should be the solution to all the disorders. Most clients find it easier acknowledging the existence of one disorder and not more than one, and if he or she does accept it, it is with a lot of difficulties. According to Lessenger and Roper, therapists must use psycho-educational and feedback approaches to help clients recognize and accept the presence of all their disorders, in order to make treatment easy for themselves and the doctor (2007). Integrated treatment combines substance abuse and mental health disorders interventions in one clinical program. Since 1990, researchers have investigated long-term outcomes in integrated dual disorders treatment programs. The recent studies and treatment are more sophisticated. The integrated kind of treatment addresses two or more interwoven, chronic diseases; for example, persons with severe mental disorders such as schizophrenia and interventions for persons with substance use disorders (Drake, Mercer-McFadden, Mueser, McHugo & Bond, 1998). What does research state about the percentage of co-morbid or dual diagnoses in the CJS vs. individual substance disorders and mental health disorders? According to Hanson, Venturelli and Fleckenstein, co-morbidity has been used to refer to a situation where two or more illnesses or disorders occur in the same person (2012). For example, smoking and schizophrenia occurring simultaneously or sequentially are described as being co-morbid. Co-morbidity also implies interaction between the illnesses that affect the course and diagnoses of both. Mackenzie, ?O'Neill and Povitsky define dual diagnosis as “a mental illness diagnosis with a substance abuse diagnosis” (2010, p. 264). In the early nineties, clinicians and researchers discovered that high rates of substance abuse complicated the community adjustment of many young persons with severe mental disorders such as schizophrenia. High rates of substance use disorder are usually prevalent in crisis settings such as jails, hospitals, homeless shelters among others (Drake, Mercer-McFadden, Mueser, McHugo & Bond, 1998). Clinicians are of the argument that for patients with dual disorders, mental health treatment and substance abuse treatments should be brought together, so as to ensure that the patients receive coherent explanations of illness, as well as coherent prescriptions for treatment. This also eliminates the burden of the patient having to attend two separate programs that deal with different or separate disorders, and the financial and other related barriers that may inhibit the process of a patient getting well (Drake, Mercer-McFadden, Mueser, McHugo & Bond, 1998). Research shows that many regular drug abusers are potential patients that get to be diagnosed with mental or psychiatric disorders and at the same time, are usually caught on wrong side of the law; the vice versa of this is also true. The prevalence of this co-morbidity has been documented in multiple national population surveys since 1980. For example, it was discovered that persons suffering from anxiety and mood were also likely to suffer from drug use disorders and vice versa. Due to the overlapping between the two conditions, co-morbidity is present (Volkow, n.d.). The high prevalence of co-morbidity between drug use disorders and other mental illness does not mean one have caused the other, even though one is said to have appeared first. But the following should be put into consideration: Substance abuse or disorders can cause abusers to experience one or more symptoms of another mental illness. For example, a person who takes marijuana has most of the time been said to be suffering from psychosis (Volkow, n.d.). Mental disorders can lead a person to substance abuse. It has been discovered that many individuals suffering from subclinical disorders abuse drugs as a form of self-treatment. For example, those there are those who abuse tobacco products believe that tobacco lessens the symptoms of the disease and improves cognition (Volkow, n.d.). Both substance and mental disorders are caused by intertwined factors such as hidden deficits in the brain, genetic hazards, among other factors such as premature exposure to trauma and stress (Volkow, n.d.). Case study (Smoking and Schizophrenia) According to Volkow, based on nationally representative survey data, 41%of the respondents with past-month mental illnesses are current smokers (Volkow, n.d). This is about twice the rate of individuals without mental illnesses. In scientific samples, the rate of those patients smoking and with schizophrenia has risen to 90% (Volkow, n.d). There are various hypotheses that have been proposed to explain the relationship between the two. For example, tobacco has nicotine which has been argued to compensate for cognitive impairment produced by schizophrenia. Nicotine is also said to help patients deal with anxiety and social stigma of their disease. Such people are usually having problems with the law and most of them end up in jails and prisons. In conclusion, it is the responsibility of each nation to improve criminal justice, while integrating treatment of substance abuse and mental disorders within the system. There is therefore need for facilities and programs to help control the situation. Treating disorders separately has been found to be ineffective, thus no disorder should be treated individually. It is rare to find a person suffering from a mental illness without having substance abuse problems. The two disorders are co-concurrent, and therefore need to be treated together. Reference List. Drake, Robert E., Mercer-McFadden, C., Mueser, Kim T. McHugo, Gregory J &Bond, Gary R. (1998). Review of Integrated Mental Health and Substance Abuse Treatment for Patients with Dual Disorders. Schizophrenia Bulletin, vol. 24(4), 589-608. Retrieved October 7, 2013, from http://schizophreniabulletin.oxfordjournals.org/content/24/4/589.full.pdf Fletcher, Bennett W., Chandler, Redonna K. and the Office of Science Policy and Communications. (2012). Principles of Drug Abuse Treatment for Criminal Justice Populations. National Institute on Drug Abuse, 1-36. Retrieved October 7, 2013, from http://www.drugabuse.gov/sites/default/files/podat_cj_2012.pdf Goldsmith, Andrew. J & Israel, Mark. (2000). Criminal Justice in Diverse Communities. New South Wales: The Federation Press. Hanson, G., Venturelli, P. & Fleckenstein, A. (Eds.). (2012). Drugs and Society. Massachusetts: Jones & Bartlett Learning, LLC. Liddle, Howard A., Rodriguez, Rosemarie A., Dakof, Gayle A., Kanzki, E. & Marvel, Francoise A. (2005). Multidimensional Family Therapy (MDFT): An Effective Treatment for Adolescent Substance Abuse. In Jay L. Lebow (Eds.), Handbook of Clinical Family Therapy (pp. 128-163) . New Jersey: John Wiley & Sons, Inc. Lessenger, James E. &Roper, Glade F. (Eds.). (2007). Drug Courts: A New Approach to Treatment and Rehabilitation. New York: Springer Science + Business Media, LLC. MacKenzie, Doris L., O'Neill, L., Povitsky, W. & Acevedo, S. (2010). Different Crimes, Different Criminals: Understanding, Treating and Preventing Criminal Behavior. New Jersey: Matthew Bender & Company, Inc. Rich, P. (Eds.). (2011). Understanding, Assessing and Rehabilitating Juvenile Sexual Offenders. New Jersey: John Wiley & Sons. Volkow, Nora D. (n.d.). Comorbidity: Addiction and Other Mental Illness. National Institute on Drug Abuse. 1-11. Retrieved October 7, 2013, from http://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf. Read More