Upload
kaitlyn-purcell
View
219
Download
1
Tags:
Embed Size (px)
Citation preview
Keith HumphreysProfessor of Psychiatry, Stanford University
Visiting Professor of Psychiatry, King’s College LondonResearch Career Scientist, VA Health Care System
Presented at 2012 NDASG, Llandrindod Wells, Wales
Public Safety Threats Stemming from Alcohol/Drug UseStreet ViolenceDriving while ImpairedSpousal Battering and Child AbuseHome Invasion, Property TheftMass Transit AccidentsSubstandard or Reckless Medical
Practice
Criminologist James Q. Wilson’s analogy for howwe respond to criminal offenders
New paradigm
Traditional Paradigm New Paradigm
Make rules complex and covert Make rules simple and transparent
Assume long-term orientation in offender
Assume short-term orientation in offender
Punish unpredictably Punish with certainty
Punish harshly Punish proportionately
Punish slowly Punish swiftly
Use Imprisonment indiscriminantly Employ behavioral triage to reserve prison for appropriate offenders
Mandate treatment, hope for abstinence
Mandate abstinence, offer treatment
Exemplars of the New ParadigmPhysician Health Plans
HOPE Probation
24/7 Sobriety
Physician Health PlansRate of physician addiction equal to general
population
Historically, doctors could get away with it until an undeniable catastrophe occurred
PHPs designed to change this through intensive monitoring
Content of PHPCan temporarily or permanently remove license
Not treatment, though they arrange treatment
All conditions specified in a contract
Comprehensive, random drug and alcohol testing
Immediate, graduated reaction to positive test
Outcome Data on 802 Physicians over five years80.7% (n=647) completed all five years of
monitoring
Only 19.5% of completers had even a single positive test
Only 5.1% had more than one positive test
Over 60,000 tests done total, 99.5% negative
Source: McLellan et al. (2008) BMJ, 337, a2038.
The World of ProbationLow social capital offenders
More serious co-occurring problems
Overwhelmed staff
Unclear rules, inconsistent rewards and punishments
HOPE Probation for Drug-involved offenders in HawaiiAll probationers given full orientation to rules
and onus of responsibility placed on them
Dirty or missed random urinalysis results in prompt arrest and certain, modest punishment (brief jail stay)
Treatment offered by not required
Inexpensive because it reduces return to prison
Randomized evaluation of HOPEIncluded all probation officers, average
caseload 87 clients, average years of experience 4.3 years
493 Felony Probationers, average 17 prior arrests
Primary drug: Crystal meth
Major 1-year trial findings of HOPE versus usual probation
Source: Hawken, A., & Kleiman, M. A. R. (2009). Managing Drug Involved Probationers with Swift and Certain Sanctions: Evaluating Hawaii's HOPE. Report to National Institute of Justice, Washington, D.C.
Drink drivers in the U.S. Northern PlainsOver 10,000 Americans a year die in alcohol-
involved car accidents
The peak states are in the Northern Plains (e.g., Montana, North Dakota, South Dakota)
Typical penalties, e.g., license removal, widely ignored
A county prosecutor (Larry Long) decided to innovate
24/7 Sobriety for repeat drink drivers in South DakotaAll offenders get careful orientation to program
rules
Twice-daily breath testing or alcohol-sensing bracelet
Alcohol use or no show results in prompt arrest and certain, modest punishment (1 night in jail)
Nearly self-sustaining financially because offenders pay for own testing
Alcohol-Impaired Motor Vehicle Fatalities/Vehicle Miles Traveled
Source: U.S. National Highway Safety and Transportation Agency
Other key data points on 24/7
Over 99% of tests collected are negative
66% of offenders have perfect compliance
Recidivism rates less than half of non-24/7 offenders
In summary, all three programsGive offenders simple, transparent rules, which
encourages responsibility and a sense of fairness
Use swift, certain and modest consequences
Mandate abstinence for all, treatment or prison only as appropriate
Have evidence of effectiveness and of cost-effectiveness
Political ProcessCame to attention of Scottish VRU and
London Deputy Mayor
Attracted Cross-Party interest in Parliament
Passed as Amendment in House of Lords in March
Law of the England and Wales as of May 1
What does the success of these programmes tell us about drink problems?
The Role of Treatment in Problem Resolution
The Role of Self-Control in Drinking
Can’t versus Won’t versus It’s Hard
Thank you for your attention!