Considerations for Introducing SBIRT into a Jail Setting.
INTRODUCTION
Nearly all chronic substance users enter the criminal justice system at some time in their use career. Drug use is closely associated with crime, and its prevalence among offenders is high (MacCoun et al., 2003; Newcomb et al., 2001). Relapse to drug use tends to occur within the first few months of release from incarceration (Prendergast et al., 2003; Siegal et al., 2002), highlighting the importance of providing intervention options at the pre-release or reentry phase of the offender’s incarceration.
Relatively few offenders with substance use problems receive treatment. Using data from the Bureau of Justice Statistics, Belenko and Peugh (2005) reported that among state inmates classified as being at the most severe level of drug use, only 20% reported having received previous drug or alcohol treatment. Despite limited resources, many local criminal justice systems do provide some treatment options, including through drug courts. Such treatment is usually intended for those at high levels of severity (abuse, dependence). Although many offenders use drugs at less problematic levels, they are at risk of progressing to abuse or dependence or of engaging in unhealthy behavior. Interventions for offenders at low or moderate risk are largely lacking within the criminal justice system. Although drug-using offenders are mostly abstinent while incarcerated, when released from jail or prison, many of them resume previous patterns of drug and alcohol use, placing them at risk for rearrest and for increased health problems and HIV risk behaviors. Thus, there exists a need for interventions that will help drug-involved offenders either reduce risky behaviors or enter appropriate treatment. One promising approach is Screening, Brief Intervention, and Referral to Treatment (SBIRT).
SBIRT is an evidence-based practice that has been found to be both effective and cost-effective in reducing alcohol use and related problems in settings outside the criminal justice system. Research on SBIRT for illicit drug use has been limited, although findings are generally positive. SBIRT is an “opportunistic” intervention intended for individuals who are not actively seeking help for their drug use. SBIRT has become recognized as an evidence-based practice and has received considerable funding from the Substance Abuse and Mental Health Services Administration (SAMHSA; Madras et al., 2009). The Office of National Drug Control Policy (2013) has included SBIRT as a key intervention strategy in the National Drug Control Strategy.
Although it remains unclear whether SBIRT is effective in reducing drug use among inmates or offenders generally or in encouraging them to enter treatment, SBIRT is considered an evidence-based practice and is likely to be tried with inmates or offender populations even in the absence of strong evidence of its effectiveness with this population (for a discussion of implementing evidence-based practices in criminal justice settings generally, see Chandler et al., 2004; for experiences in implementing SBIRT with women in jail, see Begun et al., 2009). The purpose of this paper is to provide a discussion of factors that are important in considering whether and how to provide SBIRT to jail inmates. It is based on the experience of two studies of SBIRT with jail inmates in Los Angeles and on more than 15 years of experience in conducting research on treatment for offenders in a variety of settings.
