Full Text PA-93-21

DRUG ABUSE TREATMENT OF CRIMINAL JUSTICE-INVOLVED POPULATIONS

NIH GUIDE, Volume 21, Number 42, November 20, 1992

PA NUMBER:  PA-93-21

P.T. 34

Keywords: 
  Drugs/Drug Abuse 
  Behavioral/Social Studies/Service 
  Community/Outreach Programs 


National Institute on Drug Abuse

PURPOSE

The purpose of this announcement is to encourage research on models of
intervention for drug abusers involved with the criminal justice system
(CJS).  Applications may focus on drug abuse treatment linked to the
criminal justice system that is delivered prior to or in lieu of
incarceration, during the period of incarceration, after release, or in
combinations of these.  Applications are also sought for
community-based outreach/intervention behavioral change strategies in
the population of criminal-justice-involved drug users not in
treatment.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of Healthy People 2000, a
PHS-led national activity for setting priority areas.  This program
announcement (PA), Drug Abuse Treatment of Criminal Justice-Involved
Populations, is related to the priority area of alcohol and other
drugs.  Some applications under this announcement may also be related
to the priority area of violent and abusive behavior.  Potential
applicants may obtain a copy of Healthy People 2000 (Full Report:
Stock No. 017-001-00474-0 or Summary Report:  Stock No.
017-001-00473-1) through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by foreign and domestic, for-profit and
non-profit, public and private organizations such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.  Women
and minority investigators are encouraged to apply.  Applications are
especially encouraged from State and municipal governments with
research units and/or State and municipal governments collaborating
with university-based research units.

MECHANISM OF SUPPORT

This program announcement will use the National Institutes of Health
(NIH) individual research grant (R01).  Responsibility for the
planning, direction, and execution of the proposed project will be
solely that of the applicant.  Support will be provided for a period of
up to five years (renewable for subsequent periods), subject to
continued availability of funds and progress achieved.  Because the
nature and scope of the research proposed in response to this program
announcement may vary, it is anticipated that the size of an award will
vary also.

RESEARCH OBJECTIVES

Summary

Carefully controlled research studies are sought to investigate the
effectiveness and cost-effectiveness of drug abuse treatment linked to
criminal justice system involvement and delivered (1) prior to or in
lieu of prosecution or incarceration; (2) in the jail or prison setting
during the period of incarceration; (3) after release or during
transition from incarceration to release; or (4) for combinations of
these.  Research studies to investigate community-based
outreach/intervention behavioral change strategies in the population of
criminal-justice-involved drug users not in treatment will be
supported.  Of particular interest are research projects in geographic
areas having a high or unmet need for drug treatment services in the
criminal justice-involved population.

Background

The passage of new anti-drug abuse legislation and the strengthening of
existing laws have increased the already high risks of arrest and
incarceration for users of illicit drugs.  Data from the NIJ Drug Use
Forecasting (DUF) program show high rates of drug use among arrestees
sampled for drug testing.  Between April and June 1989, for example,
percentages in 13 metropolitan sites ranged from 56 percent positive in
Phoenix to 84 percent positive in Philadelphia.  According to the 1990
National Drug Control Strategy, an estimated 50 percent of Federal and
nearly 80 percent of State prison inmates have had experience with
drugs.  Likewise, it is estimated that 90 percent of institutionalized
juvenile offenders are drug abusers.

Although involvement with the criminal justice system may be considered
a powerful intervention in its own right, high rates of recidivism by
drug offenders suggest that incarceration alone is not sufficient to
prevent post-release return to drug use and drug-related crime.
Significant barriers to drug abuse treatment often exist in the
criminal justice system, including lack of resources, institutional
conflicts between security demands and treatment needs, recruitment and
retention of drug offenders in treatment, and problems implementing
effective treatment protocols.  Courts have few objective or systematic
means to identify those most likely to benefit from treatment or the
specific treatment most likely to be effective. Nevertheless, faced
with court mandates to reduce overcrowding, high rates of recidivism,
and State budgets that are shrinking while drug-related criminal costs
are escalating, many in criminal justice and elsewhere have recognized
the need to intervene effectively to treat drug abusers in the criminal
justice system.

There is an extensive history linking drug abuse treatment and the
criminal justice system.  Legislation passed in the 1960s by Federal
and State governments to provide for civil commitment of addicts to
treatment met with varying degrees of success (Leukefeld and Tims,
1988).  The California Civil Addict Program (CAP), which coupled drug
abuse treatment with a period of intensive supervision, was one of the
more successful of these programs (McGlothlin et al., 1977).  A variety
of other programs, including diversionary, pre-trial/pre-sentencing
programs such as Treatment Alternatives to Street Crime (TASC; Cook et
al., 1988), jail- or prison-based programs, and treatment as a
condition of parole, have been implemented, many without rigorous
evaluation.

In general, research on CJS-involved drug abuse treatment clients
suggests that treatment is effective in reducing drug use and criminal
activity while the client is in treatment and for some time thereafter.
The Stay-n-Out program, a comparison of prison-based milieu and
therapeutic community treatment, found that inmates in treatment
between 9 and 12 months had the best outcomes (Wexler et al., 1988).
The Treatment Outcome Prospective Study (TOPS; Hubbard et al.,
1989:132-133) found that clients with criminal justice involvement were
retained longer in community-based treatment than those with no legal
involvement and reported less drug use in the year after treatment.
There is some evidence from TOPS that early intervention, such as the
compulsory treatment of juvenile offenders and others not heavily
invested in the drug/crime culture, may be particularly beneficial in
interrupting evolving drug using and criminal careers.

Program Description

Applicants are advised to review existing information relevant to drug
abuse treatment of CJS-involved populations and to design controlled
clinical studies to determine the impact of providing drug abuse
treatment to CJS-involved clients.  Areas of research interest include
the following:

General

o  Improvement of treatment outcomes for individuals under legal
sanction.

o  Joint effects of criminal justice sanctions and treatment.

o  Strategies to increase retention, improve participation in
treatment, and reduce relapse to drug use and recidivism to criminal
activity.

o  Effectiveness of drug abuse treatment intervention strategies for
the drug-abusing juvenile offender.

Pre-Incarceration

o  Characterization and assessment of criminal justice clients most
likely to benefit from drug abuse treatment.

o  The effectiveness of matching criminal justice clients to
appropriate treatment.

o  Effectiveness of treatment in lieu of prosecution/incarceration in
reducing drug use, reducing criminal behavior, and increasing
productive activities.

o  Effect of legal pressure on client treatment compliance and outcome
variables.  For example, does drug testing increase compliance with
treatment or improve outcomes?

Institution-Based

o  Effectiveness and cost-effectiveness of institution-based treatment
approaches, including effectiveness of treatment beyond the period of
incarceration, and strategies to maintain and increase treatment gains
after return to the community.

o  Increasing the effectiveness of treatment delivered early in an
individual's period of incarceration.

o  Overcoming barriers to implementation of effective treatment within
the institutional setting, and effect of institutional incentives and
disincentives on treatment outcomes.

o  Relationship of inmate characteristics and criminal backgrounds to
treatment compliance and outcomes.

Post-Incarceration

o  Improvement of the effectiveness of drug abuse treatment and
aftercare in halfway houses and similar transitional programs charged
with re-integrating former inmates into the community.

o  Effectiveness of treatment after release compared with non-treatment
alternatives such as intensive supervision and monitoring, parole
supervision, and release without supervision.

o  Treatment program and client factors which predict relapse to
illicit drug use and recidivism to drug-related criminal activity.

Community-Based

o  Community-based outreach/intervention behavior change strategies,
especially in out-of-treatment individuals, to reduce illicit drug use
and drug-related risks such as HIV, TB, STDs, and re-involvement in the
criminal justice system/process.

o  Efficacy of community-based outreach/intervention strategies to
improve health and to reduce drug use and criminal behavior among youth
and adults at different stages of involvement in the criminal justice
system/process.

The importance of a sound research plan and qualified research staff
cannot be over-emphasized.  It is recommended that investigators use
the most rigorous methodology consistent with the purposes of the
research.  If controlled trials are not feasible, other types of
controls may be used, including case controls, equivalent comparison
groups, regression-discontinuity, or other designs.  Although many
treatment or criminal justice agencies have a research department,
those who do not may wish to enter into collaboration with
well-qualified researchers.  All applications are strongly urged to
address issues of project feasibility and collaborative arrangements,
study design, sampling procedures, implementation of the intervention,
instrumentation and measurement, data collection, quality control,
tracking of clients, followup, and data analysis, as appropriate.

Investigators are encouraged to offer HIV testing and counseling in
accordance with current guidelines to subjects identified during the
course of the research as being at risk for HIV acquisition or
transmission.  In high risk populations, investigators are encouraged
to assess the effects of new interventions on the acquisition and
transmission of infectious diseases, including HIV.

STUDY POPULATIONS

NIH POLICY CONCERNING INCLUSION OF MINORITIES AND WOMEN AS SUBJECTS IN
RESEARCH

Applications for clinical research grants and cooperative agreements
that involve human subjects are required to include minorities and both
genders in study populations so that research findings can be of
benefit to all persons at risk of the disease, disorder, or condition
under study; special emphasis should be placed on the need for
inclusion of minorities and women in studies of diseases, disorders,
and conditions which disproportionately affect them.  This policy
applies to all research involving human subjects and human materials,
and applies to males and females of all ages.  If one gender and/or
minorities are excluded or are inadequately represented in this
research, particularly in proposed population-based studies, a clear
compelling rationale for exclusion or inadequate representation should
be provided.  The composition of the proposed study population must be
described in terms of gender and racial/ethnic group, together with a
rationale for its choice.  In addition, gender and racial/ethnic issues
should be addressed in developing a research design and sample size
appropriate for the scientific objectives of the study.

Applicants are urged to assess carefully the feasibility of including
the broadest possible representation of minority groups.  However, NIH
recognizes that it may not be feasible or appropriate in all research
projects to include representation of the full array of United States
racial/ethnic minority populations (i.e., American Indians or Alaskan
Natives, Asians or Pacific Islanders, Blacks, Hispanics).
Investigators must provide the rationale for studies on single minority
population groups.

Applications for support of research involving human subjects must
employ a study design with minority and/or gender representation (by
age distribution, risk factors, incidence/prevalence, etc.) appropriate
to the scientific objectives of the research.  It is not an automatic
requirement for the study design to provide statistical power to answer
the questions posed for men and women and racial/ethnic groups
separately; however, whenever there are scientific reasons to
anticipate differences between men and women, and racial/ethnic groups,
with regard to the hypothesis under investigation, applicants should
include an evaluation of these gender and minority group differences in
the proposed study.  If adequate inclusion of one gender and/or
minorities is impossible or inappropriate with respect to the purpose
of the only study population available, there is a disproportionate
representation of one gender or minority/majority group, the rationale
for the study population must be well explained and justified.

The NIH funding components will not make awards of grants, cooperative
agreements or contracts that do not comply with this policy.  For
research awards which are covered by this policy, awardees will report
annually on enrollment of women and men, and on the race and ethnicity
of subjects.

Human Subjects Protections for Research Involving Prisoners

Activities carried out under this announcement may be governed by DHHS
Regulations for the Protection of Human Research Subjects (45 CFR 46).
These regulations require awardees to establish procedures for the
protection of human subjects involved in any research activities.
Projects involving prisoners require special additional protections in
accordance with Subpart C of the DHHS regulations.

Prior to funding and upon request of the Office for Protection from
Research Risks (OPRR), prospective awardees not holding an
OPRR-approved Multiple Project Assurance must file a Single Project
Assurance with OPRR and establish or identify an Institutional Review
Board (IRB) to review and approve the procedures for carrying out any
human subjects research occurring in conjunction with this award.  A
formal request for the required Assurance will be issued by OPRR at an
appropriate point in the review process, and examples of required
materials will be supplied at that time.  However, applicants may wish
to contact OPRR (301-496-7041) to obtain preliminary guidance on human
subjects issues.  When calling OPRR, applicants should identify
themselves as having questions about research involving prisoners.

APPLICATION PROCEDURES

Applications are to be submitted on the grant application form PHS 398
(rev. 9/91) and will be accepted at the standard application deadlines
as indicated in the application kit.  The receipt dates for
applications for AIDS-related research are found in the PHS 398
instructions.

Application kits are available at most institutional offices of
sponsored research and may be obtained from the Office of Grant
Inquiries, Division of Research Grants, National Institutes of Health,
Westwood Building, Room 240, 5333 Westbard Avenue, Bethesda, Maryland
20892, telephone 301/496-7979).  The title and number of the
announcement must be typed in Section 2a on the face page of the
application.

The completed original and five permanent, legible copies of the PHS
398 form must be submitted to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

REVIEW PROCEDURES

Applications received under this announcement will be assigned to an
initial review group (IRG) in accordance with established PHS referral
guidelines.  The IRGs, consisting primarily of non-Federal scientific
and technical experts, will review the applications for scientific and
technical merit in accordance with the standard NIH peer review
procedures.  Notification of the review recommendations will be sent to
the applicant after the initial review.  Applications will receive a
second-level review by an appropriate National Advisory Council, whose
review may be based on policy considerations as well as scientific
merit.  Only applications recommended for further consideration by the
Council may be considered for funding.

AWARD CRITERIA

Applications recommended for further consideration by an appropriate
Advisory Council will be considered for funding on the basis of overall
scientific, clinical, and technical merit of the proposal as determined
by peer review, appropriateness of budget estimates, program needs and
balance, policy considerations, adequacy of provisions for the
protection of human subjects, and availability of funds.

INQUIRIES

Written and telephone inquiries are encouraged.  The opportunity to
clarify any issues or questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues related to treatment
research to:

Bennett W. Fletcher, Ph.D.
National Institute on Drug Abuse
5600 Fishers Lane, Room l0A-30
Rockville, MD  20857
Telephone:  (301) 443-4060

Direct inquiries regarding programmatic issues related to
community-based behavioral change research to:

Richard H. Needle, Ph.D., M.P.H.
National Institute on Drug Abuse
5600 Fishers Lane, Room 9A-30
Rockville, MD  20857
Telephone:  (301) 443-6720

Direct inquiries regarding fiscal matters to:

Ms. Shirley Ann Denney
Chief, Grants Management Branch
National Institute on Drug Abuse
5600 Fishers Lane, Room 8A-54
Rockville, MD  20857
Telephone:  (301) 443-6710

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance
No. 93.279.  Awards are made under authorization of the Public Health
Service Act, Sections 301 and 405, and administered under PHS policies
and Federal Regulations at Title 42 CFR 52, Grants for Research
Projects; Title 45 CFR Part 74 & 92, Administration of Grants; and 45
CFR Part 46, Protection of Human Subjects.  Title 42 CFR Part 2,
Confidentiality of Alcohol and Drug Abuse Patient Records, may also be
applicable to these awards.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or
Health Systems Agency review.

References

Cook, L.F., Weinman, B.A., et al.  Treatment Alternatives to Street
Crime.  In C.G. Leukefeld and F.M. Tims (eds.)  Compulsory treatment of
drug abuse: Research and clinical practice.  NIDA Research Monograph
86.  DHHS Pub. No. (ADM)88-1578.  Washington, DC:  U.S. Government
Printing Office, 1988.

Hubbard, R.L., Marsden, M.E., Rachal, J.V., Harwood, H.J., Cavanaugh,
E.R., and Ginzburg, H.M.  Drug abuse treatment:  A national study of
effectiveness.  Chapel Hill, NC:  University of North Carolina Press,
1989.

Leukefeld, C.G., and Tims, F.M. (Eds.).  Compulsory treatment of drug
abuse: Research and clinical practice.  NIDA Research Monograph 86.
DHHS Pub. No. (ADM)88-1578.  Washington, DC:  U.S. Government Printing
Office, 1988.

McGlothlin, W.H., Anglin, M.D., and Wilson, B.D.  Evaluation of the
California Civil Addict Program.  NIDA Services Research Monograph
Series, DHEW Pub. No. (ADM) 78-558.  Washington, DC: Superintendent of
Documents, U.S. Government Printing Office, 1977.

Wexler, H.K., Falkin, G.P., Lipton, D.S., Rosenblum, A.B., and Goodloe,
L.P. A model for prison-based drug treatment:  An evaluation of the
"Stay'n Out" therapeutic community.  (Final Report, NIDA Research Grant
R18 DA03310.)  NY:  Narcotic and Drug Research, Inc., 1988.

.

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