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The United States is currently experiencing a major resurgence of interest, initially identified as early as 1914 in dealing with drug addicts and criminal behavior especially the intervention of mechanisms treatment, rehabilitation, and integration.
One of the major problems with any treatment and rehabilitation program is measuring its effectiveness. There are no identified solutions that are generally integrated into programs. Also, one has to understand that we are dealing with individuals from a population group having relatively high levels of both social and personal instability. Related to this is the over-arching problem of motivating this distinct population to become socially integrated as non-deviant/non-criminal/mainstream members of society. What kind of services would be acceptable and effective for rehabilitants to counterbalance the existing skewness of drug addicts?
The gathering of data on a national level with specific inform'. ation on current addicts such as age, sex, race, prior criminal offense details, and length of sentence if any (including components of rehabilitation) would be helpful in the development of an effective treatment plan for the addict. What are the differing characteristics of a successful versus unsuccessful réhabilitant? This kind of analogy would add new insight to the existing dilemmas of addiction/treatment/rehabilitation.
This project was funded by the 1995-96 "State University of New York Faculty Research on the North Country Program."
This study departs from typical social scientific research that focuses on urban drug programs, often with a narrow view using simple variables such as demographic characteristics of the addicts, the communities they represent, and their criminal behavior. The existing literature on drug abuse, prevention, and treatment policies generally reflects and revolves around urban social structure. The reason for this central focus on urban social structure and related demographic characteristics appears to be due to the easy access to these data which are conducive to simple statistical analyses.
This study focuses on addicts from urban settings who enter drug and alcohol rehabilitation programs in rural areas. Relocation for treatment is considered a useful mechanism as it removes the addict from the social setting where the addiction initiated. However, those relocated post-rehabilitation clients choosing to remain in relocated rural communities face major social integration issues due to the lack of 1) population (heterogeneity), 2) support facilities, and 3) programs other than 12-step programs such as Alcohol Anonymous (AA) and/or Narcotics Anonymous (NA). At present, social service agencies are providing some of these services for this population; however, they are minimal at best.
The objectives of this research project are to 1) explore how this post-rehabilitation population attempts to integrate into the community, assuming they choose to remain in the rural community after successful completion of the rehabilitation program; 2) compilation of a needs assessment for this post-rehabilitation population, and 3) presentation of alternatives to deal with this transition and integration.
In this project, the definition of drug abuse is: "Illicit drug use that results in social, economic, psychological, or legal problems for the user" (U.S. Department of Justice, NCJ-133652, 1992, p. 20). Rehabilitation refers to treating an individual whose substance violations/criminal behaviors have been identified as wrong doings.
The National Household Survey on Drug Abuse has shown that 1) males are more likely than females to have used drugs in the past month, and 2) those ages 18 to 25 are most likely to have used drugs in the past month (U.S. Department of Justice, NCJ133652, 1992, p. 28). In terms of race and drug use, whites appear to represent higher percentages for the four types of drugs examined (heroin, cocaine, crack cocaine and marijuana), contrary to most of the seminal works in criminology, deviance, and corrections. The following table reveals these common characteristics,
Drugs and Social Policy
As early as 1914, narcotic usage was viewed as an illegal activity in this country. Historically those administering criminal justice played an influential role in identifying, adjudicating, incarcerating, and rehabilitating the addict. This is still the case.
Attempts at treatment/rehabilitation invariably focus on minimizing the elements of client criminality. At the same time, general societal goals reflecting community norms should be introduced as part of the rehabilitation program. Since these programs are publicly funded, addict's rehabilitation should in some manner enhance the stability of the community.
There are significant differences in the philosophical orientation of correctional and health services programs/personnel. However, there are also some significant similarities between the two, such as introducing effective intervention mechanisms whereby the addict becomes a useful member of the community. Thus maintenance and free exchange of information regarding the addict throughout the duration of rehabilitation would be in the best interest of all involved.
Another important dimension of rehabilitation is the provision for some after-care supervision or guidance. The existing literature indicates that there is currently no provision for after-care in any treatment modality. After-care's focus is mainly on the elements of the addict's re-entry into the community. Weissman and George (1982, p. 177) rightly point out that "Drug abuse treatment may eliminate the addict's need for drugs, but it cannot prepare him adequately for survival in a complex world whose values are unfamiliar and for which he has not been socialized."
Based on the above argument, one can cautiously state that the lack of the post-rehabilitative component might be a factor for the (so-called) rehabilitated addict falling into the trap of previous and new criminal activities. Winick (1957, p. 26) argues that the ex-addict returns to his home under difficult circumstances: "He has no money and is back in the same community which helped to spawn his addiction, with the additional handicap of being known as a former addict. Employers are often worried about hiring a person who has been an addict, and since he is often unskilled to begin with, his legitimate employment is likely to be difficult. His family situation is likely to have been strained by his long absence. Social agencies are often reluctant to help the former addict in his attempt at rehabilitation, especially in the vocational retraining which he is likely to need. His non-addict friends may be suspicious of him, and his addict friends may be all too available."
These types of concerns influenced Congress to pass the 1965 Narcotic Addict Rehabilitation Act, which emphasized that after-care should be provided to all addicts who were committed to treatment facilities. However, one of the major problems is the effectiveness of this after-care supervision. Peterson's (1974, p. 159) exhaustive research led him to conclude that" it means that compulsory treatment of the narcotic addict in the community, whether in a parole, probation or halfway house setting, is less than successful. None of these treatment modalities is dramatically effective in improving the adjustment of the addict patients in these settings. Further, it is not established in existing studies that compulsory or authoritarian supervision in the community is more effective than other treatment modes."
The above conclusion raises some critical questions regarding rehabilitation as well as the integration of the addict. Is there any social mechanism through which we can introduce individual client/ addicts to "successful adjustment" programs? What is the time-frame requirement in determining the outcome of rehabilitation?
Identifying Addicts
National Institute on Drug Abuse data indicate that involuntary admissions represent only 14 percent of drug treatment clients. Also, experienced administrators estimate that over two-thirds of the clients enter treatment/ rehabilitation facilities as a result of legal system coercion. It is evident from these data that the client/rehabilitant is involved with two distinct systems: 1) the criminal justice system, and 2) the health care delivery system. Thus it would be ideal for both systems to coordinate the information on aspects of the client's rehabilitation and integration. One should also realize that unless clients are free of pathology and/or criminal behavior, they are not completely rehabilitated. Thus, for any rehabilitation program to work effectively, the rehabilitation agencies must coordinate closely with the criminal justice system (Newman 1982, p. 161).
As indicated above, drug abuse is consistently perceived by the public as a major problem in our society. This perception can be related to the public's fears associated with violent criminal acts often committed by addicts. These acts can range anywhere from simple robbery, to theft or even murder. Similar perceptions are fostered by the media, both print and electronic.
Social Policy Interventions — Historical Analyses
Most literature indicates that there are no simple solutions for the problems associated with illicit drug use/addiction. The main focus is on supply and demand which are complex issues. The retail value of illegal drugs sold in the United States in 1990 has been estimated at over forty billion dollars (Office of National Drug Policy, 1991). From this estimate it is quite evident that a large number of drug abusers and addicts are in need of treatment/rehabilitation. Various control strategies have been introduced by the federal government, as early as 1973. Between 1973 and 1984 the federal strategy focused on 1) reducing drug abuse, 2) consequences of use, and 3) identifying drugs that cause the greatest harm to society (such as increased rates of violence and other criminal activities). Also, since 1977 various federal departments have been initiated to deal with the increasing availability of drugs at both local and international levels. By 1989-1990 new strategies were introduced identifying seven national priority areas:
1) criminal justice system initiative;
2) drug abuse treatment, prevention, and control;
3) education, community action, and the workplace;
4) international initiatives;
5) interdiction of illegal drugs at the southwest border;
6) research; and
7) integration of intelligence and information management.
(U.S. Department ofJustice, NCJ-133652, 1992, p. 89.)
These priorities/strategies indicate the need for concerted efforts by various social and medical scientists to monitor and introduce control mechanisms. Thus, the urgency is dealing with illicit drug trafficking from international dealers through local dealers.
The first large-scale project that examined drug and alcohol treatment in the United States was the Drug Abuse Reporting Program (DARP) with emphasis placed on urban areas. This study was conducted during 1969-73 in which 23 treatment programs were followed for 12 years. The major conclusion was that treatment can be effective in reducing drug use patterns and associated behaviors of opium users in urban areas of
the United States.
The second large-scale drug and alcohol treatment study was the Treatment Outcome Perspective Study (TOPS). This study followed 11,000 drug abusers who entered treatment from 1979 to 1981 in forty-one outpatient treatment programs. This study's major conclusion was that methadone treatment is effective for those who remain in treatment. However, further research would be useful to address the issue of methadone dependence/treatment. This project was also urban-centered (Hubbard, et. al., 1989).
Skolnick and Currie (1994) argue that current drug problems have two distinct dimensions: 1) abuse and addiction of legal and illegal drugs, and 2) the crime and violence associated with illegal drug sale and use. The federal administration has introduced stringent law enforcement regulations which have had minimal impact on these issues/ problems. On the contrary, there has been an increase in street violence as well as arrest rates. These regulations have failed to address the social and economic underpinnings of drug marketing and the use in the United States. The authors acknowledge the complexity of both the problem and solution for drug abuse in the United States. They emphasize the necessity for a sharp reversal in current thinking patterns, "from a perspective centered on moral failure to a broader and more complex etiology highlighting public health and underlying social issues."
An example of a radical change which is aimed at producing some new insights, as directed by Dr. Andrew Mecca, Director of California's Department of Alcohol and Drug Programs, is allocating 50 percent of a one billion dollar budget to enforcement, and 50 percent for treatment and prevention (including post-rehabilitative measures). On the contrary, at the national level with a budget of $13 billion, nearly two-thirds of the budget is allocated to interdiction and law enforcement. Only one-third is earmarked for prevention and treatment. We should critically evaluate this budget allocation/distribution if we are concerned about the various prevention, treatment, and rehabilitation programs. Also, one has to understand that as more emphasis is placed on law enforcement, there will be more arrests/punishment for even simple/minor drug offenses (Skolnick and Currie, 1994).
Thus, in the recent past, general concern has been raised regarding the need for providing some monitoring of rehabilitants in the community after release from an institutional program. Some research clearly emphasizes that a major drawback of institutional programs (hospitals, prisons, etc.) is their failure to provide opportunities for the client's post-treatment care following completion of their treatment/ rehabilitation program and release to the community (Peterson, 1974).
The existing literature does not demonstrate a strong positive relationship between drug addiction and continued participation in criminality after treatment or rehabilitation. However, the literature does point out that the above relationship is a complicated phenomenon. Hence further research is necessary to understand this relationship.
Future Research
Smart et. al. (1990-91) indicate that a major challenge to the existing drug policy agenda is to develop additional research, exploring alternatives such as: Can we introduce "less punitive models than those of criminal controls and prohibition?" Or, can we provide other alternatives since the legal coercion mechanisms have not effectively dealt with criminal deterrence?
In terms of prevention, the scientific community has to define what it is trying to prevent. Is it the addiction, the criminal behavior, or related personal, family and social problems. The issue at hand is to develop effective intervention mechanisms. How can we generate this broad spectrum of information in order to develop any kind of intervention/ treatment or rehabilitation plan for the addict?
tating these people" (Corrections Today, 1993, p. 143). Thus we must analyze post-rehabilitation if we are to develop effective programs to integrate addicts into community/society. •
Regarding the treatment question, there should be a component for evaluating the effectiveness of treatment or rehabilitation. Can we effectively introduce a concerted effort by health care professionals (including counselors, etc.) as well as correctional system personnel? Thus, a diligent argument can be made that there is a need for reorienting programs in the field of drug abuse addiction, treatment and rehabilitation by involving all related scientists.
Proposed Research
The focus of this project is to integrate some of the above-discussed facets by interviewing clients from urban New York areas, as far away as New York City, who are undergoing drug and alcohol treatment/rehabilitation in facilities located in rural northern New York. A questionnaire will be utilized. The target population will be those who choose to remain in rural New York following their discharge. This proposed research includes: 1) ascertaining the clients' level of satisfaction in terms of going through the said treatment/rehabilitation program, including how they plan to attempt integration in the community after completion of the program; 2) the compilation of a needs assessment for post-rehabilitation as expressed by the subject population; 3) development of proposed alternatives to deal with' this transitional phase (such as establishment of a "resource center"); and 4) tracking relocated rehabilitants for two to five years who can then add their evaluation of the effectiveness of the treatment/rehabilitation/relocation programs and propose changes that might enhance their effectiveness.
Conclusion
A cautious argument can be made that treatment and rehabilitation philosophies from the 1960s through the present remain rather ambiguous. Political leaders, policy-makers, related professionals associated with the field of treatment and rehabilitation and various citizen advocacy groups all tend to emphasize the need for the existing correctional and health care institutions to provide more rehabilitative programs for drug addicts (Inciardi, 1993). Similar themes are reiterated by past and present presidents and attorney generals of the United States. In a 1993 media interview, United States Attorney General Janet Reno noted: "We've got to lock the bad guys up, but some 80 percent that clog our jails and prisons are drug offenders. We've got to start talking about rehabili-
Korni Swaroop Kumar Sociology Department, State University of New York, 44 Pierrepont, Potsdam, NY 13676; Shari L. Gibson, director, Church & Community Service; and Randy Widrick, job placement counselor
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