GROUP 1: Brenda Owe, Happiness Mukora, Gertrude Nawire, Ruth Zipporah Njeri

LEGAL INITIATIVES DEALING WITH DRUG ADDICTION

Our laws often still fail to distinguish between general criminal activity and crimes motivated
by or directly related to drug and alcohol abuse — especially non-violent crimes such as
possession and DUI. These laws treat violent criminals and people who use drugs exactly
the same way. It’s not surprising that we’re seeing soaring incarceration rates for addicts
(who have less than a 25% chance of getting proper treatment in prison) and little effort to
combat the underlying challenges fueling the core addiction that leads to these illicit
behaviors.

Legal issues are a common barrier to treatment and a primary cause of “against medical
advice” (AMA) discharges from private rehabs. The result is an unstable patient population
that resists commitment to long-term treatment due to the fear of legal repercussions.

In dealing with drug abusers who are criminal justice offenders, many clinicians and service
providers support a public health perspective, contending that clients are best served through
a focus on treatment, with only minimal involvement of the criminal justice system.
They sometimes find themselves at odds with public safety proponents who say that criminal
offenders require constant supervision to succeed. Both views are valid, but neither is
adequate in itself. Research has shown that neither the pure public safety nor an exclusively
public health approach to the problem works fully; instead, it supports an integrated approach
that has very specific implications for best practices.

The most effective models integrate criminal justice and drug treatment systems and services.
Treatment and criminal justice personnel work together on treatment planning, monitoring,
and supervision, as well as on the systematic use of sanctions and rewards. Treatment for
incarcerated drug abusers should include continuing care, monitoring, and supervision after
incarceration and during parole.

4 core attributes contributing to the success of integrated programs:

 They provide treatment in the community – for sustained reduction in drug use and
rates of recidivism, clients practice their new skills in the context of social support.
Incarceration, on the other hand, removes the individual from a supportive environment.
 Opportunity to avoid incarceration or a criminal record - Treatment completion and
drug abstinence are reinforced by removal of criminal justice sanctions, and clients can
avoid the debilitating stigma of a criminal record.
 Clients are closely supervised to ensure compliance - random weekly urinalyses, status
hearings with criminal justice authorities, and monitoring of official re-arrest records.
Clinicians provide regular progress reports to supervising authorities and may provide
testimony at status hearings. As a result, clients are less apt to drop out of the system
through inattention and cannot exploit gaps in communication
 The consequences for noncompliance are certain and immediate - Termination for
non-compliance or new infractions automatically results in a criminal conviction and
criminal disposition
Initiatives:

1. Publicly Funded Drug Courts

Drug courts are separate criminal court dockets that provide judicially supervised
treatment and case-management services for drug offenders in lieu of prosecution or
incarceration. The core components of a drug court typically include regular status
hearings in court, random weekly urinalyses, mandatory completion of a prescribed
regimen of substance abuse treatment, progressive negative sanctions for program
infractions, and rewards for program accomplishments.

Example of USA: In drug courts, police, judges and prosecutors work with attorneys
and treatment specialists to help addicts facing criminal charges get help, rather than a
criminal charge and prison time. The model removes addicts from the criminal court
system and instead requires them to complete group counseling and undergo
mandatory drug testing. Drug courts are generally a more effective option for people
with drug-related criminal issues than standard criminal prosecution.

Examples of negative sanctions include verbal reprimands by the judge, writing

assignments, and brief intervals of detention. However, depending on the severity, persistent
non-compliance or new infractions can lead in criminal convictions

Common examples of rewards include verbal praise, token gifts, and graduation certificates.
Counseling requirements may also appropriately be decreased when the client complies well
with treatment or increased if he or she has poor attendance or participation or other
problems. Clients who satisfactorily complete the program may have their current criminal
charges dropped or may be sentenced to time served in the drug court program

2. Incarceration-based therapeutic communities (TCs)

These are separate residential drug treatment programs in prisons or jails for treating
substance-abusing and addicted offenders. The defining feature of TCs is the emphasis on
participation by all members of the program in the overall goal of reducing substance
use and recidivism.

The TC theory proposes that recovery from substance abuse involves rehabilitation to learn
healthy behaviors and habilitation to integrate those healthy behaviors into a routine (NIDA
2015). TCs differ from other models of treatment by their focus on recovery, overall
lifestyle changes, and the use of the “community” as the key instrument for that change.

3 treatment stages of TCs:

1) induction and early treatment – introduction to rules, procedures, staff and community
members
2) primary treatment – e.g., CBT, motivational interviewing
3) re-entry - prepares the residents for their transition from the program and includes
aftercare services.

- Residents of TCs are housed separately from other inmates in order to establish
and maintain a drug-free, rehabilitative, prosocial environment.
- Residents must follow strict community rules and norms, reinforced with set
rewards or punishments, as a way to facilitate self-control and responsibility.
Routines are established to teach goal planning and accountability.
- Residents must participate in TC-related roles, as assigned, based on a hierarchy
of increasing responsibilities and privileges.
- Residents must also participate in TC-related activities such as community
meetings, individual and group counseling, games, and chores and jobs for
maintaining the community and its daily operations.
- All activities, aside from individual counseling, occur in group formats.

3. Controlling the supply/availability/selling of drugs

- Corruption (mostly at the port) – both large- and small-scale

- Don’t ask for IDs to ensure the sale of alcohol isn’t to underaged people. Fake IDs
being produced
- Step in the right direction  Restricting time  implementing time restrictions
during which bars can serve alcohol
- E.g., local brew readily available
- Step in the right direction  restriction of selling codeine without doctor’s
prescription
- Mombasa  high rate of drug use, particularly heroin
- Police are part of the problem  distribution of drugs

4. Medically Assisted Treatment: Effective But Requires Medical Professionals

Diverting nonviolent offenders to treatment

Due to the intense way the human body reacts to drugs, successfully treating drug
addiction often requires medically assisted treatment, or MAT. MAT involves
administering FDA-approved medications that alleviate withdrawal symptoms — such
as disulfiram (Antabuse), methadone, acamprosate, and naltrexone — alongside
holistic treatment such as counseling and behavioral therapies.

Challenges –
- Gaining access to proper treatment through publicly funded options is particularly
tricky for addicts. Drug courts aren’t required to administer MAT to drug addicts.
 - One of the most significant issues with MAT clinics is that they emphasize the
“medical” aspect over the “treatment” aspect. With limited resources, these clinics
are more likely to hand out medication to alleviate addicts’ withdrawal symptoms
than provide addicts with the counseling and support that increase the chances of
addiction recovery.
- Expecting heavily addicted users to quit cold turkey creates a potentially deadly
cycle of relapse into both drug use and criminal behavior.
- The consequences of administering MAT without proper support can be severe.
Ideally, the decision to use any type of MAT should be made by a medical
professional who has direct knowledge of and interaction with the individual
patient. E.g., Use of counsellors, psychologists, psychiatrists at prisons

5. Stipulating treatment as a condition of incarceration, probation, or pretrial release

- Need for guaranteed access to adequate addiction treatment at all stages. Prisoners,
while incarcerated should have access to treatment for their addiction while in
prison. Initiating drug abuse treatment in prison and continuing it upon release is vital
to both individual recovery and to public health and safety. Various studies have
shown that combining prison- and community-based treatment for addicted offenders
reduces the risk of both recidivism to drug-related criminal behavior and relapse to
drug use—which, in turn, nets huge savings in societal costs. A 2009 study in
Baltimore, Maryland, for example, found that opioid-addicted prisoners who started
methadone treatment (along with counseling) in prison and then continued it after
release had better outcomes (reduced drug use and criminal activity) than those who
only received counseling while in prison or those who only started methadone
treatment after their release.
- Treatment can be mandated as a condition for probation, or conditional release.
But what happens when offenders don’t meet these requirements?

Challenge - The stakes are only heightened if probation terms require addicts to get and
stay clean. For example, addicts can be sent to jail if they test positive for drug use while
on probation—marking them a criminal just for struggling with their disease. Yet those
same people are not guaranteed access to adequate addiction treatment.

CONCLUSION – THE ROLE OF NACADA

Mission statement: “To lead and coordinate the fight against alcohol and drug abuse
through prevention, advocacy, policy development, research, treatment and rehabilitation
programmes, and execution of relevant statutes in Kenya.”
- NACADA also contributes towards supply suppression. The aim of supply
suppression measures is to control, limit or otherwise curtail access to intoxicating
substances by the general public especially the vulnerable populations.
- It involves formulation, enactment and enforcement of policy, legislation and other
measures to control the production, trafficking and sale of alcohol and intoxicating
drugs