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. .
Return to NIH Guide Main Index
Office of Extramural Research (OER) |
National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892 |
Department of Health and Human Services (HHS) |
||||||||
Note: For help accessing PDF, RTF, MS Word, Excel, PowerPoint, Audio or Video files, see Help Downloading Files. |