Treatment can be critical in reducing addiction-related crimes and overdoses. In the US, however, some do not receive treatment until interfacing with the legal system. This study examined the feasibility of a pre-arrest diversion program designed to refer people to treatment in lieu of arrest and prosecution.
l
There is an association between addiction and criminal activity– estimates of substance use disorder prevalence among jail inmates has been as high as 63%. Law enforcement officers often encounter individuals with substance use disorders engaging in drug use-related crime (e.g., theft, drug possession and/or overdose). This is problematic as involvement with the criminal justice system may further marginalize those with substance use disorders (i.e., having a criminal record restricts employment and housing opportunities), limiting recovery capital, and ultimately making it more difficult to initiate and sustain recovery. Financially, the use of law-enforcement as first-responders to substance use related medical consequences like overdose has resulted in an estimated economic burden of over $19 billion and counting. There is a need to develop and test programs which divert those with substance use disorders away from the criminal justice system and into treatment. To this end, the present study examined perspectives of multiple stakeholders – law enforcement, program staff, and participants – in a pre-arrest diversion program designed to link non-violent drug-use related offenders to substance use treatment instead of arrest or prosecution.
This was a feasibility study to evaluate how well a pre-arrest diversion program, the Madison Addiction Recovery Initiative (MARI), was implemented and the corresponding experiences of program stakeholders. The goals of this program were to reduce crime and improve health (i.e., reduce overdose deaths) among adults who committed minor, non- violent, drug use-related offense by offering them a referral to treatment instead of arrest and prosecution of criminal charges.
The MARI process was as follows: at the time of arrest, police officers would discuss the program with potential participants. Officers would then assess potential participants for eligibility (see below) and provide informed consent to interested individuals. Officers would provide eligible individuals with the referral form to the MARI Assessment Hub, a local certified addiction treatment program. Participants had 3 business days to contact the MARI Assessment Hub. At the MARI Assessment Hub, participants were assessed by study staff for substance use disorders and received treatment (e.g., peer support and recovery coaching). MARI participants were not initially arrested/charged- official charges were not documented and were held in abeyance through the duration of the MARI program. If participants completed the program all charges were voided. Those who did not complete MARI had their formal arrest charges referred to the District/City Attorney’s Offices at the time they left the program. Although total abstinence was the goal of this program it was not required- participants were not removed from the program for a single recurrence of use.
To be referred to MARI, potential participants had to: 1) be adults (18 years old or older), 2) reside in Dane County, and 3) have committed an “eligible” non-violent, drug use-related crime (excluding alcohol only). Eligible nonviolent crimes included: a) possession of narcotics / drugs or drug paraphernalia (for personal use only), b) prostitution, c) retail theft, theft from auto without property damage, or burglary / theft from family members who are agreeable to not pressing charges, or e) drug overdose. Participants were excluded from the MARI program if they 1) did not reside in Dane County, 2) had an active warrant for their arrest, 3) were a registered sex offender, 4) were on parole/probation supervision, 5) had committed a violent crime in the past 3 years, or 6) were a danger to the program staff members.
The goal of the study was to determine how feasible the MARI program was to implement in the community. To test this, the present study encompassed both formative and process evaluations. The formative evaluation assessed how the program was developed over time and how well the final program was implemented in the community. The goal of this evaluation was to identify the facilitators, barriers, and steps taken to overcome identified barriers to program implementation. Data for this evaluation were derived from key interviews with stakeholders and surveys. The authors also engaged in process evaluation to determine participant engagement with MARI and participant and police officers’ engagement with the program. Surveys were sent at multiple time points throughout the study to gauge program attitudes and its perceived efficacy. Police officers were surveyed twice: the first survey was distributed to police officers 1 year post-MARI implementation and the second survey was distributed towards the end of the entire MARI program. Surveys were sent to MARI participants immediately after completing the 6-month program. Staff (i.e., at the assessment hub) completed a 12-item survey as the entire program ended in 2021. Results of these assessments consisted of descriptive statistics of survey data and thematic analysis of qualitative data.
The MARI program was implemented between September 2017-August 2021 in Dane county Wisconsin. A total of 349 adults were referred to the MARI program, of which 263 were eligible to participate. Most participants (92%) were referred to MARI due to drug overdose related crimes. Eligible participants were on average 35 years old, White (79.8%) men (63.1%).
There was a large drop off between referral to and engagement with program
A total of 263 people were eligible to participate, but of these only 160 (60.8%) went to the initial evaluation. Of these 100 (62.5%) completed the MARI program (i.e., completed substance use treatment and did not re-offend for at least 6 months post-referral).
The referral process was identified as a barrier to treatment engagement
Through interim program evaluation, team members determined that the participant-directed referral process was leading to program drop-off. This was partially due to some participants not remembering/understanding that they were required to contact the participating program “hub”. This was possibly due to some referrals occurring during overdose-related events. It was also found that some participants lacked the means to reach treatment. To rectify this, additional funds were secured for bus passes and cell phones to be distributed to a sub-set of participants to ensure they initiated treatment.
The program was considered feasible and was perceived as beneficial by participants and community stakeholders
Most police officers involved with the MARI did not complete either the first (100 [21.7%]) or second survey (193 [41.9%]). Most police officers that completed their survey (97.9%) reported being somewhat or very familiar with the program and 46.1% considered eligibility of MARI when interacting with people. All program staff surveyed believed the program had some effect. Among the 100 who completed the program, 68 completed an end-program survey. Of those, 62 (91.2%) planned to continue treatment, 63 (92.6%) rated the program good to very good, and 51 (75%) reported positive change.
The results of this study suggest that an arrest-diversion program may be a feasible strategy for getting individuals who commit drug-related crime the help they need. A total of 100 people committing drug related offenses (e.g., theft) were successfully referred to and completed drug treatment program via the MARI program. Most of these participants who also provided follow-up data reported that they were positively impacted by the arrest-diversion program and planned to continue treatment. In addition, reports from key stakeholders suggest that the program was successfully implemented and beneficial. Also, most police officers who completed a survey indicated awareness of the MARI program and almost half responded that they considered MARI eligibility during investigations. Furthermore, sampled program staff involved with the MARI program stated that the program assisted with participants pursuing recovery. Of note, however, those with an existing criminal record could not be referred to the MARI program and thus were not included in this study. Whether similar findings would apply to an arrest-diversion program for individuals who had previously been involved in the criminal justice system (e.g., those with longer histories of severe substance use disorder) is unclear.
Taken together, these results suggest that arrest-diversion programs like the MARI program may help link individuals with substance use disorder to treatment and recovery support services if they encounter the criminal justice system. However, it also seems that there is room for improvement regarding referral methods of such programs to better engage and retain participants in care. In the present study, once participants were referred to the MARI program by police officers it was the participants’ responsibility to go to the program hub for an initial assessment. This initial “cold handoff” between the criminal justice system and MARI staff resulted in a precipitous drop between the number of participants referred to care and the number that initiated treatment. This was likely due to multiple factors including participant misunderstanding of MARI procedures and/or lack of resources (e.g., transportation). Future efforts may do well to use a cascade of care framework to address how best to bridge gaps between need for care and receipt of care.
An arrest-diversion program may be feasibly implemented to link those who commit drug-related non-violent offenses to substance use disorder treatment and recovery support services. However, those who provided data may have had especially positive experiences with the program, so it is difficult to know how the program was perceived more generally. Furthermore, there was a significant drop-off at each inflection point. Nevertheless, the data suggest that police officers were aware of the program and implemented screening when appropriate in support of MARI implementation. In addition, stakeholders felt the program was useful both for participants and in the community more generally. Additionally those who competed the MARI program planned on continuing treatment and felt the program had benefitted them. More research is needed to better understand the efficacy of arrest-diversion programs like the MARI, the goals of which are to link those in need of substance use disorder treatment to care instead of arresting them. Ultimately research can help determine whether programs like these prevent individuals with substance use disorder who are arrested from deleterious cycles through the criminal justice system and promoting public health.
Zhang, A., Balles, J. A., Henningfield, M. F., Nyland, J. E., Nguyen, T. H., & Zgierska, A. E. (2024). Offering recovery rather than punishment: Implementation of a law enforcement–led pre-arrest diversion-to-treatment program for adults with substance use disorders. Journal of Substance Use and Addiction Treatment, 159, 209274. doi: 10.1016/j.josat.2023.209274
l
There is an association between addiction and criminal activity– estimates of substance use disorder prevalence among jail inmates has been as high as 63%. Law enforcement officers often encounter individuals with substance use disorders engaging in drug use-related crime (e.g., theft, drug possession and/or overdose). This is problematic as involvement with the criminal justice system may further marginalize those with substance use disorders (i.e., having a criminal record restricts employment and housing opportunities), limiting recovery capital, and ultimately making it more difficult to initiate and sustain recovery. Financially, the use of law-enforcement as first-responders to substance use related medical consequences like overdose has resulted in an estimated economic burden of over $19 billion and counting. There is a need to develop and test programs which divert those with substance use disorders away from the criminal justice system and into treatment. To this end, the present study examined perspectives of multiple stakeholders – law enforcement, program staff, and participants – in a pre-arrest diversion program designed to link non-violent drug-use related offenders to substance use treatment instead of arrest or prosecution.
This was a feasibility study to evaluate how well a pre-arrest diversion program, the Madison Addiction Recovery Initiative (MARI), was implemented and the corresponding experiences of program stakeholders. The goals of this program were to reduce crime and improve health (i.e., reduce overdose deaths) among adults who committed minor, non- violent, drug use-related offense by offering them a referral to treatment instead of arrest and prosecution of criminal charges.
The MARI process was as follows: at the time of arrest, police officers would discuss the program with potential participants. Officers would then assess potential participants for eligibility (see below) and provide informed consent to interested individuals. Officers would provide eligible individuals with the referral form to the MARI Assessment Hub, a local certified addiction treatment program. Participants had 3 business days to contact the MARI Assessment Hub. At the MARI Assessment Hub, participants were assessed by study staff for substance use disorders and received treatment (e.g., peer support and recovery coaching). MARI participants were not initially arrested/charged- official charges were not documented and were held in abeyance through the duration of the MARI program. If participants completed the program all charges were voided. Those who did not complete MARI had their formal arrest charges referred to the District/City Attorney’s Offices at the time they left the program. Although total abstinence was the goal of this program it was not required- participants were not removed from the program for a single recurrence of use.
To be referred to MARI, potential participants had to: 1) be adults (18 years old or older), 2) reside in Dane County, and 3) have committed an “eligible” non-violent, drug use-related crime (excluding alcohol only). Eligible nonviolent crimes included: a) possession of narcotics / drugs or drug paraphernalia (for personal use only), b) prostitution, c) retail theft, theft from auto without property damage, or burglary / theft from family members who are agreeable to not pressing charges, or e) drug overdose. Participants were excluded from the MARI program if they 1) did not reside in Dane County, 2) had an active warrant for their arrest, 3) were a registered sex offender, 4) were on parole/probation supervision, 5) had committed a violent crime in the past 3 years, or 6) were a danger to the program staff members.
The goal of the study was to determine how feasible the MARI program was to implement in the community. To test this, the present study encompassed both formative and process evaluations. The formative evaluation assessed how the program was developed over time and how well the final program was implemented in the community. The goal of this evaluation was to identify the facilitators, barriers, and steps taken to overcome identified barriers to program implementation. Data for this evaluation were derived from key interviews with stakeholders and surveys. The authors also engaged in process evaluation to determine participant engagement with MARI and participant and police officers’ engagement with the program. Surveys were sent at multiple time points throughout the study to gauge program attitudes and its perceived efficacy. Police officers were surveyed twice: the first survey was distributed to police officers 1 year post-MARI implementation and the second survey was distributed towards the end of the entire MARI program. Surveys were sent to MARI participants immediately after completing the 6-month program. Staff (i.e., at the assessment hub) completed a 12-item survey as the entire program ended in 2021. Results of these assessments consisted of descriptive statistics of survey data and thematic analysis of qualitative data.
The MARI program was implemented between September 2017-August 2021 in Dane county Wisconsin. A total of 349 adults were referred to the MARI program, of which 263 were eligible to participate. Most participants (92%) were referred to MARI due to drug overdose related crimes. Eligible participants were on average 35 years old, White (79.8%) men (63.1%).
There was a large drop off between referral to and engagement with program
A total of 263 people were eligible to participate, but of these only 160 (60.8%) went to the initial evaluation. Of these 100 (62.5%) completed the MARI program (i.e., completed substance use treatment and did not re-offend for at least 6 months post-referral).
The referral process was identified as a barrier to treatment engagement
Through interim program evaluation, team members determined that the participant-directed referral process was leading to program drop-off. This was partially due to some participants not remembering/understanding that they were required to contact the participating program “hub”. This was possibly due to some referrals occurring during overdose-related events. It was also found that some participants lacked the means to reach treatment. To rectify this, additional funds were secured for bus passes and cell phones to be distributed to a sub-set of participants to ensure they initiated treatment.
The program was considered feasible and was perceived as beneficial by participants and community stakeholders
Most police officers involved with the MARI did not complete either the first (100 [21.7%]) or second survey (193 [41.9%]). Most police officers that completed their survey (97.9%) reported being somewhat or very familiar with the program and 46.1% considered eligibility of MARI when interacting with people. All program staff surveyed believed the program had some effect. Among the 100 who completed the program, 68 completed an end-program survey. Of those, 62 (91.2%) planned to continue treatment, 63 (92.6%) rated the program good to very good, and 51 (75%) reported positive change.
The results of this study suggest that an arrest-diversion program may be a feasible strategy for getting individuals who commit drug-related crime the help they need. A total of 100 people committing drug related offenses (e.g., theft) were successfully referred to and completed drug treatment program via the MARI program. Most of these participants who also provided follow-up data reported that they were positively impacted by the arrest-diversion program and planned to continue treatment. In addition, reports from key stakeholders suggest that the program was successfully implemented and beneficial. Also, most police officers who completed a survey indicated awareness of the MARI program and almost half responded that they considered MARI eligibility during investigations. Furthermore, sampled program staff involved with the MARI program stated that the program assisted with participants pursuing recovery. Of note, however, those with an existing criminal record could not be referred to the MARI program and thus were not included in this study. Whether similar findings would apply to an arrest-diversion program for individuals who had previously been involved in the criminal justice system (e.g., those with longer histories of severe substance use disorder) is unclear.
Taken together, these results suggest that arrest-diversion programs like the MARI program may help link individuals with substance use disorder to treatment and recovery support services if they encounter the criminal justice system. However, it also seems that there is room for improvement regarding referral methods of such programs to better engage and retain participants in care. In the present study, once participants were referred to the MARI program by police officers it was the participants’ responsibility to go to the program hub for an initial assessment. This initial “cold handoff” between the criminal justice system and MARI staff resulted in a precipitous drop between the number of participants referred to care and the number that initiated treatment. This was likely due to multiple factors including participant misunderstanding of MARI procedures and/or lack of resources (e.g., transportation). Future efforts may do well to use a cascade of care framework to address how best to bridge gaps between need for care and receipt of care.
An arrest-diversion program may be feasibly implemented to link those who commit drug-related non-violent offenses to substance use disorder treatment and recovery support services. However, those who provided data may have had especially positive experiences with the program, so it is difficult to know how the program was perceived more generally. Furthermore, there was a significant drop-off at each inflection point. Nevertheless, the data suggest that police officers were aware of the program and implemented screening when appropriate in support of MARI implementation. In addition, stakeholders felt the program was useful both for participants and in the community more generally. Additionally those who competed the MARI program planned on continuing treatment and felt the program had benefitted them. More research is needed to better understand the efficacy of arrest-diversion programs like the MARI, the goals of which are to link those in need of substance use disorder treatment to care instead of arresting them. Ultimately research can help determine whether programs like these prevent individuals with substance use disorder who are arrested from deleterious cycles through the criminal justice system and promoting public health.
Zhang, A., Balles, J. A., Henningfield, M. F., Nyland, J. E., Nguyen, T. H., & Zgierska, A. E. (2024). Offering recovery rather than punishment: Implementation of a law enforcement–led pre-arrest diversion-to-treatment program for adults with substance use disorders. Journal of Substance Use and Addiction Treatment, 159, 209274. doi: 10.1016/j.josat.2023.209274
l
There is an association between addiction and criminal activity– estimates of substance use disorder prevalence among jail inmates has been as high as 63%. Law enforcement officers often encounter individuals with substance use disorders engaging in drug use-related crime (e.g., theft, drug possession and/or overdose). This is problematic as involvement with the criminal justice system may further marginalize those with substance use disorders (i.e., having a criminal record restricts employment and housing opportunities), limiting recovery capital, and ultimately making it more difficult to initiate and sustain recovery. Financially, the use of law-enforcement as first-responders to substance use related medical consequences like overdose has resulted in an estimated economic burden of over $19 billion and counting. There is a need to develop and test programs which divert those with substance use disorders away from the criminal justice system and into treatment. To this end, the present study examined perspectives of multiple stakeholders – law enforcement, program staff, and participants – in a pre-arrest diversion program designed to link non-violent drug-use related offenders to substance use treatment instead of arrest or prosecution.
This was a feasibility study to evaluate how well a pre-arrest diversion program, the Madison Addiction Recovery Initiative (MARI), was implemented and the corresponding experiences of program stakeholders. The goals of this program were to reduce crime and improve health (i.e., reduce overdose deaths) among adults who committed minor, non- violent, drug use-related offense by offering them a referral to treatment instead of arrest and prosecution of criminal charges.
The MARI process was as follows: at the time of arrest, police officers would discuss the program with potential participants. Officers would then assess potential participants for eligibility (see below) and provide informed consent to interested individuals. Officers would provide eligible individuals with the referral form to the MARI Assessment Hub, a local certified addiction treatment program. Participants had 3 business days to contact the MARI Assessment Hub. At the MARI Assessment Hub, participants were assessed by study staff for substance use disorders and received treatment (e.g., peer support and recovery coaching). MARI participants were not initially arrested/charged- official charges were not documented and were held in abeyance through the duration of the MARI program. If participants completed the program all charges were voided. Those who did not complete MARI had their formal arrest charges referred to the District/City Attorney’s Offices at the time they left the program. Although total abstinence was the goal of this program it was not required- participants were not removed from the program for a single recurrence of use.
To be referred to MARI, potential participants had to: 1) be adults (18 years old or older), 2) reside in Dane County, and 3) have committed an “eligible” non-violent, drug use-related crime (excluding alcohol only). Eligible nonviolent crimes included: a) possession of narcotics / drugs or drug paraphernalia (for personal use only), b) prostitution, c) retail theft, theft from auto without property damage, or burglary / theft from family members who are agreeable to not pressing charges, or e) drug overdose. Participants were excluded from the MARI program if they 1) did not reside in Dane County, 2) had an active warrant for their arrest, 3) were a registered sex offender, 4) were on parole/probation supervision, 5) had committed a violent crime in the past 3 years, or 6) were a danger to the program staff members.
The goal of the study was to determine how feasible the MARI program was to implement in the community. To test this, the present study encompassed both formative and process evaluations. The formative evaluation assessed how the program was developed over time and how well the final program was implemented in the community. The goal of this evaluation was to identify the facilitators, barriers, and steps taken to overcome identified barriers to program implementation. Data for this evaluation were derived from key interviews with stakeholders and surveys. The authors also engaged in process evaluation to determine participant engagement with MARI and participant and police officers’ engagement with the program. Surveys were sent at multiple time points throughout the study to gauge program attitudes and its perceived efficacy. Police officers were surveyed twice: the first survey was distributed to police officers 1 year post-MARI implementation and the second survey was distributed towards the end of the entire MARI program. Surveys were sent to MARI participants immediately after completing the 6-month program. Staff (i.e., at the assessment hub) completed a 12-item survey as the entire program ended in 2021. Results of these assessments consisted of descriptive statistics of survey data and thematic analysis of qualitative data.
The MARI program was implemented between September 2017-August 2021 in Dane county Wisconsin. A total of 349 adults were referred to the MARI program, of which 263 were eligible to participate. Most participants (92%) were referred to MARI due to drug overdose related crimes. Eligible participants were on average 35 years old, White (79.8%) men (63.1%).
There was a large drop off between referral to and engagement with program
A total of 263 people were eligible to participate, but of these only 160 (60.8%) went to the initial evaluation. Of these 100 (62.5%) completed the MARI program (i.e., completed substance use treatment and did not re-offend for at least 6 months post-referral).
The referral process was identified as a barrier to treatment engagement
Through interim program evaluation, team members determined that the participant-directed referral process was leading to program drop-off. This was partially due to some participants not remembering/understanding that they were required to contact the participating program “hub”. This was possibly due to some referrals occurring during overdose-related events. It was also found that some participants lacked the means to reach treatment. To rectify this, additional funds were secured for bus passes and cell phones to be distributed to a sub-set of participants to ensure they initiated treatment.
The program was considered feasible and was perceived as beneficial by participants and community stakeholders
Most police officers involved with the MARI did not complete either the first (100 [21.7%]) or second survey (193 [41.9%]). Most police officers that completed their survey (97.9%) reported being somewhat or very familiar with the program and 46.1% considered eligibility of MARI when interacting with people. All program staff surveyed believed the program had some effect. Among the 100 who completed the program, 68 completed an end-program survey. Of those, 62 (91.2%) planned to continue treatment, 63 (92.6%) rated the program good to very good, and 51 (75%) reported positive change.
The results of this study suggest that an arrest-diversion program may be a feasible strategy for getting individuals who commit drug-related crime the help they need. A total of 100 people committing drug related offenses (e.g., theft) were successfully referred to and completed drug treatment program via the MARI program. Most of these participants who also provided follow-up data reported that they were positively impacted by the arrest-diversion program and planned to continue treatment. In addition, reports from key stakeholders suggest that the program was successfully implemented and beneficial. Also, most police officers who completed a survey indicated awareness of the MARI program and almost half responded that they considered MARI eligibility during investigations. Furthermore, sampled program staff involved with the MARI program stated that the program assisted with participants pursuing recovery. Of note, however, those with an existing criminal record could not be referred to the MARI program and thus were not included in this study. Whether similar findings would apply to an arrest-diversion program for individuals who had previously been involved in the criminal justice system (e.g., those with longer histories of severe substance use disorder) is unclear.
Taken together, these results suggest that arrest-diversion programs like the MARI program may help link individuals with substance use disorder to treatment and recovery support services if they encounter the criminal justice system. However, it also seems that there is room for improvement regarding referral methods of such programs to better engage and retain participants in care. In the present study, once participants were referred to the MARI program by police officers it was the participants’ responsibility to go to the program hub for an initial assessment. This initial “cold handoff” between the criminal justice system and MARI staff resulted in a precipitous drop between the number of participants referred to care and the number that initiated treatment. This was likely due to multiple factors including participant misunderstanding of MARI procedures and/or lack of resources (e.g., transportation). Future efforts may do well to use a cascade of care framework to address how best to bridge gaps between need for care and receipt of care.
An arrest-diversion program may be feasibly implemented to link those who commit drug-related non-violent offenses to substance use disorder treatment and recovery support services. However, those who provided data may have had especially positive experiences with the program, so it is difficult to know how the program was perceived more generally. Furthermore, there was a significant drop-off at each inflection point. Nevertheless, the data suggest that police officers were aware of the program and implemented screening when appropriate in support of MARI implementation. In addition, stakeholders felt the program was useful both for participants and in the community more generally. Additionally those who competed the MARI program planned on continuing treatment and felt the program had benefitted them. More research is needed to better understand the efficacy of arrest-diversion programs like the MARI, the goals of which are to link those in need of substance use disorder treatment to care instead of arresting them. Ultimately research can help determine whether programs like these prevent individuals with substance use disorder who are arrested from deleterious cycles through the criminal justice system and promoting public health.
Zhang, A., Balles, J. A., Henningfield, M. F., Nyland, J. E., Nguyen, T. H., & Zgierska, A. E. (2024). Offering recovery rather than punishment: Implementation of a law enforcement–led pre-arrest diversion-to-treatment program for adults with substance use disorders. Journal of Substance Use and Addiction Treatment, 159, 209274. doi: 10.1016/j.josat.2023.209274
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