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Drug institute offers guidelines for treating addicts

CHICAGO -- In its first report aimed at improving how the criminal justice system deals with drug addicts, the National Institute on Drug Abuse offered 13 guidelines yesterday for what works and what fails.

The key is understanding that drug addiction is a brain disease that affects behavior, and that it requires carefully monitored, personalized treatment, including access to medication such as methadone after the drug offender is released into society, the institute said.

``What does not work? Putting a person who is addicted to drugs in jail for five or 10 years and thinking that will cure him with no treatment," said Dr. Nora Volkow, director of the antidrug abuse agency. ``The likelihood of that person relapsing is very high."

The guidelines urge a mix of traditionally liberal and conservative approaches.

The institute argues that prisons and court-ordered treatments don't use methadone and other addiction medications enough. At the same time, the guidelines support pressuring offenders into treatment as a condition of probation, and they advocate urine testing during treatment to track and prevent relapses.

``The criminal justice system offers an extraordinary opportunity to help people with drug problems," Volkow said.

Every $1 spent on drug treatment programs also saves the nation an estimated $4 in crime costs, she said. The annual estimated national cost for drug crimes is $107 billion.

The drug treatments Cheryl Cline started in an Illinois prison after using crack cocaine for nine years probably saved the 29-year-old's life. This week, she is marking her third drug-free year, and her life has been turned around.

While she was using, Cline said, she lived in an abandoned building or a car, and she shoplifted to support her habit. Now she works as a waitress, has reunited with her family, and is studying to be a drug counselor.

``I'd like people to know that everybody deserves an opportunity for treatment, but when you're on the outside and running wild, most people won't take it," said Cline, who lives in Aurora. ``Prison is one of the best places to do it because you are confined. You have nothing but time on your hands."

Maia Szalavitz, a drug policy specialist not involved with the report, said the guidelines are excellent. Methadone is used rarely in the criminal justice system despite evidence that it helps people addicted to opioids such as heroin, she said.

She faulted the system's current reliance on 12-step programs modeled after Alcoholics Anonymous, which she said works only for some people .

``If these guidelines help addicts in the justice system to get more sensitive and appropriate care, they will be highly useful," said Szalavitz, a senior fellow at the media watchdog group Statistical Assessment Service.

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