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The “How to” of placing offenders at a Meth Treatment Center: How do I place, or recommend a revoked probationer to be placed at a Meth Treatment Center? In order to have a revoked probationer placed at a Meth treatment facility, the probation officer must file a report of violation with the court and county attorney. The report of violation should be based on actions of the probationer that fit into one or more of the Meth treatment center referral criteria categories 2, 3 or 4 (Located on pages 4-6). If the court finds that the probationer is in violation, the court can do one of the following: 1. Revoke a portion of the suspended sentence, say 24 months, and commit the person to the Department of Corrections for that period. During this time, the person would be placed at the Meth treatment center and expected to successfully complete the program. The balance of the sentence would be suspended and the offender would serve it on probation. Even if the offender originally received a commitment to prison, district court judges have the authority to transfer the offender from a prison commit to a DOC commit, pursuant to §46-18-203(7)(a)(iii), provided that the sentence does not impose a longer imprisonment or commitment than the original sentence. 2. Revoke the offender’s suspended sentence and commit the offender to the Department of Corrections. The DOC will then have the authority to place the individual in an appropriate program or facility, such as the Meth treatment. If the individual placed at the Meth treatment program and successfully completes the program, then the DOC would have the discretion to conditionally release the person to community supervision. Similar to #2, a judge may convert a prison commitment to a DOC commitment, provided the judge does not impose a longer sentence of imprisonment than the original sentence. Draft 4/26/07 ACCD 1 How do I place, or recommend an offender on Conditional Release to be placed at a Meth Treatment Center? Similar to probationers, the conditional releasee who will be considered for placement at a Meth treatment facility is one who is in violation, based on actions of the conditional releasee that fits into one or more of the Meth treatment center referral criteria categories 2, 3 or 4. In this case, the probation officer should proceed to revoke the offender’s conditional release status by filing a statement of charges/notice of disciplinary hearing. The probation bureau should use the same process that is used for revoking conditional release and sending them back to prison. Instead, the conditional release offender will go to the Meth treatment. The offender who is revoked from conditional release and sent to Meth treatment must receive all the same due process protections as an offender being sent to prison. How do I place or recommend an offender who is a Parolee to be placed at a Meth Treatment Center? For a parolee who will be considered for placement at a Meth treatment facility is one who is in violation, based on actions of the parolee that fits into one or more of the Meth treatment center referral criteria categories 2, 3 or 4. The Board of Pardon and Parole, at their discretion, may recommend disposition of the parole violator to the Meth treatment center or recommend the parole violator returns to prison. The probation bureau should use the same process that is used for revoking parole violators to START. How do I place or recommend an offender who is a Prison Inmate to be placed at a Meth Treatment Center? Prison Inmates who’s previous criminal activity and/or lifestyle that fits into one or more of the Meth treatment center referral criteria categories 2, 3 or 4 and at the discretion of the Board of Pardon and Parole have a disposition indicating parole upon successful completion of the Meth treatment program, including the 6 months aftercare at a prerelease or have a disposition of a parole hearing while at the prerelease center. Inmates who have been identified by IPPOs and/or inhouse screening committees and are within 16 to 18 months of Parole eligibility can be considered for placement at a Meth treatment facility. Draft 4/26/07 ACCD 2 There is one important caveat to these options – not all offenders will be screened and accepted by the Meth treatment programs, just like all other Community Correction programs. The Meth treatment centers are responsible for screening all offenders who apply for admission to the program, and the programs have the discretion to accept or deny admission. Because admission is dependant on an offender’s circumstances, including criminal history, there is no guarantee that every offender will be accepted into the programs. (See A.R.M. 20.7.913) For purposes of placement at a Meth treatment facility, successful completion of the Meth treatment program, means a 9 month successful stay at the Meth treatment center and 6 months successful stay at an aftercare program at a prerelease center. Draft 4/26/07 ACCD 3 Meth Treatment Center Referral Criteria: 2. Chronic Methamphetamine Abuse Abuse is defined as: A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: 1. recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use, substance-related absences, suspensions, or expulsions from school; neglect of children or household) 2. recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) 3. recurrent substance-related legal problems (e.g., arrests for substance related disorderly conduct). 4. continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about the consequences of intoxication, physical fights). A. The symptoms have never met the criteria for Substance Dependence for this class of substance. Referral Criteria: Offenders sentenced to DOC for any offense, but have continued to use methamphetamine while on supervision and have had one or more failed opportunities for treatment in the community. Recommendations from LAC, LCPC or other community based addiction specialists, based on a CD evaluation completed in the previous 6 months may be used for referral to treatment programs. Draft 4/26/07 ACCD 4 3. Stimulant Use Disorder – abuse of other amphetamines or cocaine. Dependence defined as: A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three or more of the following, occurring at any time in the same 12-month period: 1. Tolerance, as defined by either of the following: a. a need for markedly increased amounts of the substance to achieve intoxication or the desired effect b. markedly diminished effect with continued use of the same amount of the substance. 2. withdrawal, as manifested by either of the following: a. the characteristic withdrawal syndrome for the substance b. the same (or closely related substance) is taken to relieve or avoid withdrawal symptoms. 3. the substance is often taken in larger amounts or over a longer period than was intended. 4. there is a persistent desire or unsuccessful efforts to cut down or control substance use 5. a great deal of time is spent in activities necessary to obtain the substance (e.g. visiting multiple doctors or driving long distances), use the substance (e.g.. chain-smoking), or recover from its effects 6. important social, occupational, or recreational activities are given up or reduced because of substance use 7. the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g. current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption). Referral criteria: Offenders sentenced to DOC who continue to abuse prescription amphetamines and/or purchase prescription amphetamines from others, use cocaine or excessive use of nonprescription stimulants. Offenders with a prior diagnosis of methamphetamine dependence or abuse who continue to use other stimulants. Offenders, who have had one or more interventions on supervision, continue to use and have not/will not participate in treatment in the community. Recommendations from LAC, LCPC or other community based addiction specialists, based on a CD evaluation completed in the previous 6 months may be used for referral to treatment programs. Draft 4/26/07 ACCD 5 3. Co-occurring Disorders Referral Criteria: Offenders sentenced to DOC who have a history of Polysubstance Dependence or Abuse and a co-occurring mental health diagnosis. Offenders who violate conditions of supervision by using any substance to self-medicate symptoms of mental illness or those who discontinue prescribed medications for symptoms of mental illness and then continually relapse on alcohol, illegal drugs, or other prescription drugs obtained illegally. Offenders, who have had failed opportunities to complete treatment in the community. Recommendations from LAC, LCPC or other community based addiction specialists, based on a CD evaluation completed in the previous 6 months may be used for referral to treatment programs. Definitions (2, 3 and 4) and referral criteria developed by Sue Orand, Treatment Manager, Montana Women’s Prison, using DSM-IV Diagnostic Criteria for abuse and dependency. Draft 4/26/07 ACCD 6 Meth Treatment Glossary of Terms: Abstinence: Non-use of a specific substance. In recovery, non-use of any addictive psychoactive substance. May also denote cessation of an addictive behavior, such as gambling, over eating, etc. Addiction: A primary, chronic, neurobiologic disease, with genetic, psychosocial and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Co-Occurring Disorders: Concurrent substance-related and mental disorders. Other terms used to describe cooccurring disorders include “dual diagnosis,” “dual disorders,” “ mentally ill chemically addicted” (MICA), “chemically addicted mentally ill” (CAMI), “mentally ill substance abusers” (MISA), “mentally ill chemically dependent” (MICD), “coexisting disorders,” “cormorbid disorders,” and “individuals with co-occurring psychiatric and substance symptomatology” (ICOPSS). Use of the term carries no implication as to which disorder is primary and which is secondary, which disorder occurred first, or whether one disorder caused the other. Continuum of Care: An integrated network of treatment services and modalities, designed so that an offender’s changing needs will be met as that offender moves through the treatment and recovery process. Dependence: Used in three different ways: (1) physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produces by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist; (2) psychological dependence is a subjective sense of need for a specific psychoactive substance, either for its positive effects or to avoid negative effects associated with its abstinence; and (3) one category of psychoactive substance abuse use disorder. Draft 4/26/07 ACCD 7 Failure (as in Treatment failure): Lack of progress and/or regression at any given level of care. Such a situation warrants a reassessment of the treatment plan, with modification of the treatment approach. Such situations may require changes in the treatment plan at the same level of care or transfer to a different (more or less intensive) level of care to achieve a better therapeutic response. Sometimes used to describe relapse after a single treatment episode—an inappropriate construct in describing a chronic disease or disorder. Length of Stay*: Meth Treatment programs are 9 month (270 days) length of stay, followed by a 6 month (180 day) aftercare in a Prerelease Center, for a 15 month continuum of care. Length of stay’s beyond the 270 days in Meth Treatment require a written approval from the Treatment Contract Program Manager and length of stay’s beyond the 180 days in Prerelease require a written approval from the Prerelease Contract Manager. Polysubstance Dependence: A DSM-IV diagnosis (304.80) reserved for behavior during the same 12-month period in which the individual was repeatedly abusing at least three groups of substances (excluding caffeine and nicotine), but no single substance predominated. Such use met the dependence criteria for substances as a group, but not for any specific substance. Definitions based on ASAM Patient Placement Criteria for the Treatment of SubstanceRelated Disorders, Second Edition-Revised. * - Length of Stay definition: ACCD/DOC Policy Draft 4/26/07 ACCD 8