Pre-arrest diversion-to-treatment programs may reduce crime, overdose deaths

Pre-arrest diversion-to-treatment programs that focus on long-term treatment for substance use disorder may reduce crime recidivism, incarceration and overdose deaths, according to new study led by a research team from Penn State College of Medicine.

Diversion programs aim to connect individuals who have committed a crime to programs or services as an alternative to the criminal justice system, avoiding prosecution and arrest. The research team evaluated the Madison Area Recovery Initiative (MARI), a community-wide, law-enforcement-led program in Madison, Wisconsin. They found that people who committed non-violent, minor drug-use related crimes and who received a clinical assessment and six months of individualized treatment were less likely to be arrested, incarcerated or have a fatal overdose in the year following their initial arrest.

They published their findings in the Journal of Substance Use & Addiction Treatment.

“There are many sectors of our community, beyond clinical providers, patients and families, that are involved in or impacted by addiction and who are interested in innovative solutions,” said Aleksandra Zgierska, Jeanne L. and Thomas L. Leaman, MD, Endowed Professor at Penn State College of Medicine and lead researcher on the MARI project.

“We thought that responding to drug use-related crime may serve as a point of intervention to facilitate addiction treatment, which we know is effective in improving health and lives and in reducing crime.”

The concept for MARI was born out of conversations dating back to 2015 between Zgierska and Captains Cory Nelson and Jason Freedman of the Madison Police Department (MPD) about how law enforcement can help address the opioid-related overdose epidemic and associated crime. They brought together partners, including the mayor’s office, the district and city attorneys’ offices and public health, treatment and community organizations, to design and implement the program.

“The key was to create evidence-based, community-focused practices in policing,” said Joseph Balles, retired MPD captain, who coordinated the MARI project and co-authored the paper. “We wanted to know if, instead of arresting someone, you connect them to treatment, can that have an impact?”

Unlike other diversion programs, MARI was designed to recognize that substance use disorder is a chronic disease and emphasize longer-term engagement, explained the research team. Adult residents of the local county who committed a minor, drug use-related crime were eligible to participate. In lieu of arrest and prosecution, they were referred for a clinical assessment for substance use disorder and connected to individually-tailored treatment, counseling, peer support and recovery services. The research team previously published several papers on the MARI project including the implementation of the program, also in the Journal of Substance Use & Addiction Treatment.

“This is an opportunity to get people who need it into long-term, evidence-based treatment, not just forcing them to quit ‘cold turkey,'” said Jennifer Nyland, assistant professor of neural and behavioral sciences at Penn State College of Medicine and first author on the paper. “Recovery is a long road riddled with setbacks. MARI was designed to support treatment as a pathway toward recovery rather than punishing individuals for their addiction-fueled mistakes and setbacks.”

Criminal charges were held in abeyance while participants engaged in MARI and then voided for those who completed the six-month program, keeping them off their permanent criminal record. If participants did not engage or did not complete the program, charges were filed with local prosecutors.

“Criminal charges that become part of one’s record and come up on background checks can adversely impact access to resources vital to recovery such as housing or employment,” Nyland said, explaining how MARI’s promotion of an “untarnished” criminal record could have a positive impact on long-term recovery.

The program enrolled 263 people between September 2017 and August 2020. Of these participants, 103 engaged in the program, 60 began the program but did not complete it and 100 successfully completed the six-month program.

Data on arrests, incarceration and fatal overdoses were collected for one year after initial program enrollment. During that period, those who completed MARI had a more favorable crime and overdose profile.

Compared to participants who completed the program, those who did not engage or who did not complete the program were 3.9 and 3.6 times, respectively, more likely to be arrested and 10.3 and 21.0 times, respectively, to be incarcerated. Up to a year later, 5.8% of participants who did not engage and 3.3% of those who did not complete MARI had a fatal overdose compared to 2.0% of those who completed the program.

The research team also found that those participants who did not engage in MARI were more likely not to have permanent housing. While the number of women in the program was low overall, women were more likely than men not to engage in the program. Those who did not complete or engage in the program were also more likely to have a more extensive criminal record, such as a higher number of prior arrests and incarceration.

The MARI program has been a model for the U.S. Department of Justice and other cities and counties across the country. For example, in Pennsylvania, the Law Enforcement Treatment Initiative, a launched by the Pennsylvania Office of Attorney General and law enforcement in 2018 currently operates in 30 counties and has implemented principles of diversion-to-treatment emphasized in MARI. MARI was recently awarded a grant from Target and the U.S. Conference of Mayors, recognizing its innovative practices.

“When you read the evaluations, people often expressed the sentiment that, ‘I can’t believe it was law enforcement that introduced me to recovery.’ That’s what I’m most proud of. We went out and connected people to treatment,” Balles said.