Jail chemical addiction programs show promise, but few are offered

As the opioid crisis continues to ravage the state and nation, Boone County is facing a familiar problem: The jail is bursting at the seams.

Mike Nielsen became acting sheriff in June 2014 before winning the post in the general election that year. He said a little more than eight months ago, the average daily population of the jail was 150. Now, that number is 210.

What’s more, the recidivism rate is 78 percent.

“Whether you’re rural, whether you’re urban, there’s no socioeconomics or demographics to this problem that we have,” he said.

As the county contemplates a new or expanded jail, Nielsen began 2018 with a goal to reduce the recidivism rate by 18 percent over 18 months. The goal may seem ambitious, but Nielsen has a tool few other sheriffs in the state do: a jail chemical addiction program.

“We’ve got to think outside the box here,” he said. “We can’t arrest our way out of this problem.”

Boone County is one of fewer than half a dozen counties in the state with a JCAP. The program is voluntary and completely funded by court fees.

“There’s not enough,” said Aaron Negangard, who served as Dearborn-Ohio prosecutor before becoming chief deputy attorney general in 2017. “There needs to be this setup, a therapeutic community

within a jail, in every county in the state. It works. It’s very effective, in my experience, with the inmates that go through it.”

Leading the way

Boone County became the first in the state when its JCAP began in 1995. At first, only men could participate. Applicants were housed separately from the rest of the inmate population, a model that continues to this day.

Inmates are taught conflict-resolution and life skills, all while working alongside others on the same path.

“Over time there were a lot of lives … that we were able to turn around,” said retired Boone County Judge James Detamore, one of the progenitors of the program.

Dearborn County Judge Sally McLaughlin said the county got the idea to start its JCAP after conducting a site visit in 2007 in Boone County.

“There’s probably always going to be a substance abuse problem, but this is an effort that has seemed to help people,” she said.

Christina Candia, of the Boone County Probation Department, took over as director of the county’s JCAP in July 2017. She said in 2017, said all but six of 81 male participants in the program graduated successfully, while 30 women did the same.

“Our judges will not order anyone into the program,” she said. “From an inmate’s perspective, it looks good before the court, but a lot of times judges will take that into serious consideration in terms of a bond release.”

Cognitive behavioral therapy

Steve Kelly, Dearborn County’s director of court services, has been involved with JCAP since the beginning. Dearborn’s program now has 16 beds each for the males and females involved in the program out of a total jail population of around 250.

“They go through a psychosocial assessment with licensed therapists and then we determine who are the best candidates for the program and place them in,” he said.

Cognitive behavioral therapy and 12-step facilitation continue to be the curriculum the 90-day program follows. Kelly said CBT is used to target the psychological triggers that cause those with substance abuse issues to use.

“It helps you train your brain to rethink situations into a positive manner,” he said. “A lot of people in addictions, a situation will happen and without really thinking, they react in a negative way.”

Vivitrol injections

While CBT targets the behaviors, another, more recent innovation can now focus on the physical cravings.

Passed in 2015, House Enrolled Act 1006 established a justice reinvestment advisory council to award grants to local corrections programs. The same year, Boone County was awarded such a grant to provide a Medication Assisted Treatment program in conjunction with inmates who have completed the JCAP and identify with opioid addiction.

After detoxing, qualifying participants are given a monthly shot of Vivitrol, or naltrexone, which blocks the opioid receptors in the brain.

“It takes care of the biological basis,” said Indiana University Maurer School of Law professor Jody L. Madeira. “No matter how much CBT you have, if you have physical cravings, you have physical cravings. So, you’re really canceling the physical cravings or diminishing them and then giving them a replacement strategy other than going to an illicit opioid.”

Long-term aftercare

Brandon George has a unique perspective, having seen the problem from both sides.

He now works with JCAP inmates at the Boone County Jail through the Pro-Active Resources Counseling Center. He’s also been in long-term recovery for the past nine years after being an IV drug user. He said he credits Nielsen — who calls George “one of the biggest successes of the program” — for having an open mind as to his participation.

“I liked to drink and drive when I was using, and I’ve been arrested for it multiple times,” he said. “And, his willingness to not get caught up in the stigma around this; I think there’s a lot of sheriffs probably throughout the state that probably would never let me set foot in their jail.”

George said JCAPs are especially important in counties where treatment options are scarce. “They don’t have a lot of places to go,” he said. “They don’t have any care that’s open 24/7. They’ve got one place that’s open 24/7 in Boone County: the jail.”

Nielsen said following up with JCAP participants once they get out of jail is key to ensuring they don’t fall back into old ways. He said a grant-funded physical medical health provider works with the JCAP for 24 hours a week. Ninety days before an inmate is released, a transition period begins to a community mental health provider. He said doing anything less would be a disservice.

“Where we fail our inmates is not inside the jail; where we fail our inmates is when they leave our jail,” he said. “So, they either go back to that same environment and they overdose, and they die. Or, they turn around, they get in trouble, and they come right back into our facility.”

George said that the very concept of the JCAP was a complete paradigm shift from the punitive to the therapeutic.

“You make them sit in a room. You don’t give them any treatment. And the idea that we’re surprised because they do the same thing when they get out, shame on us for thinking that,” he said. “They’re not the people that are missing the boat. It’s us that’s missing the boat.”•