Really important paragraph on substance use and recidivism:
One challenge in defining success for people with substance use disorders returning from prison is identifying appropriate criteria for relapse. Any measure of relapse, if used, needs to be defined by clinical practice and based on the recognition that episodic use (lapse) is inherent to the illness and not pathologic or necessarily health-harming. While a positive drug screen is often used in studies as a measure of failure following prison release (and cause for reincarceration), addiction medicine experts, including the American Society of Addiction Medicine, do not define a single positive urine drug screen as pathologic or a treatment failure, but an expected consequence of a chronic health condition (Jarvis et al., 2017). Even in clinical practice, where urine drug screening is used to help guide treatment plans for either harm reduction or recovery, its use is of questionable value (Jarvis et al., 2017). Studies of licensed physicians with years of clinical training have found confusion about proper implementation and that misinterpretations of urine drug screening results are common (Ceasar et al., 2016; Chua et al., 2020). For these reasons, urine drug screening, which is currently used to surveil and sanction addiction relapse for those on probation and parole, is not an appropriate measure of success (or failure) by researchers or practitioners. Instead, reliance on self-reported measures of substance use that define success as a progression of health-promoting behaviors over time may be more reliable indicators of improvement and offer better insights for those making decisions about probation and parole supervision. For instance, a person who is using less and thus able to maintain better communication with their family or a person who has not overdosed in a year may be defined as “successful,” when viewed in the context of that individual’s past (see Table 4-1).
National Academies of Sciences, Engineering, and Medicine. 2022. The Limits of Recidivism: Measuring Success After Prison. Washington, DC: The National Academies Press.?https://lnkd.in/gh_AUFQs.
