Offering recovery rather than punishment: Implementation of a law enforcement-led pre-arrest diversion-to-treatment program for adults with substance use disorders

Alice Zhang; Joseph A Balles; Mary F Henningfield; Jennifer E Nyland; Thao H Nguyen; Aleksandra E Zgierska

doi:10.1016/j.josat.2023.209274

Offering recovery rather than punishment: Implementation of a law enforcement-led pre-arrest diversion-to-treatment program for adults with substance use disorders

J Subst Use Addict Treat. 2024 Apr:159:209274. doi: 10.1016/j.josat.2023.209274. Epub 2023 Dec 17.

Authors

Alice Zhang¹, Joseph A Balles², Mary F Henningfield³, Jennifer E Nyland⁴, Thao H Nguyen⁵, Aleksandra E Zgierska⁶

Affiliations

¹ Penn State College of Medicine - Department of Family and Community Medicine, 500 University Drive, Hershey 17033, PA, USA. Electronic address: azhang@pennstatehealth.psu.edu.
² Safe Communities Madison-Dane County, Inc., Retired Captain, City of Madison Police Department, 211 S. Carroll Street, Madison 53703, WI, USA.
³ University of Wisconsin-Madison- Department of Family Medicine and Community Health, 1100 Delaplaine Ct., Madison 53715, WI, USA. Electronic address: mary.henningfield@fammed.wisc.edu.
⁴ Penn State College of Medicine - Department of Neural and Behavioral Sciences, 500 University Drive, Hershey 17033, PA, USA. Electronic address: jnyland@pennstatehealth.psu.edu.
⁵ Family Health Centers of San Diego, 5454 El Cajon Boulevard, San Diego 92115, CA, USA. Electronic address: thaongu@fhcsd.org.
⁶ Penn State College of Medicine - Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, 500 University Drive, Hershey 17033, PA, USA. Electronic address: azgierska@pennstatehealth.psu.edu.

PMID: 38113995
DOI: 10.1016/j.josat.2023.209274

Abstract

Background: The opioid epidemic has strained the US criminal justice system. Law enforcement frequently encounters persons with substance use disorder (SUD). Law enforcement-led, pre-arrest diversion programs linking individuals with SUD to addiction treatment instead of arrest and prosecution has the potential to reduce crime, overdoses, and other community harms. We implemented a pre-arrest diversion-to-treatment program-the Madison Addiction Recovery Initiative (MARI)-from September 2017 to August 2020, and describe the key components of MARI's effective implementation.

Methods: Adults who committed an eligible, drug use-related crime were offered a 6-month MARI participation with referral to treatment in lieu of arrest; criminal charges for that crime were "voided" upon the successful MARI completion. Formative evaluation, with stakeholder feedback and team meeting minutes, assessed key factors influencing implementation. Process evaluation consisted of tracking participant referrals, enrollment, and engagement. Police officers, MARI participants, and treatment center staff members were surveyed about program experiences and attitudes. The study used descriptive statistics to describe quantitative survey responses; thematic qualitative analysis identified major themes in qualitative responses.

Results: Of 263 participants, 160 initiated program engagement, with 100 successfully completing MARI. Interim evaluations and community partner feedback informed program protocol adjustments to increase participant enrollment, retention and diversity, streamline the referral processes, and transition to telehealth during the COVID-19 pandemic.

Conclusion: Rigorous evaluation and community partner feedback are essential components of effective implementation and sustainability of a law enforcement-led pre-arrest diversion-to-treatment program, which has the potential to both reduce crime and overdose, and change the lives of people with SUD.

Keywords: Addiction; Crime; Opioid use disorder; Pre-arrest diversion; Substance use disorder; Treatment.

MeSH terms

Adult
Drug Overdose*
Humans
Law Enforcement
Pandemics
Punishment
Substance-Related Disorders* / therapy