NIDA funds a broad portfolio of research addressing drug abuse in the context of the justice system. Drug abuse and crime are highly correlated in both the adult criminal justice system and the juvenile justice system. Estimates suggest that over half of individuals in prison and nearly two thirds of individuals in jails met criteria for drug dependence or misuse.1 Among adolescents involved in serious offenses, substance dependence or misuse is approximately 3-4 times higher than that of the general population of adolescents.2 In addition to a portfolio of independent research projects, NIDA has funded four major multisite initiatives to address the myriad issues at the intersection of the criminal justice system and substance use and misuse. These initiatives include:
- The Justice Community Opioid Innovation Network (JCOIN; 2019-2024)
- The Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS; 2013-2019)
- Criminal Justice Drug Abuse Treatment Studies (CJ-DATS; 2002-2014)
- Seek, Test, and Treat: Addressing HIV in the Criminal Justice System (STTR; 2010-2017)
Justice Community Opioid Innovation Network (JCOIN)
The Helping to End Addiction Long-termSM Initiative, or NIH HEAL InitiativeSM, will support the Justice Community Opioid Innovation Network (JCOIN) to study approaches to increase high-quality care for people with opioid misuse and OUD in justice settings. JCOIN will test strategies to expand effective treatment and care in partnership with local and state justice systems and community-based treatment providers.
JCOIN will include:
- A national survey of addiction treatment delivery services within the justice system
- Studies on the effectiveness and adoption of new medications, prevention and treatment interventions, and technologies
- Using existing data sources in novel ways to understand care in justice populations
Together, these studies will generate real-world evidence to address the unique needs of individuals with OUD in justice settings.
Through the NIH HEAL Initiative, NIH awarded 15 grants to form JCOIN. The awards, which total approximately $141.3 million, will support the innovation network over multiple years. JCOIN consists of research institutions and two centers that will provide supportive infrastructure — the Coordination and Translation Center and the Methodology and Advanced Analytic Resource Center.
The research institutions will each work with five or more communities, engaging with justice settings and with service providers in the community. They will study evidence-based medications, behavioral interventions, digital therapeutics, and comprehensive patient-centered treatments in 21 states and Puerto Rico.
The Coordination and Translation Center will manage logistics, engagement with practitioners and other key stakeholders in the justice and behavioral health fields, and dissemination of products and key research findings. It will also conduct research to identify effective dissemination strategies for reaching criminal justice stakeholders and provide funding for innovative, rapid-turnaround pilot studies. An educational component will provide outreach and mentorship to researchers and practitioners on conducting rigorous studies in justice settings.
The Methodology and Advanced Analytic Resource Center will provide data infrastructure and statistical and analytic expertise to support individual JCOIN studies and cross-site data synchronization. The center will also conduct novel empirical research to understand changes in state policies and practices within the criminal justice system as they relate to the opioid crisis.
Through the research institutions, JCOIN will address gaps in OUD treatment and related services in a wide range of criminal justice settings, including jails, drug and other problem-solving courts, policing and diversion, re-entry, and probation and parole.
Examples of research that the research institutions will undertake include:
- Studying the effectiveness and adoption of new medications for OUD
- Evaluating new state mandates around medication services and drug courts
- Assessing the effectiveness and implementation of processes to engage and retain individuals in OUD treatment (e.g., telehealth, patient navigation, peer recovery support services)
- Determining how to implement opioid-related services at the community, state, and national levels
Funded Research Institutions
- Baystate Medical Center – Massachusetts
- Brown University – Rhode Island
- Chestnut Health Systems, Inc. – Illinois
- Friends Research Institute, Inc. – Maryland
- New York State Psychiatric Institute – New York
- New York University School of Medicine – New York
- Texas Christian University – Texas
- University of Chicago – Illinois
- University of Kentucky – Kentucky
- Yale University – Connecticut
- Indiana University – Purdue University at Indianapolis - Indiana
Coordination and Translation Center
- George Mason University – Virginia
Methodology and Advanced Analytic Resource Center
- University of Chicago – Illinois
Questions about JCOIN can be addressed to Tisha Wiley.
Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS)
NIDA’s Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) was a multisite cooperative agreement that launched in 2013 and ended in 2018. JJ-TRIALS was a seven-site cooperative research program designed to identify and test strategies for improving the delivery of evidence-based substance abuse and HIV prevention and treatment services for justice-involved youth. Virtually all justice-involved youth could benefit from HIV and substance misuse prevention and/or treatment interventions. Many evidence-based interventions targeting adolescent substance misuse and HIV screening, assessment, prevention, and treatment currently exist. Unfortunately, implementation of these interventions within juvenile justice settings is variable, incomplete, and non-systematic at best.
The JJ-TRIALS cooperative fielded three interrelated studies:
- A longitudinal, nationally representative survey of juvenile justice community supervision agencies about policies and practices related to substance use assessment and service delivery. National survey data was collected in 2014 and 2017. In addition to community supervision agencies, the national survey also collected supplemental data from the perspective of juvenile justice judges and behavioral health agencies that work with justice involved youth in the surveyed communities. Key findings from the national survey can be found in the following publications:
- Scott, C. K., Dennis, M. L., Grella, C. E., Funk, R. R., & Lurigio, A. J. (2019). Juvenile justice systems of care: Results of a national survey of community supervision agencies and behavioral health providers on services provision and cross-system interactions. Health & Justice, 7, 11. doi:10.1186/s40352-019-0093-x
- Robertson, A., Hiller, M., Dembo, R., Dennis, M., Scott, C., Henry, B.F., & Elkington, K. (2019). National survey of juvenile community supervision agency practices and caregiver involvement in behavioral health treatment. Journal of Child and Family Studies, 1-11.
- Elkington, K.S., Robertson, A.A., Knight, D.K., Gardner, S.K. Funk, R.F., Dennis, M.L., … DiClemente, R. (2020). HIV/STI service delivery within juvenile community supervision agencies: A national survey of practices and approaches to moving high-risk youth through the HIV care cascade. AIDS Patient Care and STDs, 34(2). doi: 10.1089/apc.2019.0157
- Funk, R., Knudsen, H.K., McReynolds, L.S., Bartkowski, J.P., Elkington, K.S., Steele, E.H., Sales, J.M., & Scott, C.K. (2020). Substance use prevention services in juvenile justice and behavioral health: Results from a national survey. Health and Justice, 8(11).
- A 36-site cluster-randomized control trial (RCT) comparing different approaches to systems improvements efforts aimed at improving the identification of substance misuse service needs among justice involved youth and delivery of services to address those needs. Juvenile justice sites partnered with local behavioral health agencies to set tailored goals around how to reduce unmet needs for justice involved youth. This RCT was guided by an implementation science framework and focused on which elements of an implementation interventions led to the most changes in unmet service needs.
- A publication describing the protocol in full can be found here (open access): Knight, D. K., Belenko, S., Wiley, T., Robertson, A. A., Arrigona, N., Dennis, M., Bartkowski, J. P., McReynolds, L. S., Becan, J. E., Knudsen, H. K., Wasserman, G. A., Rose, E., Diclimente, R. & Leukefeld, C. (2016). Juvenile Justice—Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS): a cluster randomized trial targeting system-wide improvement in substance use services. Implementation Science, 11(1), 57. doi:10.1186/s13012-016-0423-5
- The concept of a behavioral health services cascade, which is the measurement framework for the study is described in the following publication: Belenko, S., Knight, D., Wasserman, G. A., Dennis, M. L., Wiley, T., Taxman, F. S., Oser, C., Dembo, R., Robertson, A. A., & Sales, J. The Juvenile Justice Behavioral Health Services Cascade: A new framework for measuring unmet substance use treatment services needs among adolescent offenders. Journal of Substance Abuse Treatment, 74, 80-91. doi:10.1016/j.jsat.2016.12.012
- Key findings from the RCT can be found in the following publications:
- Knight, D.K., Joe, G.W., Morse, D.T., Smith, C., Knudsen, H., Johnson, I., … Wiley, T.R.A. (2019). Organizational context and individual adaptability in promoting perceived importance and use of best practices for substance use. Journal of Behavioral Health Services & Research, 46(2), 192-216.
- Becan, J.E., Fisher, J.H., Johnson, I.D., Bartkowski, J., Seaver, R., Gardner, S.K., … Knight, D.K. (2020). Improving Substance Use Services for Juvenile Justice-Involved Youth: Complexity of Process Improvement Plans in a Large Scale Multi-site Study. Administration and Policy in Mental Health and Mental Health Services Research. doi:10.1007/s10488-019-01007-z
- Robertson, A., Fang, Z., Weiland, D., Joe, G., Gardner, S., Dembo, R., …Dennis, M. (in press). Recidivism among justice-involved youth: Findings from JJ-TRIALS. Crime and Behavior.
- Wasserman, G.A., McReynolds, L.S., Taxman, F., Belenko, S., Elkington, K.S., Robertson, A., … Wiley, T.A. (in press). The missing link(age): Multilevel contributors to service uptake failure in youths on community justice supervision. Psychiatric Services.
- A 6-site pilot trial examined the degree to which the model developed in the 36-site RCT can be adapted to meet unmet needs around STI/HIV risk behaviors and service needs for justice involved youth. Five of 6 participating sites were able to facilitate health and JJ partnerships; 3 developed on-site HIV/STI education and testing protocols, and 2 developed education and referral protocols. Four of 5 sites successfully implemented their protocols. Across the 3 sites that implemented on-site HIV/STI education and testing protocols, 98.5% of youth who were offered agreed to a behavioral risk assessment.
Seven research centers were funded as part of the JJ-TRIALS collaborative: Chestnut Health Systems (PIs: Michael Dennis and Christy Scott), Columbia University (PI: Gail Wasserman), Emory University (PIs: Ralph DiClemente and Gene Brody), Mississippi State University (PI: Angela Robertson), Temple University (PI: Steven Belenko), Texas Christian University (PI: Danica Knight), and the University of Kentucky (PI: Carl Leukefeld).
Questions about JJ-TRIALS can be addressed to Tisha Wiley.
Overview of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) Phase I & II
CJ-DATS (the national Criminal Justice Drug Abuse Treatment Studies) was launched in 2002 and two initiatives (CJ-DATS-1 and CJ-DATS-2) were carried out from 2002 to 2014. The overarching goal of the CJ-DATS cooperative research programs was to improve both public health and public safety outcomes for substance abusing offenders leaving prison or jail and returning to the community by integrating substance abuse treatment into the criminal justice system. At that time CJ-DATS-1 was launched, an estimated 600,000 inmates were released each year in the United States, with approximately two-thirds having substance misuse problems that, if left unaddressed, could increase the risk of relapse and recidivism to crime.
CJ-DATS was designed to identify ways in which these offenders could benefit from the continuum of effective substance abuse treatment services. CJ-DATS tested several strategies for improving drug abuse treatment services through the coordination with criminal justice assessment, monitoring, and supervision activities. Further, the CJ-DATS initiatives were designed to inform the development of models for integrating evidence-based substance abuse treatment with the criminal justice system. More information on CJ-DATS can be found on our Archive site.
Seek, Test, and Treat: Addressing HIV in the Criminal Justice System (STTR-CJ)
The Seek, Test, and Treat: Addressing HIV in the Criminal Justice System (STTR-CJ) funded twelve R01 applications that empirically tested the “seek, test, treat, and retain” paradigm with drug abusers in criminal justice populations. Researchers developed, implemented, and tested strategies to increase HIV testing and the provision of HAART to HIV seropositive individuals involved with the criminal justice system, with particular focus on continuity of HAART during and after community re-entry following incarceration.
- A description of the full cohort of 11,070 criminal justice involved individuals is described in the following publication: Chandler, R., Gordon, M. S., Kruszka, B., Strand, L. N., Altice, F. L., Beckwith, C. G., ... & Golin, C. E. (2017). Cohort profile: seek, test, treat and retain United States criminal justice cohort. Substance abuse treatment, prevention, and policy, 12 (1), 24.
For more information, see: Seek, Test, Treat and Retain
- JCOIN Coordination and Translation Center: RFA-DA-19-024
- JCOIN Methodology and Advanced Analytics Resource Center: RFA-DA-19-023
- JCOIN Clinical Research Centers: RFA-DA-19-025
- CJ-DATS Phase 1: RFA-DA-02-011
- CJ-DATS Phase 2: RFA-DA-08-002 and RFA-DA-09-006
- JJ-TRIALS RFA: RFA-DA-13-009
- STTR-CJ RFA: RFA-DA-10-017
- Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2017). Drug use, dependence, and abuse among state prisoners and jail inmates, 2007–2009. Washington, DC: United States Department of Justice, Bureau of Justice Statistics .
- Mulvey, E. P., Schubert, C. A., & Chassin, L. (2010). Substance Use and Delinquent Behavior Among Serious Adolescent Offenders. Washington, DC: United States Department of Justice, Office of Juvenile Justice and Delinquency Prevention .