Modeling Benefits and Costs of Prison-Based Substance Abuse Treatment

描述(申请人提供)：反映出整个20世纪80年代和90年代的政策，监狱关押着不成比例的社会吸毒者人数。1980至1999年间，毒品逮捕人数几乎增加了两倍，各州毒品犯罪人口的增长率大约是美国总人口增长率的50倍(BJS，2001)。囚犯使用非法药物的比例很高；69%的州立监狱囚犯报告在入狱前一个月经常吸毒(Belenko，2002)。从社会的角度来看，治疗这种吸毒很重要，因为经常吸毒的囚犯比其他囚犯有更高的再犯罪率(Belenko，2002)。然而，至多有10%的州立囚犯报告自入狱以来接受过任何临床或医学上的药物治疗(Belenko和Peugh，2005年)。鉴于监禁成本高且不断上升(BJS，2005)，犯罪成本高，基于监狱的治疗成本相对较低，投资于可减少监禁的有效和有针对性的治疗可能具有经济意义。尽管关于监狱药物滥用治疗的益处和成本的现有文献为这一领域的研究和政策提供了大量信息，但结果是有限的，因为这些研究认为药物滥用是一个可以在一次治疗中解决的严重问题。不过，从“戒毒生涯”和成瘾为慢性病的模式来看，吸毒者在一生中很可能会经历多次戒毒。此外，鉴于吸毒与犯罪活动之间的密切关系，滥用毒品的囚犯很可能会有多次监禁经历。因此，全面分析以监狱为基础的药物治疗的效益和成本需要较长的后续时期，因为治疗的效益可能会在较长时期内增加。由于没有任何数据集跟踪吸毒囚犯的余生过程，而且收集此类数据的可能性不大，因此只能通过使用数学模型(如模拟模型)来捕捉终身前景。由于没有一个模型能够捕捉到药物滥用、药物治疗和监禁的终生动态，本研究的具体目的是(1)开发一个针对州立监狱囚犯队列的药物滥用、治疗和监禁的动态模拟模型；(2)使用该模型来估计州立监狱囚犯队列的监狱药物治疗的终生收益和成本；以及(3)使用该模型来估计替代监狱药物治疗情景对监狱药物治疗的终生收益和成本的影响。拟议的动态模拟模型在我们先前实施的模型的基础上进行了扩展(Zarkin等人，2005a)。结果将帮助政策制定者更好地判断监狱药物治疗资源的资金分配。

DESCRIPTION (provided by applicant): Reflecting policies throughout the 1980s and 1990s, prisons hold a disproportionate number of society's drug abusers. Between 1980 and 1999, drug arrests nearly tripled, and the rate of growth in states' drug offender population was approximately 50 times greater than the growth rate of the general U.S. population (BJS, 2001). A high proportion of inmates use illicit drugs; 69% of state prison inmates report regular drug use the month before entering prison (Belenko, 2002). Treating this drug use is important from a societal perspective because inmates who regularly use drugs have higher criminal recidivism rates than other inmates (Belenko, 2002). However, at most, 10% of state inmates report receiving any clinically or medically based drug treatment since admission (Belenko and Peugh, 2005). Given the high and rising cost of incarceration (BJS, 2005), the high cost of crimes committed, and the relatively modest cost of prison-based treatment, investing in effective and targeted treatment that can reduce incarceration may make economic sense. Although the existing literature on the benefits and costs of prison-based drug abuse treatment has greatly informed research and policy in this area, the results are limited because the studies consider drug abuse as an acute problem that can be addressed in one treatment episode. However, from the perspective of "treatment careers" and the model of addiction as a chronic disease, drug abusers are likely to engage in multiple episodes of treatment over the course of their lives. In addition, given the strong relationship between drug abuse and criminal activity, inmates who abuse drugs are likely to have multiple episodes of incarceration. Thus, comprehensive analysis of the benefits and costs of prison-based drug treatment requires long follow-up periods as the benefits of treatment may increase over a long horizon. Because no data set follows drug-abusing inmates over the course of their remaining lifetimes and collecting such data is unlikely, the lifetime perspective can only be captured through the use of mathematical models, such as simulation models. As no model has captured the lifetime dynamics of drug abuse, drug treatment, and incarceration, the specific aims of this study are to (1) develop a dynamic simulation model of drug abuse, treatment, and incarceration for a state prison inmate cohort; (2) use the model to estimate the lifetime benefits and costs of prison-based drug treatment for a state prison inmate cohort; and (3) use the model to estimate the effect of alternative prison-based drug treatment scenarios on lifetime benefits and costs of prison-based drug treatment. The proposed dynamic simulation model expands on a model that we have previously implemented (Zarkin et al., 2005a). Results will help policy makers make better judgments about the allocation of funding to prison-based drug treatment resources.