Modeling Benefits and Costs of Prison-Based Substance Abuse Treatment

描述（由申请人提供）：监狱关押着不成比例的社会吸毒者，这反映了整个20世纪80年代和90年代的政策。在1980年至1999年期间，因毒品被捕的人数几乎增加了两倍，各州毒品犯罪者人口的增长率大约是美国总人口增长率的50倍（BJS，2001年）。囚犯使用非法药物的比例很高; 69%的国家监狱囚犯报告在入狱前一个月经常使用药物（Belenko，2002年）。从社会角度来看，治疗这种药物使用很重要，因为经常使用药物的囚犯比其他囚犯的犯罪累犯率更高（Belenko，2002年）。然而，至多有10%的州立囚犯报告说，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）。鉴于监禁的成本很高且不断上升（英国司法部，2005年），犯罪的成本很高，而监狱治疗的成本相对较低，投资于能够减少监禁的有效和有针对性的治疗可能具有经济意义。虽然关于监狱内药物滥用治疗的益处和费用的现有文献为这一领域的研究和政策提供了大量信息，但结果有限，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。然而，从“治疗生涯”的角度和吸毒成瘾作为一种慢性疾病的模式来看，吸毒者在其一生中可能会接受多次治疗。此外，鉴于药物滥用与犯罪活动之间的密切关系，药物滥用的囚犯很可能有多次监禁。因此，对监狱戒毒治疗的效益和成本进行全面分析需要长期的跟踪，因为治疗的效益可能会随着时间的推移而增加。由于没有数据集跟踪吸毒囚犯的余生，而且不可能收集这类数据，因此只能通过使用数学模型，如模拟模型，从终生角度来把握。由于没有模型能够捕捉到药物滥用、药物治疗和监禁的终身动态，本研究的具体目的是：（1）为州立监狱囚犯队列开发药物滥用、治疗和监禁的动态模拟模型;（2）使用该模型估计州立监狱囚犯队列基于监狱的药物治疗的终身收益和成本;以及（3）使用该模型来估计替代监狱戒毒方案对监狱戒毒终身收益和成本的影响。所提出的动态模拟模型扩展了我们先前实现的模型（Zarkin等人，2005年a）。研究结果将有助于决策者更好地判断监狱戒毒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.