The nation’s "War on Drugs" has unintentionally created "casualties" among vulnerable populations by applying mandatory minimums, "three strikes" and other harsh policies to mentally ill, substance-abusing individuals.

The National GAINS Center for People with Co-Occurring Disorders in the Justice System reports that between 25% to 50% of all people with mental illness also have substance abuse problems. For a variety of reasons, individuals with co-occurring disorders present special problems for the justice system.

Co-occurring disorders are associated with poor social functioning, homelessness, violence, arrest and incarceration. According to the GAINS Center, at any given time half a million people in the justice system have co-occurring mental health and substance abuse disorders. They have often come to the attention of the justice system as a result of fragmented services and a lack of social support. Not surprisingly, offenders with these co-occurring disorders often exhibit impaired functioning in jail, prison and community corrections settings. While acknowledging the need for treatment in jail for individuals who have committed serious crimes, the Center advocates diversion to community-based mental health programs for those who have been arrested for less serious, nonviolent crimes.

New York State’s tough "Rockefeller Drug Laws" have contributed to skyrocketing rates of incarceration for low-level drug offenders from 1973 to the present. In 1990, Kings County (NY) District Attorney Charles J. Hynes created the "Drug Treatment Alternative to Prison Program" (DTAP), the first prosecution-run substance abuse program for prison-bound, non-violent drug offenders. The program diverts offenders to two years of residential treatment instead of a comparable time in prison at more than twice the cost. This unique program has served almost 1200 participants, with a 66% retention rate after one year of treatment. Altogether, DTAP has 416 successful graduates, with another 246 currently enrolled in the program. The rearrest rate among the graduates to date is half that of the defendants to went to prison instead of treatment.

More recently, Mr. Hynes’ office has broadened its efforts to address non-violent defendants who have mental illness as well as substance abuse disorders. These offenders were found to spend a disproportionate amount of time in prison as compared with substance abusers who did not have a co-occurring mental illness. Based on the success of the DTAP model, the office has initiated a pilot project known as TADD (Treatment Alternatives for Dually Diagnosed Defendants). TADD diverts mentally ill substance abusers into treatment after a guilty plea. A Senior District Attorney screens defendants who have been identified as candidates, and a forensic psychiatrist at Bellevue Hospital is available for diagnostic evaluation as needed. If deemed appropriate for treatment, the defendant is diverted to a residential facility for treatment and rehabilitation services. Defendants enter a guilty plea to the charges with the understanding that they will be subject to incarceration if they fail to comply with the treatment mandate. They also return to court periodically to discuss their treatment progress and compliance with the sentencing judge.

Only a handful of dually-diagnosed defendants have so far been diverted to community-based residential facilities, due largely to the lack of facilities that are equipped to treat this population. The D.A.’s office has brought together organizations that are now working to help develop the needed services for individuals who do not belong in jail and could be much more effectively served by diversion to treatment.

"Co-occurring disorders" and "dual diagnosis" are interchangeable terms.

January 2000