Addiction Data Bulletin 7

This bulletin presents an analysis of trends in criminal legal involvement among individuals engaged in substance use disorder (SUD) treatment in New York State (NYS) between 2018-2023. Specifically, this bulletin examines annual changes in criminal legal involvement overall, by region, by race/ethnicity, age group, sex at birth, and primary substance used. 

• Rates of criminal legal involvement among those engaged in SUD treatment decreased from 2018 to 2023, with the largest decrease occurring between 2019 and 2020.
• Those who were 25 and younger and males had significantly higher rates of criminal legal involvement than their older and female counterparts, respectively.
• The non-Hispanic (NH) white population engaged in SUD treatment had a larger decrease in the rate of criminal legal involvement than the non-Hispanic black and Hispanic groups from 2018-23.
• The largest significant decreases in rates of criminal legal involvement were among those with cannabis-related treatment from 2018-23.

Data Elements and Definitions 

Treatment engagement reflects unique individuals who received SUD treatment in that calendar year regardless of the year of their treatment initiation.

Substance-related treatment is reported at SUD treatment entry. An individual can report up to three substances of use. The first substance recorded is the one primarily responsible for the individual’s treatment, and is the one used in this analyses.

The unit of analysis was unique individuals in SUD treatment. For individuals with more than one treatment record in a calendar year, we used the last record of that individual during the specified year to ensure unduplicated data. Regional comparisons used the county of individual’s residence.

Criminal legal involvement was defined as those referred from courts, during reentry following incarceration, and during community supervision at time of SUD treatment initiation. (See Figure 1) For individuals with more than one treatment initiation in a calendar year, we used the last record that indicated any criminal legal involvement.

Criminal legal involvement rate was defined as the number of individuals with criminal legal involvement per 1,000 individuals receiving SUD treatment in that calendar year.

Statistical significance tests were conducted to compare annual rates using Poisson tests, with significance level set at α = 0.05.* denotes statistical significance compared with the previous year unless otherwise specified. 

Substances Use Categories

Alcohol: psychoactive substance and central nervous system depressant.

Cannabis: naturally occurring psychoactive substance derived from the cannabis plant.

Opioids: naturally occurring, semi-synthetic, or synthetic psychoactive substances that act on opioid receptors in the brain. Food and Drug Administration (FDA)-approved indication for opioids is for pain. The main substances within this category included in these analyses are prescription opioids, heroin, and illegally manufactured fentanyl and its analogues. Opioids are central nervous system depressants.

Cocaine: naturally occurring psychoactive stimulant derived from the leaves of the coca plant. Cocaine stimulates the central nervous system. FDA-approved indications of cocaine are primarily as a local anesthetic.

Methamphetamine: synthetic psychoactive stimulant that stimulate the central nervous system. 

The criminal legal system is the largest referral source for substance use disorder (SUD) in the US and in NYS. ^{[1, 2]} Legally mandated SUD treatment is a common component of community supervision (probation or parole) and incarceration diversion programs from both drug-related and non-drug-related sentences and arrests. (Figure 1) While criminal legal referrals to SUD treatment in the US have decreased since 2015, as of 2024, the criminal legal system remained the largest referral source of cannabis-related treatment in the US.^[3] 

Criminal Legal Involvement Among Those Engaged in SUD Treatment Overall and by Region

From 2018 to 2023, the rate of criminal legal involvement among individuals engaged in SUD treatment fell from 436 to 328 per 1,000 residents, with significant declines each year both statewide and across all regions. (Figure 2) The largest significant single-year decrease occurred between 2019 and 2020 (-41 per 1,000).

Criminal Legal Involvement Among Those Engaged in SUD Treatment by Region and Race/Ethnicity

The rate of criminal legal involvement among those engaged in SUD treatment significantly decreased within each racial/ethnic group across all of NYS between 2018 and 2023. (Figure 3) This decrease was significantly larger for the non-Hispanic white population than for non-Hispanic black or Hispanic populations, respectively, in both NYC and rest of state. (Figure 3)

Criminal Legal Involvement by Age Group and Sex at Birth

The rate of criminal legal involvement among those engaged in SUD treatment significantly decreased for both females and males overall between 2018 to 2023. (Figure 4) Those who were 25 and younger and males had significantly higher rates of criminal legal involvement than their older and female counterparts, respectively. (Figure 4)

Criminal Legal Involvement by Primary Substance Use

From 2018 to 2023, the rate of criminal legal involvement among those engaged in SUD treatment significantly decreased for all substances. The rate of criminal legal involvement for people in cannabis-related treatment had the largest rate decrease (-178) between 2018 and 2023. (Figure 5) 

The most common primary substance used among the criminal legal involved population was alcohol, followed by opioids. For those without criminal legal involvement, that order was reversed. (Figure 6) While the proportion of people having primary substance use of cannabis remains relatively constant among those without criminal legal involvement, that proportion has been decreasing among those with criminal legal involvement (22% to 16%).

Between 2018 and 2023, criminal legal involvement among those engaged in SUD treatment significantly decreased in every year. The largest decrease in criminal legal involvement occurred between 2019 and 2020, when bail reform ^[4] and decriminalization of cannabis were implemented in 2019. The largest decrease in rates of criminal-legal involvement occurred among non-Hispanic white individuals (vs. non-Hispanic black or Hispanic individuals), women (vs. men), individuals 25 years of age and younger (vs. >26 years of age) and individuals with cannabis-related treatment (vs. alcohol, opioids, cocaine, or methamphetamine). The decrease in criminal legal involvement differed significantly by race and ethnicity, sex at birth, age group, and primary substance use.

1. Shearer, R.D., T.N. Winkelman, and U.G. Khatri, State level variation in substance use treatment admissions among criminal legal-referred individuals. Drug and alcohol dependence, 2022. 240: p. 109651.
2. Aletraris, L., B.D. Graves, and J.J. Ndung’u, Assessing the impact of recreational cannabis legalization on cannabis use disorder and admissions to treatment in the United States. Current addiction reports, 2023. 10(2): p. 198-209.
3. Fry, C.E., J. Harris, and M.E. Burns, Changes in legal referrals to specialty substance use disorder treatment from 2015–2019. Health & Justice, 2024. 12(1): p. 42.
4. Rahman, I., New York, New York: Highlights of the 2019 bail reform law. 2019: Vera Institute of Justice Brooklyn, NY.