It’s been around 20 years since the National Center on Addiction and Substance Abuse first reported on substance abuse among the nation’s incarcerated. Since that report, there has been little to no work on reducing the number of prisoners who are combating substance abuse problems inside jails and prisons. At least 65% of the inmates in this country meet the medical criteria for drug abuse and addiction, but shockingly, only around 11% receive actual treatment for their problem.

In February of 2010, the second report on this topic was released, “Behind Bars II, Substance Abuse and America’s Prison Population.” This found that a staggering 1.5 million of the 2.3 million inmates in the US suffer from substance abuse addiction. Another 458,000 had histories of substance abuse and addiction. These two groups combine to make up a good 85% of the US prison population. What’s more, inmates struggling with substance abuse disorders are more likely to be incarcerated again than inmates who do not.

addiction and incarcerationAnd yet, despite the identification of the problem as well as the recognition of potential solutions to it, prison policies remain stuck in place. As chair and president of the National Center on Addiction and Substance Abuse, Joseph Califano Jr. put it, they’re “inane and inhumane.” There has simply been no progress on the front end of combating substance abuse within prisons and jails.

“The United States has less than five percent of the world’s population…we consume two-thirds of the world’s illegal drugs and incarcerate almost a quarter of the world’s prisoners, more than 8 of 10 of whom have some substance involvement,” said Califano.

While an incredible $74 billion has been spent on incarceration by federal, state, and local governments, only around $632 million was used for prevention and treatment. That’s 1% of the total incarceration budget.

Let’s take a look at what inmates with drug problems have to contend with.

First of all, let go of the notion that inmates will have to quit once they’re inside prison walls. The fact is that those incarcerated can find access to drug trade inside prison as easily as they can outside of it. Getting incarcerated can therefore be particularly bad news for people who are already struggling with substance abuse disorders.

What’s worse, prisons don’t tend to be supportive environments for addicts who are trying to quit. Quite the contrary, in fact. Even if an inmate is actively trying to get rid of their addiction, they simply cannot count on receiving the treatment they need at either federal prisons, state prisons, or local jails. As we mentioned earlier, only around 11% of inmates get access to help. The rest can hope for, at best, peer counseling meetings. Is it really any wonder that the majority of inmates with histories of addiction will relapse within a month of being released?

What Exactly Does The System Need?

If every single inmate received treatment for substance abuse and addiction disorders, we would reap the economic benefits of it in a year – and that’s assuming only 10% of the inmates treated remained sober, employed and crime-free. For every such sober inmate, the state would save $91,000.

So what would this change entail?

The report by the National Center on Addiction and Substance Abuse recommends first of all, using trained healthcare professionals to screen, assess, and treat substance-involved offenders. Care should also be provided for physical and mental health problems that occur in parallel with drug abuse and addiction. Prisons are in dire need of inmate evaluations to spot addictions and underlying issues that may be fueling them – conditions like anxiety, depression and trauma. Additionally, there must be consistent treatment that includes addiction medicine specialists who have a fundamental understanding of how to use evidence-based treatments, such as medication-assisted therapy.

There should also be comprehensive pre-release planning and after-care, so as to continue treatment services for inmates with substance-use disorders and not leave them in the lurch once they’ve been released. These long term treatment programs will follow the inmate into their community and continue to support them after they have been released.

One suggestion that sounds radical is the use of treatment-based alternatives to jail and prison. A large percentage of crimes are committed while under the influence. Addiction is a disease and not a moral failing. Instead of purely punitive measures being employed against criminals whose drug abuse has contributed to their crime, it might be helpful for some of them to receive alternatives based in treatment. These alternatives would require accreditation for prison and jail-based treatment programs and providers.

Quite a few states have already shortened prison time for drug related crimes, a move that has been inspired in large part by the need to help the prison system cope with ballooning populations. However, this alone is far from enough. There needs to be a focus on improving prison conditions if the inmate population is to be reduced.

At present, only 1.9% of all the money spent on substance abuse and addiction pays for prevention and treatment. The remaining 98.1%? It covers the consequences. We are quite literally spending billions of dollars in order to clean up after addiction instead of helping people overcome it, which is the only thing that has potential to pay off.

So Why Isn’t This Happening?

Part of the reason behind the prison system’s abysmally glacial response to this problem is the failure to understand what addiction is. “At least they won’t be able to do drugs anymore,” is what the popular mantra is – prison is supposed to scare inmates on the right path. Except we know that doesn’t work at all.

Addiction is a disease that necessitates treatment and long term care. Punishment might seem like the easy answer to this problem, but it does little to help change the addict’s behavior or thinking. It doesn’t repair damaged neural pathways or reduce cravings. The only thing that can help is treatment.

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