What is the relationship between prison and substance abuse?

Demographics

The US criminal justice system is overburdened by an epidemic of drug addiction and alcoholism. The United States consumes two-thirds of the world’s illegal drugs and incarcerates more than one-quarter of the world’s prisoners. According to a December 2014 report by the US Department of Justice, Bureau of Justice Statistics (BJS), 6.899 million people were identified within the criminal justice system as incarcerated, on parole, or on probation in 2013.

In the second of a two-part landmark report, Behind Bars II: Substance Abuse and America’s Prison Population
(2010), published by the National Center on Addiction and Substance Abuse at Columbia University, substance use disorders among inmates were found to be at epidemic proportions. Prison inmates are seven times more likely to have a substance use disorder (SUD) than are persons in the general population.

The BJS noted in “Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002,” a survey of federal and state prisons, that 68 percent of inmates, in the year before their imprisonment, met the criteria of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders
(DSM) for substance dependence or abuse. An additional 16 percent acknowledged that their convictions were directly related to obtaining money for drugs, and more than one-half acknowledged the use of drugs or alcohol in the commission of a property crime or other violent crime. Of inmates who did not meet the full DSM criteria for SUD, an additional 20 percent acknowledged that substance use was a factor in their crimes, that is, the inmate had been under the influence at the time of the offense or had directly violated alcohol or drug laws.

The survey further showed that diagnoses of alcohol abuse and dependence (47 percent) and drug abuse and dependence (53 percent) were fairly evenly distributed within the prison population. Female prisoners (52 percent) were found to have higher rates of substance dependence than males (44 percent), although males had higher rates of substance abuse. Race also varied among inmates. More white inmates (78 percent) were diagnosed with SUD than were black inmates (64 percent) or Hispanic inmates (59 percent). White women, although they represented 43 percent of all incarcerated women, had the highest rates of SUD.

Age is also significantly related to SUD in the prison population. The survey showed that younger prisoners age twenty-five to forty-four years had higher rates of SUD than prisoners age fifty-five years or older, who had the lowest rates of SUD. Younger inmates tended to abuse drugs, whereas older inmates tended to abuse alcohol. Ten percent of juvenile offenders were found to have been involved with drugs.

The family backgrounds of prisoners with SUD are different from those inmates not diagnosed with addiction. Of those inmates who met criteria for SUD, most had a previous criminal record and had a previous history of homelessness. Their family backgrounds showed that they were twice as likely to be the child of a parent or guardian with a history of SUD as an inmate who has no history of SUD. Almost twice as many prisoners with SUD (21 percent) reported being victims of physical or sexual abuse. More prisoners with a diagnosis of SUD had a parent who also had been incarcerated.

A study published in Current Psychiatry Reports in 2013 reported that more than 80 percent of inmates in state prison and local jails had used an illegal drug, and that 53.4 percent of inmates met the DSM-4 criteria for drug abuse or dependence. The same study found that 69 percent of offenders on probation reported using an illegal drug and 32 percent had used an illegal drug in the month before their arrest.

Benefits of Treatment

Since about 2000, substance abuse treatment has been offered to some people in the criminal justice system. Special attention has been focused on diversion programs and the use of drug courts to provide alternative paths to incarceration.

The National Institute on Drug Abuse issued several principles advocating treatment for the criminal offender. The principles acknowledge that drug abuse is a disease that requires proper assessment and treatment. Co-occurring mental and physical health issues, such as human immunodeficiency virus, acquired immunodeficiency syndrome, and hepatitis, should be addressed and treated. Drug treatment should be tailored to the criminal justice population. Special attention to treatment for the criminal offender must have strong drug-monitoring procedures and familiarity with correctional facility requirements. Treatment must target criminal behavior and thinking patterns and must help the inmate anticipate the consequences of his or her drug and alcohol use. Ideally, treatment should begin in prison and have aftercare programs in place within the community upon release.

In 2005, the US government spent $74 billion on incarceration, court proceedings, probation, and parole for offenders of substance-related crimes. However, the government committed less than 1 percent of that amount—$632 million—to prevention and treatment programs. In contrast, the National Drug Intelligence Center places the cost of effective prevention and treatment at $113 billion, which includes the cost of the criminal justice system itself and the cost of crime to its victims. An overwhelming body of evidence supports the inclusion of substance abuse treatment in the criminal justice system as a cost-effective and humanitarian way to reduce crime.

Recidivism

Substance-involved offenders are more likely to recidivate (repeat crimes) than those who are not involved with substance use. More than one-half (52.2 percent) of substance-involved inmates have been previously incarcerated, compared with 31.2 percent of inmates who are not involved with substances.

SUD is preventable and treatable. Without treatment, however, the statistics suggest that substance-involved offenders will return to prison. Also, in spite of the recommendations for drug treatment, few inmates actually receive drug treatment that is adequate or tailored to their specific needs. Without treatment the rates of relapse will continue, driving up the rate of recidivism.

Bibliography

Balenko, Steven, Matthew Hiller, and Leah Hamilton. “Treating Substance Use Disorders in the Criminal Justice System.” Current Psychiatry Reports 15.11 (2013): n. pag. NCBI PMC. Web. 30 Oct. 2015.

Chandler, R. K., B. W. Fletcher, and N. D. Volkow. “Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety.” Journal of the American Medical Association 301 (2009): 183–90. Print.

Glaze, Lauren E., and Danielle Kaeble. “Correctional Populations in the United States, 2013.” Bureau of Justice Statistics. BJS, 19 Dec. 2014. Web. 30 Oct. 2015.

Karberg, Jennifer C., and Doris J. James. “Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002.” July 2005. Web. 3 Apr. 2012. http://bjs.ojp.usdoj.gov/content/pub/pdf/sdatji02.pdf.

National Center on Addiction and Substance Abuse. Behind Bars II: Substance Abuse and America’s Prison Population. Feb. 2010. Web. 3 Apr. 2012. http://www.casacolumbia.org/articlefiles/575-report2010behindbars2.pdf.