We can’t afford to ignore drug addiction in prison

August 14

As the addiction epidemic rages and prisons overflow, our nation seems to be backing away at last from the “lock ’em up and throw away the key” mindset that has characterized the failed war on drugs.


Many states have shortened prison time for drug crimes, and the federal system is inching toward doing the same, with new guidelines that will be effective Nov. 1 and retroactive releases starting a year later.

Sure, this is inspired largely by the need to relieve the pressure on our prison system, which is straining to cope with a population that has more than quadrupled since 1980. But it’s also recognition that we can't incarcerate ourselves out of our drug problems.

As someone who helps people with addictions, I consider this good news. But I'd be more encouraged if we also focused on improving conditions in prison. In the long run, this will have more power to reduce our inmate population. As it is, our prison system does little more than teach addicts how to be better addicts.

Inmates are likely to find a drug trade as active as the one outside prison walls. Many is the time I’ve listened sadly as family members have consoled themselves about a loved one’s incarceration by saying, “At least he'll have to quit using now.” If only.

Inmates with addictions are surrounded by similarly troubled souls. Of the more than 2.3 million people in American prisons and jails, more than 65 percent meet medical criteria for substance abuse addiction. When you combine this with those who have histories of substance abuse, were under the influence when they committed a crime, committed it to get drug money, or were incarcerated for a drug or alcohol violation, the percentage rises to 85 percent. In other words, if an inmate is looking for encouragement to “Just say no,” odds are he won't find it from his bunkmates.

But most disturbing is the fact that inmates who do hope to kick an addiction can’t count on getting the help they need. The National Center on Addiction and Substance Abuse (CASA) at Columbia University found that only 11 percent of inmates with substance use disorders received treatment at federal and state prisons or local jails. The best that most can hope for is occasional mutual support or peer counseling meetings. No wonder that more than half of inmates with addiction histories relapse within a month of release.

Investing in recovery

So what is needed?

  • Inmate evaluations to spot addictions and underlying issues that may be fueling them – conditions such as depression, trauma and anxiety.
  • Consistent treatment by a trained staff that includes addiction medicine specialists who understand how to use evidence-based treatments, including medication-assisted therapy.
  • Long-term treatment programs that follow the inmate into his community and continue to support him after his release.

It’s a substantial investment, and your first thought may be, “We can't afford to do that.” But the reality is we can’t afford not to do it.

As it stands now, only 1.9 cents of every dollar our federal and state governments spend on substance use and addiction go to pay for prevention and treatment; 95.6 percent pay for the consequences. That means we are shelling out billions of dollars to clean up the mess of addiction rather than doing what we know pays off – helping people overcome it.

A 2010 CASA study, for example, determined that if we gave quality addiction treatment and aftercare to every inmate who needed it, we'd break even on the investment in only a year if just more than 10 percent were successful in staying employed, out of trouble and drug free. In dollar terms, that translates to an economic benefit for the nation of more than $90,000 annually per former inmate.

Studies confirm that addicts pressured to undergo treatment by the legal system fare as well or better than those who seek treatment voluntarily.

Healing the addicted mind

So if we know what to do, why aren't we doing it?

Part of the reason may be a failure to understand how addiction works. Many still expect prison to scare addicts straight. The worse the experience, the less inclined they'll be to use drugs in the future and risk a return, right? So why invest in treatment?

It’s not that simple when you're an addict. Addiction is a chronic illness that needs long-term care, much like diabetes or heart disease. It changes the brain, often turning users – including those we love – into people we don’t understand, trust or like. While it’s tempting to think punishment is the answer, prison alone doesn’t teach addicts how to change their thinking and behavior, doesn’t help repair damaged neural pathways and doesn't take away drug cravings or offer strategies to prevent relapse. In most cases, prison just buys a little time before the addict relapses and re-offends, perpetuating the cycle and hurting himself along with the rest of us.

So bring on the reduced prison sentences. It’s a good incentive to look beyond incarceration for solutions to society’s ills. But let’s also – finally – make a real commitment to seeing how much we can accomplish with effective addiction treatment. All things considered, it’s a small price to pay.

David Sack is a psychiatrist, addiction specialist and CEO of Elements Behavioral Health, a network of addiction treatment centers.

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