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August 27, 2014

Drug addiction specialist laments that "our prison system does little more than teach addicts how to be better addicts"

I just saw this notable recent Washington Post commentary by David Sack, a psychiatrist and addiction specialist, headlined "We can’t afford to ignore drug addiction in prison." The piece merits a full read and here are excerpts:

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.... 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.... 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.

So what is needed?  Inmate evaluations to spot addictions and underlying issues that may be fueling them....  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....

While it’s tempting to think punishment is the answer [to drug crimes and addiction], 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.

August 27, 2014 at 09:08 AM | Permalink


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More evaluations? You've got to me kidding me. And, dear doctor, what does the data show for drug treatment for prison inmates?

Posted by: Steve Erickson | Aug 27, 2014 12:44:51 PM

Addiction has much more to do with the DNA of the addicted than with the drug they are addicted to. Treatment is rarely effective if it is not freely sought.

A little known tip of the hat to treatment professionals is that in many prisons inmates who have not used drugs take treatment in order to get points toward good behavior. It is a mocking use of resourced.

Posted by: beth | Aug 27, 2014 8:14:00 PM

Your statement is pretty much soot on, both comments. Below.

Addiction has much more to do with the DNA of the addicted than with the drug they are addicted to. Treatment is rarely effective if it is not freely sought.

I would like to see more trade school in federal prison. Carpentry, brick laying, construction management, welding, auto body, electrical, plumbing, ship them to where they can get a skill. Difficult to crawl up out if the hole theyve dug and get a job that pays more than cheap rent and beer money for them.

Posted by: Midwest Guy | Aug 27, 2014 10:05:50 PM

Extended prison time save the life, career and marriage of Robert Downey Jr., after a dozen failures in rehab.

Posted by: Supremacy Claus | Aug 28, 2014 9:11:21 AM

By extended SC, you mean 3-5 yrs.. No problem.

But 12 - 40 or even life with the 3 strikes law, is where the Feds are lost.

Posted by: Midwest Guy | Aug 28, 2014 1:35:33 PM

There is another little known piece of information about vocational training and rehabilitation in federal prisons. Many nonviolent offenders with life or defacto life sentences spend lots of time developing course material for various trades or skills.

They teach courses on things that they have had business experience in before their incarceration. They also act as mentors for nonviolent problem solving and teach classes for passing GEDs. I know of one who is serving a life sentence for marijuana who taught GED classes and had the highest % of students pass in the federal system.

It's a wonderful resource for the prison system, but does not speak well about our overincarceration. More often than not their students have participated in violent acts and the teachers are nonviolent drug offenders who will die in prison.

Posted by: beth | Aug 28, 2014 2:59:40 PM

Beth, may I ask how one gets a life sentence for marijuana? Had to of been some enhancements and priors, guessing.

I enjoy you posts Beth. Simple, open and makes sense.

Posted by: Midwest Guy | Aug 28, 2014 3:54:05 PM

Well, the way most nonviolent drug offenders get life sentences starts with the charging. They are charged with conspiracy to import or distribute or both. Prior to 2000 most indictments did not specify the weights. Frequently defendants with life are the last in the conspiracy to be offered or to explore a plea agreement, or they are not offered a plea.

In most instances, prosecutors have given pleas to many members of the conspiracy already and simply add all the weights from the total conspiracy. Sometimes it was a reverse sting and there were no drugs to weigh, but weights are provided by co-operating witnesses in order to comply with their plea agreement. When the defendant is informed of his or her options, the weights have increased to enhance the sentence to life without parole.
In a conspiracy you can be charged with actions you did do and did not know about.

The next decision is one made by the defendant. In all cases I've seen where someone was given life without parole for marijuana the defendant made the decision to go to trial. Going to trial and being charged with conspiracy is the perfect storm.

Posted by: beth | Aug 28, 2014 6:20:58 PM

Oh, I did forget to add that priors most certainly enter the mix, but you can get life without them simply based on weight.

I have a very narrow criteria for nonviolent marijuana offenders - that is no violence in the case, no violent priors, and no other substance in current case or priors.

Now I'm in the process of vetting other nonviolent drug offenders serving life without parole with the same criteria - no violence in the case and no violent priors. Of course these cases may be any substance or mix of product.

I don't know what the results will be, but conspiracy charges and deciding to go to trial seem to be major components.

Posted by: beth | Aug 28, 2014 8:11:31 PM

Beth, I have heard that conspiracy is bad and I knew not to go trial simply because of the 3 level drop one gets. Going to trial does make a big mess for sure.

Thank You for the info.

Posted by: Midwest Guy | Aug 28, 2014 11:41:05 PM

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