Substance Abuse in the Criminal Justice System

Drug and alcohol abuse is a large and rapidly growing problem in the United States. One population which is largely affected is the general correctional population. As of 1999 there were over 6,288,600 people in the correctional population (Office of National Drug Control Policy, 2001). The Bureau of Justice Statistics (BJS) and the National Center of Addiction and Substance Abuse (CASA) estimate that 60 percent to 83 percent of the correctional population has used drugs at some point in their lives. This is twice the estimated drug use of the entire population of the United States (Office of National Drug Control Policy).

Many crimes are committed by people who are under the influence of drugs or alcohol. In 1997 it was estimated that over 22 percent of federal male inmates and 32 percent of state male inmates were under the influence of drugs or alcohol at the time they committed the crime (Office of National Drug Control Policy, 2001). It was also estimated that over 19 percent of federal female inmates and over 40 percent of state female inmates were also the influence of drugs or alcohol at the time the crime was committed (Office of National Drug Control Policy).

The desire to obtain drugs can often play a part in crimes that are committed. In 1997, it was estimated that 19 percent of federal prisoners and 16 percent of state prisoners committed crimes to pay for drugs (Office of National Drug Control Policy).

The National Center of Addiction and Substance abuse (CASA) estimates that in 1996 over $38 billion was spent on corrections. More than $30 billion was spent on inmates who had a history of drug and/or alcohol abuse, were using drugs at the time the crime was committed, were convicted of drug and/or alcohol related crimes, or committed their crime for money to buy drugs (Office of National Drug Control Policy, 2001). It is estimated that over $20,000 is spent on each state and federal inmate per year (Office of National Drug Control Policy). Costs in a local jail can range from over $8,000 up to over $66,000 (Office of National Drug Control Policy).

When it comes to the criminal justice system there is often debate as to if incarceration is the answer. Many people feel that this is not a method of rehabilitation. It is also believed that treatment is a more cost effective than imprisonment. Many people also believe that treatment is also the best way reduce chances of a person re-offending.

A study conducted by the Justice Policy Institute in 2004 found that many states are facing budget shortfalls and can help to solve this problem by focusing more on treatment rather than incarceration. The study focused on the state of Maryland. It 1999 there were 12,577 people incarcerated in the state. 41.6 percent of the population was drug offenders. This was a 16 percent increase from the mid-1980's (McVay, D., Schiraldi, V., Ziedenberg, J., 2004). Maryland ranked third in the nation with the percentage of drug offenders. Drugs abuse was also the largest single category of conviction in the state (McVay, Schiraldi, Ziedenberg).

The Center for Substance Abuse Treatment (CSAT) and the U.S. Department of Health and Human Services found that treatment does seem to be more cost effective than incarceration. In Maryland the cost to incarcerate one person each year is over $20,000. Costs of treatment ranged from $1,800 to $6,800 for each person (McVay, D., Schiraldi, V., Ziedenberg, J., 2004).

Some states have used state or city wide ballot initiatives to try to divert non-violent drug offenders to treatment programs rather than incarceration. Arizona, California, Maryland, Indiana and Washington DC are among the states who have taken these steps towards using treatment before incarceration (Drug Policy Alliance, 2004).

In 1996, Arizonans passed Proposition 200. This is known as the Drug Medicalization Prevention and Control Act of 1996 (Drug Policy Alliance, 2004). This proposition diverts first and second time non-violent drug offenders to treatment rather than incarceration. According to a report that was conducted by the Supreme Court of Arizona, Proposition 200 saved taxpayers in Arizona over $6 million in 1999 (Drug Policy Alliance). Also, 67 percent of all probationers successfully completed court ordered drug treatment (Drug Policy Alliance).

Proposition 200 states that any person who is convicted of possession or use of a controlled substance shall be eligible for probation (National Organization for the Reform of Marijuana Laws (NORML), 1996). Only first and/or second time offenders are eligible for probation. They must also complete a drug treatment or education program. States funds are also available for people who cannot afford these programs (National Organization for the Reform of Marijuana Laws).

Non-violent inmates who were currently in prison for possession of illegal drugs were made immediately eligible for parole as long as they were not serving a concurrent sentence for another crime (National Organization for the Reform of Marijuana Laws, 1996). They were also released to participate in drug treatment, education, and community service. At the time Proposition 200 was enacted 976 inmates were eligible for release under the new law (National Organization for the Reform of Marijuana Laws).

When a violent crime is committed under the influence of drugs there is no option for diversion to treatment. The person is to serve their entire sentence with no change of an early release (National Organization for the Reform of Marijuana Laws, 1996).

In November 2002, 78 percent of voters in Washington DC passed Measure 62. Measure 62 is also known as the drug treatment initiative (National Organization for the Reform of Marijuana Laws, 1996). Under measure 62 the city would provide substance abuse treatment rather than incarceration for non-violent offenders. The measure would help to provide a plan for rehabilitation and provides for dismissal of all legal proceeding upon successful completion of the treatment program (National Organization for the Reform of Marijuana Laws).

As of 2005 there were 10,000 people in the district receiving treatment out of the 60,000 who need it (Drug Policy Alliance, 2005). More than 86,000 people voted to enact Measure 62. The measure was later overturned by just three judges and the Mayor. Mayor Anthony Williams challenged the measure in court saying it interfered with the city's spending authority because it allocated funds for drug treatment. (Drug Policy Alliance).

In California 61 percent of voters passed Proposition 36 in November 2000. This initiative makes it possible for most first and second time, non violent drug offenders to receive treatment instead of incarceration (California Proposition 36, 2006).

Each year over 35,000 Californians enter treatment through Proposition 36. Initial funding for the program is scheduled to run out by July 2006 (California Proposition 36, 2006). At this time over 150,000 people will have experienced the benefits from Proposition 36. California taxpayers will also have saved around $1.5 billon. Requests for future funding were scheduled to being early 2006 (California Proposition 36, 2006).

In Indiana a law was passed in 2001 that allows a person who is charged with delivering a controlled substance eligible for treatment instead of prosecution (Lyons, D., 2002). The law allows courts to place people convicted of controlled substance felonies into community corrections programs. This measure also allows juveniles to remain in the juvenile justice system rather than be transferred to district courts on drug trafficking charges (Lyons, D.).

The state of Maryland has also moved away from incarceration and focuses more on the treatment aspect. The state has created several programs to try to improve the situation. These programs are aimed to divert low-risk drug offenders from incarceration into treatment programs. Maryland's Break the Cycle program is one program that has helped to reduce substance abuse and recidivism rates (McVay, D., Schiraldi, V., Ziedenberg, J., 2004).

The findings from the Justice Policy Institute yielded several recommendations for improvement. The first recommendation was to abolish mandatory drug sentencing and allow judges to decide if treatment or incarceration was best for each individual (McVay, D., Schiraldi, V., Ziedenberg, J., 2004). The second recommendation was to divert non-violent drug offenders from incarceration and right into treatment. The final recommendation was to use the money saved from the first two recommendations to fund other programs that are aimed at reducing substance abuse (McVay, Schiraldi, Ziedenberg).

Despite the findings from studies such as this, there continue to be an enormous amount of people who are incarcerated for non-violent drug offenses. This means that these people must use various treatment programs and options that are available within the correctional system.

Treating substance abuse in a correctional facility can be very challenging for everyone involved. Substance abuse can be defined as a pattern of harmful use of any substance for mood-altering purposes (About.com, 2006).

There are several types of treatment options that an offender may encounter while they are incarcerated. Programs can include residential programs, therapeutic communities, self-help programs, drug education, medical detoxification and counseling (Drug-addiction.com, 2006).

Residential treatment programs are one of many of the treatment options that are available. The prison-based version of the program is known as RDAP, or residential drug treatment program (Pelissier, B, and Cadigan, T., 2004). The program generally lasts six to 12 months (McBride, Ruel, Terry-McElrath, Vander Waal, 2002). Participants in the program must meet selected criteria. They must have a documented substance abuse program and the willingness to participate fully in treatment (Pelissier and Cadigan). The programs are operated by professional drug treatment staff and usually use scientifically based treatment interventions. Inmates in a residential treatment program tend to live in drug treatment units which are separated for the other inmates (McBride, et al.).

Therapeutic communities (TC) are another form of treatment that is utilized in treating substance abuse. The prison-based therapeutic community is an intensive program that generally lasts nine-12 months. It is a highly structured program and it geared towards hard-core drug users (McBride, Ruel, Terry-McElrath, Vander Waal, 2002). This program works on a confrontation-based self-help model. It allows inmates to have some control of the program and their rewards. The program is run by professional staff that maintains control of general operations of the program (McBride, et al.).

Self-help programs such as Alcoholics Anonymous (A.A.) and Narcotics Anonymous (NA.) are a widely used form of treatment. These programs help to form a fellowship of men and women who share their experiences, knowledge, and strength to solve common problems and help everyone with recovery (Alcoholics Anonymous.org, 2006). These programs do not have any fees or membership dues and are self-supporting. These programs are not affiliated with any organizations, political or religious entity. The primary purpose is to help everyone achieve sobriety (Alcoholics Anonymous.org).

Support groups such as A.A. and NA utilize a 12-step program to help work towards the goal of recovery. The 12 steps help a person to overcome obstacles during various stages of recovery. The 12-step program has been one of the most successful programs for helping people to overcome addictive or dysfunctional behaviors (12Step.org, n. d.).

Medical detoxification is often considered a precursor of treatment because it helps to treat the physiological affects that take when drug use is discontinued (Drug-addiction.com, 2006). It is a process where the individual is withdrawn from the addicting substance using a systematic approach (Drug-addiction.com). Medications are available to help with detoxification of many drugs. These drugs include nicotine, opiates, alcohol, barbiturates, benzodiazepines, and other sedatives. Medical detoxification is often necessary to help with the withdrawal process. In some cases untreated withdrawal can be dangerous or even fatal (Drug-addiction.com).

One of the most popular medications used to treat drug addiction is methadone. Methadone is a synthetic narcotic that has been used for more than 30 years to treat opioid addiction (Office of National Drug Control Policy, 2000). Drugs like heroin release an excess of dopamine into the body. This causes the user to require an opiate on a continuous basis. Methadone helps to occupy the opiod receptor in the brain. This is the stabilizing factor that helps addicts on methadone to change their behavior and eventually discontinue the use of heroin (Office of National Drug Control Policy).

Methadone is generally taken orally once a day. It helps to suppress withdrawal for 24 to 36 hours (Office of National Drug Control Policy, 2000). Methadone is only effective on the treatment of heroin, morphine, and other opioid drugs. It is used to reduce the cravings for the drug and to block the high that the drug provides (Office of National Drug Control Policy). The patient will remain dependent on the opioid, but will not have the compulsive, disruptive behaviors a heroin addict (Officer of National Drug Control Policy).

Withdrawal from methadone is much slower than heroin withdrawal. This makes make it possible to maintain an addict on methadone without them experiencing any harsh side affects (Office of National Drug Control Policy, 2000). Patients who are receiving methadone maintenance treatment (MMT) can often require continuous treatment. In some cases treatment can last many years (Office of National Drug Control Policy).

Some people question the safety of methadone maintenance treatment. Studies have shown that long-term MMT is safe (Office of National Drug Control Policy, 2000). When taken under medical supervision methadone does not cause any long term effects to the heart, lungs, liver, kidneys, bones, blood, brain, or any other vital organs (Office of National Drug Control Policy). These studies also showed that methadone does not have any serious side effects. In some cases a patient may experience minor symptoms such as drowsiness, skin rash, constipation and excessive sweating (Office of National Drug Control Policy). These symptoms usually cease when the methadone dosage is adjusted and stabilized (Office of National Drug Control Policy).

Methadone is a legal medication that is taken under quality control standards. Methadone does not impair cognitive functions or interfere with day to day activities. There is no affect on a patient's mental capability or intelligence (Office of National Drug Control Policy, 2000). It is also not intoxicating or sedating. It does relieve the craving that is associated with the addiction to opiates. For most heroin addicts a typical street dose will not produce the same state of euphoria as before. This tends to make the use of heroin less desirable (Office of National Drug Control Policy).

There are several other benefits associated to methadone maintenance treatment. One of the biggest benefits is the cost. In 1998 it was determined that MMT typically was about $13 a day (Office of National Drug Control Policy). This made MMT a cost-effective alternative to incarceration.

Methadone maintenance treatment also reduces the risk of HIV/AIDS, hepatitis B and C, tuberculosis and other sexually transmitted diseases (Office of National Drug Control Policy, 2000). It is common for heroin users to share needles and engage in at-risk sexual activities such as prostitution. Reducing the desire to use heroin helps lower the risks associated with these negative factors.

MMT helps a patient to break free from their heroin addiction. This decrease in use helps the patient live a healthier, more productive life (Office of National Drug Control Policy, 2000). Eliminating heroin addiction also eliminated the need to live a life of crime to support the drug addiction. In 1994 criminal activity decreased 52% in patients who were receiving MMT. Full-time employment also increased by 24% (Office of National Drug Control Policy).

Recently two states have implemented new meth treatment programs. One facility is located at the Miami Correctional Facility in Kokomo. The other is located in Montana (Heiseman, A., 2006).

The new meth treatment program was established in at Miami Correctional Facility to help better service the high number of inmates who are there due to methamphetamine abuse. It estimated that about 80 percent of the facilities population is in need of a treatment program like this (Heiseman, A., 2006).

The program has been named CLIFF, Clean Living is Freedom Forever. The 200-bed male unit was established in April 2005. A 100-bed female treatment center opened in November 2005 at the Rockville Correctional Facility (Heiseman, A., 2006).

Inmates who are within three years of parole are able to participate in CLIFF (Heiseman, A., 2006). The program takes six to nine months, but enrollees are able to take six months off of their sentence upon successful completion of the program. Inmates spend a great deal of time working on setting up a support group to help them once they are released. They also attend hours of group sessions talking about the affects of their addiction on their lives, as well as their family and friends (Heiseman, A.)

In Montana, plans to build a lockdown meth treatment center are being evaluated. The treatment center is to have 80 beds for men and 40 for women (Heiseman, A., 2006).

According to the Department of Corrections in Montana meth is involved in the crimes of more than 50 percent of the female inmates (Heiseman, A.) It is also estimated that it is involved in about 35 percent of the male cases. A new state law will make it possible for judges to sentence particular cases to this new treatment prison (Heiseman, A.).

Despite the growing need for drug and alcohol abuse treatment and the treatment options that are possible, relatively few inmates receive treatment while incarcerated (Belenko and Peugh, 2004). Programs such as drug education classes and 12-step programs tend to be too limited and short term for many inmates. Programs such as long-term residential treatment tend to be too intensive and expensive. Residential treatment followed by continuing care in the community reduces recidivism and relapse (Belenko and Peugh). This type of treatment seems to be the most beneficial, but is not readily available. Long-term residential beds are limited in the correctional system (Belenko and Peugh). They are also not available to inmates with fairly short terms of incarceration such as parole violators. This means that many of the inmates who are re-incarcerated for drug-related parole violations never receive the care that they need. They are returned to the community with little treatment and are likely to relapse (Belenko and Peugh).

Another form of treatment that is available is prisons that focus primarily on substance abuse treatment. These prisons are often referred to as "Drug Prisons" (St. Gerald, V., 2005) There are about a dozen of these prisons in the United States. One of the biggest is Sheridan Correctional Center, located in Illinois. In 2002 Sheridan Correctional Center closed its doors. In January 2004 it reopened as a prison that focuses on drug treatment (St. Gerald, V., 2005).

A year after the re-opening of Sheridan Correctional Center statistics showed that this plan seemed to be working. A report was conducted by the criminal justice department at Loyola University that compared the first 150 inmates released from the facility with other parolees with similar backgrounds (St. Gerald, V., 2005). The report showed that only about 12 percent of parolees for Sheridan Correctional Center were rearrested. This is considerably lower than the 27 percent from the other group of parolees. These numbers were even more promising considering the fact that the participants in this program had extensive substance abuse and criminal histories (St. Gerald, V.).

1,100 beds are available in Sheridan Correctional Center (St. Gerald, V., 2005). One of the reasons for the success of the facility is the mandatory job-preparedness program. The program places a great deal of emphasis on reentry into society and helps with the job searching process. It teaches inmates how to make resumes and cover letters. Mock interviews are also conducted to help ease the stresses of the interview process (St. Gerald, V.).

Upon return to society, many inmates face a great deal of obstacles. It is fairly common for drug-involved inmates to have poor job history and educational deficits (Belenko and Peugh, 2004). Factors such as these can complicate the transition back into the community. An inmate who is looking for a job may lack the skills and knowledge to obtain employment. The stress associated with seeking employment can also make an inmate more susceptible to relapse into drugs and alcohol. This increases the odds that the individual will return to a life of crime in order to survive. Other physical and mental health problems may also complicate the inmate's job ability to obtain and maintain employment (Belenko and Peugh).

Housing problems present another complicated issue for an inmate who is trying to return to society. It can be a challenge to find affordable housing that is in a drug-free environment. It can be difficult for someone who does not have help from family members or the financial means to obtain their own housing (Belenko and Peugh). Many inmates may also face discrimination from landlords when trying to obtain housing as well. These obstacles increase the chances of homelessness, relapse, and a life of crime. It is also possible that some people may intentionally try to return to a correctional environment for the basic needs like food or shelter. Incarceration may be a lifestyle that they have grown accustomed to and they may feel that this is the only way they know how to survive.

Transitional services (TS) in another component of the BOP's drug treatment program (Pelissier and Cadigan, 2004). These services are help to provide outpatient treatment during placement in a halfway house. Anyone can participate in the transitional services even if they did not participate in RDAP (Pelissier and Cadigan).

Once an inmate is placed on supervised release or parole, they may be required to participate in the substance abuse treatment program (SATP). This program covers many different areas including assessment, outpatient treatment, detoxification, and methadone maintenance (Pelissier and Cadigan, 2004). SATP is primarily an abstinence program, but uses a wide range of treatment modules. This treatment consists of cognitive and behavior modifications, as well as self help programs (Pelissier and Cadigan).

There are many treatment options for drug and alcohol abuse treatment in correctional settings. There is no easy answer and not every solution will work for each person. As the problem continues to grow, it is likely that programs will continue to immerse to try to control the problem. With any luck someday the war on drugs will be won. In the meantime, treatment programs over incarceration may be one of the best answers. Statistics seems to show that it is the best option financially. Treatment also seems to be more of a solution than just a temporary fix.

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