Substance Abuse and the Criminal Offender
By Sonia Torrey, Counselor for Hope Homes Atlanta
Is substance abuse treatment for the criminal offender worth the time, effort and money?
Research shows that the benefit is markedly significant for society as a whole. Offenders who either use drugs or sell them have the ability to change the course of their life for the better with treatment. Such changed individuals once released from prison can become more productive members of society which also helps to reduce the amount of crime with their changed behavior. Staggering numbers of note indicate the benefit of substance abuse treatment. “In 2007, it was estimated that the cost to society of drug abuse was $193 billion (National Drug Intelligence Center [NDIC], 2011), a substantial portion of which—$113 billion—is associated with drug-related crime, including criminal justice system costs and costs borne by victims of crime” (2). Well then how much does treatment cost? Is treatment a financially sound option? $14.6 billion is the amount estimated for health costs, hospitalizations and government specialty treatment for drug abuse, far less than the costs incurred from drug related crimes (NDIC, 2011).
Substance abuse treatment for the criminal offender is the best choice for arresting the cycle of drug abuse and criminal justice. The cost of treatment is markedly less than the cost of incarceration. Avoiding the cost of crime to include incarceration and victimization costs is seen as the largest economic benefit of treatment (2). Statistics show the cost of treatment averages $4,700 whereas the cost of incarceration can run around $24,000 (2). The benefit to society as related to increasing productive members and decreasing drug related crimes is immeasurable. Offering substance abuse treatment while incarcerated allows offenders to work on themselves during the time they are away from the drug lifestyle and culture. Making the most of the time behind bars by offenders engaging in treatment allows for increasing the chance of a changed and recovered individual post-release.
There are certain needs specific to different populations in the criminal justice system. Among them cultural minorities, females dealing with sexual abuse, self-esteem, parenting and child custody, men dealing with fathering and developing relationships, violent offenders, older adults, cognitive/learning, physical and sensory disabilities, sexual orientation, people with infectious diseases and sex offenders all present challenges unique to their situation (1). Specific attention that is sensitive to each type is important in the success of addressing the individual’s needs and can make a difference in the healing of that person. Though there are not too many individualized treatment options for each culture, a sensitivity to differences can greatly help the course of treatment.
Culture and population play a big role in defining the needs of substance abuse treatment in criminal offenders. For example, African Americans have a disproportionate representation in jails, prisons and community service programs such as probation in comparison to the general population. The numbers indicate African Americans made up 39.2 percent of the jail population and 44.1 percent of the prison population in 2003. Only 13 percent of the U.S. population was made up of African Americans alone or as a mixed race according to the 2000 Census (2). The Hispanic/Latino race is also indicated similarly in this fashion. Also tied in to this cultural matter can be the tendency for these populations to be involved in gangs coming into prison or jail and continuing while incarcerated. Drug use and dealing is common in gang life including violence which is a daily part of life in the prison culture. Working with inmates on substance abuse issues including life skills and anger management throughout their incarceration can help break the cycle of arrest,conviction, incarceration, punitive measures, release. A newer approach allowing for more options would be arrest and assess, sentence and treat, community treatment with legal restrictions, integration through education, housing, employment and restitutions (2).
Another area which requires individualized care is the criminal offender suffering from infectious diseases such as HIV/AIDS, Hepatitis B and C or sexually transmitted diseases. Offenders have a disproportionately high rate of substance abuse and diseases. Research shows that treatment for drug abuse can lessen the spread of infectious diseases by reducing high-risk behaviors like needle-sharing and unprotected sex (Metzgeret al. 2010) (2). Connecting these individuals with community services prior to release is extremely important as the person’s likelihood to do so on his or her own is low.
Difficulties arising in working with inmates on substance abuse come from the power struggle between the inmate and the counselor or correctional staff members as they are seen as the dominant culture. A counselor can represent the same institutional force that is responsible for the conviction and incarceration of the client. This creates a high level of distrust and is a great obstacle for the chances of successful treatment. Culture, socioeconomic class and language are factors that can create the most common misunderstandings in counseling so is it very important the counselor is aware of and sensitive to all areas when dealing with each individual (1).
Mental disorders among inmates with substance abuse issues require a unique approach. First an assessment must be made in order to accurately diagnosis the person’s condition. Medication management is usually required though unfortunately “medical care for offenders in the criminal justice system is inadequate and underfunded” (1). Other methods effective in treating those with co-occurring issues include cognitive behavioral therapy, contingency management which can assist those to adhere to their medication regimens by providing tangible rewards for meeting goals, and intensive case management which allows for coordination of treatment, mental health care and community services. Modified Therapeutic Communities is a type of treatment that combines traditional Therapeutic Communities specializing in addressing co-occurring mental health conditions (2). In-prison therapeutic communities offer the best approach in working with incarcerated offenders as an individual learns how to utilize a community, develop life skills and lays the foundation of the importance on a healthy unit as opposed to the “me against them” mentality. Residential prison treatment is more cost effective if offenders attend treatment post-release, according to research (Martin et al. 1999; Butzin et al. 2006) (2). Post-release, the benefit to having drug courts which allows for greater accountability for offenders, includes avoided incarceration and the economic effects of crime.
Of course, the effectiveness of treatment is dependent upon the willingness of the individual and the availability of quality care. Longitudinal outcome studies find that those who participate in community-based drug abuse treatment programs commit fewer crimes than those who do not participate (Prendergast et al. 2002; Butzin et al. 2006; and Kinlock et al. 2009) (1). This is definitely an offering of hope for both providers and the abuser. In a survey of State and Federal prisoners, BJS estimated that about half of the prisoners met Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria for drug abuse or dependence, and yet fewer than 20 percent who needed treatment received it (Chandler et al.2009; Karberg and Mumola 2006) (2). Although the past several decades have witnessed an increased interest in providing substance abuse treatment services for criminal justice offenders, only a small percentage of offenders has access to adequate services, especially in jails and community correctional facilities (Taxman et al. 2007; Sabol et al. 2010) (2). Not only is there a gap in the availability of these services for offenders, but often there are few choices in the types of services provided. Some people who have drug abuse history are not always in need of drug abuse treatment. Sometimes drug abuse education or self-help groups are appropriate if the individual does not meet criteria for drug dependence. Another issue to point out is that in some instances, legal pressure is enough to make someone be willing to submit to treatment and once involved that person has the chance at internalizing recovery. Proper assessment is vital to appropriately utilize drug treatment resources as substance abuse treatment is not always indicated.
Certain risk factors unique to criminal offenders are important to focus on as they contribute to drug relapse and criminal recidivism. Stress related to family difficulties, poor life and social skills, educational and employment problems which contribute to financial difficulties, and medical conditions including mental health disorders, all are triggers that can cause someone to relapse. Often times people going into prison leave behind unsafe living conditions and broken families so when re-entering society their options are limited. Going back to the same environment can be a huge trigger that leads to relapse. For all of the reasons above, life skills are an important part of treatment that will prepare the individual for life on the outside. (2)
One of the best indicators for treatment success is the duration of the treatment. “Generally, better outcomes are associated with treatment that lasts longer than 90 days, with treatment completers achieving the greatest reductions in drug abuse and criminal behavior.” (2) Providing treatment in prison and continuing it in community programs leads to even better rates of prolonged sobriety and the absence of the return to criminal behavior. Rewards and sanctions are another great tool to encouraging behavioral change. The efficacy of rewarding positive behavior outweighs that of punishing negative behavior. Contingency management strategies such as voucher-based incentives or rewards work best when specific goals were focused on and rewarded such as abstinence and counseling attendance. (2)
Treatment for the offender with substance abuse issues holds unique challenges as outlined above. The services available to those offenders with substance abuse problems are vital to society though sometimes it is overlooked or deemed as an unnecessary privilege. On the same note, the more these individuals are open to investing themselves in drug treatment services, the higher the efficacy of incarceration itself. With all of these facts and figures and less tangible yet equally important examples of an individual with a renewed sense of self-esteem equipped with life skills, the benefit of substance abuse treatment for the criminal offender is indeed worth the cost and effort.
References:
1 – Center for Substance Abuse Treatment. Substance Abuse Treatment for Adults in the Criminal Justice System. Treatment Improvement Protocol (TIP) Series 44. DHHS Publication No. (SMA) 05-4056.Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005. Available from: http://www.ncbi.nlm.nih.gov/books/NBK64128/
2 – “Principles of Drug Abuse Treatment for Criminal Justice Populations – A Research-Based Guide.” National Institute on Drug Abuse.Available from: http://www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations
