Report Confirms Sad State of Drug Treatment for Inmates

Treating inmates who are addicted to drugs can help to reduce the costs associated with incarceration, crime, and unemployment and may slow the spread of HIV and other infectious diseases, according to a new report from the National Institute on Drug Abuse (NIDA).

The report, released last month, describes a number of principles of drug abuse treatment for criminal justice populations (see box below). A question-and-answer section addresses the needs of women and adolescents in the criminal justice system who have drug-addiction problems.

Approximately 70 percent of people incarcerated in prisons and jails have used drugs regularly during their lifetimes as compared with about 9 percent of the general population, according to the report, and for every dollar spent on addiction treatment, there is a $4 to $7 reduction in cost attributed to drug-related crimes.

The report confirms that drug abuse is costly in many ways: in 2002, costs related to drug abuse reached $181 billion, including $107 billion associated with drug-related crime. Other costs include those related to emergency room visits, unemployment, reduced productivity, and child abuse and neglect.

Inmates who are released with untreated substance use disorders are much more likely to reoffend, according to the report, which indicates that a thorough assessment of inmates should include a drug abuse history and a mental health evaluation, and services should address “issues of motivation, problem-solving, and skill-building for resisting drug use and criminal behavior.”

Though the report advocates for increased treatment of inmates with drug addiction, it does not address the funding of such treatment.

Treatment must follow inmates into the community after their release, Nora Volkow, M.D., NIDA director, told Psychiatric News. “Before going to jail, many of these people have alienated their families, lost their jobs, eroded their social supports—so when they are released, they return to the community with little or no support, and without support, the chances of them succeeding will be very low.”

Important aspects of treatment in and out of jails and prisons may combine training in problem solving, coping with stress in constructive ways, and developing cognitive skills and skills to resist the lure of drugs and engaging in criminal behavior.

Only an estimated 20 percent of U.S. inmates with substance use disorders receive some treatment while incarcerated, Volkow pointed out. Judges may decide to incarcerate drug-addicted offenders instead of sending them to treatment programs because the resources to pay for treatment are lacking or there are no programs available in the community.

For treatment to be successful, treatment providers and criminal justice supervisors must work together closely to ensure that treatment plans meet correctional-supervision requirements and the inmate's needs. For instance, the report states, “abstinence requirements may necessitate a rapid clinical response such as more counseling, a targeted intervention, or increased medication to prevent relapse. Ongoing coordination between treatment providers and courts or parole and probation officers is important in addressing the complex needs of these re-entering individuals.”

In addition, the report acknowledges that many inmates with substance abuse problems also have comorbid mental disorders and recommends that inmates with either a substance abuse or other mental disorder be assessed for the presence of the other and treated appropriately.

Treatment adherence can sometimes be problematic for inmates with drug problems so implementing a system of rewards can motivate them to continue with treatment, according to the report.

Said Volkow, “We tend to do things that are positively reinforced. These reinforcements don't have to be large—even a ticket to the movies can have an impact.”

Volkow recalled visiting a drug court in Pennsylvania where the presiding judge acknowledged the success of offenders who had been participating in substance abuse treatment programs. “Everyone, including the treatment providers who were present, applauded,” she noted, and some of the inmates who received the recognition were moved to tears.

“One of the most powerful reinforcers of humans is acceptance by a group,” she observed.

“Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide” is posted at<www.nida.nih.gov/drugpages/cj.html>. There is also a companion guide for inmates who are addicted to drugs and their families. ▪