Consider these three facts: We in the United States make up 5 percent of the world’s population. We consume 66 percent of the world’s illegal drugs. We incarcerate 25 percent of the world’s prisoners.
It is no coincidence that of the 2.3 million inmates in American prisons, 1.5 million—or 65 percent—meet the standard medical criteria for drug and alcohol addiction and abuse. Another 20 percent of inmates, who do not meet those criteria, nevertheless were either under the influence of alcohol or drugs at the time of their offense, stole money to buy drugs, abused drugs, violated the alcohol or drug laws or share some combination of these characteristics.
Yet only 11 percent of the 1.5 million inmates with substance abuse problems receive any treatment while incarcerated. And the treatment they receive routinely fails to meet even minimum professional standards, much less approach that of high-end centers like the Betty Ford Center and Hazelden’s Center for Youth and Families. As a result, most inmates who have undergone treatment end up back in prison months or even weeks after their release.
The problem is growing. The prison population is rising at a faster pace than that of the general population, and the number of inmates with drug and alcohol problems is climbing even faster. Between 1996 and 2006, the U.S. population rose by 12 percent, but the number of adults incarcerated rose by 33 percent and the number of inmates with drug and alcohol abuse and addiction problems jumped by 43 percent.
Crime and drugs (including alcohol) are related. Those who committed a crime to get money to buy drugs average seven past arrests, the highest rate in the prison system. The second highest, inmates with six prior arrests, includes those with a history of alcohol treatment and those who were under the influence of alcohol or other drugs at the time of their crime. Alcohol is implicated in the incarceration of 57 percent of all inmates in America.
The tragedy is that we know how to stop spinning this costly and inhumane revolving door but have not acted on what we know. It starts with a recognition that addiction is a complex disease, that scientifically proven prevention and treatment programs can counter it and that such programs can be administered effectively through the criminal justice system.
Addiction Treatment for Prisoners
Our society provides treatment for prisoners with other chronic diseases like hypertension and diabetes. It should do so also for the chronic disease of addiction, where treatment offers the added benefits of reductions in crime and prison costs.
Christian compassion demands that we help this prison population. Our failure to do so runs counter to fundamental precepts of social justice. As Pope John Paul II said during his Jubilee Year 2000 homily when he celebrated Mass in Rome’s Regina Coeli prison, “Pu-nishment and imprisonment have meaning if, while maintaining the demands of justice and discouraging crime, they serve the rehabilitation of the individual by offering those who have made a mistake an opportunity to reflect and to change their lives in order to be fully reintegrated into society.” Without such efforts at rehabilitation, however, punishment and imprisonment are mostly acts of vengeance.
One need not be a saint or a liberal to favor treatment for all inmates who need it. Even the most hard-nosed, tough-on-crime, anti-tax citizens should put treatment and job training for substance-involved inmates high on their list of essential public policies because these reduce both crime and taxes.
Behind Bars II: Substance Abuse and America’s Prison Population, a recent study by the National Center on Addiction and Substance Abuse (and the source of most of the statistics cited in this article), reveals that drug and alcohol abuse and addiction are implicated in 78 percent of violent crimes like assault and rape; 83 percent of property crimes like burglary; and 77 percent of weapon, public order and immigration offenses and probation and parole violations.
The continued failure of government to prevent and treat addiction actually enables such crimes and reflects an inexcusable misallocation of funds. In 2005 (the most recent data available) federal, state and local governments spent $74 billion in court, probation, parole and incarceration costs for drug and alcohol-involved offenders. Yet federal and state governments spent only $632 million—less than 1 percent of that amount—on prevention and treatment for them.
Even at low rates of success in treating this admittedly difficult population, dramatic savings and reductions in crime are likely. Behind Bars II reports that providing professional treatment and aftercare to each inmate in this population (and connection with services for the mental illness that a quarter of them suffer concurrently) would cost on average $9,745 for each inmate. Yet calculations in the report show that the nation would recover its investment in such treatment if only 11 percent of those inmates remained substance- and crime-free and employed for the year following their release. For every additional year of sobriety and employment, the nation would reap enormous economic benefits, estimated in the report to exceed $90,000 per inmate. The return on investment would cause even the greediest Wall Street banker to salivate.
Providing such treatment also offers our nation the greatest opportunity it has to reduce crime. On average, a drug addict is conservatively estimated to commit at least 100 crimes a year. Reducing substance abuse and addiction in just 11 percent of this population would eliminate millions of crimes, making it the most effective crime reduction program in our nation’s history.
We should seize this opportunity by offering individuals with drug and alcohol addiction the option of effective treatment and by encouraging them to take advantage of the option. Unfortunately, we do the opposite.
The most counterproductive criminal justice policy in our nation is the mandated sentence, which arbitrarily sets the term of incarceration for an offender and requires that it be served in its entirety. Shaking an addiction to drugs and alcohol is tough stuff. Addicts need every carrot and stick that can be mustered to assist them in their effort. By mandating sentences, we take away the carrot of early release for those inmates who enter treatment and maintain sobriety. Moreover, if an offender must serve his entire sentence, we lose the stick of placing him on parole, which requires him to enter aftercare programs, Alcoholics Anonymous or Narcotics Anonymous or face a parole violation and return to prison.
Even greater opportunities for cost control and crime reduction can come from treatment-based diversion programs, such as drug courts and prosecutorial initiatives, like the Drug Treatment Alternative Program instituted in Brooklyn by District Attorney Joe Hynes. Such initiatives avoid imprisonment if the offender enters treatment and becomes a sober, law-abiding citizen, returning to school or getting a job. These initiatives have been shown to reduce recidivism rates by more than 50 percent.
Providing addiction treatment to inmates also benefits the correctional system. In prisons where therapeutic community treatment takes place, guards report less stress, greater job satisfaction, lower rates of illness and sick leave, fewer inmate-on-inmate and inmate-on-guard assaults and less disruptive behavior among inmates. Violent behavior is more than twice as likely to occur among inmates not in treatment programs.
Failure to provide treatment to substance-abusing inmates helps create another generation prone to abuse drugs and alcohol and fill the criminal justice system.
Prisoners as Parents
Inmates who abuse drug and alcohol are also parents to more than 2.2 million minor children. Three-fourths of these children are under the age of 13. The children of inmates are at a high risk of juvenile delinquency, adult criminality and substance abuse.
Female inmates have special needs. They make up almost 9 percent of the total prison population and are about as likely as the males to be drug and alcohol abusers and addicts. But they are almost twice as likely to have mental health disorders as well. One explanation is that compared with incarcerated males female inmates are more than seven times as likely to have been sexually abused and almost four times as likely to have been physically abused. Before their imprisonment, 80 percent of these women were daily primary caregivers to their children.
Pope John Paul II could have been talking about the United States during his jubilee year prison message when he said, “We are still a long way from the time when our conscience can be certain of having done everything possible to prevent crime and to control it effectively...and at the same time, to offer to those who commit crimes a way of redeeming themselves and making a positive return to society. If all those in some way involved in this problem tried to…develop this line of thought, perhaps humanity as a whole could take a great step forward in creating a more peaceful and serene society.”
The U.S. prison system could take a giant step forward by providing treatment for its inmates. It should also measure the effectiveness of its prisons not by how many lawbreakers it can put behind bars, but by how many of those it releases become sober, law-abiding, tax-paying citizens. Breaking the cycle of re-arrests and re-incarceration requires breaking the cycle of addiction.
Listen to an interview with Joseph A. Califano Jr.