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Today, an estimated 46.3 million Americans struggle with a substance use disorder. Of those, over 24 million have a drug use disorder or a “drug addiction”. And, that drug abuse and use often results in committing crimes, arrest, and incarceration.
In fact, an estimated 48-83% of all arrests are intoxicated or high at the time of arrest and 17% of all crimes resulting in imprisonment were committed as part of an attempt to get drugs or alcohol. Those problems with drugs and alcohol continue inside of prisons and facilities, where an estimated 17% of all inmates in state and federal populations met qualifications for substance abuse and 42% show signs of substance dependence.
Those statistics show that the justice system does not work for people with substance use disorders – because it doesn’t have the resources to treat, offer therapy, or work on improving outcomes. Today, there are increasingly more options and alternatives to incarceration for drug-related crimes, providing they did not involve violent crime.
Of the over 1.2 million people imprisoned in 2021, an estimated 42% meet the medical requirements for a drug dependence diagnosis. This happens for multiple reasons, starting with the fact that even illicit drug use can result in jail time. People who are dependent on drugs may also resort to illegal activities to source drugs, which also result in increased risk of incarceration. As a result, an estimated 25% of all inmates in federal prisons are there because of drug-related charges. Not only are prisoners more likely to be addicted to drugs, drug addicts are more likely to commit felonies, resulting in extremely high ratios of people in prison struggling with substance use disorders.
That’s exacerbated by high rates of imprisonment for even simple possession. For example, the state of Minnesota defines possession of anything more than 25g of a Schedule I drug as a 3rd degree felony – which can result in prison times of up to 25 years.
In most states, a single arrest for possession can result in up to a year in prison, a third day can result in up to three years. And possessing 500mg of a schedule I or schedule II drug can result in imprisonment of up to 7 years. This means that any arrest with a larger quantity of a drug can result in significant sentencing.
Once imprisoned, many people continue to have access to drugs and alcohol – but with fewer outlets to improve life and fewer resources to get treatment.
Once incarcerated, many prisoners have extremely limited resources to get help or treatment of any kind. In fact, while many prisoners theoretically have access to 90-day drug rehabilitation programs through RDAP (Federal Residential Drug Abuse Program) – those programs are short and can have wait lists of months or even years. Individuals with a shorter sentence can sometimes qualify for a 12-week program involving a cognitive behavioral approach. Unfortunately, with almost half of all federal prisoners requiring drug treatment, wait lists mean that programs are practically available to about 10% of all prisoners.
Some patients can also qualify for going to a federal rehabilitation center instead of prison. Here, sentences are typically 12-18 months and are followed by a stay in a halfway house with AA and weekly meetings with a parole officer.
And, from 2019, patients qualifying for a diagnosis with an opioid use disorder can take part in a medication-assisted treatment program, where patients essentially receive methadone treatment while on the wait list for therapy. That can improve outcomes, but the Bureau of Prisons has yet to release data on how many prisoners have received it, what the qualifications are, or whether opportunities for therapy have adjusted.
The justice system is increasingly advocating for the use of drug courts and rehab as an alternative to jail for non-violent drug-related crimes. This court-ordered rehab involves 28-180 days of outpatient care overseen by a parole officer, with checkups up to 6-12 months after initial sentencing.
That approach is designed to reduce the negative impacts of prison, reduce costs to the taxpayer, and improve outcomes. For example, prison reduces opportunities for education, employment, and life improvement following release. At the same time, it shows greater recidivism rates than rehab and higher costs. Re convictions are at 65% for drug addicts who are imprisoned and at 42% of those who are sent to rehab instead. And, with studies showing that if 10% of all drug and alcohol-related crimes were pushed to rehab instead of prison, it would save taxpayers $4.8 billion per year, rehab is also cheaper.
Persons who attend drug court and then go to rehab are typically required to waive due process rights, sign a confession, and consent to long-term monitoring including drug and alcohol testing. Afterwards, they’re moved into outpatient treatment. Unfortunately, while drug courts are shown to reduce re-arrests and repeat crimes, they’re still the minority option. In 2021, the 2,600 drug courts in the United States processed just 0.01% of all prisoners who qualified – meaning that most still went through the normal prison and justice system.
All of the problems discussed above break down into significant issues with the criminal justice system as a whole. Often, they mean that individuals with drug use problems don’t have access to care or treatment and are instead released into a general population where they’re unable to get healthy.
Today’s prisons are working harder than ever to provide mental health treatment and adequate drug use disorder treatment to inmates. However, those systems still aren’t enough to meet demand and many people still fall through the cracks, receiving rushed, limited, or no treatment at all – which puts them more at risk inside the prison and on existing the prison system.
If you or a loved one is seeking help for alcohol or other substance abuse, contact us at Stairway Resource Center today. At Stairway Resource Center we provide a 60 to 90-day outpatient program that takes place in an engaging and supportive community setting. We offer dual diagnosis treatment and daily group and individual therapy for our clients, in addition to fun community-based events and activities.
Michael D. Stone, MD has been in practice for over 30 years. He graduated from Medical School in 1986 and attended LA County/USC Medical Center Residency in the field of Emergency Medicine. He is a practicing E.R. doctor at 2 hospitals in the Southern California area. Dr. Stone also has a Specialty in Chemical Dependency and Addiction Medicine for 22 years. He is the Medical Director of numerous Residential and Outpatient Facilities in the Los Angeles area. Dr. Stone’s interests outside of medicine include a commercial pilot, all outdoor activities including skiing, fishing and boating.